Background Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Although corticosteroids possess potent anti-inflammatory and antiangiogenic properties, systemic corticosteroid therapy in patients with diabetes may adversely affect retinal outcomes. This study evaluated the association between systemic corticosteroid use and DR progression, visual outcomes, retinal structural changes, and ocular complications. Methods A prospective comparative observational study was conducted at a tertiary care ophthalmology centre between August 2024 and May 2025. Forty adults with DR were enrolled and allocated into a corticosteroid-exposed group (n = 20) and a matched non-corticosteroid control group (n = 20). Participants were followed for 9 months, and assessments were performed for best-corrected visual acuity (BCVA), intraocular pressure (IOP), Early Treatment Diabetic Retinopathy Study (ETDRS) scores, central macular thickness (CMT) measured by optical coherence tomography, DR progression, ocular adverse events, and vision-related quality of life using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Results Baseline demographic and clinical characteristics were largely comparable between the groups. The corticosteroid group demonstrated greater deterioration in BCVA (0.43 ± 0.15 to 0.52 ± 0.17 logMAR vs. 0.68 ± 0.18 to 0.72 ± 0.19 logMAR; p < 0.001) and a larger decline in ETDRS scores (− 6.5 vs. − 5.2 letters). DR progression was observed more frequently among corticosteroid users than among controls (70% vs. 55%; p = 0.03). Mean IOP increased significantly in the corticosteroid group (19.1 ± 1.8 to 21.6 ± 2.0 mmHg; p < 0.001), and follow-up CMT was significantly higher than that in the controls (355.5 ± 59.1 vs. 303.5 ± 13.0 μm; p = 0.004). Cataract progression (60% vs. 30%; p = 0.04) and new or worsened macular oedema (20% vs. 5%; p = 0.03) were more frequent among corticosteroid users. Despite poorer anatomical outcomes, corticosteroid-treated patients reported relatively preserved vision-related quality of life compared with controls. Conclusions Systemic corticosteroid therapy in patients with diabetic retinopathy was associated with accelerated disease progression, greater visual decline, increased central macular thickness, elevated intraocular pressure, and a higher incidence of ocular adverse events. These findings highlight the importance of individualised risk–benefit assessment and regular ophthalmic monitoring in patients with diabetes who require systemic corticosteroid therapy.

The role of corticosteroids in modulating diabetic retinopathy: a comparative analysis

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发表日期：

2026年7月18日

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Swathy Govindaswamy,
Narayanan Balakrishnan,
Meera Muthu

摘要

Background

Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Although corticosteroids possess potent anti-inflammatory and antiangiogenic properties, systemic corticosteroid therapy in patients with diabetes may adversely affect retinal outcomes. This study evaluated the association between systemic corticosteroid use and DR progression, visual outcomes, retinal structural changes, and ocular complications.

Methods

A prospective comparative observational study was conducted at a tertiary care ophthalmology centre between August 2024 and May 2025. Forty adults with DR were enrolled and allocated into a corticosteroid-exposed group (n = 20) and a matched non-corticosteroid control group (n = 20). Participants were followed for 9 months, and assessments were performed for best-corrected visual acuity (BCVA), intraocular pressure (IOP), Early Treatment Diabetic Retinopathy Study (ETDRS) scores, central macular thickness (CMT) measured by optical coherence tomography, DR progression, ocular adverse events, and vision-related quality of life using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25).

Results

Baseline demographic and clinical characteristics were largely comparable between the groups. The corticosteroid group demonstrated greater deterioration in BCVA (0.43 ± 0.15 to 0.52 ± 0.17 logMAR vs. 0.68 ± 0.18 to 0.72 ± 0.19 logMAR; p < 0.001) and a larger decline in ETDRS scores (− 6.5 vs. − 5.2 letters). DR progression was observed more frequently among corticosteroid users than among controls (70% vs. 55%; p = 0.03). Mean IOP increased significantly in the corticosteroid group (19.1 ± 1.8 to 21.6 ± 2.0 mmHg; p < 0.001), and follow-up CMT was significantly higher than that in the controls (355.5 ± 59.1 vs. 303.5 ± 13.0 μm; p = 0.004). Cataract progression (60% vs. 30%; p = 0.04) and new or worsened macular oedema (20% vs. 5%; p = 0.03) were more frequent among corticosteroid users. Despite poorer anatomical outcomes, corticosteroid-treated patients reported relatively preserved vision-related quality of life compared with controls.

Conclusions

Systemic corticosteroid therapy in patients with diabetic retinopathy was associated with accelerated disease progression, greater visual decline, increased central macular thickness, elevated intraocular pressure, and a higher incidence of ocular adverse events. These findings highlight the importance of individualised risk–benefit assessment and regular ophthalmic monitoring in patients with diabetes who require systemic corticosteroid therapy.