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The effect of posterior vitreous detachment on aflibercept response in diabetic macular oedema
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  • Published on:
    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...

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    Conflict of Interest:
    None declared.
  • Published on:
    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...

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    Conflict of Interest:
    None declared.