The edition · Ophthalmology
SGLT2 inhibitors were linked to less retinopathy progression across 1.8 million patients
A meta-analysis of 16 studies found a 23% lower relative risk of diabetic retinopathy progression with SGLT2 inhibitors than with other glucose-lowering drugs, the ESCRS has published cataract surgery guidelines answering 32 clinical questions, and pooled data put rhegmatogenous detachment after anti-VEGF injection at 1 in 8,675.
The edition in brief
Which glucose-lowering drug a patient takes may matter for their eyes. This meta-analysis pooled 16 studies and 1,785,409 patients comparing SGLT2 inhibitors against other glucose-lowering agents. SGLT2 inhibitor therapy was associated with lower relative risk of diabetic retinopathy progression against all comparators (relative risk 0.77, 95% CI 0.72-0.82) and against each subclass individually, with a similar reduction for diabetic macular oedema (0.75, 0.69-0.82). Benefit was proportional to baseline risk: in a cohort with a 20% retinopathy rate, the absolute risk difference was about 4%. The advantage was largest against sulfonylureas and smallest against GLP-1 receptor agonists. The ESCRS has published evidence-based cataract surgery guidelines developed with GRADE methodology across 32 clinical questions. Recommendations include intracameral antibiotics for endophthalmitis prevention, topical anaesthesia as the preferred technique, and toric intraocular lenses for corneal astigmatism of 1.0 dioptre or more. Conventional and femtosecond laser-assisted surgery are described as comparably safe and effective. A meta-analysis of 834,814 intravitreal anti-VEGF injections found rhegmatogenous retinal detachment in 0.012% per injection, about 1 in 8,675, and 0.08% per eye, about 1 in 1,250. One study of severe proliferative diabetic retinopathy reported tractional detachment in 3.6%. Centrally placed teleretinal screening bulk orders raised diabetic retinopathy screening completion (odds ratio 1.78).
SGLT2 inhibitors were associated with slower retinopathy progression
SGLT2 inhibitors were associated with 23% less diabetic retinopathy progression than other glucose-lowering agents, so for a patient with progressing retinopathy on a sulfonylurea or DPP-4 inhibitor it is worth raising the drug choice with the diabetes team.
ESCRS cataract surgery guidelines answer 32 clinical questions
New ESCRS guidelines answer 32 clinical questions on cataract surgery, recommending intracameral antibiotics, topical anaesthesia and toric lenses at 1.0 dioptre of astigmatism, and finding femtosecond laser no better than conventional surgery.
Retinal detachment after anti-VEGF injection: the numbers for consent
Rhegmatogenous retinal detachment follows about 1 in 8,675 anti-VEGF injections and affects about 1 in 1,250 eyes, and the per-eye figure — which still understates lifetime exposure — is the one to use when consenting.
Centralised bulk ordering raised diabetic eye screening rates
Centrally placed teleretinal screening bulk orders raised diabetic retinopathy screening completion by nearly 80% in relative terms without using clinician time, though absolute completion remained only 17.5% at six months.
Quote the per-eye risk, not the per-injection risk
When consenting for a course of intravitreal injections, quote the cumulative per-eye risk rather than the per-injection figure, and say explicitly that it accumulates with each treatment.
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