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   Table of Contents      
LETTER TO THE EDITOR
Year : 2018  |  Volume : 66  |  Issue : 1  |  Page : 175

Response to comment on “Case report of a secondary macular hole closure after intravitreal bevacizumab therapy in a patient with retinal pigment epithelial detachment”


Department of Ophthalmology, University of Göttingen, Göttingen, Germany

Date of Web Publication28-Dec-2017

Correspondence Address:
Dr. Marcus Storch
Department of Ophthalmology, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Göttingen
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_788_17

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How to cite this article:
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

How to cite this URL:
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 [serial online] 2018 [cited 2019 Jun 27];66:175. Available from: http://www.ijo.in/text.asp?2018/66/1/175/221818



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.



 
  References Top

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  Back to cited text no. 1
    
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.  Back to cited text no. 2
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