We appreciate the interest and comments of Aktas and associates concerning our article. They reviewed our study and reported their concerns about the absence of further examination of participants such as retinal fiber layer thickness (RNFL) measurements and visual field (VF) tests for detection of glaucoma. We agree that the study has some limitations in this respect. Although clinical examination of the optic nerve head and retinal nerve fiber layer is essential for the detection of glaucoma, currently available devices such as optical coherence tomography (OCT) and scanning laser polarimetry (SLP) would facilitate the diagnosis and monitoring of glaucomatous optic neuropathy. Several previous studies reported that diabetic patients without glaucoma have a thinner RNFL than nondiabetic healthy subjects, based on measurements with clinically available devices. Although effects of diabetes on RNFL have been reported, no significant difference was found in the cup-to-disc ratio between diabetic and normal eyes. Also, studies performed with OCT and SLP have documented that peripapillary RNFL thinning is increased with disease severity. RNFL loss in eyes of patients with diabetes mellitus is a common finding, but is not associated with an enlarged cup, and thus can be differentiated from glaucoma-related RNFL defects, which accompany glaucomatous excavation of the disc. In our study RNFL thickness was not used because of the effect of diabetes on RNFL thickness at baseline, to avoid a bias. We did compare the RNFL thickness between the baseline and postinjection period only in patients with increased intraocular pressure following intravitreal triamcinolone injection. Visual field testing is one of the primary methods used for detection of glaucomatous functional abnormalities. Reliability of visual field testing is essential for accurate diagnosis and follow-up of glaucoma. In our study, many patients with diabetic macular edema and low visual acuity had unreliable test results because of excessive fixation losses and false-positive errors in conventional (white-on-white) visual field test. Hence, VF tests were not considered at the baseline. After reduction of macular edema following intravitreal triamcinolone injection, however, we assessed VF test results only for patients who had had increased intraocular pressure following intravitreal triamcinolone injection and who had reliable test results. To avoid a bias, we did not compare RNFL thickness and VF test results between groups at baseline.

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Jan 12, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reply

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