Sodium–Glucose Cotransporter 2 Inhibitors and Risk of Retinal Vein Occlusion Among Patients With Type 2 Diabetes: A Propensity Score–Matched Cohort Study

OBJECTIVE

To assess the association between use of sodium-glucose cotransporter-2 (SGLT2) inhibitors and retinal vein occlusion (RVO) using data from the National Health Insurance Service in South Korea.

RESEARCH DESIGN AND METHODS

We used an active comparator, new user design and nationwide data from 2014 to 2017. Based on a 1:1 propensity score match, we included 47 369 new users of SGLT2 inhibitors and 47 369 users of other glucose-lowering drugs (oGLD). In the matched sample, we used the Cox proportional hazards model to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for developing RVO. Based on the main outcome, exploratory subgroup analyses were undertaken.

RESULTS

During the follow-up of 2.57 years, the incidence rate of RVO was 2.19 and 1.79 per 1000 person-years in patients treated with SGLT2 inhibitors and oGLD, respectively. The new use of SGLT2 inhibitors was associated with an increased risk of RVO compared with oGLD use (HR 1.264, 95% CI 1.056–1.513). In the subgroup analyses, a significant interaction with SGLT2 inhibitors was observed for age and estimated glomerular filtration rate (eGFR); the HR for RVO was higher in patients aged ≥ 60 years and those with eGFR <60 mL/min/1.73m² than in others.

CONCLUSIONS

In a matched cohort study, we found that SGLT2 inhibitors were associated with a significantly increased risk of RVO. The older patients and those with chronic kidney disease were at higher risk for RVO.