[Downloaded free from http://www.ijo.in on Thursday, December 28, 2017, IP: 131.255.110.108]
174
Indian Journal of Ophthalmology
Financial support and sponsorship Nil.
Volume 66 Issue 1
bevacizumab. Indian J Ophthalmol 2014;62:468‑71. 5. Das T, Volety S, Ahsan SM, Thakur AK, Sharma S, Padhi TR, et al. Safety, sterility and stability of direct‑from‑vial multiple dosing intravitreal injection of bevacizumab. Clin Exp Ophthalmol 2015;43:466‑73.
Conflicts of interest There are no conflicts of interest.
Bakulesh M Khamar Consultants, Netralaya, Near Parimal Garden, Ambawadi, Ahmedabad, Gujarat, India Correspondence to: Dr. Bakulesh M Khamar, Former Professor of Opthalmology, NHL Municipal Medical College, 103, Elegance Tower, Ambawadi, Ellisbridge, Ahmedabad ‑ 380 006, Gujarat, India. E‑mail:
[email protected]
6. Le Rouic JF, Breger D, Peronnet P, Hermouet‑Leclair E, Alphandari A, Pousset‑Decré C, et al. Extemporaneous withdrawal with a mini‑spike filter: A low infection risk technique for drawing up bevacizumab for intravitreal injection. J Fr Ophtalmol 2016;39:415‑20.
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online
References
Quick Response Code:
1. Kumar A, Ravani R. Using intravitreal bevacizumab (Avastin®) – Indian Scenario. Indian J Ophthalmol 2017;65:545-8.
DOI: 10.4103/ijo.IJO_802_17
2. Kahook MY, Liu L, Ruzycki P, Mandava N, Carpenter JF, Petrash JM, et al. High‑molecular‑weight aggregates in repackaged bevacizumab. Retina 2010;30:887‑92. 3. Fielden M, Nelson B, Kherani A. Acute intraocular inflammation following intravitreal injection of bevacizumab – A large cluster of cases. Acta Ophthalmol 2011;89:e664‑5. 4. Entezari M, Ramezani A, Ahmadieh H, Ghasemi H. Batch‑related sterile endophthalmitis following intravitreal injection of
Website: www.ijo.in
PMID: *** Cite this article as: Khamar BM. Intravitreal bevacizumab. Indian J Ophthalmol 2018;66:173-4. © 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”
management with intravitreal bevacizumab in the presented case[1] may need elucidation. A history of systemic or local steroid use is also relevant in the presented case, as central serous chorioretinopathy, though unlikely in a 73 year old, needs to be ruled out.
Sir, I read with interest the case report on the closure of a macular hole over a serous retinal pigment epithelial detachment (PED) with intravitreal bevacizumab.[1] I want to humbly discuss a few facts.
Conflicts of interest There are no conflicts of interest.
The role of anti‑vascular endothelial growth factor (anti‑VEGF) agents in serous PED without subretinal or intraretinal fluid or active choroidal neovascular membrane/ idiopathic polypoidal choroidal vasculopathy may require further research. In the present case,[1] the shallow subretinal fluid at one margin of the macular hole could have been related to the macular hole itself or the mechanical effect of the high PED. In such a scenario, fundus fluorescein angiogram and indocyanine green angiogram would add significant scientific value and justification for the use of bevacizumab in this case, if they are available. Furthermore, we need to consider the fact that intravitreal anti‑VEGF agents can cause retinal pigment epithelial tears[2] in cases of high serous PEDs. The rare but potentially blinding complications of intravitreal anti‑VEGF agents such as endophthalmitis[3] and retinal detachment should be kept in mind. The goal of
Financial support and sponsorship Nil.
Koushik Tripathy Department of Vitreoretina and Uvea, ICARE Eye Hospital and Post Graduate Institute, Noida, Uttar Pradesh, India Correspondence to: Dr. Koushik Tripathy, Department of Vitreoretina and Uvea, ICARE Eye Hospital and Post Graduate Institute, E3A, Sector‑26, Noida ‑ 201 301, Uttar Pradesh, India. E‑mail:
[email protected]
References 1. Storch MW, Hoerauf H. Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment. Indian J Ophthalmol 2017;65:632‑3. 2. Tripathy K, Chawla R, Kumar V, Sharma YR, Venkatesh P. A 56‑year‑old male with unilateral painless diminution of vision. Oman J Ophthalmol 2016;9:119.
[Downloaded free from http://www.ijo.in on Thursday, December 28, 2017, IP: 131.255.110.108]
175
Letters to the Editor January 2018 3. Kumar A, Tripathy K, Chawla R. High Alert on intraocular use of bevacizumab (Avastin®) in India: An Indian ophthalmologist’s perspective. Natl Med J India 2017; In press.
Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/ijo.IJO_733_17 PMID: ***
This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Response to comment on “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment” Sir, We thank you for the valuable comments. [1] Fluorescein angiography (FAG) is indeed helpful in the diagnosis of exsudative age‑related macular degeneration, but in our opinion, FAG would not provide additional information about the point of interest which is the pathomechanism of either coexisting or secondarily developed macular hole.[2] In fact, bevacizumab was chosen instead of the approved intravitreal vascular endothelial growth factor (VEGF) inhibitors since besides the retinal pigment epithelial detachment (PED), there was no intra‑ or sub‑retinal fluid and thus no in‑label indication was present at that time. Bevacizumab was therefore chosen as an off‑label therapeutic attempt which at that time was affordable by the patient. It is correct that retinal pigment epithelial tears may occur in high PED spontaneously or under anti‑VEGF‑therapy; however, in this situation, it seemed a less invasive strategy to close the macular hole by reducing the stretching forces. In addition, vitrectomy probably would not have affected the height of PED and possibly reduced the efficacy period of further intravitreal drug therapies. We explicitly emphasize that the patient presented here was treated with an off‑label medication and that an extensive informed consent was undertaken before therapy.[2] Best regards. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Cite this article as: Tripathy K. Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”. Indian J Ophthalmol 2018;66:174-5. © 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Marcus Storch, Hans Hoerauf Department of Ophthalmology, University of Göttingen, Göttingen, Germany Correspondence to: Dr. Marcus Storch, Department of Ophthalmology, University of Göttingen, Robert‑Koch‑Str. 40, D‑37075 Göttingen, Göttingen, Germany. E‑mail:
[email protected]‑goettingen.de
References 1. Tripathy K. Comment on: “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”. Indian J Ophthalmol 2018;66:174-5 2. Storch MW, Hoerauf H. Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment. Indian J Ophthalmol 2017;65:632-3. This is an open access article distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as the author is credited and the new creations are licensed under the identical terms. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/ijo.IJO_788_17 PMID: ***
Cite this article as: Storch M, Hoerauf H. Response to comment on “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”. Indian J Ophthalmol 2018;66:175. © 2017 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
