Re: Staurenghi et al.: Efficacy and safety of ranibizumab 0.5 mg for the treatment of macular edema resulting from uncommon causes: twelve-month findings from PROMETHEUS (Ophthalmology. 2018;125:850-862)

Abstract

We read the article by Staurenghi et al1Staurehghi G. Lai T.Y.Y. Mitchell P. et al.Efficacy and safety of ranibizumab 0.5 mg for the treatment of macular edema resulting from uncommon causes: twelve-month finding from PROMETHUS.Ophthalmology. 2018; 125: 850-862Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar and we applaud their undertaking of a randomized, controlled trial to evaluate the effect of ranibizumab on uncommon causes of macular edema. However, we would like to comment on a few points. Retinitis pigmentosa and central serous retinopathy were mentioned in the exclusion criteria, but were included in the analysis. Both patients with retinitis pigmentosa were in the sham group; there were also differences in the distribution of patients with central serous retinopathy, with more patients in the sham group. Past studies have shown no or variable effect of bevacizumab in these 2 diseases.2Gunther J.B. Altaveel M.M. Bevacizumab for treatment of ocular disease.Surv Ophthalmol. 2009; 54: 372-400Abstract Full Text Full Text PDF PubMed Scopus (108) Google Scholar There were more pseudophakic patients in the treatment group, and past studies have shown higher efficacy of anti-vascular endothelial growth factor in patients with pseudophakic cystoid macular edema.3Guo S. Patel S. Baumrind B. et al.Management of pseudophakic cystoids macular edema.Surv Ophthalmol. 2015; 60: 123-133Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar This might have an effect on the results; however, the authors have not mentioned anything regarding this in the discussion. It is common practice to give a loading dose of 3 anti–vascular endothelial growth factor injections in the majority of clinical trials4The Diabetic Retinopathy Clinical Research NetworkAflibercept, bevacizumab, or ranibizumab for diabetic macular edema.N Engl J Med. 2015; 372: 1193-1203Crossref PubMed Scopus (1075) Google Scholar and proceed with further analysis. However, the authors have chosen a primary end point after baseline injection and a second injection based on evidence of disease activity. The rationale of this decision is not discussed. Although rescue treatment with steroids is mentioned in the Methods, none of the patients received it. The reasons for giving ranibizumab instead of rescue treatment to 2 patients in the sham group are not discussed. In the group with uveitic cystoid macular edema, the mean change in best-corrected visual acuity at 12 months in the sham group is significantly higher than the ranibizumab 0.5 mg group. This result gives us the impression that, if we treat late, we might have better results in the group with uveitic cystoid macular edema. If the authors can share clinical photos, angiography photos, and OCT images, readers would be able to delve deeper into these findings. The authors have stated the importance of a 2.8-letter gain in treatment group being clinically less relevant. We appreciate the authors for conducting a randomized, controlled trial on uncommon causes of macular edema. Their results, especially regarding pattern dystrophy, Coat’s disease, Eales disease, and polypoidal choroidal vasculopathy, are encouraging. Efficacy and Safety of Ranibizumab 0.5 mg for the Treatment of Macular Edema Resulting from Uncommon Causes: Twelve-Month Findings from PROMETHEUSOphthalmologyVol. 125Issue 6PreviewTo evaluate the efficacy and safety of ranibizumab 0.5 mg in adult patients with macular edema (ME) resulting from any cause other than diabetes, retinal vein occlusion, or neovascular age-related macular degeneration. Full-Text PDF Open AccessReplyOphthalmologyVol. 126Issue 6PreviewWe would like to thank Drs Awasthi and Videkar for their interest in our article.1 In this study, we evaluated efficacy and safety of ranibizumab 0.5 mg in adult patients with macular edema (ME) resulting from any cause other than diabetes, retinal vein occlusion, or neovascular age-related macular degeneration. Full-Text PDF