|LETTER TO EDITOR
|Year : 1997 | Volume
| Issue : 4 | Page : 259-260
Treatment outcome in diabetic macular edema
K J Singh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Singh K J. Treatment outcome in diabetic macular edema. Indian J Ophthalmol 1997;45:259-60
| Editor:|| |
I congratulate Gupta et al for suggesting, on the basis of their study, that diabetic maculopathy should be treated early, when the visual acuity is normal or near normal, and the size of clinically significant macular edema (CSME) is still small. It is more important to treat it early in Indian conditions where the follow-up is quite unreliable.
I applaud the authors' effort, but beg to differ on the following points:
a. The authors have concluded that increasing size of CSME was associated with poor prognosis. How this inference was drawn is not clear since they have not analysed different size of the CSME for risk factors.
b. What were the causes for poor baseline visual acuity? For instance, a plaque of exudates in the foveal area has poor initial vision, comes under the definition of CSME, and is a poor prognostic sign too. Even after the treatment, this plaque cannot be removed. Thus, causes for poor vision at baseline, whether included or excluded, in the study would have given us a clear picture.
c. The authors have concluded that advanced age of the patients was a significant risk factor after including both insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients. In this study, it is difficult to compare the data in these two groups because 7 of 47 patients in Group I, and 12 of 49 patients in Group II belonged to IDDM variety. As IDDM occurs at an early age, we may consider IDDM patients in the younger age group (≤49 years). Then, we have 13 patients of NIDDM left in Group I, and only 1 in Group II. In such a situation, the risk factor analysis will be difficult. Perhaps the study would have given us a better insight into the risk factors if it had restricted its sample to only one type of diabetic patients as most studies are being carried out in this fashion.
| References|| |
Gupta A, Gupta V, Dogra MR, Pandav SS. Risk factors influencing treatment outcome in diabetic macular edema. Indian J Ophthalmol
Vitale S, Maguire MG, Murphy RP, Hiner CJ, Rourke L, Sackett C, et al. Clinically significant macular edema in type I diabetes: incidence and risk factors. Ophthalmology
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. II. Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol
Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. The Wisconsin epidemiologic study of diabetic retinopathy. III. Prevalence and risk of diabetic retinopathy when age at diagnosis is 30 or more years. Arch Ophthalmol