Author: Natalia Palarie (Moldova, Republic of)
Co-authors: Natalia Palii, Olga Tagadiuc
Purpose
Hard macular exudates in diabetic retinopathy represent deposits of lipid and proteinaceous material that settle in the outer retinal layers. They often cause significant visual loss when deposited in the foveal region and substantially impacts patient's quality of life. Fenofibrate is a fibric acid derivate that is currently used to treat high triglycerides and low HDL or as adjunct to statin therapy. It regulates the expression of many genes that work against lipids, inflammation, angiogenesis and cell apoptosis. Purpose of our study was to assess whether long-term lipid-lowering therapy with fenofibrate could reduce the number and extension of massive macular exudates in type 2 diabetes patients.
Setting/Venue
This study was performed at the International Clinic, Orhei, Moldova in 2018-2020.
Methods
There were 97 person (194 eyes) with type 2 diabetes, dyslipidemia and moderate nonproliferative diabetic retinopathy with hard exudates included in this study. Age ranged from 42 to 82 years. All patients had relatively well compensated diabetes with HbA1C ranging from 6% to 8%. The mean visual acuity on presentation was 0,3 +- 0,1. Patients were divided into 2 groups - main (52 person) and control (45 person). Exclusion criteria: patients who were already on lipid lowering drugs or glitazones, females taking oral contraceptive pills or hormone replacement therapy or pregnant, familial hypercholesterolemia, hypothyroidism, chronic liver disease, kidney disease. All patients in the main group received fenofibrate 145 mg once a day for 8 months, patients in control group had conventional therapy. All patients had undergone standard ophthalmological examination, fundus photos and OCT imaging on presentation and during follow up visits. Patients were followed at 2, 6,12 and 18 months after the start of the treatment.
Results
In the main group anatomic result expressed by the reduction of number and extension of hard exudates, decrease in central retinal thickness was achieved in 88% of patients (46 patients, 92 eyes). Central retinal thickness in the main group decreased from mean 382 mkm to 250 mkm +- 30 mkm. Good functional result was achieved in 67 % of patients (70 eyes), where visual acuity increased from 0,3 to 0,5 +- 0,1. This effect was stable for the whole follow up period. In the control group 75 % of patients had no anatomic neither functional changes. In 15 % of patients mean visual acuity slightly improved from 0,3 to 0,4 +- 0,05 with decrease in central retinal thickness from mean 382 mkm to 320 mkm +- 30 mkm due to better compensation of the main disease. In 10% the number and extension of hard exudates increased with further vision deterioration. No fenofibrate side effects were noticed in either group.
Conlusions
Fenofibrate in type 2 diabetic patients diminishes number of macular hard exudates, reduces macular edema, improves visual acuity with stable effect over the time.
Financial Disclosure
n/a
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