Spontaneous resolution of diabetic macular oedema after discontinuation of thiazolidenediones

Abstract

To report a case of spontaneous resolution of diabetic maculopathy with cystoid macular oedema in a diabetic patient after discontinuation of rosiglitazone, documented with serial ocular computed tomography (OCT) images. A 59-year-old male with a 6-year history of well-controlled diabetes mellitus presented with reduced visual acuity (VA) attributed to clinically significant macular oedema (CSMO). The patient had been started on rosiglitazone 8 months previously. Glitazone treatment was stopped and the patient prospectively followed up. The patient demonstrated CSMO on OCT at presentation. Three months after cessation of rosiglitazone, CSMO had completely resolved and VA improved. Resolution of CSMO was confirmed on OCT examination. The patient required no interventional treatment, i.e. no laser or intravitreal therapy, for his CSMO. To the best of our knowledge, this is the first case to document spontaneous resolution of CSMO and improvement in VA on discontinuation of a glitazone. Glitazones have a definitive role in the management of diabetic patients and ophthalmologists and physicians should both be aware that there may be an association with weight gain, peripheral oedema and CSMO. We recommend that ophthalmologists consider discontinuing glitazones in consultation with the diabetologist before embarking on interventional management such as laser or intravitreal injections.