Reply to ‘Comments on Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants’

Abstract

Sir, Comments on 'Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants'We read with interest the article titled 'Long-term outcomes of phakic patients with diabetic macular oedema treated with intravitreal fluocinolone acetonide (FAc) implants' by Yang et al. 1 They present a post hoc analysis of the FAME study 2 and compare visual outcomes in patients undergoing cataract surgery after low-dose FAc implant with those who were pseudophakic at baseline. They conclude the former group to have possibly better long-term results.In the cataract surgery after implant (CAI) group, the favorable change in visual acuity may have been partly contributed by removal of lenticular aberrations 3 expected in diabetes patients having early lens opacities or even lenticular swelling. Hence, crediting FAc for better visual results in the CAI group may be erroneous. Single intravitreal steroid injections have been reported to cause subcapsular cataract and multiple injections may affect all the lens layers. 4 Given the continuous low intraocular concentration of steroid with FAc implant, it would be interesting to evaluate the type of cataract seen in the CAI group.The other adverse effect of FAc noted in the FAME study was ocular hypertension, with nearly 4% of subjects injected with low-dose FAc needing incision glaucoma surgery. 2 As lens extraction is known to decrease intraocular pressure, 5 we suggest analyzing change in intraocular pressure in patients in the CAI group after cataract surgery. It is possible that ocular hypertension may have resolved altogether in some patients, especially in the presence of anterior synechiae.As the diabetic macular edema and its treatment are of utmost importance, we wish the authors would share their opinion on these issues. Conflict of interestThe authors declare no conflict of interest.