We have read the article published in the Journal by Suzuki and associates: “Distinct responsiveness to intravitreal ranibizumab therapy in polypoidal choroidal vasculopathy with single or multiple polyps.” In that paper, the prognosis of polypoidal choroidal vasculopathy (PCV) has been investigated by taking the response of the patients to intravitreal ranibizumab (IVR) monotherapy in the presence of a single or multiple polyps. The authors included 48 previously untreated eyes of 48 patients who received monthly IVR injections for 3 months, followed by pro re nata (PRN) injections. The patients were divided into 2 groups (single-polyp and multiple-polyp groups), taking indocyanine green angiography and optical coherence tomography (OCT) findings into consideration. The outcome measures were the alterations in best-corrected visual acuity (BCVA) and OCT findings over 2 years after the initial IVR. Although the central retinal thickness (CRT) decreased in both groups, the patients with BCVA did not show any improvements when multiple polyps were present. The authors demonstrated that the IVR therapy was less beneficial in PCV patients with multiple polyps compared to those with a single polyp. We first congratulate the authors for their valuable work; however, we would like to ask for further details to contribute to the article.

A number of local and systemic physiological and pathologic conditions may affect CRT and/or choroidal thickness (CT). Various studies in the literature indicated that diurnal variation, systemic and local disorders and medications used for them, smoking, consumption of alcohol, the axial length of the globe, intraocular pressure, refractive error, and a number of other factors affected CRT and/or CT.

Suzuki and associates reported the mean age of their patients in both study groups as 72 years. We suppose that comorbid diseases, the medications used for them, and the aforementioned ocular parameters might have affected CRT and/or CT significantly. Although the authors did not mention those parameters in the paper, we suppose that this is a major limitation of the study, since this situation results in significant suspicion about the results and the statistical analysis of the study. We wonder about the opinion of the authors on this subject.