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Letters to the Editor
January 2019
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optic nerve head, and glaucoma, low‑tension glaucoma and allied disorders. Doc Ophthalmol 1985;59:217‑46. 6. Hayreh SS, Zimmerman B. Visual field abnormalities in nonarteritic anterior ischemic optic neuropathy: Their pattern and prevalence at initial examination. Arch Ophthalmol 2005;123:1554‑62.
Conflicts of interest There are no conflicts of interest
Sohan Singh Hayreh Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa 52242‑1091, USA Correspondence to: Prof. Sohan Singh Hayreh, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242‑1091, USA. E‑mail: sohan‑
[email protected]
References 1. Gandhi U, Chhablani J, Badakere A, Kekunnaya R, Rasheed MA, Goud A, et al. Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema. Indian J Ophthalmol 2018;66:1144‑8. 2. Hayreh SS. Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol 1974;58:955‑63. 3. Hayreh SS. Ischemic Optic Neuropathies. Heidelberg: Springer‑Verlag; 2011. p. 265‑424. 4. Hayreh SS. Scientific literature and gospel truth. Indian J Ophthalmol 2000;48:93‑9. 5. Hayreh SS. Inter‑individual variation in blood supply of the optic nerve head. Its importance in various ischemic disorders of the
Response to comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema Sir, We thank Dr. Hayreh for his comments[1] on our study[2] and fully appreciate his volume of work and expertise on this subject. Regarding some of the points raised – we agree that fundus fluorescein angiography (FFA) findings in non‑arteritic anterior ischemic optic neuropathy (NAION) have been extensively reported and would like to explain that this study was not designed to compare optical coherence tomography angiography (OCT‑A) with FFA or any other modality. It was aimed at trying to analyze the results of OCT‑A in NAION, since it is a relatively new modality and a little is known about its utility in this disorder. Hence, we wish to clarify that we do not propose any new hypothesis regarding the pathophsiology of NAION based on this study, it would be very premature to do so since the technology and our understanding of OCT‑A is still evolving. We do not claim to be the first to describe these findings and there are other
7. Hayreh SS. Pathogenesis of oedema of the optic disc (papilloedema). A preliminary report. Br J Ophthalmol 1964;48:522‑43. 8. Briggs G. Ophthalmographia, Sive Oculi Ejusque Partium Descriptio Anatomica. Foan, Hayes, Celeberrimae, Cantab; 1676. p. 28. This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/ijo.IJO_1308_18 PMID: ***
Cite this article as: Hayreh SS. Comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema. Indian J Ophthalmol 2019;67:176-7. © 2018 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
studies which have tried to use OCT‑A to delve deeper into the pathology of this disease[3-5] and we have cited them in the original article as well. Visual fields are routinely tested using the Humphrey perimeter in everyday clinical practice and most studies on NAION[6] use this investigative modality. While we realize the inherent limitations of automated perimetry, we have described our visual field testing results based on the investigative modality available to us for routine use. The terminology used to describe the vascular beds has been used in reference with the OCT‑A and has been described in the methodology. Again, we thank Dr. Hayreh for his interest in our article. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Uppal Gandhi, Jay Chhablani1, Preeti P Chhablani Neuro-Ophthalmology Services, 1Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, L.V. Prasad Marg, Banjara Hills, Hyderabad, Telangana, India
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Correspondence to: Dr. Preeti P Chhablani, Neuro‑Ophthalmology Service, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad ‑ 500 034, India. E‑mail:
[email protected]
Volume 67 Issue 1
Keyl PM, et al. Ischemic Optic Neuropathy Decompression Trial Research Group. Visual fields at follow‑up in the ischemic optic neuropathy decompression trial: Evaluation of change in pattern defect and severity over time. Ophthalmology 2008;115:1809‑17.
References 1. Hayreh SS. Comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema. Indian J Ophthalmol 2019;67:176-7. 2. Gandhi U, Chhablani J, Badakere A, Kekunnaya R, Rasheed MA, Goud A, et al. Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema. Indian J Ophthalmol 2018;66:1144‑8.
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Access this article online Quick Response Code:
3. Sharma S, Ang M, Najjar RP, Sng C, Cheung CY, Rukmini AV, et al. Optical coherence tomography angiography in acute non‑arteritic anterior ischaemic optic neuropathy. Br J Ophthalmol 2017;101:1045‑51.
Website: www.ijo.in DOI: 10.4103/ijo.IJO_1771_18
4. Wright Mayes E, Cole ED, Dang S, Novais EA, Vuong L, Mendoza‑Santiesteban C, et al. Optical coherence tomography angiography in nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2017;37:358‑64.
PMID: ***
5. Hata M, Oishi A, Muraoka Y, Miyamoto K, Kawai K, Yokota S, et al. Structural and functional analyses in nonarteritic anterior ischemic optic neuropathy: Optical coherence tomography angiography study. J Neuroophthalmol 2017;37:140‑8.
Cite this article as: Gandhi U, Chhablani J, Chhablani PP. Response to comment on: Optical coherence tomography angiography in acute unilateral nonarteritic anterior ischemic optic neuropathy: A comparison with the fellow eye and with eyes with papilledema. Indian J Ophthalmol 2019;67:177-8.
6. Scherer RW, Feldon SE, Levin L, Langenberg P, Katz J,
© 2018 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Comment on: Dramatic response to intravitreal bevacizumab in hypertensive retinopathy 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.
Ramanuj Samanta Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India Correspondence to: Dr. Ramanuj Samanta, Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh ‑ 249 203, Uttarakhand, India. E‑mail:
[email protected]
References 1. Padhy S, Kumar V. Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy. Indian J Ophthalmol 2018;66:1494‑5. 2. Velez‑Montoya R, Fromow‑Guerra J, Burgos O, Landers MB,
