Korean J Ophthalmol.  2012 Aug;26(4):312-315. 10.3341/kjo.2012.26.4.312.

Resolution of Macular Edema after Systemic Treatment with Furosemide

• Koo NK
• Kim YC

• KMID: 1387402
• DOI: http://doi.org/10.3341/kjo.2012.26.4.312

Abstract

We report two cases of macular edema treated with the oral administration of furosemide. The first case presented here was a 78-year-old male patient with visual disturbance of the left eye. He had been taking an oral agent for diabetes and had chronic renal failure for 7 years. From 10 days prior to the visit, he had visual disturbance of the left eye accompanied by systemic edema. There were no specific findings in the anterior segment, but sub-retinal fluid was observed in the left fundus. Macular edema was observed on fluorescein angiography and optical coherence tomography; therefore, the oral administration of furosemide was initiated. After seven days, the sub-retinal fluid disappeared. The second case was a 43-year-old female patient with visual disturbance of the left eye who had been taking hypoglycemic agents for diabetes for 13 years. There were no specific findings in the anterior segment, but flame-shaped retinal hemorrhages were scattered over both posterior poles, neovascularization was observed in the left eye, and, of particular note, sub-retinal fluid was detected in the macula of the left eye. Macular edema was also observed on fluorescein angiography and optical coherence tomography, and oral administration of furosemide was initiated. After 3 weeks, the macular edema had significantly decreased.

Keyword

Furosemide; Macular edema

MeSH Terms

Administration, Oral
Adult
Aged
Diabetes Complications/diagnosis/*drug therapy
Diuretics/administration & dosage/*therapeutic use
Female
Fluorescein Angiography
Furosemide/administration & dosage/*therapeutic use
Humans
Macular Edema/diagnosis/*drug therapy
Male
Tomography, Optical Coherence

Figure

• 

  Fig. 1 Angiographic and optical coherence tomographic findings of case 1. (A) Macular edema and fluorescein leakage in the left eye before oral administration of furosemide. (B) Minimal fluorescein leakage in the right eye before oral administration of furosemide. (C) Serous retinal detachment of the macula and large, intraretinal, cystoid spaces in the left eye before oral administration of furosemide. (D) Near complete resolution of the subretinal fluid and cystoid spaces in the left eye after oral administration of furosemide.

• 

  Fig. 2 Fundus and optical coherence tomographic findings of case 2. (A) Marked thickening of the macula and scattered flame-shaped retinal hemorrhage in the left eye before oral administration of furosemide. (B) Serous retinal detachment of the macula and large, intraretinal cystoid spaces in the left eye before oral administration of furosemide. (C) Partial resolution of the subretinal fluid and cystoid spaces in the left eye after oral administration of furosemide. (D) Near complete resolution of the subretinal fluid and cystoid spaces in the left eye after intravitreal bevacizumab injection.

Reference

1. Shankar SS, Brater DC. Loop diuretics: from the Na-K-2Cl transporter to clinical use. Am J Physiol Renal Physiol. 2003. 284:F11–F21.

2. Ciardella AP. Partial resolution of diabetic macular oedema after systemic treatment with furosemide. Br J Ophthalmol. 2004. 88:1224–1225.

3. Knudsen ST, Bek T, Poulsen PL, et al. Macular edema reflects generalized vascular hyperpermeability in type 2 diabetic patients with retinopathy. Diabetes Care. 2002. 25:2328–2334.

4. Otani T, Kishi S, Maruyama Y. Patterns of diabetic macular edema with optical coherence tomography. Am J Ophthalmol. 1999. 127:688–693.

5. Kang SW, Park CY, Ham DI. The correlation between fluorescein angiographic and optical coherence tomographic features in clinically significant diabetic macular edema. Am J Ophthalmol. 2004. 137:313–322.

6. Farber MD, Lam S, Tessler HH, et al. Reduction of macular oedema by acetazolamide in patients with chronic iridocyclitis: a randomised prospective crossover study. Br J Ophthalmol. 1994. 78:4–7.