Abstract
We read the article by dr avitable and associates 1 Avitabile T. Longo A. Reibaldi A. Intravitreal triamcinolone compared with macular laser grid photocoagulation for the treatment of cystoid macular edema. Am J Ophthalmol. 2005; 140: 695-702 Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar with interest. However, we are left with few unanswered questions after reading the article. They mentioned that focal or grid laser treatment of the macular areas showing leakage, usually performed for treatment of cystoid macular edema (CME) in diabetic retinopathy, often fails to lead to improvement of visual acuity according to Early Treatment Diabetic Retinopathy Study (ETDRS). 2 Early Treatment Diabetic Retinopathy Study Research GroupTreatment techniques and clinical guidelines for photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Research Group Report No. 2. Ophthalmology. 1987; 94: 761-774 Crossref PubMed Scopus (632) Google Scholar However, ETDRS only addressed clinically significant macular edema (CSME) and not CME in particular. The patients in macular laser grid (MLG) group received laser according to ETDRS criteria, 3 Photocoagulation of diabetic macular edema. Early Treatment Diabetic Retinopathy Study Research Group Report No. 1. Arch Ophthalmol. 1985; 103: 1796-1806 Crossref PubMed Scopus (2490) Google Scholar with an exposure time of 0.2 to 0.5 seconds. According to the ETDRS guidelines, the exposure time was 0.1 second. The Central Vein Occlusion Study (CRVO) study concluded that laser treatment did not improve vision in eyes with macular edema. 4 Central Vein Occlusion Study Group M.Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. Ophthalmology. 1995; 102: 1425-1433 PubMed Google Scholar Therefore we feel it was inappropriate to compare this group of patients, when we know that laser is not the standard of care in eyes with CRVO and macular edema. Most of the references cited are about diabetic macular edema unresponsive to laser treatment and not about CME in particular. ReplyAmerican Journal of OphthalmologyVol. 142Issue 3PreviewIn the early treatment diabetic retinopathy study (ETDRS), the laser grid photocoagulation was used for the treatment of diffuse macular edema.1 Other studies reported, after macular laser grid, a visual acuity (VA) improvement of two or three lines in 12% to 17% of eyes.2–4 Full-Text PDF
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