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Letter to the Editor
Comment on: Diagnostic vitrectomy: A case series in a single referral center
Comentario al artículo «Vitrectomía diagnóstica: serie de casos en un centro de referencia»
C. Faua,
Corresponding author
chfauf@gmail.com

Corresponding author.
, S. Nabzoa, V. Nasabunb
a Fundación Oftalmológica 2020, Iberoamerican Cochrane Network, Santiago, Chile
b Universidad Andrés Bello, Santiago, Chile
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In the previous issue&#44; Dr&#46; Alba-Linero et al&#46; published the article titled &#171;Diagnostic vitrectomy&#58; a case series in a single referral center&#187;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; which we have read and would like to share some comments&#44; shown below&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The article exhibits some inconsistencies&#58; 1&#41; the methodology section states that patients had a diagnostic of &#171;panuveitis of unknown origin&#187; although the description of results indicates that only 16 eyes had anterior chamber inflammation and 31 eyes had vitreous haze&#59; 2&#41; the age description states that the minimum age was 44 years&#44; although the table in page 532 indicates that the patient with the lowest age was 39&#59; 3&#41; figure 1 indicates that the images correspond to an African race male patient age 42 but the table in page 532 does not include any patient with these characteristics&#59; 4&#41; the description of comorbidities is not clear in relation to the table of page 531&#59; 5&#41; the amount of cytology&#44; PCR and culture techniques described in the text and in the table of page 534 do not match those reported in the table of page 532&#44; which shows a lower number&#59; 6&#41; the table of page 534 indicates 3 eyes with a diagnostic of amyloidosis although the table of page 532 indicates 4 patients with said disease&#44; i&#46;e&#46;&#44; patients number 2&#44; 13 and 29&#44; while the table of page 524 indicates 22 neoplasia cases and the table on page 532 indicates 21&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In the statistical analysis&#44; mean visual acuity was 20&#47;40&#44; although this result excludes 8 patients with visual acuity under 20&#47;200&#44; and this is a problem because there is no reason for this and it gives rise to a biased estimate&#46; The article does not make a clear comparison between conditions before and after vitrectomy&#59; apparently&#44; some improvements in inflammation could have occurred but pressure could have increased&#46; In addition&#44; referring to visual acuity the article states that &#171;most of visual deterioration was due to vitreous occupation&#187;&#44; but it is not possible to determine if this occurred due to the evolution of the disease or as the result of vitrectomy&#46; The author does not explain the reasons why it was not possible to establish the cause of the disease in a patient with bilateral disease &#40;14&#41; and&#44; taking into account that the sample size of the study was small&#44; this patient had an important impact in overall results &#40;5&#46;41&#37;&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Finally&#44; the author commits a recurring statistical error&#46; Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> estimate that this error is committed by 19&#37; of articles&#44; and it consists in analyzing eyes instead of patients&#44; i&#46;e&#46;&#44; 37 eyes of 29 patients&#46; Statistically&#44; this generates an inter-eye correlation and usually statistics are based on the assumption that the values of observations are independent in each measured eye&#46; This leads to biased estimators&#46; For this reason&#44; we decided to input the data of page 532 in a Stata 14&#46;2 5 sheet and reanalyze data&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In what concerns the above-mentioned errors&#44; the age we obtained was 62&#46;72 years&#8239;&#177;&#8239;13&#46;92 standard deviation &#40;range&#58; 39&#8211;91 years&#41;&#46; The diagnostic results were calculated on the basis of patients instead of eyes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; producing an infectious cause in 9 patients &#40;27&#46;59&#37;&#41;&#44; an inflammatory cause in 4 patients &#40;13&#46;79&#37;&#41;&#44; a neoplastic cause in 16 patients &#40;55&#46;17&#37;&#41; and unknown in one patient &#40;3&#46;45&#37;&#41;&#46; When comparing these calculations with those of the original article&#44; there is an increase in the representation of infectious and inflammatory causes and a reduction in the neoplastic and unknown causes&#46; This was foreseeable due to the inter-eye correlation because the data obtained from both eyes corresponds to 8 patients &#40;27&#46;59&#37;&#41;&#46; In addition&#44; the authors state in the original article that the etiological diagnostic was obtained in 96&#46;6&#37; of patients&#44; which is a higher value than that reported&#46; However&#44; it is not clear whether these results are applicable to panuveitis or vitritis&#46; The patient with the unknown diagnostic has a lower impact on results&#44; which goes down from 5&#46;41 to 3&#46;45&#37;&#46; Even so&#44; some explanation about the case is necessary&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Carrying out a subgroup analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41; with patients having unilateral and bilateral disease&#44; 52&#46;38&#37; of unilateral cases had a neoplastic disease whereas in bilateral patients this percentage increases to 62&#46;5&#37;&#46; Likewise&#44; in unilateral cases vitrectomy seems to be a main contributor to the diagnostic but in 75&#37; of bilateral cases a diagnostic was not obtained or it was neoplasia&#46; Perhaps it would have been better to obtain said diagnostic in a different manner&#46; In addition&#44; in the discussion the author indicates that visual prognosis was positive 12 months after vitrectomy but that &#8220;most visual impairment was due to the occupation of the vitreous&#8221;&#46; This could be due to dissemination of the disease in neoplastic cases&#44; while visual improvements could be due to improved treatments derived from diagnostic precision in the infectious and inflammatory cases&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have not received funding for this paper&#46;</p></span></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Inflammatory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Neoplastic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Unknown&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
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ISSN: 21735794
Original language: English
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