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Letters

Rosiglitazone and macular edema

Gurusamy Sivagnanam
CMAJ August 01, 2006 175 (3) 276; DOI: https://doi.org/10.1503/cmaj.1060089
Gurusamy Sivagnanam
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As noted in Box 1 in the article by Claire Kendall and Eric Wooltorton,1 long-standing diabetes mellitus, poor diabetes control and insulin therapy are by themselves risk factors for macular edema. Furthermore, only 1 of the 9 cases of visual impairment reported in Canada for patients taking rosiglitazone was clearly associated with macular edema, and in that case the problem was resolved by discontinuation. The questions thus arise of whether macular edema (especially if it is asymptomatic) is an absolute contraindication to rosiglitazone therapy and whether every patient with diabetes must be subjected to ophthalmologic evaluation before starting this drug.

Although adverse symptoms may diminish upon discontinuation of rosiglitazone, the potential for loss of glycemic control must also be considered. In such situations, what is the risk-benefit ratio for continuation of rosiglitazone therapy, especially if good glycemic control has been achieved?

Perhaps there is a role for “drug holidays” with rosiglitazone. In this regard, macular edema induced by latanoprost, echothiophate iodide or nicotinic acid is usually reversible upon discontinuation of the drug,2 which can be reintroduced later.

Systemic factors that may contribute to the progression of diabetic macular edema are blood glucose control, hypertension, nephropathy and proteinuria. It has been suggested that use of an angiotensin-converting enzyme (ACE) inhibitor be considered for patients with diabetic retinopathy and nephropathy.3 ACE inhibitors are already indicated for microalbuminuria of diabetes, but it is not known whether they would be beneficial in preventing macular edema as well.

REFERENCES

  1. 1.↵
    Kendall C, Wooltorton E. Rosiglitazone (Avandia) and macular edema. CMAJ 2006;174(5):623.
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  2. 2.↵
    Roth DB. Nonpseudophakic cystoid macular edema [Internet]. In: eMedicine.com. [place unknown]: WebMD; updated 2005 May 13. Available: www.emedicine.com/oph/topic638.htm (accessed 2006 May 2).
  3. 3.↵
    Chang S. Recent developments in the treatment of diabetic macular edema. Proceedings of 11th International Conference on Health Problems Related to the Chinese; 2002 May 25-26; New York. p. 25-27. Available: www.fcmsdocs.org/Conference/11th/Diabetic%20Macular%20Edema.pdf (accessed 2006 May 2).
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Canadian Medical Association Journal: 175 (3)
CMAJ
Vol. 175, Issue 3
1 Aug 2006
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Rosiglitazone and macular edema
Gurusamy Sivagnanam
CMAJ Aug 2006, 175 (3) 276; DOI: 10.1503/cmaj.1060089

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Rosiglitazone and macular edema
Gurusamy Sivagnanam
CMAJ Aug 2006, 175 (3) 276; DOI: 10.1503/cmaj.1060089
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