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  1. A Lux,
  2. H Llacer,
  3. F M A Heussen,
  4. A M Joussen
  1. Department of Ophthalmology, University of Düsseldorf, Düsseldorf, Germany
  1. Dr A Lux, Department of Ophthalmology, University of Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany; anja.lux{at}

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We thank the authors Nigam et al for their helpful response to our article. They have added an interesting new aspect to the discussion, confirmed our findings in some respects and suggested an interesting subgroup analysis.

They found a significantly better visual acuity outcome in patients primarily treated with bevacizumab (Avastin) compared with patients who had previously been treated with photodynamic therapy (PDT) or pegaptanib (Macugen),1 suggesting that prior treatment had caused scarring that was responsible for a lack in later improvement of visual acuity by bevacizumab (Avastin). This conclusion is reasonable given that the natural disease progression itself may progress to scarring and that slow-growing membranes or older lesions have higher amounts …

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  • Competing interests: None.

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