Semaglutide

A 68-year-old man with poorly controlled type 2 diabetes mellitus developed simultaneous bilateral non-arteritic anterior ischaemic optic neuropathy (NAION) following initiation of high-dose semaglutide for glycaemic control. The man, who had significant hyperopia (+5 diopters), received semaglutide 0.5 mg weekly. Fourteen days after starting treatment, he experienced visual loss in both eyes, which progressed to functional blindness within four weeks. Ophthalmological assessment revealed bilateral optic disc oedema, haemorrhages, exudates and subretinal fluid. Investigations excluded infectious and autoimmune aetiologies, and cerebrospinal fluid analysis was unremarkable. Glycated haemoglobin levels decreased after semaglutide initiation, though the rapidity and extent of this reduction were noted as potentially relevant to the clinical course. The man discontinued semaglutide and was treated with corticosteroids; however, his visual impairment persisted. …