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LETTER TO THE EDITOR
Year : 2013  |  Volume : 61  |  Issue : 11  |  Page : 691

Low-fluence PDT better than anti-vascular endothelial growth factor


Consultant ophthalmologist, Kamala Nethralaya, # 81, 7th Cross, 4th Block, Koramangala, Bangalore - 560 034, Karnataka, India

Date of Web Publication16-Dec-2013

Correspondence Address:
K S Santhan Gopal
Consultant ophthalmologist, Kamala Nethralaya, # 81, 7th Cross, 4th Block, Koramangala, Bangalore - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.121181

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How to cite this article:
Santhan Gopal K S. Low-fluence PDT better than anti-vascular endothelial growth factor. Indian J Ophthalmol 2013;61:691

How to cite this URL:
Santhan Gopal K S. Low-fluence PDT better than anti-vascular endothelial growth factor. Indian J Ophthalmol [serial online] 2013 [cited 2019 Dec 7];61:691. Available from: http://www.ijo.in/text.asp?2013/61/11/691/121181

Sir,

It was interesting to read the article "Low-fluence photodynamic therapy" for early onset choroidal neovascular membrane (CNVM) following LASIK by Dr. George J Manayath et al. [1] The authors have to be commended for an excellent work. But I have some reservations that I would like to state.

Were there any pathological myopia changes recorded by the refractive surgeon, prior to the refractive surgery? The time lapse between break in Bruch's membrane at the macula and appearance of CNVM is usually quite long. Often many weeks and not just 2 weeks. The break in Bruch's membrane can be induced by the stretch of the microkeratome, for a minute or so (the time the microkeratome suction ring exerts pressure) cannot be deduced from a single case study.

I disagree with the author's statement that low fluence PDT is an alternative to intravitreal anti vegf anti-vascular endothelial growth factor (VEGF) injections for the following reasons.

The anti vegf VEGF has been shown to be clearly superior to the PDT for the treatment of subfoveal CNVM in Myopia. [2] "The superior functional results of anti-VEGF drugs provide the reason for the first-line status of this treatment modality. Increasing safety data and consistent results of prospective pilot trials have proved photodynamic therapy to be inferior". [3] Considering the cost of PDT and the ease of intraviteral injection, I would have expected the authors to try intravitreal injection of anti VEGF, rather than the inferior quality of treatment of low fluence PDT. Also statistics extracted from near by Retina Centre (Retina Institute of Karnataka, Bangalore) revealed that the PDT rate that used to be around 50 in 2004 has now come down to less than 6, in 2011, since the ubiquitous use of anti-VEGF. It is to the credit of the authors that they do mention in passing the anti-VEGF treatment for myopic choroidal neovscularization.

 
  References Top

1.
Manayath GJ, Narendran V, Ganesh A, Arora S. Low-fluence photodynamic therapy for early onset choroidal neovascular membrane following laser in situ Keratomileusis. Indian J Ophthalmol 2012;60:584-5.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Yoon JU, Byun YJ, Koh HJ. Intravitreal anti-VEGF versus photodynamic therapy with verteporfin for treatment of myopic choroidal neovascularization. Retina. 2010;30:418-24  Back to cited text no. 2
    
3.
Cohen SY Anti-VEGF drugs as the first-line therapy for choroidal revascularization in pathologic myopia. Retina. 2009;29:1062-6.  Back to cited text no. 3
    




 

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