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Diabetic Macular Edema Following Panretinal Photocoagulation

Khalil Ghasemi Falavarjani, MD; Mehdi Modarres, MD; Hossein Nazari, MD; Masood Naseripour, MD; Mohammad Mehdi Parvaresh, MD
[+] Author Affiliations

Author Affiliations: Iran University of Medical Science, Tehran, Iran.


Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Ophthalmol. 2010;128(2):262-262. doi:10.1001/archophthalmol.2009.392
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Published online

We read with great interest the study by Brucker et al1 describing the effects of single-sitting vs 4-sitting panretinal photocoagulation on macular edema in subjects with severe nonproliferative or early proliferative diabetic retinopathy. The results appear appealing; however, the following aspects need clarification.

Some patients without optical coherence tomographic (OCT) measurements were described by Brucker et al1 to have completed the scheduled follow-up. For example, the study flowchart shows that 74 patients in the 1-sitting group and 58 in the 4-sitting group completed the week 34 visit; however, 72 and 55 patients had OCT measurement in each group, respectively. Wouldn't the study flowchart be more informative if it described the number of persons who completed the primary outcome measurement (ie, OCT central subfield thickness) rather than completed visits?

The first major eligibility criterion was reported to be early proliferative diabetic retinopathy or severe nonproliferative diabetic retinopathy. However, based on the first table, 14 patients with mild to moderate nonproliferative diabetic retinopathy were included in the study. It seems that the classification of diabetic retinopathy in the first table was reported according to the review of the reading center; however, the value of the reading center opinion was not clearly reported. Why were fundus photographs sent to the reading center if they were not used to confirm inclusion criteria or measure the effectiveness of clinical outcome?

Brucker et al1 sent 567 OCT follow-up scans to the reading center “Methods”. However, 555 OCT measurements were reported in the “Results” (Table 2), so what happened for the remaining 12 scans?

Were uncontrolled hypertension and the glitazone group of antidiabetic drugs considered in the analysis, since both are known to be independently associated with diabetic macular edema?2 4

AUTHOR INFORMATION

Correspondence: Dr Falavarjani, Eye Research Center, Rassoul Akram Hospital, Sattarkhan-Niayesh St, Tehran 14455-364, Iran (drghasemi@yahoo.com).

Financial Disclosure: None reported.

REFERENCES

Brucker  AJ, Qin  H, Antoszyk  AN.  et al. Diabetic Retinopathy Clinical Research Network,  Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol 2009;127 (2) 132- 140
PubMed
Matthews  DR, Stratton  IM, Aldington  SJ, Holman  RR, Kohner  EM.UK Prospective Diabetes Study Group,  Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol 2004;122 (11) 1631- 1640
PubMed
Fong  DS, Contreras  R. Glitazone use associated with diabetic macular edema [published online ahead of print February 1, 2009]. Am J Ophthalmol 2009;147 (4) 583- 586.e1
PubMed
Liazos  E, Broadbent  DM, Beare  N, Kumar  N. Spontaneous resolution of diabetic macular oedema after discontinuation of thiazolidenediones. Diabet Med 2008;25 (7) 860- 862
PubMed

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Brucker  AJ, Qin  H, Antoszyk  AN.  et al. Diabetic Retinopathy Clinical Research Network,  Observational study of the development of diabetic macular edema following panretinal (scatter) photocoagulation given in 1 or 4 sittings. Arch Ophthalmol 2009;127 (2) 132- 140
PubMed
Matthews  DR, Stratton  IM, Aldington  SJ, Holman  RR, Kohner  EM.UK Prospective Diabetes Study Group,  Risks of progression of retinopathy and vision loss related to tight blood pressure control in type 2 diabetes mellitus: UKPDS 69. Arch Ophthalmol 2004;122 (11) 1631- 1640
PubMed
Fong  DS, Contreras  R. Glitazone use associated with diabetic macular edema [published online ahead of print February 1, 2009]. Am J Ophthalmol 2009;147 (4) 583- 586.e1
PubMed
Liazos  E, Broadbent  DM, Beare  N, Kumar  N. Spontaneous resolution of diabetic macular oedema after discontinuation of thiazolidenediones. Diabet Med 2008;25 (7) 860- 862
PubMed

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