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Short-Term Changes in Choroidal Thickness After Aflibercept Therapy for Neovascular Age-Related Macular Degeneration
CORRESPONDENCE Short-Term Changes in Choroidal Thickness After Aflibercept Therapy for Neovascular Age-Related Macular Degeneration
diseases (diabetes mellitus, hypertension, hyperlipidemia, etc), medications used previously, and body mass index, as well as for sleeping and exercise status and for consuming of alcohol and beverages with or without caffeine before OCT testing. We are also curious about the systemic blood pressure measurement results. SALIH UZUN
EDITOR: WE HAVE READ AND REVIEWED THE ARTICLE ENTITLED
‘‘Short-Term Changes in Choroidal Thickness After Aflibercept Therapy for Neovascular Age-Related Macular Degeneration,’’ by Koizumi and associates, with interest.1 Choroidal thickness (CT) was analyzed in 102 eyes of 102 patients with treatment-naı¨ve neovascular agerelated macular degeneration (AMD) using either sweptsource optical coherence tomography (OCT) or enhanced-depth imaging OCT. All 102 eyes underwent injections of 2.0 mg intravitreal aflibercept for 3 consecutive months: at baseline, month 1, and month 2. The authors demonstrated that the mean baseline subfoveal CT decreased from 252.0 6 99.7 mm to 217.9 6 95.6 mm at month 3, after intravitreal aflibercept injections. In addition, the mean CT measurements done 3 mm away from the foveal center in the superior, inferior, temporal, and nasal directions showed significant reductions. We would like to ask for further details, and contribute to the paper. We realized that the axial length (AL) and intraocular pressure (IOP) measurements of the participants were not analyzed in the study. Axial length and IOP were shown to have significant effects on CT.2 Sanchez-Cano and associates demonstrated a strong negative correlation between subfoveal AL and CT in healthy adults.3 Additionally, Saeedi and associates showed a negative correlation between IOP and mean CT.4 On the other hand, we have anticipated that intravitreal aflibercept injections may affect CT by increasing IOP, since it has already been demonstrated in the literature that aflibercept may significantly increase IOP.5 Therefore, AL and IOP measurements should be taken into consideration while analyzing CT in such studies. Another important issue is the diurnal variation of CT. Usui and associates demonstrated that diurnal variation of CT might be up to 65 mm.6 Therefore it should be expected that physiologic fluctuation of CT might affect test measurement results and statistical analyses. We suggest performing OCT measurements along with preoperative and postoperative follow-up examinations at the same time, and at certain time periods of the day. In addition, various local or systemic physiological/pathologic conditions affect CT.2 We wonder whether the authors evaluated the participants of this study for systemic 0002-9394/$36.00 http://dx.doi.org/10.1016/j.ajo.2016.04.026
©
2016
Ankara, Turkey EMRE PEHLIVAN
Eskisehir, Turkey FUNDING/SUPPORT: NO FUNDING OR GRANT SUPPORT. Financial disclosures: The following authors have no financial disclosures: Salih Uzun and Emre Pehlivan. The authors attest that they meet the current ICMJE criteria for authorship.
REFERENCES
1. Koizumi H, Yamamoto A, Saito M, et al. Short-term changes in choroidal thickness after aflibercept therapy for neovascular age-related macular degeneration. Am J Ophthalmol 2015; 159(4):627–633. 2. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res 2010;29(2):144–168. 3. Sanchez-Cano A, Orduna E, Segura F, et al. Choroidal thickness and volume in healthy young white adults and the relationships between them and axial length, ammetropy and sex. Am J Ophthalmol 2014;158(3):574–583.e1. 4. Saeedi O, Pillar A, Jefferys J, et al. Change in choroidal thickness and axial length with change in intraocular pressure after trabeculectomy. Br J Ophthalmol 2014;98(7):976–979. 5. Freund KB, Hoang QV, Saroj N, Thompson D. Intraocular pressure in patients with neovascular age-related macular degeneration receiving intravitreal aflibercept or ranibizumab. Ophthalmology 2015;122(9):1802–1810. 6. Usui S, Ikuno Y, Akiba M, et al. Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci 2012; 53(4):2300–2307.
REPLY WE THANK DRS UZUN AND PEHLIVAN FOR SHOWING INTER-
est in our paper.1 Unfortunately, the axial length was not evaluated in our study. Therefore, it is not possible to clarify the impact of the axial length on our results. The authors also speculated that the increase in intraocular pressure after aflibercept therapy might decrease the choroidal thickness. The authors cited the paper by Freund and associates2 with respect to the changes in the intraocular pressure during the VIEW (VEGF Trap-Eye:
ELSEVIER INC. ALL
RIGHTS RESERVED.
287
diseases (diabetes mellitus, hypertension, hyperlipidemia, etc), medications used previously, and body mass index, as well as for sleeping and exercise status and for consuming of alcohol and beverages with or without caffeine before OCT testing. We are also curious about the systemic blood pressure measurement results. SALIH UZUN
EDITOR: WE HAVE READ AND REVIEWED THE ARTICLE ENTITLED
‘‘Short-Term Changes in Choroidal Thickness After Aflibercept Therapy for Neovascular Age-Related Macular Degeneration,’’ by Koizumi and associates, with interest.1 Choroidal thickness (CT) was analyzed in 102 eyes of 102 patients with treatment-naı¨ve neovascular agerelated macular degeneration (AMD) using either sweptsource optical coherence tomography (OCT) or enhanced-depth imaging OCT. All 102 eyes underwent injections of 2.0 mg intravitreal aflibercept for 3 consecutive months: at baseline, month 1, and month 2. The authors demonstrated that the mean baseline subfoveal CT decreased from 252.0 6 99.7 mm to 217.9 6 95.6 mm at month 3, after intravitreal aflibercept injections. In addition, the mean CT measurements done 3 mm away from the foveal center in the superior, inferior, temporal, and nasal directions showed significant reductions. We would like to ask for further details, and contribute to the paper. We realized that the axial length (AL) and intraocular pressure (IOP) measurements of the participants were not analyzed in the study. Axial length and IOP were shown to have significant effects on CT.2 Sanchez-Cano and associates demonstrated a strong negative correlation between subfoveal AL and CT in healthy adults.3 Additionally, Saeedi and associates showed a negative correlation between IOP and mean CT.4 On the other hand, we have anticipated that intravitreal aflibercept injections may affect CT by increasing IOP, since it has already been demonstrated in the literature that aflibercept may significantly increase IOP.5 Therefore, AL and IOP measurements should be taken into consideration while analyzing CT in such studies. Another important issue is the diurnal variation of CT. Usui and associates demonstrated that diurnal variation of CT might be up to 65 mm.6 Therefore it should be expected that physiologic fluctuation of CT might affect test measurement results and statistical analyses. We suggest performing OCT measurements along with preoperative and postoperative follow-up examinations at the same time, and at certain time periods of the day. In addition, various local or systemic physiological/pathologic conditions affect CT.2 We wonder whether the authors evaluated the participants of this study for systemic 0002-9394/$36.00 http://dx.doi.org/10.1016/j.ajo.2016.04.026
©
2016
Ankara, Turkey EMRE PEHLIVAN
Eskisehir, Turkey FUNDING/SUPPORT: NO FUNDING OR GRANT SUPPORT. Financial disclosures: The following authors have no financial disclosures: Salih Uzun and Emre Pehlivan. The authors attest that they meet the current ICMJE criteria for authorship.
REFERENCES
1. Koizumi H, Yamamoto A, Saito M, et al. Short-term changes in choroidal thickness after aflibercept therapy for neovascular age-related macular degeneration. Am J Ophthalmol 2015; 159(4):627–633. 2. Nickla DL, Wallman J. The multifunctional choroid. Prog Retin Eye Res 2010;29(2):144–168. 3. Sanchez-Cano A, Orduna E, Segura F, et al. Choroidal thickness and volume in healthy young white adults and the relationships between them and axial length, ammetropy and sex. Am J Ophthalmol 2014;158(3):574–583.e1. 4. Saeedi O, Pillar A, Jefferys J, et al. Change in choroidal thickness and axial length with change in intraocular pressure after trabeculectomy. Br J Ophthalmol 2014;98(7):976–979. 5. Freund KB, Hoang QV, Saroj N, Thompson D. Intraocular pressure in patients with neovascular age-related macular degeneration receiving intravitreal aflibercept or ranibizumab. Ophthalmology 2015;122(9):1802–1810. 6. Usui S, Ikuno Y, Akiba M, et al. Circadian changes in subfoveal choroidal thickness and the relationship with circulatory factors in healthy subjects. Invest Ophthalmol Vis Sci 2012; 53(4):2300–2307.
REPLY WE THANK DRS UZUN AND PEHLIVAN FOR SHOWING INTER-
est in our paper.1 Unfortunately, the axial length was not evaluated in our study. Therefore, it is not possible to clarify the impact of the axial length on our results. The authors also speculated that the increase in intraocular pressure after aflibercept therapy might decrease the choroidal thickness. The authors cited the paper by Freund and associates2 with respect to the changes in the intraocular pressure during the VIEW (VEGF Trap-Eye:
ELSEVIER INC. ALL
RIGHTS RESERVED.
287