Efficiency of fenofibrate in facilitating the reduction of central macular thickness in diabetic macular edema

Abstract

Purpose:The purpose of this study is to study the benefit of addition of oral fenofibrate to the current regimen of diabetic macular edema (DME) management and quantify its effect on macular thickness and visual function in DME.Methods:Fifty-three eyes of 50 patients were randomized into treatment (Group A) (oral fenofibrate 160 mg/day) and control groups (Group B). Both groups underwent treatment of DME as per the standard treatment protocol of our hospital including intravitreal injections (anti-vascular endothelial growth factor/steroid) and grid laser. Patients were followed up every 2 months to note the visual acuity and central macular thickness (CMT) for 6 months.Results:Our groups were matched with respect to age (P = 0.802), mean diabetic age (P = 0.878), serum HbA1C levels (P = 0.523), and serum triglyceride levels (P = 0.793). The mean reduction in CMT was 136 μ in Group A and 83 μ in Group B at the end of 6 months. This difference was statistically significant (P = 0.031). Visual acuity improvement was 0.15 in Group A and 0.11 in Group B at the end of 6 months (P = 0.186). On subgroup analysis in Group A, we found that there was no difference in reduction of CMT between hypertensives and normotensives (P = 0.916), in patients with normal triglyceride levels and increased triglyceride levels (P = 0.975).Conclusion:Addition of fenofibrate to the standard protocol of DME management seems to facilitate reduction of CMT and probably have an added benefit on the visual functions.

Fenofibrate Reduces the Severity of Neuroretinopathy in a Type 2 Model of Diabetes without Inducing Peroxisome Proliferator-Activated Receptor Alpha-Dependent Retinal Gene Expression

“…Fenofibrate was shown in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) and Action to Control Cardiovascular Risk in Diabetes (ACCORD) studies to slow the progression of mild to moderate non-proliferative DR and reduce the need for treatment of macular edema [ 5 , 6 ]. In patients with extant diabetic macular edema, fenofibrate used in conjunction with VEGF inhibitors led to greater improvement than VEGF inhibitors alone [ 7 ]. Although fenofibrate shows promise in the treatment of DR, its mechanism of action remains unclear.…”

Management of Diabetic Macular Edema: Guidelines from the Emirates Society of Ophthalmology

“…Patients should therefore be encouraged to pursue this with their diabetologist. Fenofibrate [29] and statins [30] can be recommended to the family physicians/endocrinologists as anti-dyslipidemia medication, as both have a positive effect on diabetic retinopathy and DME. We recommend also checking for any new medications that can exacerbate DME, such as glitazones [17,28,31].…”