Sir,

We read with interest the recent paper by Chhablani et al1 reporting the outcome of recalcitrant and naive eyes with diabetic macular edema (DME) treated with intravitreal dexamethasone implant (Ozurdex) injection. Although the study is indeed interesting, there are certain points we wish to highlight. First, as systemic hypertension is a risk factor for the development of both diabetic retinopathy and DME, and hyperlipidemia increases the risk of leakage and exudative deposits in the macula,2 blood pressure and lipid profile should have been recorded at baseline and at subsequent visits to assess whether improvement in macular edema was as a result of strict systemic control or as a result of the implant itself. Second, according to the authors, 7 eyes had proliferative diabetic retinopathy (PDR), and 26 had lasered PDR. These 26 eyes had undergone panretinal photocoagulation, minimum of 4 months before the first Ozurdex implant was administered. What about the remaining seven eyes that had PDR? Were they lasered during the follow-up period after implant insertion? If panretinal photocoagulation was performed during the follow-up, it could acutely worsen the DME and affect the visual outcomes.3 Third, authors need to rectify the discrepancy in the values; in the manuscript, it is mentioned that ‘mean treatment-free interval among naive eyes and previously treated eyes was 10.53±7.8 and 6.5±4.5 months, respectively’, whereas in Table 1, the mean treatment-free interval in previously treated eyes has been written as 6.17±3.3 months.