Effect of empagliflozin on macular thickness in patients with type ۲ diabetes

Introduction: Macular edema following diabetes is one of the most common retinal disorders that can lead to decreased vision in patients with non-proliferative diabetic retinopathy. Sodium-glucose cotransporter ۲ inhibitors (SGLT۲i) have become one of the standard treatments for patients with type ۲ diabetes. The mechanism of action of SGLT۲i drugs is related to the ability to inhibit glucose reabsorption in the proximal tubules and the secretion of glucose into the urine, thus improving patients' blood sugar control. SGLT۲i has been hypothesized to improve macular edema in patients with DME, although this has not been investigated in clinical trials. Aim: To evaluate the effect of empagliflozin on macular thickness in patients with type ۲ diabetic by comparing it with OCT findings. Method: In this retrospective cross-sectional study, ۴۵-to ۷۵-year-old patients with diabetes who have had diabetes for at least ۱۰ years and whose last HbA۱c test was below ۸% were examined. Macular thickness and visual acuity of patients were compared before and after receiving empagliflozin. Result: In this study, ۴۷ eyes of ۳۰ patients with diabetes mellitus with a mean age of ۶۶.۹±۸.۴ years were studied. The thickness of the macula before receiving the drug was ۴۰۰.۴±۸۴.۸ μm, which, after a mean follow-up of ۸ weeks, had significantly decreased to ۳۴۴.۳±۷۶.۷ μm (p=۰.۰۰۰۱). The mean initial visual acuity of patients was ۰.۳۲۳±۰.۲۰۹ Logmar (۲۰/۴۱ Snellen) that after receiving empagliflozin was ۰.۲۶۶±۰.۲۷۶ Logmar (۲۰/۳۶ Snellen). No significant improvement was observed in the mean visual acuity of patients (p=۰.۵۷). Conclusion: It was concluded that systemic use of empagliflozin in patients with diabetes mellitus can significantly reduce macular edema, although therapeutic recommendations including the addition of anti-VEGFs can also be helpful.

Keywords:

Diabetic macular edema , Sodium-glucose ۲ cotransport inhibitors , Diabetes , Neovascularization