The role of concomitant immunosuppressants in impeding the progression of diabetic retinopathy: A pilot study

PURPOSE: Hallmark of Diabetic Retinopathy (DR) is blood-retinal barrier alteration. Vascular endothelial growth factor (VEGF) and inflammation are involved in the pathogenesis of DR. Anti-VEGFs and lasers are effective in treating DR but have numerous drawbacks, hence the need to develop alternative therapies that may delay the onset or progression of DR. METHODS: Fifteen patients were recruited in each group; the study group was on immunosuppressants for some other coexisting disease and the control group was not on them. Each subject underwent detailed history, ophthalmic examination, and glycosylated hemoglobin (HbA1c) and renal function tests at the time of recruitment and the end of one year. Primary outcome measure was to compare the progression of DR in diabetics on immunosuppressant versus those not on it. RESULTS: Median age in the study and control group was 57 years and 60 years, respectively (P = 0.6). Median duration of diabetes was 11 and 12 years in the study and control group, respectively (P = 0.7). HbA1c for the study and control group for first visit was 7.6% and 8.0%, respectively (P = 0.26) and for second visit was 7.5% and 8.1%, respectively (P = 0.11). Hypertensives in the study and control groups were 9 and 4, respectively (P = 0.065); renal disease in the study and control groups was 4 and 2, respectively (P = 0.361). The control group showed 33.3% progression of DR, and no progression was seen in the study group (P = 0.014). CONCLUSION: Immunosuppressants seemed to delay the onset and progression of DR in the earlier stages.