Response to comment on: Dramatic response to intravitreal Bevacizumab in hypertensive retinopathy

Sir, We would like to thank the authors for their interest in the article[1] and valuable comments.[2] Point wise response to the author’s queries is as follows: 1. We agree that the decrease in blood pressure could have attributed to the decrease in subfoveal fluid in the fellow eye. However, the decrease in the intraretinal and subfoveal fluid in both the eyes was noted at one‐week post injection itself while patient was still under treatment for control of blood pressure. It is therefore unlikely that blood pressure could have attributed to the decrease in subfoveal fluid in the fellow eye. The patient did not undergo any interventions to control the BP including haemodialysis. 2. We thank the authors for pointing out the typographical error. MAP is 163 mm of Hg and not 136 mm of Hg. We regret the typographical error. 3. We agree with the author that the adequate control of hypertension is the most important intervention in hypertensive retinopathy, which we have also emphasized in our report. The patient in this report was a known case of IgA nephropathy and was having labile hypertension. The prompt hypertensive control may not be feasible in these cases. The persisting edema and exudation may result in permanent visual loss in such cases. Intravitreal Bevacizumab, by decreasing intra and subretinal fluid, may thus provide a longer window for adequate control of blood pressure. It also allows early visual rehabilitation. As mentioned by authors, the endophthalmitis after Bevacizumab is rare. The reported risk of endophthalmitis after intravitreal Bevacizumab in United States and India is (0.056% and 0.08% respectively).[3,4] In fact Gonzalez et al. recently pointed out that infectious endophthalmitis cases occurring after the intravitreal injection of Bevacizumab is not the result of the drug or the injection technique, but rather of the compounding procedures.[5] All recommended procedures are meticulously followed at our institute for preparation of Bevacizumab aliquots. Thus the patients who are likely to benefit from this drug should not be kept devoid of this treatment in view of this rare side effect.