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To the Editor:
We read the article “Intravitreal bevacizumab for proliferative diabetic retinopathy: results from the Pan-American Collaborative Retina Study Group (PACORES) at 24 months of follow-up” by Arevalo et al,1 with great interest. The number of patients on insulin, oral hypoglycemic agents, or both was 30, 23, and 44, respectively, which sums up to 97 patients. But the total number of patients included in the study was only 81. Of the 37 treatment-naive eyes, 18 eyes received “immediate PRP.” However, the authors have not clarified why these 18 cases required immediate panretinal photocoagulation (PRP) after primary intravitreal injection of bevacizumab (IVB). If we presume it to be because of inadequate/suboptimal response to IVB, these cases should have been included for analysis. Thus, in treatment-naive eyes, those who required additional treatment are 18 + 11 = 29 of 37 (78.37%). These 18 eyes have not been included by the authors for analysis. This could give us a biased result that the number of eyes requiring additional treatment is only 57.8% (11 of 19). Also, we believe that a separate subgroup analysis of these 18 cases which required immediate PRP may reveal certain clinical characteristics which can guide us in deciding between IVB and PRP at the time of presentation. The article states that 3 treatment-naive eyes (without previous PRP) avoided vitreoretinal surgery. However, the authors did not clarify whether these patients were treated only with IVB or IVB with PRP. If they were treated with IVB and PRP, the avoidance of a vitreoretinal surgery cannot be attributed to IVB alone.
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