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   Table of Contents      
LETTER TO THE EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 189-190

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


Department of Vitreoretina, 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
Chief Medical Officer and Vitreoretinal Surgeon, 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_2929_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;69:189-90

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 16];69:189-90. Available from: https://www.ijo.in/text.asp?2021/69/1/189/303324



Dear Editor,

Thank you for your interest in our article entitled “Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema”.[1],[2] We have mentioned that it is non comparative study and first of its kind to analyze the outcome of Intravitreal dexamethasone in treatment naïve patients of Diabetic Macular Edema, but never mentioned that there is no previous data on use of dexamethasone implant,[3],[4] rather we have compared results of our study with the previous similar studies.[5],[6],[7],[8],[9]

Clarifications to other points raised by the responder are as follows

  1. The primary outcome measures are very clear. The Central Macular Thickness (CMT) and VA in terms of lines of improvement have been vividly analyzed in the paper with appropriate statistical tools at different time intervals. Evaluation of CMT and VA (Lines of Improvement) are no doubt robust way to look at the results as they supplement and validate each other, hence they are the primary outcomes. Data analysis was done using IBM SPSS Statistics 24.00, SPSS South Asia Pvt. Ltd, www.spss.co.in
  2. This is an extensive and intensive analysis taking various parameters CMT, VA in terms of lines of improvement has been analyzed in terms of mean (SD) over different follow-ups. Depending on the HbA1c, the blood sugar control was divided into good control (<7%), fair control (7.1–8.9%), and poor control (≥9%) and categorization of VA is divided into mild, moderate and severe impairment. This type of classification adds more significance as it furnishes the real clinical status which is rather lost in mean and SD. No doubt categorization along with mean ± SD is more comprehensive analysis.


  3. Admittedly the sample size is relatively small, because of availability of the cases in the study period. Nevertheless a sample size of 30 or more is considered fair for statistical analysis. There is always scope for studying with more sample size.

  4. We have used Topcon SS OCT Triton Plus, Tokyo Japan for evaluating DME.


  5. In fact the term 'association' should have been used instead of Correlation. This is an inadvertent typographical mistake.

  6. In methods visual loss or impairment is categorized into Mild, Moderate and Severe and in results we have mentioned about 02 people having good vision (who had better vision than mild visual impairment), hence there is no disparity in comparing the vision. In all places 'P' values have been mentioned whenever it is significant including CMT i.e., Significant improvement was found in OCT done at 3 months (P = 0.000) and further improvement was seen in OCT at 6 months (P = 0.142).
  7. It has been mentioned in the methods section that comprehensive ophthalmic examination was done and lens status in each patient was noted in the master chart. Based on this data the last paragraph in the result section mentions that 18 phakic patients were followed up showing neither development nor progression of cataract.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sahu V, Misra S. Comments on: Long-term results of a single injection of intravitreal dexamethasone as initial therapy in diabetic macular edema. Indian J Ophthalmol 2021;69:188-9.  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.
Iglicki M, Busch C, Zur D, Okada M, Mariussi M, Chhablani JK, et al. Dexamethasone implant for diabetic macular edema in naive compared with refractory eyes: The International Retina Group real-life 24-month multicenter study. The IRGREL-DEX Study. Retina 2019;39:44-51.  Back to cited text no. 3
    
4.
Mastropasqua R, Toto L, Borrelli E, Antonio LD, Nicola CD, Mastrocola A, et al. Morphology and function over a one-year follow up period after intravitreal dexamethasone implant (Ozurdex) in patients with diabetic macular edema. PLoS One 2015;10:e0145663.  Back to cited text no. 4
    
5.
Pacella E, Vestri AR, Muscella R. Preliminary results of an intravitreal dexamethasone implant (Ozurdex) in patients with persistent diabetic macular edema. Clin Ophthalmol 2013;7:1423-8.  Back to cited text no. 5
    
6.
Lazic R, Lukic M, Boras I, Draca N, Vlasic M, Gabric N, et al. Treatment of anti-vascular endothelial growth factor-resistant diabetic macular edema with dexamethasone intravitreal implant. Retina 2014;34:719-24.  Back to cited text no. 6
    
7.
Kuppermann BD, Blumenkranz MS, Haller JA, Williams GA, Weinberg DV, Chou C, et al. Randomized controlled study of an intravitreous dexamethasone drug delivery system in patients with persistent macular edema. Arch Ophthalmol 2007;125:309-17.  Back to cited text no. 7
    
8.
Rishi P, Rishi E, Kuniyal L, Mathur G. Short-term results of intravitreal dexamethasone implant in the treatment of recalcitrantdiabetic macular edema: A case series. Oman J Ophthalmol 2012;5:79-82.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Blumenkranz MS, Haller JA, Kuppermann BD, Williams GA, Davis M. Correlation of visual acuity and macular thickness measured by optical coherence tomography in patients with persistent macular edema. Retina 2010;30:1090-4.  Back to cited text no. 9
    




 

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