Optic disc edema during semaglutide therapy: case report and literature review

To report fundus characteristics of patients who developed optic disc edema during semaglutide therapy and perform a review of the literature.

Patient 1 was a 62-year-old female with a 5-year history of type 2 diabetes mellitus (T2DM), while Patient 2 was a 51-year-old female with documented T2DM for 6 years. Both patients were enrolled in a multicenter, randomized, open-label, parallel-controlled clinical trial titled 'Comparative Study of the Efficacy and Safety of two Semaglutide Injections in Patients with Type 2 Diabetes Mellitus'. Baseline fundoscopic examinations prior to trial initiation confirmed the absence of diabetic retinopathy in both cases. Following the initiation of semaglutide therapy for glycemic control, surveillance fundoscopic examinations performed at 28 weeks (Case 1) and 24 weeks (Case 2) post-treatment revealed the development of optic disc edema. Case 1 remained entirely asymptomatic throughout the observation period. For case 1, the best-corrected visual acuity (BCVA) was 0 logMAR bilaterally. Pupillary reflexes was normal and color vision was unaffected. Optic disc edema with peripapillary hemorrhages and focal yellow-white exudates were detected. Significant increased retinal nerve fiber layer (RNFL) thickness was detected by OCT in the right eye, while the RNFL thickness of the left eye was normal. Visual fields were grossly normal in both eyes. For case 2, dim vision was reported. Ophthalmic examination revealed the BCVA of both eyes were 0.1logMAR. Pupillary reflexes was normal, and color vision was unaffected. Severe bilateral optic disc edema accompanied by extensive peripapillary patchy hemorrhages and yellow-white exudates were detected. Significant bilateral RNFL thicking were detected by OCT. Bilateral physiological blind spot enlargement were detected by visual field testing. No significant optic nerve functional impairment was observed in either patient. Oral corticosteroid therapy induced substantial resolution of optic disc edema in both patients.

During semaglutide therapy for glycemic control, clinicians should implement regular ophthalmic monitoring, particularly in the initial treatment phase, to detect potential neuro-ophthalmic complications including optic disc edema.