Sir,
We thank Gupta and Ram1 for their interest in our publication2 on dexamethasone implant in diabetic macular edema (DME). Because of the retrospective nature of the study, we could not get the complete information on systemic factors such as hypertension and lipid profile. However, recently, Singh et al reported that the vision outcome with ranibizumab in DME was not influenced by systemic factors such as diabetes medication history, serum glucose, HbA1c, renal function, and blood pressure in the RIDE and RISE phase 3 studies.3
Seven eyes underwent panretinal photocoagulation (PRP) during the follow-up. We agree with the authors that there could be slight increase in the macular edema after PRP and may have affected the final outcome. Interestingly, a recent prospective study by Lee et al4 showed no effect on visual acuity of PRP at 12 months irrespective of persistent macular edema.
We thank the authors once again for this interesting discussion.
References
Gupta PC, Ram J . Dexamethasone implant in diabetic macular edema in real-life situations. Eye (Lond) 2016. epub ahead of print 12 August 2016; doi: 10.1038/eye.2016.191.
Chhablani J, Bansal P, Veritti D, Sambhana S, Sarao V, Pichi F et al. Dexamethasone implant in diabetic macular edema in real-life situations. Eye (Lond) 2016; 30: 426–430.
Singh RP, Habbu K, Ehlers JP, Lansang MC, Hill L, Stoilov I . The Impact of Systemic Factors on Clinical Response to Ranibizumab for Diabetic Macular Edema. Ophthalmology 2016; 123: 1581–1587.
Lee SB, Yun YJ, Kim SH, Kim JY . Changes in macular thickness after panretinal photocoagulation in patients with severe diabetic retinopathy and no macular edema. Retina 2010; 30: 756–760.
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Chhablani, J. Dexamethasone implant in diabetic macular edema. Eye 30, 1650 (2016). https://doi.org/10.1038/eye.2016.192
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DOI: https://doi.org/10.1038/eye.2016.192