|LETTER TO THE EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 180
Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy
Koushik Tripathy1, Arpan Chaudhuri2
1 Department of Vitreoretina and Uvea, ASG Eye Hospital, Dakshindari Road, VIP Road, Sreebhumi, Near Lake Town, West Bengal, India
2 Department of Internal Medicine and Intensive Care, Columbia Asia Hospital, Salt Lake City, Kolkata, West Bengal, India
|Date of Web Publication||21-Dec-2018|
Dr. Koushik Tripathy
Department of Vitreoretina and Uvea, ASG Eye Hospital, 403/1 Alcove Gloria, Dakshindari Road, VIP Road, Sreebhumi, Near Lake Town, Kolkata - 700 048, West Bengal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tripathy K, Chaudhuri A. Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy. Indian J Ophthalmol 2019;67:180
|How to cite this URL:|
Tripathy K, Chaudhuri A. Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jun 18];67:180. Available from: http://www.ijo.in/text.asp?2019/67/1/180/248132
We read with interest the case report on the resolution of bilateral subfoveal fluid and disc edema due to hypertensive retinopathy (HTNR) after unilateral intravitreal bevacizumab. We want to discuss few points.
- As one eye did not receive the intravitreal injection, one could consider that eye as the control eye as opposed to the other interventional eye with intravitreal injection. Resolution of the control eye's subfoveal fluid after 1 month of the intervention may denote a positive effect of the control of blood pressure (BP) or systemic disease and may not solely be related to the contralateral effect of the injection as the authors have proposed. It would be interesting to know if the patient underwent any interventions to control BP including hemodialysis.
- Typically mean arterial BP (MABP) is calculated as diastolic BP + (systolic BP − diastolic BP)/3. Thus, the calculated MABP of 210/140 mm Hg would be 140 + (210 − 140)/3 = 163.3 mm Hg and not 136 mm Hg. Was MABP measured invasively by an arterial line?
- As the primary cause of HTNR is hypertension, the adequate control of hypertension is the most important intervention. Without the adequate control of BP, any intervention including intravitreal anti-vascular endothelial growth factor (VEGF) agents may not be considered. Though bevacizumab has been considered as a “wonder drug,” it carries a rare but devastating risk of blindness due to endophthalmitis. However, in the clinical setting even after control of hypertension, the subfoveal fluid may not resolve and the patient may want earlier visual rehabilitation. Salman used intravitreal bevacizumab in 12 cases of persistent HTNR despite control of hypertension for 1 month and noted stabilization and improvement of vision in all cases. This paper also adds to the evidence, that anti-VEGF agents may be helpful in HTNR. The exact role of anti-VEGF agents in HTNR needs further exploration, but these agents may add to the armamentarium to treat the cases of HTNR with subfoveal fluid which do not resolve despite good systemic control.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Padhy S, Kumar V. Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy. Indian J Ophthalmol 2018;66:1494-5.
] [Full text]
Kumar A, Tripathy K, Chawla R. Intraocular use of bevacizumab in India: An issue resolved? Natl Med J India 2017;30:345-7.
] [Full text]
Salman AG. Intravitreal bevacizumab in persistent retinopathy secondary to malignant hypertension. Saudi J Ophthalmol 2013;27:25-9.
Kim EY, Lew HM, Song JH. Effect of intravitreal bevacizumab (Avastin(®)) therapy in malignant hypertensive retinopathy: A report of two cases. J Ocul Pharmacol Ther Off J Assoc Ocul Pharmacol Ther 2012;28:318-22.
Al-Halafi AM. Tremendous result of bevacizumab in malignant hypertensive retinopathy. Oman J Ophthalmol 2015;8:61-3.
] [Full text]