SGLT2 inhibitors and retinal vein occlusion

Last edited 07/2021 and last reviewed 06/2023

Retinal vein occlusion (RVO) is the second most common etiology for vision loss

• RVO exists as 2 subtypes:
  • central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO)
  • BRVO may result from compression of a branch retinal vein by an adjacent arteriosclerosis retinal artery
  • CRVO shows low prevalence compared to BRVO
  • CRVO is associated with a worse visual prognosis
  • CRVO is typically caused by thrombus formation near the lamina cribrosa and frequently leads to devastating complications such as neovascular glaucoma

A meta-analysis suggested that DM is a risk factor for RVO (2)

• significant association between DM and the risk of RVO (OR = 1.68, 95% CI: 1.43-1.99)
• subgroup analysis indicated that DM was significantly associated with central RVO (OR=1.98, 95% CI: 1.29-3.03, I2=67.9%), but not significantly associated with branch RVO (OR=1.22, 95% CI: 0.95-1.56, I2=64.1%)

SGLT2 inhibitors and RVO

• a study found use of SGLT2 inhibitors was associated with an increased risk of retinal vein occlusion vs use of other glucose-lowering drugs (HR 1.264; 95% CI 1.06-1.51); risk was higher in those aged >=60 years and those with eGFR <60 mL/min/1.73 m2
  • found that SGLT2 inhibitors were associated with a significantly increased risk of RVO. Older patients and those with chronic kidney disease were at higher risk for RVO.

Reference:

• Wang Y, Wu S, Wen F, Cao Q. Diabetes mellitus as a risk factor for retinal vein occlusion: A meta-analysis. Medicine (Baltimore). 2020;99(9):e19319.
• Lee M et al. Sodium-Glucose Cotransporter 2 Inhibitors and Risk of Retinal Vein Occlusion Among Patients With Type 2 Diabetes: A Propensity Score-Matched Cohort Study. Diabetes Care Jul 2021, dc203133.