REGRESSION OF HARD EXUDATES IN DIABETIC B ACKGROUND RETINOPATHY UNDERTREATMENT WITH THE LIPID-LOWERING DRUG ETOFIBRATE

Background: The aim of this pilot study was to investigate the influen ce of a lipid lowering therapy with etofibrate on the progression of d iabetic background retinopathy in patients with diabetes mellitus and combined hyperlipoproteinemia. In addition to the well known correlati on between the duration of diabetes and the quality of blood glucose c ontrol, a correlation between diabetic microangiopathy and elevated tr iglyceride levels is discussed for many years. The most important path ogenic mechanisms in this respect seem to be an elevation of blood vis cosity and alterations in the fibrinolytic system. Fibrinogen and trig lycerides are the main determinants of plasma viscosity. As lipid lowe ring drugs containing fibrates and nicotinic acid are able to lower tr iglycerides and fibrinogen effectively, a favourable therapeutic effec t on the progression of diabetic retinopathy may be expected. Patients and Method: 11 type II diabetics with combined hyperlipoproteinemia ( Fredrickson type IIb) and mild to moderate background retinopathy dete cted by fundus photography were treated with etofibrate (2 x 500 mg/da y) for a period of 6 months. Results: In 7 of 10 patients hard exudate s, which had been present at the beginning of treatment, showed clear regression at the end of the treatment period. Among the laboratory te st parameters a significant 30% reduction of triglycerides (p < 0.010) was observed. There was also a clear 25% increase in HDL cholesterol and a 12% fibrinogen reduction. Considerable changes of the quality of blood glucose control were not evident during the treatment period. C onclusion: Treatment with the lipid lowering drug etofibrate seems to produce favourable therapeutic effects on hard exudates in diabetic ba ckground retinopathy in patients with diabetes mellitus and combined h yperlipoproteinemia. The mechanisms of this effect are not yet clearly understood, in addition to positive effects on the microcirculation o f the retina by lowering blood viscosity there is a direct lipolytic e ffect in the area of hard exudates to be discussed, too. It is importa nt to point out that we did not see any positive effect of etofibrate therapy concerning other morphological changes of diabetic background retinopathy, i.e. microaneurysms or hemorrhages in our pilot study.