In the pathogenesis of diabetic macular oedema (DME), the mechanism of action of fenofibrate (used in FIELD and ACCORD-EYE trials) in reducing diabetic retinopathy progression is attributed to:
- A PPARα-mediated anti-inflammatory, anti-angiogenic, and neuroprotective effects on the retina independent of lipid lowering ✓
- B Lipid-lowering effect reducing lipaemia retinalis and hard exudates
- C Improved glycaemic control through PPARγ agonism
- D Reduction of blood viscosity improving retinal perfusion
Explanation
The FIELD trial showed fenofibrate reduced laser treatment requirements for diabetic retinopathy by 31%, and the ACCORD-EYE trial (fenofibrate + simvastatin vs placebo + simvastatin) showed 40% relative risk reduction in retinopathy progression. These benefits appeared independent of plasma lipid levels and were seen even in patients with normal lipids. PPARα activation by fenofibrate reduces retinal VEGF expression, inflammatory cytokines (TNF-α, IL-1β), retinal oxidative stress, and has neuroprotective effects on retinal ganglion cells and pericytes. Fenofibrate is now considered an adjunct to standard diabetic retinopathy management especially in patients already on fenofibrate for dyslipidaemia.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.