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   Table of Contents      
LETTER TO EDITOR
Year : 1997  |  Volume : 45  |  Issue : 4  |  Page : 260

Letter


Correspondence Address:
S Saxena


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Source of Support: None, Conflict of Interest: None


PMID: 9567027

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How to cite this article:
Saxena S. Letter. Indian J Ophthalmol 1997;45:260

How to cite this URL:
Saxena S. Letter. Indian J Ophthalmol [serial online] 1997 [cited 2020 Apr 4];45:260. Available from: http://www.ijo.in/text.asp?1997/45/4/260/14987


  Editor: Top


I read with interest the article on risk factors influencing the treatment outcome in diabetic macular edema by Gupta et al.[1] In this retrospective study, advanced age, large size of clinically significant macular edema (CSME), and poor baseline visual acuity were found to be associated with poorer outcome. Diabetic macular edema (DME) was defined as CSME by Early Treatment Diabetic Retinopathy Study (ETDRS).[2] Each of the defined characteristics include retinal thickening, the hall mark of DME. Retinal thickening cannot be seen in non-stereo photographs. CSME is assessed by contact lens or non-contact lens biomicroscopy and stereo photography. A magnified stereo examination of the macula is necessary to detect retinal thickening.[2] Thus, assessment of the size, extent and location of CSME, in this study remains unclear. Assessment of CSME from fundus drawings is also questionable.

Recent ETDRS report number 19 reported whether the efficacy of focal photocoagulation treatment of DME may be influenced by degree of capillary closure, severity or source of fluorescein leakage, extent of retinal edema, presence of cystoid changes or severity of hard exudates.[3] Grading of baseline stereoscopic fluorescein angiograms and colour fundus photographs was done. The extent of thickening within 1,500 μm of the centre of the macula and the degree of thickening at the centre were found to correlate well. Treatment effect increased as the extent of retinal thickening increased. The analyses by degree of thickening at the centre of macula showed that treatment effect increased from zero when thickening was questionable to about 50% when retinal thickness at the centre was estimated to equal or exceed the "reference thickness" (maximum thickness of the normal retina at a distance of 750 to 1,500 μm from the centre). Argon and krypton laser used for the treatment did not significantly influence,the outcome in this study.

 
  References Top

1.
Gupta A, Gupta V, Dogra MR, Pandav SS. Risk factors influencing the treatment outcome in diabetic macular edema. Indian J Ophthalmol 1996;44;145-48.  Back to cited text no. 1
    
2.
Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for diabetic macular edema. ETDRS report number 1. Arch Ophthalmol 1985;103:1796-806.  Back to cited text no. 2
    
3.
Early Treatment Diabetic Retinopathy Study Research Group. Focal photocoagulation treatment of diabetic macular edema: relationship of treatment effect to fluorescein angiographic and other retinal characteristics at baseline. ETDRS report number 19. Arch Ophthalmol 1995;113:1144-55.  Back to cited text no. 3
    




 

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