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To the Editor:
We read with great interest the article by Muftuoglu et al1 entitled “Long-term remission of neovascular age-related macular degeneration with as-needed anti-vascular endothelial growth factor therapy” published in Retina Journal 2017; doi: 10.1097/IAE.0000000000001572.1 The study evaluated the characteristics of the patients with wet age-related macular degeneration with long-term remission (LTR), which was defined as the absence of intraretinal/subretinal fluid or hemorrhage, and absence of leakage on fluorescein angiography for longer than 6 months while on pro re nata anti–vascular endothelial growth factor treatment. The authors concluded that the presence of retinal angiomatous proliferation (RAP), thinner choroidal thickness, more intraretinal fluid (IRF), and less subretinal fluid at presentation were associated with higher likelihood of achieving LTR in patients receiving as-needed treatment for age-related macular degeneration. We would like to address several challenges that have arisen from the study by Muftuoglu et al,1 which can be specifically summarized below.
Altogether, the potentially presumed prognosticators associated with LTR and development of the macular atrophy mentioned by the authors in this series (e.g., RAP, subfoveal thinner choroidal thickness, more IRF, and less subretinal fluid) can not be validated and extrapolated because the multivariate regression analysis was not used to adjust for the baseline differences and to decide which of the predictive factors remained in the end significantly associated with LTR.
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