Sir,
We are grateful for Ziahosseini and associates' comments regarding our article.1 Various studies have shown the benefit of intravitreal triamcinolone acetonide injection in patients with macular oedema secondary to several reasons.2, 3, 4, 5, 6 In our article, the effect of intravitreal triamcinolone in 12 eyes of 12 patients with diabetic macular oedema that had no previous laser treatment was evaluated. This is the first article in the literature that shows the beneficial effect of intravitreal triamcinolone in eyes with diabetic macular oedema that had no previous laser treatment. Most of the patients in this series showed an increase in visual acuity compared to the baseline of the study. Parallel to the increase in visual acuity, central macular thickness decreased significantly. At 1-month follow-up, a reduction in mean central macular thickness of 40.8% from 448.6 to 265.4 μm was obtained. At the same period, no eyes lost vision and 10 eyes (83.2%) showed improvement. It is clear that the response of the treatment is dramatic.
The type of the macular oedema was clearly explained in the Material and methods according to the angiographic and tomographic findings. So fluorescein angiographic macular oedema was thought to be present if the typical oval or petaloid hyperfluorescent cystoid spaces radiating from the fovea were evident during fluorescein angiography. The optical coherence tomography examination was thought to show macular oedema if there were hyporeflective intraretinal cavities radiating from the centre of the macula in cross-sectional scans.
As Ziahosseini and associates pointed out that topical beta-blockers have been reported to be associated with the occurrence of cystoid macular oedema.7 However, in our series topical medication was began at the 1 month follow up in patients, which developed raised intraocular pressure (cases 2, 5, and 8). Therefore, it was clear that all three patients showed anatomical and functional improvement before the topical beta-blockers.
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Karacorlu, M. Reply: Intravitreal triamcinolone as a primary therapy in diabetic macular oedema. Eye 20, 862–863 (2006). https://doi.org/10.1038/sj.eye.6702041
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DOI: https://doi.org/10.1038/sj.eye.6702041