Intensive Hmgcoa-Reductase Inhibitor Therapy Suppresses Hard Exudates in Diabetic Macula Edema Patients

Abstract

Purpose: : Precipitation of hard exudates at the macular area in diabetic macular edema is a vision-threatening phenomenon. Several efforts to remove the hard exudates, including vitrectomy, have proved unsuccessful. HMGCoA-reductase inhibitors (statins) improve diabetic retinopathy and diabetic maculopathy. In this study, we investigated if hard exudates improved when we increased the dose of statins, or changed statins to a stronger type.

Methods: : We recruited patients who consulted Kansai Medical University Hospital or Yamada Eye Clinic between April, 2005 and October, 2007. Inclusion criteria were patients that had hypercholesterolemia with statin therapy prior to this study, and exhibited hard exudate precipitation in the macular area that had not improved in the past 6 months. At the start point, patients either increased the dose of statins or changed to a stronger statin. Patients were observed monthly and for 6 months, their vision, macular thickness, amount of hard exudates, and blood cholesterol were evaluated and compared to their initial values.

Results: : Nine patients (18 eyes) were entered in this study. Six patients were male and 3 patients were female. Age ranged from 53 to 84 and the mean age was 64. Visual acuity and blood cholesterol levels tended to improve over time, but the results were not statistically different. Macular hard exudates decreased in all cases. Macula thickness decreased with statistical significance (p=0.04).

Conclusions: : Intensive statin therapy was very effective in decreasing hard exudates in diabetic macular edema without other therapy including vitrectomy. It is interesting that a decrease of blood cholesterol level was not necessary to reduce hard exudates and macular thickness. These results suggest that intensive statin therapy is a successful treatment for reducing hard exudates in diabetic maculopathy patients.

Keywords: diabetic retinopathy • drug toxicity/drug effects • lipids