Sodium-glucose co-transporter 2 inhibitors reduce the intravitreal anti-VEGF treatment necessity in eyes with early diabetic macular oedema: A post-hoc analysis focusing on the fellow eye of the COMET trial.

AIMS: This study aimed to determine the efficacy of oral administration of sodium-glucose co-transporter 2 inhibitors (SGLT2i) therapy for early diabetic macular oedema (DMO).

MATERIALS AND METHODS: We conducted a post-hoc analysis of the COMET trial, a prospective, randomized, parallel, investigator-driven protocol. Sixty patients with DMO eligible for anti-vascular endothelial growth factor (VEGF) therapy were randomized to receive either the SGLT2i luseogliflozin or sulfonylurea (SU) glimepiride. Intravitreal ranibizumab (IVR) injections were administered per protocol to both eyes over 48 weeks. For this analysis, we included eyes with no or mild macular oedema at baseline and excluded those that had received treatment within a defined period prior to enrolment. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and the number of IVR injections were compared between the SGLT2i and SU groups.

RESULTS: At baseline, 20 eyes in the SU group and 22 eyes in the SGLT2i group did not require IVR. Changes in BCVA and CRT did not differ significantly between the groups. IVR was required in 9 of 20 eyes in the SU group versus 2 of 22 eyes in the SGLT2i group. The rate of the first IVR was significantly lower in the SGLT2i group.

CONCLUSIONS: Systemic SGLT2i therapy reduced the need for intravitreal anti-VEGF treatment in eyes with early and mild DMO. These results suggest that SGLT2i may be effective in preventing the progression of early and mild DMO.