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Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema
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  • Published on:
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    • Maria Vittoria Cicinelli, Ophthalmologist San Raffaele Scientific Institute
    • Other Contributors:
      • Francesco Bandello, Opthalmologist
      • Giuseppe Querques, opththalmologist

    We warmly thank Calugaru D and associates for their correspondence regarding our article entitled " Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema".1
    We agree with them about some of the challenges concerning our study. As we have acknowledged in the limitation section of our article, our study is limited by several biases, as its design was retrospective. In particular, patients selection and follow-up represented some of the major flaws in our study. We collected data about patients switched to dexamethasone for different reasons; some patients were treatment-naïve, other had already undergone treatments for diabetic macular edema (DME). No one disclosed any feature of chronic long-standing DME; all of them received prompt therapy after DME diagnosis.
    Some of them showed a good response to ranibizumab loading-dose, with satisfying reduction of macular thickness after the injections. Nevertheless, no patient disclosed a completely dry macula after the anti-vascular endothelial growth factor (VEGF) loading-dose.
    As far as it regards the final functional and anatomical gain at the end of the follow-up, the Authors state that the outcomes of this series were unsatisfactory. However, in the non-responders group, despite initial poor results, the best-corrected visual acuity (BCVA) had improved significantly (p<0.05) and clinically (> 5 letters), as highlighted in the...

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    Conflict of Interest:
    None declared.
  • Published on:
    Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema
    • Dan CAlugaru, Ophthalologist Univ of Medicine Cluj-Napoca/Romania
    • Other Contributors:
      • Mihai CAlugaru, Professor of Ophthalmology

    Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema
    Dan Calugaru, Mihai Calugaru
    Department of Ophthalmology, Univ of Medicine Cluj-Napoca/Romania

    Re: Early response to ranibizumab predictive of functional outcome after dexamethasone for unresponsive diabetic macular oedema. Cicinelli et al. Br J Ophthalmol 2017; http: /dx.doi. org/ 10.1136/bjophthalmol-2017-310242.

    Dear Editor
    We would like to address several challenges that have arisen from the study by Cicinelli et al (1), which can be specifically summarized below.
    1. The study was retrospectively conducted, with a selection bias attributable to the heterogeneity of the patients included, for example, six patients were affected by the type 1 diabetes mellitus; eighteen eyes were phakic; twenty seven eyes underwent cataract extraction and intraocular lens implant; and thirteen eyes received grid macular photocoagulation for diabetic macular oedema (DME) prior to ranibizumab (RNB).
    2. After undergoing three loading-dose intravitreal injections of RNB performed at fixed 4-week intervals for the first 12 weeks, all the patients regardless of functional and anatomical characteristics, were shifted to dexamethasone implant (DEX implant 0.7 mg; Ozurdex; Allergan, Irvine, California, USA) continued at 4-month intervals until stable best-corrected visual acuity (BCVA) was reached. However, nothing was...

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    Conflict of Interest:
    None declared.