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Macular Edema and Thiazolidinediones—Reply

Walter T. Ambrosius, PhD; Ronald P. Danis, MD; Matthew C. Riddle, MD; David C. Goff Jr, MD, PhD; Hertzel C. Gerstein, MD; Craig M. Greven, MD; Emily Y. Chew, MD
Arch Ophthalmol. 2010;128(12):1631-1632. doi:10.1001/archophthalmol.2010.288.
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In reply

We appreciate the interest in our article1 expressed by Colucciello and Ryan. They take issue with our report of no association between recent thiazolidinedione exposure and macular edema in our baseline evaluation of the ACCORD Eye Substudy population, suggesting that our findings are inconclusive owing to exclusion of high-risk persons. They cite a single-patient case report,2 a report of 30 patients referred to a group specializing in retinal disease,3 and a database review of patients identified by new diagnosis of macular edema4 as evidence for greater risk related to use of a thiazolidinedione. In response we would make several points. First, while individuals known to have prior photocoagulation, high serum creatinine levels, or congestive heart failure were not enrolled in ACCORD, ours was not a low-risk population. The mean duration of diabetes was 10 years, 32% had known cardiovascular disease, 72% had microalbuminuria, 4% had macroalbuminuria, 21% had pretibial edema, 50% had retinopathy, and 6% had macular edema on the baseline examination.


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