Diabetic macular edema associated with glitazone use

Area of Science:

• Ophthalmology
• Endocrinology
• Pharmacology

Background:

• Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients.
• Glitazones are a class of antidiabetic drugs known to cause fluid retention.
• The association between glitazone use and DME is not fully understood.

Purpose of the Study:

• To investigate the occurrence and characteristics of diabetic macular edema (DME) in patients using glitazone medications.
• To describe the effects of glitazone discontinuation on macular edema and visual acuity.

Main Methods:

• Retrospective chart review of 30 patients using pioglitazone or rosiglitazone with concurrent lower extremity and macular edema.
• Analysis of clinical data, fundus photography, and fluorescein angiography.
• Separate analysis of patients with follow-up exceeding 3 months after glitazone cessation.

Main Results:

• Most patients (17/30) used pioglitazone; 11 used rosiglitazone.
• In patients followed >3 months after cessation, mean weight gain was 30 lb, with 19 lb lost post-discontinuation.
• Macular edema resolved rapidly in 4/11 patients, with 8/11 showing improvement over 2 years. Visual acuity declined from 20/60 to 20/85.
• Three patients experienced macular edema resolution and improved vision after stopping glitazones without laser treatment.

Conclusions:

• Fluid retention, a known side effect of glitazones, can manifest as diabetic macular edema (DME) in 5-15% of users.
• Glitazone cessation can lead to resolution of both peripheral and macular edema.
• Clinicians should consider glitazone-induced fluid retention in DME patients, particularly those with peripheral edema.