Recovery from Diabetic Macular Edema in a Diabetic Patient After Minimal Dose of a Sodium Glucose Co-Transporter 2 Inhibitor

Hideyuki Yoshizumi, Tetsushi Ejima, Tetsuhiko Nagao, Masanori Wakisaka, Hideyuki Yoshizumi, Tetsushi Ejima, Tetsuhiko Nagao, Masanori Wakisaka

Abstract

BACKGROUND Diabetic macular edema (DME) causes serious visual impairments in diabetic patients. The standard treatments of DME are intra-vitreous injections of corticosteroids or anti-vascular endothelial growth factor antibodies and pan-photocoagulation. These treatments are unsatisfactory in their effects and impose considerable physical and economic burdens on the patients. CASE REPORT A 63-year-old woman was diagnosed as type 2 diabetes with retinopathy 7 years ago. Before the initiation of an SGLT2 inhibitor, the dipeptidyl peptidase-4 inhibitor, sitagliptin (50 mg daily), and metformin (250 mg dai- ly) were used for her glycemic control. The level of her hemoglobin A1c had been controlled around 7%. She began to feel decreased visual acuity and blurred vision of her left eye 8 months before the visit to our clin- ic. She was diagnosed as DME, which turned out to be corticosteroid-resistant. Her visual acuity further de- creased to 20/50. Metformin was changed to ipraglifl (25mg/day). Her left visual acuity started to improve after 4 weeks of treatment with ipragliflozin and improved to 20/22 after 24 weeks. The macular edema did not change until 12 weeks of the treatment, however, it decreased prominently after 16 weeks. CONCLUSIONS In our patient with steroid-resistant DME, her visual symptoms and macular edema recovered after the initiation of an SGLT2 inhibitor. SGLT2 inhibitors might be a potential candidate for the DME treatment.

Conflict of interest statement

Conflict of interest: None declared

Conflicts of interest

None.

Figures

Figure 1.
Figure 1.
Clinical course of macular edema in our patient before and after the administration of the SGLT2 inhibitor until 24 weeks. Cyst heights were 762 μm (0W), 843 μm (4W), 670 μm (8W), 884 μm (12W), 767 μm (16W), 601 μm (20W), and 589 μm (24W).

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