Abstract
Previous studies have found that metformin can reduce cardiovascular risk, but its association with retinal vein occlusion (RVO) is unknown. In this population-based cohort study using the Taiwan National Health Insurance Research Database (NHIRD), we demonstrated the protective effect of metformin against RVO in diabetes mellitus (DM) and explored the incidence rate and factors associated with RVO development in general and diabetic populations. One million patients were randomly selected from the registry files of the NHIRD, and all their claims data were collected for the 1996–2011 period. Patients with a new diagnosis of central or branch RVO were identified using International Classification of Disease codes. DM was defined for patients with diagnoses and treatments. Factors associated with RVO development in the non-DM and DM cohorts were explored using Cox proportional regression models. In total, 1,018 RVO patients were identified from the database. The average incidence of RVO was 9.93 and 53.5 cases per 100,000 person-years in the non-DM and DM cohorts, respectively. Older age, DM, hypertension, and glaucoma were significant risk factors for RVO, whereas the prescription of anticoagulants was a significant protective factor. In the DM cohort, older age, hypertension, and diabetic retinopathy were significant risk factors for RVO, whereas metformin treatment was a significant protective factor. These results confirmed the risk factors for RVO and demonstrated the protective effect of metformin against RVO in DM patients. Prescribing metformin for DM patients may be beneficial for reducing the incidence of RVO, along with its hypoglycemic action.
Highlights
Retinal vein occlusion (RVO) is the second most common retinal vascular disease and a major cause of vision loss worldwide
As we evaluate the risks for developing RVO in all participants, diabetes mellitus (DM) patients were divided into two groups: with or without metformin treatment based on their metformin intake
Our result show that repaglinide treatment alone had no protective effect against RVO in DM patients, but a protective effect was noted when repaglinide was combined with metformin; this protective effect was more pronounced than that in those treated with metformin alone
Summary
Retinal vein occlusion (RVO) is the second most common retinal vascular disease and a major cause of vision loss worldwide. Various treatments for RVO have been advocated over the past decade, including laser photocoagulation, thrombolytic agent administration, surgical intervention, and intravitreal steroid or anti-vascular endothelial growth factor (VEGF) agent injection [8, 9]. Anti-VEGF agent injection significantly reduces macular edema, improving visual acuity in most cases [8, 9]. These intraocular medications impose a considerable burden on health care systems because of the required repeated administrations, and fewer than 10% of patients have significant vision loss even after multiple anti-VEGF agent injections [10]
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