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October 2006

Intravitreal Triamcinolone in Diabetic Macular Edema—Reply

Arch Ophthalmol. 2006;124(10):1507. doi:10.1001/archopht.124.10.1507-a

In reply

We would like to thank Mr Aslam and colleagues for their interest in our study.1 We agree that the follow-up was not complete, as at 9 months after the injection, data were available for only 8 patients. This incomplete follow-up is, without doubt, a limitation of the study. However, because the increase in visual acuity after an intravitreal injection of triamcinolone acetonide usually takes place within 4 weeks after the intervention and because the main purpose of the study was to assess factors associated with the increase in visual acuity, the loss of patients mainly at the end of follow-up might not have markedly influenced the conclusions drawn. We also agree with Mr Aslam and colleagues that the grading system of macula edema, such as the use of standard nonstereoscopic photographs, a single examiner, and the combination of the categories 0 to 2, 3 to 4, and 5 to 6 for statistical analysis, had its limitations. However, because there is no universally accepted grading system for macular edema, we chose the system described in the study. Examination by an experienced single examiner may be better than examination by 2 moderately trained examiners, even if the examination by 2 examiners allows for the calculation of an interobserver variation. Although Figure 2 contains only 32 squares, it represents the data of all of the 53 eyes included in the study. The reason for the lower number of squares in Figure 2 than eyes included in the study is that some squares represent the data of 2 or more eyes. As explained in the legend of Figure 2, the scattergram shows the correlation between the preinjection visual acuity and the best postoperative visual acuity during follow-up. It does not refer to a specific date during follow-up. The ordinate unit in Figure 1 is visual acuity for which the visual acuity measurements obtained on Snellen charts were converted to Snellen lines. A peak in the figure therefore indicates an improvement in visual acuity. The mean maximal visual acuity during follow-up was the highest visual acuity measurement obtained at any point during the entire follow-up. It may have been at the first month after the injection for one eye and at the second month after the injection for the other eye. The mean visual acuity measurements at specific dates after the injection are given in Figure 1.

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