Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Comments on 'Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants'

Sir,

We read with interest the article titled ‘Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants’ by Yang et al.1 They present a post hoc analysis of the FAME study2 and compare visual outcomes in patients undergoing cataract surgery after low-dose FAc implant with those who were pseudophakic at baseline. They conclude the former group to have possibly better long-term results.

In the cataract surgery after implant (CAI) group, the favorable change in visual acuity may have been partly contributed by removal of lenticular aberrations3 expected in diabetes patients having early lens opacities or even lenticular swelling. Hence, crediting FAc for better visual results in the CAI group may be erroneous. Single intravitreal steroid injections have been reported to cause subcapsular cataract and multiple injections may affect all the lens layers.4 Given the continuous low intraocular concentration of steroid with FAc implant, it would be interesting to evaluate the type of cataract seen in the CAI group.

The other adverse effect of FAc noted in the FAME study was ocular hypertension, with nearly 4% of subjects injected with low-dose FAc needing incision glaucoma surgery.2 As lens extraction is known to decrease intraocular pressure,5 we suggest analyzing change in intraocular pressure in patients in the CAI group after cataract surgery. It is possible that ocular hypertension may have resolved altogether in some patients, especially in the presence of anterior synechiae.

As the diabetic macular edema and its treatment are of utmost importance, we wish the authors would share their opinion on these issues.

References

  1. Yang Y, Bailey C, Holz FG, Eter N, Weber M, Baker C et al. Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants. Eye (Lond) 2015; 29: 1173–1180.

    CAS  Article  Google Scholar 

  2. Campochiaro PA, Brown DM, Pearson A, Ciulla T, Boyer D, Holz FG et al. Long-term benefit of sustained-delivery fluocinolone acetonide vitreous inserts for diabetic macular edema. Ophthalmology 2011; 118: 626–635.

    Article  Google Scholar 

  3. Sachdev N, Ormonde SE, Sherwin T, McGhee CN . Higher-order aberrations of lenticular opacities. J Cataract Refract Surg 2004; 30: 1642–1648.

    Article  Google Scholar 

  4. Sarao V, Veritti D, Boscia F, Lanzetta P . Intravitreal steroids for the treatment of retinal diseases. ScientificWorldJournal 2014; 2014: 989501.

    Article  Google Scholar 

  5. Dada T, Rathi A, Angmo D, Agarwal T, Vanathi M, Khokhar SK et al. Clinical outcomes of clear lens extraction in eyes with primary angle closure. J Cataract Refract Surg 2015; 41: 1470–1477.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S Azad.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Takkar, B., Azad, S. Comments on 'Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants'. Eye 30, 1023 (2016). https://doi.org/10.1038/eye.2016.27

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/eye.2016.27

Further reading

Search

Quick links