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H. Yamada, A. Higuchi, N. Jo, M. Matsumura, M. Wada, A. Kosaki, T. Iwasaka; Protective Effect Against Retinal Neovascularization in Diabetic Retinopathy by Angiotensin Converting Enzyme Inhibitors. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5015.
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Angiotensin converting enzyme inhibitors (ACEIs) are used in the treatment of systemic hypertension throughout the world. Our former investigation using animal models revealed that ACEIs had an inhibitory effect on pathological neovascularization (NV) in the retina and the choroid. In this study, we investigated the efficacy of an ACEI for preventing retinal NV in hypertensive patients with pre-proliferative diabetic retinopathy (DR).
Fifty patients with hypertensive pre-proliferative DR participated in this study. After informed consent was provided, patients were separated randomly into two groups. The control group was given anti-hypertensive drugs other than ACEIs. The ACEI group was given Perindopril. Both groups were followed monthly at Kansai Medical University Eye Clinic for 2 years. Every 3 months, fluorescein angiography was carried out. If retinal NV was detected, the patient was terminated from the study. A Kaplan-Meier analysis was used for statistical evaluation of the efficacy of the ACEI for prevention of retinal NV.
Twenty-two cases (44 eyes) in the control group and 19 cases (37 eyes) in the ACEI group were observed for a 2-year period. Diabetic control, systemic blood pressure, age, and gender did not differ statistically between groups at baseline. Six cases (12 eyes) in the control group and 1 case (2 eyes) in the ACEI group developed retinal NV. Kaplan-Meier analysis showed that the ACEI group had a significantly lower rate of occurrence of retinal NV than the control group (p=0.0054). Throughout the observation period, there were no differences in visual acuity, diabetic control, and systemic blood pressure between the two study groups, but the size of the avascular areas and the fluorescence leakage from the retinal vasculature tended to be greater in the ACEI group.
ACEI were very effective in preventing retinal NV in pre-proliferative DR. We suggest that ACEI may inhibit retinal NV in a direct manner rather than by improving hypoxia or vascular damage.
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