We would like to thank Drs Uzun and Pehlivan for their interest in our recent study, which demonstrates the different responses to intravitreal 0.5 mg ranibizumab (IVR) therapy in 2 groups with treatment-naïve polypoidal choroidal vasculopathy (PCV), a subtype of age-related macular degeneration (AMD). The groups were classified according to the presence of single or multiple polyps. Although the baseline central retinal thickness (CRT) was almost the same between the groups, and both groups showed reduction in CRT after IVR, the single-polyp group showed significantly thinner CRT compared with the multiple-polyps group, 1 year after the initial IVR treatment. We proposed that classifying PCV based on the presence of single or multiple polyps may aid in the understanding of the prognosis. They mentioned that systemic and/or ocular parameters could be involved in the prognosis of CRT and central choroidal thickness (CCT). In fact, the risk factors for AMD involve systemic and/or ocular parameters, daily habits such as smoking, and genetic background ; thus, we agree that their point can be considered for further understanding of PCV pathogenesis. Because of the nature of the retrospective study, data for smoking and alcohol consumption, axial length of the globe, and systemic medications were not available in clinical records of all patients. However, systemic disorders were analyzed and the below data were obtained.

Out of 48 patients (48 eyes), 11 had hypertension (8 and 3 patients in the single-polyp and multiple-polyps groups, respectively), 5 had hyperlipidemia (5 and 0), 4 had diabetes (3 and 1), 3 had ischemic heart disease (1 and 2), 3 had other heart diseases (2 and 1), 1 had hyperuricemia (1 and 0), 1 had hyperthyroidism (0 and 1), 1 had hypothyroidism (1 and 0), 2 had asthma (1 and 1), and 1 had lung cancer (0 and 1). No statistically significant differences were observed with or without either hypertension or hyperlipidemia, in terms of mean CRT and CCT values at baseline and mean CRT value and mean CRT change from the baseline at 1 year. With regard to the data obtained at 2 years, mean CRT value was smaller in patients with hyperlipidemia (131.1 μm, P = .016) compared with those without hyperlipidemia (243.4 μm). Further, mean CRT change compared with the baseline was larger in patients with hyperlipidemia (362.3 μm, P = .037) compared with those without hyperlipidemia (136.3 μm), although only a small number of patients had hyperlipidemia. There were no differences in the 2-year data with or without hypertension. Data for CCT after IVR treatment were not collected in all eyes, and thus, we did not continue further evaluation. Interestingly, the incidence of hypertension tended to be higher in the single-polyp group (27.6% vs 10.5%), and all patients with hyperlipidemia were in the single-polyp group (17.2% vs 0%). Further analyses with more patients are warranted to determine whether these systemic parameters are related to our classification; this will aid in the understanding of the etiology of single polyp or multiple polyps in PCV.

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Jan 5, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reply

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