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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 187-188

Response to comments on: Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema


JPM Rotary Club of Cuttack Eye Hospital and Research Institute, CDA, Cuttack, Odisha, India

Date of Web Publication15-Dec-2020

Correspondence Address:
Dr. Santosh Kumar Mahapatra
JPM Rotary Club of Cuttack Eye Hospital and Research Institute, CDA, Cuttack, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_1136_20

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How to cite this article:
Mahapatra SK, Kumari S. Response to comments on: Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol 2021;69:187-8

How to cite this URL:
Mahapatra SK, Kumari S. Response to comments on: Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol [serial online] 2021 [cited 2021 Jan 21];69:187-8. Available from: https://www.ijo.in/text.asp?2021/69/1/187/303268



Dear Editor,

We sincerely thank Varghese et al.[1] for their interest in our article[2] and we would like to put our response to their comments as follows:

The authors are not denying the effectiveness of anti-VGEF in DME. This study is conducted as a prospective noncomparative study to evaluate the efficacy of intravitreal dexamethasone implant as an initial therapy in DME as a part of a thesis protocol of a DNB Post Graduate Trainee. We still stand by our claim of being the first noncomparative study as the study mentioned by Varghese et al. in their reference to the study by Gillies MC et al.[3] is a comparative study between intravitreal bevacizumab and dexamethasone implant. In the same study, they have mentioned and I quote that “We found no significant difference between two groups with respect to Visual gain” and “Ozurdex generally achieved better anatomical outcomes with substantially fewer injections”. Hence, intravitreal dexamethasone can definitely be considered as a viable alternative to anti-VGEF in DME.

The statement “DME is known to have two phases, the initial VEGF mediated phase and the late inflammation-mediated phase” is not agreeable as suggested by various studies and I would like to quote a few important statements to support the same from the study by Pedro RA et al.[4] like “it still remains to be clarified whether angiogenesis following VEGF overexpression is a cause or a consequence of inflammation… Our analysis suggests that angiogenesis and inflammation act interdependently during the development of DME”. Hence, both anti-VGEF and anti-inflammatory agents are effective in the management of any stage of DME. However, the anti-VEGF agents are the preferred molecules over inflammatory agents in the management of DME with PDR.

We have mentioned in our study that out of 30 eyes, 06 (26.6%) had recurrent DME upon 1 year follow up, which implies that a small group is having recurrence of disease after a period of 04 to 06 months. However, most of the patients exhibit anatomical and visual improvement and retain the same at the end of 1-year follow up, which is comparable to other studies.[5],[6],[7] Complications like increase in the postinjection risk of development of cataract and IOP is minimal and acceptable as mentioned in different studies.[8],[9],[10] Postinjection IOP increase is marginal and self-limiting, if steroid responders are excluded before injecting dexamethasone as done in our study.

Thus, we can came to a conclusion that intravitreal dexamethasone can be considered as a suitable alternative to anti-VEGF as an initial therapy for DME patients except for those with PDR or at high risk for glaucoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Verghese S, Ranjan R, Manayath GJ. Comments on: Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol 2021;69:186-7.  Back to cited text no. 1
  [Full text]  
2.
Mahapatra SK, Kumari S. Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol 2020;68:490-3.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Gillies MC, Lim LL, Campain A, Quin GJ, Salem W, Li J, et al. A Randomized clinical trial of intravitreal bevacizumab versus intravitreal dexamethasone for diabetic macular edema. Ophthalmology 2014;121:2473-81.  Back to cited text no. 3
    
4.
Romero-Aroca P, Baget-Bernaldiz M, Pareja-Rios A, Lopez-Galvez M, Navarro-Gil R, Verges R. Raul navarro-gil and raquel verges. diabetic macular edema pathophysiology: Vasogenic versus inflammatory. J Diabetes Res 2016;2016:2156273.  Back to cited text no. 4
    
5.
Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, et al. Ozurdex MEAD Study Group. Three year, randomized, sham controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014;121:1904-14.  Back to cited text no. 5
    
6.
Querques G, Lattanzio R, Querques L, Triolo G, Cascavilla ML, Cavallero E, et al. Impact of intravitreal dexamethasone implant on macular morphology and function. Retina 2014;34:330-41.  Back to cited text no. 6
    
7.
Zalewski D, Raczyska D, Raczyska K. Five month observation of persistent diabetic macular edema after intravitreal injection of Ozurdex implant. Mediators Inflamm 2014;2014:364143.  Back to cited text no. 7
    
8.
Bahadorani S, Krambeer C, Wannamaker K, Tie W, Jansen M, Espitia J, et al. The effects of repeated Ozurdex injections on ocular hypertension. Clin Ophthalmol 2018;12:639-42.  Back to cited text no. 8
    
9.
Scaramuzzi M, Querques G, Spina CL, Lattanzio R, Bandello F. Repeated intravitreal dexamethasone implant (Ozurdex) for diabetic macular edema. Retina 2015;35:1216-22.  Back to cited text no. 9
    
10.
Boyer DS, Yoon YH, Belfort R Jr, Bandello F, Maturi RK, Augustin AJ, et al. Three-year, randomized, sham-controlled trial of dexamethasone intravitreal implant in patients with diabetic macular edema. Ophthalmology 2014;121:1904-14.  Back to cited text no. 10
    




 

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