Severe macular edema induced by pioglitazone in a patient with diabetic retinopathy: a case study

Case report

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Authors: Toshiyuki Oshitari, Noriko Asaumi, Masaru Watanabe, Ken Kumagai, Yoshinori Mitamura

Published Date July 2008 Volume 2008:4(5) Pages 1137 - 1140

DOI: http://dx.doi.org/10.2147/VHRM.S3446

Toshiyuki Oshitari¹, Noriko Asaumi¹, Masaru Watanabe¹, Ken Kumagai¹, Yoshinori Mitamura^1,2

¹Department of Ophthalmology, Kimitsu Central Hospital, Kisarazu City, Chiba, Japan; ²Department of Ophthalmology and Visual Science, Chuo-ku, Chiba, Japan

Abstract: We report a case of severe diabetic macular edema (DME) that developed after pioglitazone was used by a patient with proliferative diabetic retinopathy. A 30-year-old woman with poorly controlled type 2 diabetes mellitus visited our clinic in 2004. She had moderate pre-proliferative diabetic retinopathy OU. Because of the rapid progression of the diabetic retinopathy, she received pan-retinal photocoagulation in both eyes. Two weeks before using pioglitazone, her visual acuity was 0.9 OD and 0.7 OS. On October 2007, pioglitazone was prescribed by her internist because of poorly controlled blood glucose level. Two weeks later, her body weight increased, and her face became edematous. Her visual acuity decreased to 0.5 OU, and ophthlamoscopy showed severe DME in both eyes. Two weeks after stopping pioglitazone, her visual acuity improved to 0.8 OD and 0.5 OS, but the DME was still severe in the optical coherence tomographic images. Then, one half the usual dose (25 mg) of spironolactone, a diuretic, was given and her macular edema was resolved. Her final visual acuity improved to 0.9 OD and 0.7 OS. We recommend that when a patient taking pioglitazone complains of decreased vision, the physician should promptly consult an ophthalmologist.

Keywords: pioglitazone, diabetic macular edema, spironolactone, optical coherence tomography

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