Indian Journal of Ophthalmology

LETTER TO THE EDITOR
Year
: 2019  |  Volume : 67  |  Issue : 1  |  Page : 178--179

Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy


Ramanuj Samanta 
 Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India

Correspondence Address:
Dr. Ramanuj Samanta
Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh - 249 203, Uttarakhand
India




How to cite this article:
Samanta R. Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy.Indian J Ophthalmol 2019;67:178-179


How to cite this URL:
Samanta R. Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy. Indian J Ophthalmol [serial online] 2019 [cited 2019 Jul 23 ];67:178-179
Available from: http://www.ijo.in/text.asp?2019/67/1/178/248131


Full Text



Sir,

I read with great interest the article “Dramatic response to intravitreal bevacizumab in hypertensive retinopathy” by Padhy and Kumar.[1] The authors have attributed rapid resolution of intra-retinal and sub-retinal fluid at macula in both eyes following intravitreal injection of bevacizumab only in the right eye. Systemic absorption of intravitreal bevacizumab had been cited as a reason for improvement in fellow eye.

Although data on the use of bevacizumab in malignant hypertension is relatively sparse, reports on fellow eye effect of unilateral intravitreal bevacizumab in diabetic macular edema (DME) are controversial. Velez-Mentoya et al.[2] failed to identify a contralateral eye effect in a prospective study involving 23 patients. Hanhart et al.[3] have shown bilateral response after unilateral injection; however, the average reduction in central subfield macular thickness (CST) was more in injected eye and a significant proportion received multiple injections. In the index case, complete resolution of intra- and sub-retinal fluid following a single intravitreal injection can be due to systemic control of hypertension as evidenced by blood pressure (BP) at presentation and BP after 1 month. Moreover, concurrent use of systemic steroids to treat primary renal disease can also reduce blood retinal barrier breakdown and help in resolution of macular fluid.

It would be interesting to know from the authors, the magnitude of reduction in CST of injected and fellow eye and to see for any differential response between the two eyes. Symmetrical reduction in both eyes may point more toward better systemic control rather than effect of bevacizumab. Injecting bevacizumab is also known to cause dysregulation of BP especially in severe hypertensive patients.[4] Hence, using bevacizumab as a primary modality in a treatment naïve malignant hypertensive retinopathy warrants caution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Padhy S, Kumar V. Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy. Indian J Ophthalmol 2018;66:1494-5.
2Velez-Montoya R, Fromow-Guerra J, Burgos O, Landers MB, Morales-Catón V, Quiroz-Mercado H. The effect of unilateral intravitreal bevacizumab (avastin), in the treatment of diffuse bilateral diabetic macular edema: A pilot study. Retina 2009;29:20-6.
3Hanhart J, Tiosano L, Averbukh E, Banin E, Hemo I, Chowers I. Fellow eye effect of unilateral intravitreal bevacizumab injection in eyes with diabetic macular edema. Eye 2014;28:646-53.
4Rasier R, Artunay O, Yuzbasioglu E, Sengul A, Bahcecioglu H. The effect of intravitreal bevacizumab (avastin) administration on systemic hypertension. Eye 2009;23:1714-8.