The Efficacy of Sodium-Glucose Cotransporter 2 (SGLT2) inhibitors for the treatment of chronic diabetic macular oedema in vitrectomised eyes: a retrospective study

Abstract

Objective: To investigate the change of chronic diabetic macular oedema (DMO) in vitrectomised eyes when the administration of sodium-glucose cotransporter 2 (SGLT2) inhibitors is initiated as a systemic medical treatment.

Methods and analysis: This study involved 10 eyes of five patients with chronic DMO lasting more than 6 months who had previously undergone vitrectomy and whose systemic medical treatments were newly changed to SGLT2 inhibitors. In this study, chronic DMO was defined as persistent diffuse macular oedema despite ophthalmic treatment in patients with diabetes. Patients who received antivascular endothelial growth factor therapy or steroids administration, or change of eye-drop medication from at 3 months before and after the initiation of SGLT2 inhibitors, were excluded. In this study, visual acuity (VA) and central retinal thickness (CRT, μm) prior to and at 3, 6 and 12 months after the initiation of SGLT2 inhibitors were retrospectively compared. The Wilcoxon signed-rank test was used for statistical analysis.

Results: In the 10 treated eyes, from at baseline to at 3, 6 and 12 months after the initiation of SGLT2 inhibitor, median VA (logMAR) improved from 0.35 to 0.15 (p=0.038), 0.2 (p=0.157) and 0.2 (p=0.096), respectively, and median CRT significantly reduced from 500.5 µm to 410 µm (p<0.01), 378 µm (p<0.01) and 339 µm (p<0.01), respectively.

Conclusion: Although this study involved only five patients, our findings indicate that SGLT2 inhibitors might have structural efficacy for chronic DMO in vitrectomised eyes.

Keywords: Macula; Retina.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1

Changes of visual acuity (VA) at baseline, at 3 and 6 months before, and at 3, 6 and 12 months after the initiation of the administration of sodium–glucose cotransporter 2 inhibitor. The vertical-column boxes indicate values between the 25th and 75th percentiles (central line, median). Median VA (logMAR) significantly improved from 0.35 at baseline to 0.15 at 3 months after the initiation of the treatment (p=0.038), and median VA improved from that at baseline to 0.2 at 6 months and 0.2 at 12 months after the initiation of the treatment (p=0.157 and p=0.096, respectively) (Wilcoxon signed-rank test).

Figure 2

Changes of central retinal thickness (CRT, μm) at baseline, at 3 and 6 months before, and at 3, 6 and 12 months after the initiation of the administration of sodium–glucose cotransporter 2 inhibitor. The vertical-column boxes indicate values between the 25th and 75th percentiles (central line, median). The circles denote outliers. Median CRT significantly reduced from 500.5 µm at baseline to 410 µm at 3 months, 378 µm at 6 months and 339 µm at 12 months after the initiation of the treatment (p

Figure 3

Optical coherence tomography images showing the chronological change of representative cases from at 6 months before to 12 months after the initiation of the administration of sodium–glucose cotransporter 2 inhibitor. (A) The right eye of case 1, (B) the left eye of case 4 and (C) the right eye of case 5.

Figure 4

Changes of (A) glycated haemoglobin (HbA1c) and (B) estimated glomerular filtration rate (eGFR) in the blood test at baseline and at 3, 6 and 12 months after the initiation of the administration of sodium–glucose cotransporter 2 inhibitor as a systemic medical treatment.