We thank Uzun and Pehlivan for their interest in our article1 and
their comments. They raise various factors that are potential confounders
of subfoveal choroidal thickness measurements. As our study was a
retrospective review of paired samples of enhanced depth imaging optical
coherence tomography (EDI-OCT) and indocyanine green angiography (ICGA) in
the right eye of patients with chronic Vogt-Koya...
We thank Uzun and Pehlivan for their interest in our article1 and
their comments. They raise various factors that are potential confounders
of subfoveal choroidal thickness measurements. As our study was a
retrospective review of paired samples of enhanced depth imaging optical
coherence tomography (EDI-OCT) and indocyanine green angiography (ICGA) in
the right eye of patients with chronic Vogt-Koyanagi-Harada disease (VKH),
we were unable to control for these factors. We recognize the limitations
of a retrospective study and thus we advocated longitudinal studies to
derive a more precise correlation between EDI-OCT and ICGA grade and hence
its utility in monitoring chronic VKH.
Soon-Phaik Chee and Aliza Jap
References
1 Jap A. Chee S-P. The role of enhanced depth imaging optical coherence
tomography in chronic Vogt-Koyanagi-Harada disease. Br J Ophthalmol
2016;0:1-4
We would like to thank Dr. Uzun and Dr. Pehlivan for showing interest
in our study.[1] It is well-known that various factors may influence
choroidal thickness. In our study,[1] there was no significant difference
in the age, sex, spherical equivalents, and incidence of diabetes mellitus
and hypertension between the ranibizumab and aflibercept groups. As
mentioned, the limitation of our retrospective...
We would like to thank Dr. Uzun and Dr. Pehlivan for showing interest
in our study.[1] It is well-known that various factors may influence
choroidal thickness. In our study,[1] there was no significant difference
in the age, sex, spherical equivalents, and incidence of diabetes mellitus
and hypertension between the ranibizumab and aflibercept groups. As
mentioned, the limitation of our retrospective study was that all
potential influencing factors could not be perfectly controlled.
Therefore, we agree with the opinion of Dr. Uzun and Dr. Pehlivan that
these uncontrolled factors could influence the data obtained from our
study. Dr. Uzun and Dr. Pehlivan particularly focused on the intraocular
pressure (IOP) and diurnal variation on choroidal thickness.
Unfortunately, the exact time of optical coherence tomography (OCT)
scanning is normally not recorded in our institution. Thus, it is not
possible to show whether the diurnal variation influenced our study
result. In our institution, IOP is routinely measured during every visit
using a pneumo-tonometer.
To evaluate whether IOP significantly influences the study result, we
reviewed the IOP values before and after the treatment. Since the primary
outcome of our study was to compare the difference in changes in choroidal
thickness between eyes treated with ranibizumab and aflibercept, the IOP
values were compared between the ranibizumab and aflibercept group. In all
the included eyes, the IOP at diagnosis and one month after the third
intravitreal anti-vascular endothelial growth factor (VEGF) injection was
13.6 +/- 3.2 and 13.6 +/- 3.0, respectively. In typical neovascular AMD,
the IOP at diagnosis and that after treatment in the ranibizumab group was
13.7 +/- 3.4 and 12.8 +/ - 2.8, respectively. The values in the
aflibercept group were 14.0 +/- 3.0 and 13.9 +/- 3.1, respectively. There
was no significant difference in the IOP at diagnosis (P = 0.571) and
after treatment (P = 0.406) between the two groups. In polypoidal
choroidal vasculopathy, the IOP at diagnosis and after treatment in the
ranibizumab group was 13.8 +/- 3.3 and 14.1 +/- 3.1, respectively, while
the values in the aflibercept group were 13.2 +/- 3.3 and 13.2 +/- 2.9,
respectively. There was no significant difference in the IOP at diagnosis
(P = 0.297) and after treatment (P = 0.374) between the two groups. In
retinal angiomatous proliferation, the IOP values at diagnosis and after
treatment in the ranibizumab group were 13.5 +/- 2.5 and 14.5 +/- 3.1,
respectively, while those in the aflibercept group were 13.5 +/- 3.8 and
13.1 +/- 3.1, respectively. There was no significant difference in the IOP
at diagnosis (P = 0.983) and after treatment (P = 0.194) between the two
groups. Although the matter is controversial,[2,3] several studies have
shown that there is an association between IOP and subfoveal choroidal
thickness.[4,5] The result of the additional analysis on IOP shows that
IOP may not significantly influence the result of our study. We hope
further studies with a more controlled design may better elucidate the
difference in the changes in choroidal thickness after injection of
different anti-VEGF agents.
REFERENCES
1.Kim JH, Lee TG, Chang YS, et al. Short-term choroidal thickness
changes in patients treated with either ranibizumab or aflibercept: a
comparative study. Br J Ophthalmol 2016. doi: 10.1136/bjophthalmol-2015-
308074. [Epub ahead of print] 2.Pekel G, Acer S, Yagci R, et al.
Relationship Between Subfoveal Choroidal Thickness, Ocular Pulse
Amplitude, and Intraocular Pressure in Healthy Subjects. J Glaucoma 2016.
doi: 10.1097/IJG.0000000000000401. [Epub ahead of print] 3.Wei WB, Xu L,
Jonas JB, et al. Subfoveal choroidal thickness: the Beijing Eye Study.
Ophthalmology 2013;120:175-80. 4.Wang YX, Jiang R, Ren XL, et al.
Intraocular pressure elevation and choroidal thinning. Br J Ophthalmol
2016. doi: 10.1136/bjophthalmol-2015-308062. [Epub ahead of print]
5.Saeedi O, Pillar A, Jefferys J, et al. Change in choroidal thickness and
axial length with change in intraocular pressure after trabeculectomy. Br
J Ophthalmol 2014;98:976-9.
eLetter
Comment on: Population-based assessment of vision-related quality of life
in corneal disease: results from the CORE study
Parul Chawla Gupta, MS; Jagat Ram, MS, FAMS
Department of Ophthalmology
Post Graduate Institute of Medical Education and Research, Chandigarh,
India, 160012
Corresponding author
Dr. Jagat Ram, MS, FAMS
Professor and Head
Department of Ophthalmology
Post Graduate Institute of Medical Education an...
eLetter
Comment on: Population-based assessment of vision-related quality of life
in corneal disease: results from the CORE study
Parul Chawla Gupta, MS; Jagat Ram, MS, FAMS
Department of Ophthalmology
Post Graduate Institute of Medical Education and Research, Chandigarh,
India, 160012
Corresponding author
Dr. Jagat Ram, MS, FAMS
Professor and Head
Department of Ophthalmology
Post Graduate Institute of Medical Education and Research, Chandigarh,
India, 160012
Email id: drjagatram@gmail.com
Conflict of interest and source of funding- None declared
Dear Editor,
We read with interest the recent paper by Vashist and associates [1]
assessing the impact of corneal disease on vision-related quality of life
(VR-QoL) in a rural North Indian population. We herein address important
issues, some of which warrant further discussion. Firstly, as the authors
stated "The Vision Related Quality of Life (VR-QoL) was assessed in 435
cases with corneal disease and 435 controls without any ophthalmic
disease". However, in Table 1, under the subheading of 'marital status';
the total number of controls add upto 436. Secondly, in the present study,
there was no statistically significant difference in VR-QoL scores between
unilateral and bilateral corneal conditions. We strongly believe that
patients with bilateral corneal involvement may have significantly more
effect on the quality of life as compared to the unilateral [2] cases.
Activities of daily living, as well as the ability to drive vehicles would
be affected more in bilateral cases. Thirdly, no mention has been made of
the variance of quality of life with the grade of corneal opacity. Lastly,
an interesting observation in the present study was that in the cases with
corneal disease, married patients had better scores on the IND-VFQ-33
questionnaire as compared to unmarried or widows/widowers in contrast to
the study by Onakoya et al [3] carried out in glaucoma patients, in whom
marital status had no significant effect on QoL scores.
No competing interests
References
1. Vashist P, Gupta N, Tandon R. Population-based assessment of vision-
related quality of life in corneal disease: results from the CORE study.
Br J Ophthalmol 2016;100:588-593.
2. Vu HTV, Keeffe JE, McCarty CA, Taylor HR. Impact of unilateral and
bilateral vision loss on quality of life. Br J Ophthalmol 2005;89:360-363
3. Onakoya AO, Mbadugha CA, Aribaba OT, Ibidapo OO. Quality of life of
primary open angle glaucoma patients in lagos, Nigeria: clinical and
sociodemographic correlates. J Glaucoma. 2012;21(5):287-95.
Dear Editor,
We have read and reviewed the article entitled "The role of enhanced depth
imaging optical coherence tomography in chronic Vogt-Koyanagi-Harada
disease''which was written by Jap and Chee with great interest [1]. The
authors evaluated 52 patients with chronic Vogt-Koyanagi-Harada (VKH)
disease using indocyanine green angiograms (ICGAs) and optical coherence
tomography (OCT). They discovered that the subfoveal...
Dear Editor,
We have read and reviewed the article entitled "The role of enhanced depth
imaging optical coherence tomography in chronic Vogt-Koyanagi-Harada
disease''which was written by Jap and Chee with great interest [1]. The
authors evaluated 52 patients with chronic Vogt-Koyanagi-Harada (VKH)
disease using indocyanine green angiograms (ICGAs) and optical coherence
tomography (OCT). They discovered that the subfoveal choroidal thickness
(SFCT) was thinner when ICGA was calm and thicker when the ICGA was
active. Jap and Chee suggested that the positive correlation of SFCT
measurements with ICGA score supporting that it might be used to monitor
disease activity in chronic VKH in addition to ICGA, possibly reducing the
number of ICGAs required. We would like to congratulate the authors for
the valuable studies of them and ask them to give more details and
contribute to the article.
Firstly, choroidal thickness (CT) gets affected from various local
and systemic factors. For example, many local diseases (glaucoma, age-
related macular degeneration, strabismus, etc.), and systemic diseases
(diabetes mellitus, hypertension, hyperlipidemia, vasculapathies, etc.)
and physiological conditions (such as menstrual cycle and pregnancy) may
have an effect on CT. Average age of 52 patients have been mentioned to be
51.7?14.1 years and 26 of them have been mentioned to be females. We would
like to ask the authors if they have taken local/systemic diseases and
their drug used for their treatment and physiological conditions of the
patients into consideration.
Secondly, it is known that many factors in relation with eyes such as
axial length of eye, intraocular pressure, and refractive error certainly
affect CT [2,3]. We think that these parameters must be stated in the
article.
Thirdly, we also would like to learn body mass indexes, systemic
blood pressure measurements, fasting and postprandial, sleeping and
exercising conditions of the patients, and their consumption of
caffeinated/non-caffeinated beverages before OCT measurements, since all
these parameters are known to be apparently affecting CT [2,3].
Fourthly, CT demonstrates considerable diurnal alteration. The
thickness of choroid is able to increase by 50% in an hour, and increase
its thickness by four times in few days [2]. It has been demonstrated by
Kee et al. that the choroid can get thinner very fast, by about 100
micrometer in 3-4 hours in chicks [4]. CT in 12 healthy humans was
measured in another prospective study by Tan et al. with intervals of two
hours between 9:00 AM-5:00 PM on two different days, and significant
differences in CT were determined within all measurement points [5]. It
has been found by Tan et al. that mean diurnal amplitude of CT was
33.7?21.5 micrometer (range: 3-67 micrometer). The alteration in CT was
also correlated with alterations in systemic blood pressure.
In consideration of those literature data, we are of the opinion that
all local and systemic factors must be considered in the studies in which
CT is evaluated.
Competing interests: None
References
1 Jap A. Chee S-P. The role of enhanced depth imaging optical
coherence tomography in chronic Vogt-Koyanagi-Harada disease. Br J
Ophthalmol 2016;0:1-4.
2 Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res
2010;29:144-68.
3 Tan KA, Gupta P, Agarwal A, Chhablani J, Cheng CY, Keane PA, et al.
State of science: Choroidal thickness and systemic health. Surv Ophthalmol
2016; doi: 10.1016/j.survophthal.2016.02.007.
4 Kee CS, Marzani D, Wallman J. Differences in time course and visual
requirements of ocular responses to lenses and diffusers. Invest
Ophthalmol Vis Sci 2001;42:575-83.
5 Tan CS, Ouyang Y, Ruiz H, Sadda SR. Diurnal variation of choroidal
thickness in normal, healthy subjects measured by spectral domain optical
coherence tomography. Invest Ophthalmol Vis Sci 2012;53:261-6.
Response to E-letter.
Thank very much for reading our article. It is true that oral insulin
analogues can lead to increased growth hormone, increasing its effect over
diabetic retinopathy, but previously it should exist a blood-retina
barrier (BRB), despite in patients with preexisting diabetic retinopathy
the BRB rupture exist in some amount. It is possible that oral insulin
analogues can affect the diabetic retinopathy...
Response to E-letter.
Thank very much for reading our article. It is true that oral insulin
analogues can lead to increased growth hormone, increasing its effect over
diabetic retinopathy, but previously it should exist a blood-retina
barrier (BRB), despite in patients with preexisting diabetic retinopathy
the BRB rupture exist in some amount. It is possible that oral insulin
analogues can affect the diabetic retinopathy level, but in patients
without diabetic retinopathy the BRB should be intact. In the present
study we demonstrate two findings, the first is the number of patients
with any-DR who increased selectively in two age groups: in patients with
age between 41-50 and patients with age between 51-60; and the second
finding is that patients with advanced-DR, showed an increase in the 31-
40, 41-50, 51-60 and 61-70 age groups. In all groups the HbA1c increased
progressively since 2008 to 2014. Can the insulin analogues do any
effects? It is difficult to give an answer. Attending our knowledge is a
possibility, but I say you a question. What is the more important effect
over the diabetic retinopathy the bad glycemic levels or the treatment by
insulin or analogues, due this bad control? In fact, is very difficult to
answer this question, in our initial studies long time ago ( ), the
insulin is an independent factor in diabetic retinopathy development, but
when we apply multivariate analysis using logistic regression the insulin
is a confounding risk factor overlapped to glycemic levels. Respect our
conclusion about a poor control of glycemic levels in the previously cited
age groups is a reality in our Country, it seems it exists a relaxation in
diabetes control exercised by patients, and all staff involved in the
treatment of diabetes should strive to re-educate patients with diabetes,
reminding how important is the glycemic control to prevent serious
complications such as diabetic retinopathy. Finally thank you very much
for your contribution to our problem.
References.
1. Romero-Aroca P, Salvat-Serra M, Mendez-Marin I, Martinez-Salcedo I.
[Is microalbuminuria a risk factor for diabetic retinopathy?]. J Fr
Ophtalmol. 2003;26(7):680-4.
2. Romero-Aroca P, Calvino-Dominguez O, del Castillo-Dejardin D.
[Epidemiologic study of diabetic retinopathy in a primary care unit]. Arch
Soc Esp Oftalmol. 2000;75(3):147-52.
3. Romero-Aroca P, Espeso-Sentis O, Sarda-Aure P, del Castillo-Dejardin D.
[Relationship between microalbuminuria and diabetic retinopathy in type 1
diabetes mellitus]. Rev Clin Esp. 2000;200(7):351-4.
We read with interest the article titled "Predictive factors for
treatment failure in patients with presumed ocular tuberculosis in an area
of low endemic prevalence" by Agarwal et al published in Br J Ophthalmol
2016;100:348-355.
We wanted to point out few things regarding the article -
The diagnosis of ocular tuberculosis was presumptive in most cases. The
authors have used clinical guide...
We read with interest the article titled "Predictive factors for
treatment failure in patients with presumed ocular tuberculosis in an area
of low endemic prevalence" by Agarwal et al published in Br J Ophthalmol
2016;100:348-355.
We wanted to point out few things regarding the article -
The diagnosis of ocular tuberculosis was presumptive in most cases. The
authors have used clinical guidelines from an article by Gupta et
alignment published in 2007.[1]The same authors have published revised
criterion in 2010.[2]It would have been more appropriate to use the latter
more recent guidelines.
The authors do not provide a break-up of the morphological forms of
posterior uveitis considered as tubercular in the present series. Few
categories of posterior uveitis such as serpiginous choroiditis and
vasculitis may have been included as ocular tuberculosis only on basis of
Quantiferon gold test positivity. All patients with these diagnosis may
not actually be due to active tubercular infection.[3] Rather only a
subset of these patients may be due to active tuberculosis. Thus it is
difficult to analyse treatment failure in cases where the aetiology is not
very certain.
The findings of the authors of higher failure rate of Anti-tubercular
therapy (ATT) in those given higher doses of immunosuppressives could also
indicate that the disease process is not due to active tubercular
infection. The ATT has probably no role in the management of these
disorders and it is actually the immunosuppression that is working. The
failure may be due to inadequate or rapid withdrawal of immunosppression.
Thus it may not be prudent to attribute failure to some property of
tubercular infection when the diagnosis of tuberculosis itself is probable
or questionable.
The authors donot mention if any cases had side-effects of the anti-
tubercular medication or if any patients dropped out.
The authors mention that the decision to start ATT was based on discretion
of physician. Although from the article it appears that the onus of
starting ATT was with the treating ophthalmologist as it was started only
on basis of ocular findings and QFT-G positivity even in the absence of
systemic evidence of tuberculosis.
The authors mention in the end that the evidence base for benefit of oral
steroids in TB-associated uveitis is weak. However we feel that the
contrary, i.e. evidence of benefit of ATT in certain cases of presumed
ocular tuberculosis is weak as in most studies ATT has been given in
combination with steroids and not alone.
References
1: Gupta V,Gupta A,Rao NA.Intraocular tuberculosis--an update.Surv
Ophthalmol 2007;52:561-87.
2: Gupta A, Bansal R, Gupta V, Sharma A, Bambery P. Ocular signs
predictive of tubercular uveitis.Am J Ophthalmol. 2010 Apr;149(4):562-70.
doi: 10.1016/j.ajo.2009.11.020. Epub 2010 Feb 10.
3: Nazari Khanamiri H, Rao NA.Serpiginous choroiditis and infectious
multifocal serpiginoid choroiditis. Surv Ophthalmol. 2013 May-
Jun;58(3):203-32.
I read with great interest the article by Romero- Aroca et al. titled "Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population" [1]. Insulin usage has found to be a risk factor for progression of DRP. Authors conclude this result as relaxation of patients in metabolic control. Beside this conclusion, insulin analogues may directly cause progression of DRP. Insulin and its analogues stimulate ins...
I read with great interest the article by Romero- Aroca et al. titled "Changes observed in diabetic retinopathy: eight-year follow-up of a Spanish population" [1]. Insulin usage has found to be a risk factor for progression of DRP. Authors conclude this result as relaxation of patients in metabolic control. Beside this conclusion, insulin analogues may directly cause progression of DRP. Insulin and its analogues stimulate insulin like growth hormone-1 (IGF-1) receptors, like growth hormone. There is a strong relationship between growth hormone and progression of DRP. Diabetic retinopathy regresses after surgical ablation or spontaneous infarction of pituitary gland [2]. Growth hormone deficiency is a protective factor for development of diabetic retinopathy in dwarfs [3]. Development of diabetic retinopathy is significantly higher in pubertal subjects than pre -pubertal subjects, despite the same glycemic control [4]. Thus, insulin analogues may cause progression of DRP through growth hormone-like effect. But I hypothesize that insulin analogues may cause progression of DRP only after deterioration of inner blood retinal barrier [5]. Hyperglycemia is a major risk factor for development of DRP. High blood glucose levels cause inner blood-retinal barrier deterioration by polyol pathway, non-enzymatic protein glycation and oxidative stress. Insulin analogues decrease blood glucose level and protect pericytes and inner blood-retinal barrier. When inner blood-retinal barrier is intact, insulin analogues may pass into the retinal tissue in very small amounts. After impairment of inner blood retinal barrier, insulin analogues may pass into the retinal tissue in much more amounts. Thus, insulin analogues may pass retinal tissue after impairment of inner blood retinal barrier and cause progression of DRP by growth hormone like effect. But before impairment, analogues can not pass through inner blood retinal barrier to cause progression of DRP, even delay onset of DRP by decreasing high blood glucose that impair pericytes.
References
1. Romero-Aroca P, de la Riva-Fernandez S, Valls-Mateu A, Sagarra-Alamo R, Moreno-Ribas A, Soler N. Changes observed in diabetic retinopathy: eight- year follow-up of a Spanish population. Br J Ophthalmol. 2016 Jan 14.
2. Adams, D.A., Rand, R.W., Roth, N.H., Dashe, A.M., Gipstein, R.M., Heuser, G. Hypophysectomy in diabetic retinopathy. The relationship between the degree of pituitary ablation and ocular response. Diabetes. 1974;23:698???707.
3. Merimee, T.J. A follow-up study of vascular disease in growth-hormone-deficient dwarfs with diabetes. N Engl J Med. 1978;298:1217???1222.
4. Murphy, R.P., Nanda, M., Plotnick, L., Enger, C., Vitale, S., Patz, A. The relationship of puberty to diabetic retinopathy. Arch Ophthalmol. 1990;108:215???218.
5. Kaya A, Kar T, Aksoy Y, Ozalper V, Basbug B. Insulin analogues may accelerate progression of diabetic retinopathy after impairment of inner blood-retinal barrier. Med Hypotheses. 2013 Dec;81(6):1012-4. 4.
We have read and reviewed the article entitled as "Short-term
choroidal thickness changes in patients treated with either ranibizumab or
aflibercept: a comparative study'' by Kim et al. with interest.1 The
authors analyzed 240 eyes of 240 treatment-naive neovascular AMD patients
who treated with three-monthly injections of either ranibizumab
(ranibizumab group) or aflibercept (aflibercept group). Th...
We have read and reviewed the article entitled as "Short-term
choroidal thickness changes in patients treated with either ranibizumab or
aflibercept: a comparative study'' by Kim et al. with interest.1 The
authors analyzed 240 eyes of 240 treatment-naive neovascular AMD patients
who treated with three-monthly injections of either ranibizumab
(ranibizumab group) or aflibercept (aflibercept group). They analyzed the
choroidal thickness (CT) alterations between the time of diagnosis and 3
months later, and compared them between two groups. They demonstrated a
greater decrease in CT in eyes treated with aflibercept compared to the
eyes treated with ranibizumab. We would like to ask for further details,
and contribute to the article.
As mentioned in the discussion section of the paper, a number of
factors including diurnal variation, refractive error, axial length (AL),
diabetes mellitus, hypertension, and consumption of water or coffee might
affect CT. However, we wonder intraocular pressure (IOP), use of local or
systemic drugs, smoking, sleep and exercise status, consumption of alcohol
before optical coherence tomography (OCT), and whether body mass index,
and systemic blood pressure of the patients were taken into consideration.
We also wonder lightening of the test room since all of the aforementioned
factors have been shown to affect CT significantly.2 3
For instance, Sanchez-Cano et al. demonstrated a strong negative
correlation between subfoveal CT and AL in healthy adults.4 In addition
Saeedi et al. showed a negative correlation between mean CT and IOP.5 On
the other hand, intravitreal ranibizumab and aflibercept may cause a
significant increase in IOP6-8, and a significant alteration in CT.
Therefore, IOP must be analyzed on control examinations just before OCT
measurements.
Additionally CT shows a significant diurnal variation. The choroid could
increase its thickness by 50% in an hour, and quadruple its thickness in a
few days.4 Kee et al. found that the choroid could thin very rapidly, by
about 100 micron, in 3-4 h in young chicks.9 Usui et al. showed that CT
might show a diurnal variation up to 65 micron in healthy individuals.10
It is highly likely that all those parameters could affect the data
obtained from the study, and the results of the statistical tests.
Therefore, one should act with suspicion towards the results of this
study.
REFERENCES
1 Kim JH, Lee TG, Chang YS, et al. Short-term choroidal thickness
changes in patients treated with either ranibizumab or aflibercept: a
comparative study. Br J Ophthalmol 2016. doi: 10.1136/bjophthalmol-2015-
308074. [Epub ahead of print].
2 Akay F, Gundogan FC, Yolcu U, et al. Choroidal thickness in
systemic arterial hypertension. Eur J Ophthalmol 2016;26:152-7.
3 Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye
Res 2010; 29:144-68.
4 Sanchez-Cano A, Orduna E, Segura F, et al. Choroidal thickness and
volume in healthy young white adults and the relationships between them
and axial length, ammetropy and sex. Am J Ophthalmol 2014;158:574-83.e1.
5 Saeedi O, Pillar A, Jefferys J, et al. Change in choroidal
thickness and axial length with change in intraocular pressure after
trabeculectomy. Br J Ophthalmol 2014;98:976-9.
6 Dedania VS, SJ Bakri. Sustained elevation of intraocular pressure
after intravitreal anti-vegf agents: What is the evidence? Retina
2015;35:841-58.
7 Freund KB, Hoang QV, Saroj N. Intraocular pressure in patients with
neovascular age-related macular degeneration receiving intravitreal
aflibercept or ranibizumab. Ophthalmology 2015;122:1802-10.
8 Hoang QV, Tsuang AJ, Gelman R, et al. Clinical predictors of
sustained intraocular pressure elevation due to intravitreal anti-vascular
endothelial growth factor therapy. Retina 2013;33:179-87.
9 Kee CS, Marzani D, Wallman J. Differences in time course and visual
requirements of ocular responses to lenses and diffusers. Invest
Ophthalmol Vis Sci 2001;42:575-83.
10 Usui S, Ikuno Y, Akiba M, et al. Circadian changes in subfoveal
choroidal thickness and the relationship with circulatory factors in
healthy subjects. Invest Ophthalmol Vis Sci 2012;53:2300-7.
We read with great interest the study titled as "Comparison of
trabeculectomy versus Ex-PRESS: 3-year follow-up" by Gonzalez-Rodriguez et
al [1].We congratulate their efforts for conducting the study with a
follow up of 3 years, making the results more significant.They concluded
that success rates, mean IOP, number of anti-glaucoma medications and
final visual acuities were similar between the two groups after 3 years.
T...
We read with great interest the study titled as "Comparison of
trabeculectomy versus Ex-PRESS: 3-year follow-up" by Gonzalez-Rodriguez et
al [1].We congratulate their efforts for conducting the study with a
follow up of 3 years, making the results more significant.They concluded
that success rates, mean IOP, number of anti-glaucoma medications and
final visual acuities were similar between the two groups after 3 years.
The positive points in favour of Ex-PRESS implant, are its standardized
pore size leading to more predictable filtration and consequently
avoidance of hypotony & other complications and a shorter learning
curve.
Interestingly many studies have also claimed that Ex-PRESS has a
faster visual recovery. In fact, the authors showed from their first year
data that by one month the Ex-PRESS group reached the baseline acuity
whereas in the trabeculectomy group, acuity remained significantly lower
from baseline at each study visit from day 1 to 6 months. However, when
excluding patients who needed a repeat glaucoma procedure, the acuity was
found to be better in Ex-PRESS group compared to Trabeculectomy group at
all time points. In our opinion, this data would have been more promising
had the authors mentioned the test-retest variability as well as the
confidence intervals of the visual acuity measurements in either group.
The e?ects of the Ex-PRESS device on cornea were previously evaluated by
the authors in their 1 year results [2]. We are keen to know their
findings with regards to corneal health at last follow-up.
The results of this study are consistent with other published
reports, proving that, there is actually no difference in success rates
between Ex-PRESS and trabeculectomy [3,4]. Though Ex-PRESS implant is
considered to be another good option in our surgical armamentarium, the
significant cost difference needs to be considered in conjunction with
e?cacy and safety, if Ex-PRESS is to supersede trabeculectomy [5].
REFERENCES -
1. Gonzalez-Rodriguez JM, et al. Br J Ophthalmol 2015
2. Wagschal et al. Prospective Randomized Study Comparing Ex-PRESS to
Trabeculectomy: 1-Year Results. J Glaucoma 2015;24:624-629.
3. Netland PAet al. Randomized, prospective, comparative trial of EX-
PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J
Ophthalmol 2014;157:433-40.e3.
4. Dahan E, Ben Simon GJ, Lafuma A. Comparison of trabeculectomy and
Ex-PRESS implantation in fellow eyes of the same patient: a prospective,
randomised study. Eye (Lond) 2012;26:703-10.
5. Buys YM. Trabeculectomy with ExPRESS: weighing the benefits and
cost. CurrOpin Ophthalmol 2013;24:111-18.
With great interest,We have read the article by Chidambara1 and
partners on characteristics and quantification of vascular changes in
macular telangiectasia type 2( MacTel 2) on optical coherence tomography
angiography(OCTA).The authors concluded that OCTA helps understand the
pathology and disease progression better in MacTel 2.We commend their
interesting and important work on this subject.However, w...
With great interest,We have read the article by Chidambara1 and
partners on characteristics and quantification of vascular changes in
macular telangiectasia type 2( MacTel 2) on optical coherence tomography
angiography(OCTA).The authors concluded that OCTA helps understand the
pathology and disease progression better in MacTel 2.We commend their
interesting and important work on this subject.However, we have a question
for the authors concerning intra- and inter-observer variation and the
reproducibility of the OCTA examination.
As far as I know, reproducibility and repeatability are indicators of
the applicability of any instrument as a diagnostic tool in clinical
practice2.OCTA is extremely sensitive to motion, some images had
significant artifacts even with the motion correction algorithm. Operator
learning curve, media opacity, and patient cooperation were factors in
poor-quality images3.If the subjects had repeated instances of unstable
fixation,the image would appear with white ambiguous lines.The analysis
software would mistake these white ambiguous lines for blood vessels and
would overestimate the retinal vessel density.Therefore,intra- and inter-
observer variation would be relatively large. I think the authors should
perform a reproducibility analysis to prove the stability of the OCTA
system examination.If such an analysis had been performed and intra- and
inter- observer variation exceeded a certain percent,the results of this
study might have been shown to be unreliable.
REFERENCES
1. Chidambara L, Gadde SGK, Yadav NK, et al. Characteristics and
quantification of vascular changes in macular telangiectasia type 2 on
optical coherence tomography angiography. Br J Ophthalmol 2016:2015-
307941.
2. Carpineto P, Mastropasqua R, Marchini G, et al. Reproducibility and
repeatability of foveal avascular zone measurements in healthy subjects by
optical coherence tomography angiography. Br J Ophthalmol 2015.
3. Hwang TS, Gao SS, Liu L, et al. Automated Quantification of Capillary
Nonperfusion Using Optical Coherence Tomography Angiography in Diabetic
Retinopathy. JAMA OPHTHALMOL 2016:1-7.
Dear Editor,
We thank Uzun and Pehlivan for their interest in our article1 and their comments. They raise various factors that are potential confounders of subfoveal choroidal thickness measurements. As our study was a retrospective review of paired samples of enhanced depth imaging optical coherence tomography (EDI-OCT) and indocyanine green angiography (ICGA) in the right eye of patients with chronic Vogt-Koya...
Dear Editor,
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EDITOR:
With great interest,We have read the article by Chidambara1 and partners on characteristics and quantification of vascular changes in macular telangiectasia type 2( MacTel 2) on optical coherence tomography angiography(OCTA).The authors concluded that OCTA helps understand the pathology and disease progression better in MacTel 2.We commend their interesting and important work on this subject.However, w...
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