You are here

Responses

Article menu
Download PDFPDF
Clinical science
The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema
Compose a Response to This Article
Compose Response

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Statement of Competing Interests

PLEASE NOTE:

  • A rapid response is a moderated but not peer reviewed online response to a published article in a BMJ journal; it will not receive a DOI and will not be indexed unless it is also republished as a Letter, Correspondence or as other content. Find out more about rapid responses.
  • We intend to post all responses which are approved by the Editor, within 14 days (BMJ Journals) or 24 hours (The BMJ), however timeframes cannot be guaranteed. Responses must comply with our requirements and should contribute substantially to the topic, but it is at our absolute discretion whether we publish a response, and we reserve the right to edit or remove responses before and after publication and also republish some or all in other BMJ publications, including third party local editions in other countries and languages
  • Our requirements are stated in our rapid response terms and conditions and must be read. These include ensuring that: i) you do not include any illustrative content including tables and graphs, ii) you do not include any information that includes specifics about any patients,iii) you do not include any original data, unless it has already been published in a peer reviewed journal and you have included a reference, iv) your response is lawful, not defamatory, original and accurate, v) you declare any competing interests, vi) you understand that your name and other personal details set out in our rapid response terms and conditions will be published with any responses we publish and vii) you understand that once a response is published, we may continue to publish your response and/or edit or remove it in the future.
  • By submitting this rapid response you are agreeing to our terms and conditions for rapid responses and understand that your personal data will be processed in accordance with those terms and our privacy notice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Other responses

Jump to comment:

  • Published on: 20 May 2021
    Reply to: The Effect of Posterior Vitreous Detachment on Aflibercept Response in Diabetic Macular Oedema
    • Cemal OZSAYGILI, Retina Specialist Kayseri City Training and Research Hospital Ophthalmology Department
    • Other Contributors:
      • Bekir KUCUK, Retina Specialist
      • Yener YILDIRIM, Ophthalmologist

    Reply

    To the Editor:
    We appreciate the comments by Wei Gui and J. Sebag about Ozsaygili Cemal’s article titled ‘The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema.’1 In our study, we used the video display mode to obtain more reliable results while evaluating the posterior vitreous detachment (PVD) status with spectral-domain optical coherence tomography (SD-OCT). In a recent clinical study comparing the PVD status with ocular ultrasonography (US) and SD-OCT in patients with diabetic macular oedema (DMO), it was reported that video display mode SD-OCT showed total agreement (100% in video display mode) with US.2 We used the video display mode in all patients instead of a single cross-sectional view and excluded patients with poor image quality. Since it was a retrospective study, we could not have the chance to perform US, but excluding these patients from the study in patients where any of the 2 independent retina specialists (CO, BK) disagreed on the PVD status draws attention as factors that increase the validity of our data. In addition, the International Vitreomacular Traction Study Group, including doctor J. Sebag, has classified the posterior vitreous-macular relationship based on OCT and has mostly replaced USG with OCT in our current clinical practice.3
    All eyes in our study were examined for vitreoschisis and similar anomalous PVD using SD-OCT video display mode. As you mentioned, SD-OCT has the abili...

    Show More
    Conflict of Interest:
    None declared.
  • Published on: 20 May 2021
    Re: Özsaygili et al.: The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema
    • Wei Gui, Vitreoretinal Surgeon VMR Insitute for Vitreous Macula Retina
    • Other Contributors:
      • J. Sebag, Vitreoretinal Surgeon

    We read with interest the study by Özsaygili et al. in which the authors report that the presence or absence of posterior vitreous detachment (PVD) purportedly had no influence on the efficacy of aflibercept intravitreal injections in patients with diabetic macular oedema (DMO). We question the validity of this conclusion since it is known that eyes with attached vitreous require more injections to manage exudative age-related macular degeneration than eyes with PVD.1 This is presumed to be due to interference with macular access by anti-vascular endothelial growth factor (anti-VEGF) by the posterior vitreous cortex. The same mechanism of action could be expected in eyes with DMO. Thus, there may be alternative explanations for the observed lack of an effect of PVD status on the response to aflibercept. We hypothesize that the findings are due to both the unreliable diagnosis of PVD by spectral domain optical coherence tomography (SD-OCT) alone, and the possible presence of vitreoschisis.

    Previous studies have shown that SD-OCT is not a robust way to diagnose PVD, since the positive predictive value is only approximately 50%.2, 3 Rather, ultrasound is the recommended way to detect complete PVD (Figure 1).2 Did Özsaygili et al. perform ultrasound in their patients? If not, they would be unable to determine true PVD status, and the validity of their conclusion needs to be called into question.

    Additionally, it is unclear from the study by Özsaygili et al. wheth...

    Show More
    Conflict of Interest:
    None declared.