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Thermotherapy of occult subfoveal choroidal neovascularization: author’s reply
Ophthalmology Volume 108, Number 6, June 2001 retina.2 The beneficial effect of factors derived from a “stimulated” RPE, such as transforming growth factor-1 and transforming growth factor-2, should also be considered (Invest Ophthalmol Vis Sci 1997;38[Suppl]:754). Suprathreshold laser photocoagulation is the standard treatment for CNV but is associated with diffuse retinal damage. The current visible end point (i.e., retinal whitening) during laser photocoagulation results in a coagulative necrosis of the whole retina, with nonspecific targeting of cells caused by extensive diffusion of thermal energy. This damage may not be needed for the therapeutic effects. PAOLO LANZETTA, MD PAOLA MICHIELETTO, MD Udine, Italy References 1. Lanzetta P, Virgili G, Ferrari E, Menchini U. Diode laser photocoagulation of choroidal neovascular membranes. Int Ophthalmol 1996;19:347–54. 2. Miller H, Miller B, Ryan SJ. The role of retinal pigment epithelium in the involution of subretinal neovascularization. Invest Ophthalmol Vis Sci 1986;27:1644 –52.
Author’s reply Dear Editor: Drs. Lanzetta and Michieletto raise interesting questions regarding the pathophysiology of transpupillary thermotherapy’s (TTT) effect on choroidal neovascularization (CNV).1 Modulation of neovascular stimuli appears to be critical in the treatment of many retinal (e.g., diabetic retinopathy) and choroidal neovascular disorders. TTT may be more effective in closing CNV in that suprathreshold laser may actually increase those factors that stimulate inflammation, and this ultimately may be responsible for further induction of angiogenesis. This may explain the high recurrence rate observed after conventional suprathreshold laser treatment of CNV. Thermal obliteration of abnormal vessels and retinal pigment epithelium migration, transformation, and proliferation are mechanisms of CNV closure that TTT (long-pulse photocoagulation) may share with conventional short-pulse laser photocoagulation. TTT or long-pulse photocoagulation may differ in that this modality of treatment may cause thrombosis, thermal inhibition of angiogenesis, or neovascular apoptosis. TTT requires a large treatment area, and this may help modulate neovascular stimuli as well. TTT
represents a paradigm shift, for the laser photocoagulation on CNV, in that less may be more. ELIAS REICHEL, MD Boston, Massachusetts Reference 1. Reichel E, Berrocal AM, Ip M, et al. Transpupillary thermotherapy of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration. Ophthalmology 1999;106:1908 –14.
Allvar Gullstrand Dear Editor: The historical image of Allvar Gullstrand, MD (1862–1930) in the September 2000 issue states he is the only ophthalmologist who has received a Nobel Prize.1 Gullstrand was the awardee in physiology or medicine in 1911. Ophthalmologists should be proud to know that the list of their colleagues who have received this illustrious award is longer.2 Fritz Pregl, MD (1869 –1930), an Austrian ophthalmologist and analytical chemist, received the Nobel Prize in chemistry in 1923. Walter Hess, MD (1881–1973), a Swiss ophthalmologist and physiologist, was awarded the Nobel Prize in physiology or medicine in 1949 for his work on autonomic control by the hypothalamus. JAMES G. RAVIN, MD Toledo, Ohio References 1. Kearney J, Tanaka S. Historical image. Ophthalmology 2000; 107:1680. 2. Ravin JG. Gullstrand, Einstein, and the Nobel Prize. Arch Ophthalmol 1999;117:670 –2.
Author’s reply Dear Editor: We thank Dr. Ravin for his interest in our article and for pointing out the often repeated error that Dr. Gullstrand was the only ophthalmologist to have received a Nobel Prize. We noted in Dr. Ravin’s article (Arch Ophthalmol 1999; 117:670 –2) and in his presentation at the Academy’s Annual Meeting (October 24, 1999), that other ophthalmologists had received the Prize but were not engaged actively in the practice of ophthalmology. We regret not having made that fine distinction. JOHN J. KEARNEY, MD STEPHEN C. TANAKA, MD Hayward, California
Errata Paul Sternberg, Jr., MD, of Atlanta, Georgia, should have been listed as an author of the March 2001 Guest Editorial, “Are the Submacular Surgery Trials Still Relevant in an Era of Photodynamic Therapy?” Dr. Sternberg’s name was inadvertently misspelled, and we apologize for any inconvenience this may have caused.
The correct title of the article by Levartovsky S, Rosenwasser GOD, Goodman DF (Ophthalmology 2001;108:321–5) is “Bacterial Keratitis after Laser In Situ Keratomileusis.” The error is regretted.
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Author’s reply Dear Editor: Drs. Lanzetta and Michieletto raise interesting questions regarding the pathophysiology of transpupillary thermotherapy’s (TTT) effect on choroidal neovascularization (CNV).1 Modulation of neovascular stimuli appears to be critical in the treatment of many retinal (e.g., diabetic retinopathy) and choroidal neovascular disorders. TTT may be more effective in closing CNV in that suprathreshold laser may actually increase those factors that stimulate inflammation, and this ultimately may be responsible for further induction of angiogenesis. This may explain the high recurrence rate observed after conventional suprathreshold laser treatment of CNV. Thermal obliteration of abnormal vessels and retinal pigment epithelium migration, transformation, and proliferation are mechanisms of CNV closure that TTT (long-pulse photocoagulation) may share with conventional short-pulse laser photocoagulation. TTT or long-pulse photocoagulation may differ in that this modality of treatment may cause thrombosis, thermal inhibition of angiogenesis, or neovascular apoptosis. TTT requires a large treatment area, and this may help modulate neovascular stimuli as well. TTT
represents a paradigm shift, for the laser photocoagulation on CNV, in that less may be more. ELIAS REICHEL, MD Boston, Massachusetts Reference 1. Reichel E, Berrocal AM, Ip M, et al. Transpupillary thermotherapy of occult subfoveal choroidal neovascularization in patients with age-related macular degeneration. Ophthalmology 1999;106:1908 –14.
Allvar Gullstrand Dear Editor: The historical image of Allvar Gullstrand, MD (1862–1930) in the September 2000 issue states he is the only ophthalmologist who has received a Nobel Prize.1 Gullstrand was the awardee in physiology or medicine in 1911. Ophthalmologists should be proud to know that the list of their colleagues who have received this illustrious award is longer.2 Fritz Pregl, MD (1869 –1930), an Austrian ophthalmologist and analytical chemist, received the Nobel Prize in chemistry in 1923. Walter Hess, MD (1881–1973), a Swiss ophthalmologist and physiologist, was awarded the Nobel Prize in physiology or medicine in 1949 for his work on autonomic control by the hypothalamus. JAMES G. RAVIN, MD Toledo, Ohio References 1. Kearney J, Tanaka S. Historical image. Ophthalmology 2000; 107:1680. 2. Ravin JG. Gullstrand, Einstein, and the Nobel Prize. Arch Ophthalmol 1999;117:670 –2.
Author’s reply Dear Editor: We thank Dr. Ravin for his interest in our article and for pointing out the often repeated error that Dr. Gullstrand was the only ophthalmologist to have received a Nobel Prize. We noted in Dr. Ravin’s article (Arch Ophthalmol 1999; 117:670 –2) and in his presentation at the Academy’s Annual Meeting (October 24, 1999), that other ophthalmologists had received the Prize but were not engaged actively in the practice of ophthalmology. We regret not having made that fine distinction. JOHN J. KEARNEY, MD STEPHEN C. TANAKA, MD Hayward, California
Errata Paul Sternberg, Jr., MD, of Atlanta, Georgia, should have been listed as an author of the March 2001 Guest Editorial, “Are the Submacular Surgery Trials Still Relevant in an Era of Photodynamic Therapy?” Dr. Sternberg’s name was inadvertently misspelled, and we apologize for any inconvenience this may have caused.
The correct title of the article by Levartovsky S, Rosenwasser GOD, Goodman DF (Ophthalmology 2001;108:321–5) is “Bacterial Keratitis after Laser In Situ Keratomileusis.” The error is regretted.
1012