We thank Professor Hammes for his comments relating to our CME article in Deutsches Ärzteblatt. We wish to address the individual items one by one, as follows:
- Unfortunately there are no data for Germany. The data we presented come from large, partly prospective studies from the US.
- The authors refer to control/monitoring of diabetic retinopathy, not that of blood glucose, even if those two factors are not mutually independent. The decisive factor is not the blood glucose concentration before pregnancy but the extent of diabetic retinopathy. This was what we described in the article. The studies further mention the need for blood glucose monitoring as a separate risk factor. Professor Hammes rightly points out that if this was taken at face value, all patients receiving intensified conventional treatment (ICT) had an increased risk. However, this should always been seen in the total context and relate primarily to the extent of retinopathy before or at the start of pregnancy.
- Professor Hammes is completely right in this point: the VEGF inhibitors are not licensed for the treatment of proliferative diabetic retinopathy. We commented on the treatment of diabetic macular edema. This is usually not required during pregnancy. Our comments relate to the use of VEGF inhibitors in other indications with acute risk to visual acuity (for example myopic neovascularization of the macula). The use of these substances will need to be decided on an individual basis in this setting.
- The recommended control examination after a year (according to the guidelines of the American Diabetes Association) is suggested in settings where no other, closer control intervals are adhered to because of the retinopathy. The article explains this in a way that may give rise to misunderstandings. We thank Professor Hammes for pointing this out
PD Dr. med. Friederike Mackensen
PD Dr. med. Thomas Ness
Klinik für Augenheilkunde, Universitätsklinikum Freiburg
Conflict of interest statement
PD Dr. Mackensen has served as a paid consultant for Merck Serono and has received payment for continuing medical education events from Heidelberg Engineering.
PD Dr. Ness has served as a paid consultant for Abbvie. He has received reimbursement of meeting participation fees and travel and accommodation expenses from Bayer Health Care, as well as payment for continuing medical education events form Abbvie and Novartis and for the performance of clinical trials on behalf of Novartis, Santen, Abbvie, Sanofi, Allergan, and pSivida corp.
|1.||Mackensen F, Paulus WE, Max R, Ness T: Ocular changes during pregnancy. Dtsch Arztebl Int 2014; 111: 567–76. VOLLTEXT|