Dear Editor,
We went through the article titled “Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders” by Ercan et al.[1] The authors have done a good study and described the choroidal vascularity index (CVI) changes in patients with vitreoretinal interface disorders following phacovitrectomy. We have a few observations and queries for the authors. Patients with diabetes and hypertension were included in the study along with patients without any systemic disorders. Systemic hypertension is associated with significant changes in the choroidal structure and a decrease in CVI.[2] This can be caused by arteriolar sclerosis and vascular contraction produced by high intravascular pressure within the choroid. Similarly, diabetes mellitus has been reported to be associated with reduced CVI even in patients without clinically evident diabetic retinopathy.[3] Reduced CVI levels in diabetes mellitus patients without retinopathy may indicate a subclinical dysfunction in such patients.
Both diabetes mellitus and systemic hypertension are confounding factors in the present study. It would have been much better if these patients were excluded from the study. The authors have not performed regression analysis to study the possible effects of both these disorders on CVI. We would also like to draw the attention of the authors to the methodology where they have mentioned the diameter of the full-thickness macular holes in millimeters (mm). This should be expressed in microns (mm). In the discussion section, the authors mentioned that the median baseline CVI values in the epiretinal membrane (ERM) and macular hole groups were 66.10 and 65.52, respectively. However, in the accompanying table, baseline median CVI values have been mentioned as 65.90 and 65.59 in the ERM and macular hole groups, respectively. The authors have also mentioned that there was no change in CVI in the fellow healthy eye following surgery. However, the median CVI in the fellow eye of the ERM group was reduced from 66.90 before surgery to 66.20 after surgery. It will be beneficial for the readers if the authors can explain what was the possible cause of the slight reduction in CVI in the fellow eyes of the ERM group.
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References
- 1.Ercan ZE, Gokgoz G, Yilmaz G. Choroidal vascularity index changes with phacovitrectomy for vitreoretinal interface disorders. Indian J Ophthalmol. 2022;70:2998–3001. doi: 10.4103/ijo.IJO_440_22. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Aşıkgarip N, Temel E, Kıvrak A, Örnek K. Choroidal structural changes and choroidal vascularity index in patients with systemic hypertension. Eur J Ophthalmol. 2022;32:2427–32. doi: 10.1177/11206721211035615. [DOI] [PubMed] [Google Scholar]
- 3.Aksoy M, Simsek M, Apaydın M. Choroidal vascularity index in patients with type-1 diabetes mellitus without diabetic retinopathy. Curr Eye Res. 2021;46:865–70. doi: 10.1080/02713683.2020.1846755. [DOI] [PubMed] [Google Scholar]