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Intravitreal Injection of Triamcinolone for Diffuse Diabetic MacularEdema

Intravitreal Injection of Triamcinolone for Diffuse Diabetic MacularEdema We read with interest "Intravitreal Injection of Triamcinolone for DiffuseDiabetic Macular Edema" by Jonas et al.1 Vascularinflammation has recently been linked to diabetic angiopathy, and therefore,the use of localized steroid could possibly improve the effects of diabeticmaculopathy. However, this study has not convinced us of the benefits of intravitrealtriamcinolone injection. The design of this study did not eliminate observer or patient biasby means of a double-masked method, although angiograms were graded in a maskedfashion. Patients were matched for age, sex, refractive error, and preoperativevisual acuity but were not matched for known predictors of poor prognosissuch as type and length of diabetes, control of blood sugar and blood pressure,smoking, and renal disease.2,3 Visual acuity is measured to gauge success in treatment but diabeticmacular edema can frequently improve with no change in visual acuity and visualacuity can improve with no change in macular edema. The variability in patientresponse for visual acuity measurement is also well known in any practice. In the article, Figure 1 illustrates significant improvement in visualacuity, but it is also apparent that the confidence interval widens as postinterventiontime increases. This trend for a wider confidence interval raises questionsof true treatment success. Fluorescein angiography is a method in which retinal leakage can beobserved,4 and the investigators have chosento use this to assess treatment success. Figure 2 in the article shows late-phaseangiograms prior to and 3 months after treatment, but it is unclear at whatstage of the angiogram these photos were taken. Furthermore, pretreatmentphotographs probably show cystoid macular edema, and we were unsure whetherthis was a pseudophakic eye. As suggested by the authors, future randomized studies will be of interestin confirming the value of intravitreal steroid injection for the treatmentof clinically significant diabetic macular edema. Correspondence: Dr Wong, Flat 3, 26 Philbeach Gardens, Earls Court,London SW5 9DY, England (drrogerwong@aol.com). References 1. Jonas JKreissig ISofker ADegenering R Intravitreal injection of triamcinolone for diffuse diabetic macularedema. Arch Ophthalmol. 2003;12157- 61PubMedGoogle ScholarCrossref 2. UK Prospective Diabetes Study Group, Tight blood pressure control and risk of macrovascular and microvascularcomplications in type 2 diabetes: UKPDS 38. BMJ. 1998;317703- 713PubMedGoogle ScholarCrossref 3. Diabetes Control and Complications Trial Research Group (DCCT), Lifetime benefits and costs of tight control therapy as practiced inthe diabetes control and complications trial. JAMA. 1996;2761409- 1415PubMedGoogle ScholarCrossref 4. Early Treatment Diabetic Retinopathy Study Research Group, Classification of diabetic retinopathy from fluorescein angiograms:ETDRS Report Number 11. Ophthalmology. 1991;98807- 822PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Intravitreal Injection of Triamcinolone for Diffuse Diabetic MacularEdema

Intravitreal Injection of Triamcinolone for Diffuse Diabetic MacularEdema

Abstract

We read with interest "Intravitreal Injection of Triamcinolone for DiffuseDiabetic Macular Edema" by Jonas et al.1 Vascularinflammation has recently been linked to diabetic angiopathy, and therefore,the use of localized steroid could possibly improve the effects of diabeticmaculopathy. However, this study has not convinced us of the benefits of intravitrealtriamcinolone injection. The design of this study did not eliminate observer or patient biasby means of a double-masked method,...
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References (6)

  • F. Ferris, A. Kassoff, G. Bresnick, I. Bailey (1982)

    New visual acuity charts for clinical research.

    American journal of ophthalmology, 94 1

  • J. Jonas, I. Kreissig, Antje Söfker, R. Degenring (2003)

    Intravitreal injection of triamcinolone for diffuse diabetic macular edema.

    Archives of ophthalmology, 121 1

  • Early Treatment Diabetic Retinopathy Study Research Group, Ophthalmology. (1991)

    Classification of diabetic retinopathy from fluorescein angiograms:ETDRS Report Number 11.

    , 98

  • M. Stearne, S. Palmer, M. Hammersley, S. Franklin, R. Spivey, J. Levy, C. Tidy, N. Bell, J. Steemson, B. Barrow, R. Coster, K. Waring, J. Nolan, E. Truscott, N. Walravens, L. Cook, H. Lampard, C. Merle, P. Parker, J. Mcvittie, I. Draisey, L. Murchison, A. Brunt, M. Williams, D. Pearson, X. Petrie, M. Lean, D. Walmsley, M. Lyall, E. Christie, J. Church, E. Thomson, A. Farrow, J. Stowers, M. Stowers, K. McHardy, N. Patterson, A. Wright, N. Levi, A. Shearer, R. Thompson, G. Taylor, S. Rayton, M. Bradbury, A. Glover, A. Smyth-Osbourne, C. Parkes, J. Graham, P. England, S. Gyde, C. Eagle, B. Chakrabarti, J. Smith, J. Sherwell, E. Kohner, A. Dornhurst, M. Doddridge, M. Dumskyj, S. Walji, P. Sharp, M. Sleightholm, G. Vanterpool, C. Rose, G. Frost, M. Roseblade, S. Elliott, S. Forrester, M. Foster, K. Myers, R. Chapman, J. Hayes, R. Henry, M. Featherston, G. Archbold, M. Copeland, R. Harper, I. Richardson, S. Martín, H. Davison, D. Hadden, L. Kennedy, A. Atkinson, A. Culbert, C. Hegan, H. Tennet, N. Webb, I. Robinson, J. Holmes, P. Bell, D. McCance, J. Rutherford, S. Nesbitt, A. Spathis, S. Hyer, M. Nanson, L. James, J. Tyrell, C. Davis, P. Strugnell, M. Booth, H. Petrie, D. Clark, B. Rice, S. Hulland, J. Barron, J. Yudkin, B. Gould, J. Singer, A. Badenock, M. Eckert, K. Alibhai, E. Marriot, C. Cox, R. Price, M. Fernandez, A. Ryle, S. Clarke, G. Wallace, E. Mehmed, S. Macfarlane, R. Greenwood, J. Wilson, M. Denholm, R. Temple, K. Whitfield, F. Johnson, C. Munroe, S. Gorick, E. Duckworth, M. Flatman, S. Rainbow, L. Borthwick, D. Wheatcroft, R. Seaman, R. Christie, W. Wheatcroft, P. Musk, J. White, S. McDougal, M. Bond, P. Raniga, R. Newton, R. Jung, C. Roxburgh, B. Kilgallon, L. Dick, N. Waugh, S. Kilby, A. Ellingford, J. Burns, C. Fox, M. Holloway, H. Coghill, N. Hein, A. Fox, W. Cowan, M. Richard, K. Quested, S. Evans, R. Paisey, N. Brown, A. Tucker, R. Paisey, F. Garrett, J. Hogg, P. Park, K. Williams, Philip Harvey, R. Wilcocks, S. Mason, J. Frost, C. Warren, P. Rocket, L. Bower, J. Roland, D. Brown, J. Youens, K. Stanton-King, H. Mungall, W. Maddison, D. Donnelly, S. King, P. Griffin, S. Smith, S. Church, G. Dunn, Apr Wilson, K. Palmer, P. Brown, D. Humphriss, A. Davidson, R. Rose, L. Armistead, S. Townsend, P. Poon, I. Peacock, N. Culverwell, M. Charlton, B. Connolly, J. Peacock, J. Barrett, J. Wain, W. Beeston, G. King, P. Hill, A. Boulton, A. Robertson, Katoulis, A. Olukoga, H. McDonald, S. Kumar, F. Abouaesha, B. Abuaisha, E. Knowles, S. Higgins, J. Booker, J. Sunter, K. Breislin, R. Parker, P. Raval, J. Curwell, H. Davenport, G. Shawcross, A. Prest, J. Grey, H. Cole, C. Sereviratne, R. Young, T. Dornan, J. Clyne, M. Gibson, I. O'Connell, L. Wong, S. Wilson, K. Wright, C. Wallace, D. McDowell, A. Burden, E. Sellén, R. Gregory, M. Roshan, N. Vaghela, M. Burden, C. Sherriff, J. Clarke, J. Grenfell, J. Tooke, K. Macleod, C. Searnark, M. Rammell, C. Pym, J. Stockman, C. Yeo, J. Piper, L. Leighton, E. Green, M. Hoyle, K. Jones, A. Hudson, A. James, A. Shore, A. Higham, B. Martin (1998)

    Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38

    BMJ, 317

  • Diabetes Control and Complications Trial Research Group (DCCT), JAMA. (1996)

    Lifetime benefits and costs of tight control therapy as practiced inthe diabetes control and complications trial.

    , 276

  • J. Hanley, A. Lippman‐Hand (1983)

    If nothing goes wrong, is everything all right? Interpreting zero numerators.

    JAMA, 249 13

Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.122.7.1082-a
Publisher site
See Article on Publisher Site

Abstract

We read with interest "Intravitreal Injection of Triamcinolone for DiffuseDiabetic Macular Edema" by Jonas et al.1 Vascularinflammation has recently been linked to diabetic angiopathy, and therefore,the use of localized steroid could possibly improve the effects of diabeticmaculopathy. However, this study has not convinced us of the benefits of intravitrealtriamcinolone injection. The design of this study did not eliminate observer or patient biasby means of a double-masked method, although angiograms were graded in a maskedfashion. Patients were matched for age, sex, refractive error, and preoperativevisual acuity but were not matched for known predictors of poor prognosissuch as type and length of diabetes, control of blood sugar and blood pressure,smoking, and renal disease.2,3 Visual acuity is measured to gauge success in treatment but diabeticmacular edema can frequently improve with no change in visual acuity and visualacuity can improve with no change in macular edema. The variability in patientresponse for visual acuity measurement is also well known in any practice. In the article, Figure 1 illustrates significant improvement in visualacuity, but it is also apparent that the confidence interval widens as postinterventiontime increases. This trend for a wider confidence interval raises questionsof true treatment success. Fluorescein angiography is a method in which retinal leakage can beobserved,4 and the investigators have chosento use this to assess treatment success. Figure 2 in the article shows late-phaseangiograms prior to and 3 months after treatment, but it is unclear at whatstage of the angiogram these photos were taken. Furthermore, pretreatmentphotographs probably show cystoid macular edema, and we were unsure whetherthis was a pseudophakic eye. As suggested by the authors, future randomized studies will be of interestin confirming the value of intravitreal steroid injection for the treatmentof clinically significant diabetic macular edema. Correspondence: Dr Wong, Flat 3, 26 Philbeach Gardens, Earls Court,London SW5 9DY, England (drrogerwong@aol.com). References 1. Jonas JKreissig ISofker ADegenering R Intravitreal injection of triamcinolone for diffuse diabetic macularedema. Arch Ophthalmol. 2003;12157- 61PubMedGoogle ScholarCrossref 2. UK Prospective Diabetes Study Group, Tight blood pressure control and risk of macrovascular and microvascularcomplications in type 2 diabetes: UKPDS 38. BMJ. 1998;317703- 713PubMedGoogle ScholarCrossref 3. Diabetes Control and Complications Trial Research Group (DCCT), Lifetime benefits and costs of tight control therapy as practiced inthe diabetes control and complications trial. JAMA. 1996;2761409- 1415PubMedGoogle ScholarCrossref 4. Early Treatment Diabetic Retinopathy Study Research Group, Classification of diabetic retinopathy from fluorescein angiograms:ETDRS Report Number 11. Ophthalmology. 1991;98807- 822PubMedGoogle ScholarCrossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Jul 1, 2004

Keywords: diabetes mellitus,triamcinolone

There are no references for this article.