DOI: 10.1097/IAE.0000000000000790
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PMID: 26441268
Issn Print: 0275-004X
Publication Date: 2015/11/01
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Excerpt
We read with great interest the article by Liu et al1 entitled “Comparison of intravitreal triamcinolone acetonide versus intravitreal bevacizumab as the primary treatment of clinically significant macular edema”. Retina 2015;35:272–279. The authors have compared the treatment outcomes of intravitreal triamcinolone versus intravitreal bevacizumab in patients with diabetic clinically significant macular edema. We have multiple issues which we would like to discuss with the authors.
First, we would like to know as to how was the sample size calculated. Another issue pertaining to the sample size calculation is whether the sample size was calculated for both the primary outcome variables separately.
Second, the authors have mentioned the use of intravitreal bevacizumab in 2 doses, 6 weeks apart. We would like to know as to how was it decided as to which patients should receive a second injection of intravitreal bevacizumab. What clinical criteria were taken into consideration before deciding on injecting the second dose of intravitreal bevacizumab?
Third, according to the DRCR.net,2 long-term benefits have been noted with focal/grid laser photocoagulation in comparison to intravitreal triamcinolone for diabetic macular edema. Focal laser photocoagulation is still considered as an important option for the treatment of diabetic macular edema. So we would like to know if the authors believe that laser photocoagulation has no role whatsoever in the treatment of clinically significant macular edema or why one should prefer an intravitreal agent as compared to focal laser for macular edema too.
Finally, in this study, fundus fluorescein angiography was not performed in all patients. Fundus fluorescein angiography is an important investigation tool for checking the macular perfusion status and thereby prognosticating the final visual recovery. It would be appropriate to get fundus fluorescein angiography performed in all patients and then exclude cases with macular non-perfusion from the study.
In the light of the above, we believe that a larger, statistically calculated sample size should have been taken and that all patients should have undergone fundus fluorescein angiography to classify them into center-involving and noncenter-involving groups and to check the macular perfusion status, and probably the noncenter group could have been excluded. Finally, the criteria for giving a second dose of intravitreal bevacizumab should have been mentioned.
