We thank Drs Uzun and Pehlivan for showing interest in our paper. Unfortunately, the axial length was not evaluated in our study. Therefore, it is not possible to clarify the impact of the axial length on our results. The authors also speculated that the increase in intraocular pressure after aflibercept therapy might decrease the choroidal thickness. The authors cited the paper by Freund and associates with respect to the changes in the intraocular pressure during the VIEW (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet Age-related Macular Degeneration) trials; however, in that paper, the mean intraocular pressure did not increase in all aflibercept groups. Accordingly, the authors’ speculation seems not to be supported.
Numerous systemic and local factors might influence the choroidal thickness and its changes. Of note, the authors pointed out that the diurnal variation in choroidal thickness should have been considered. We totally agree with this matter, while noting that the macular choroidal volumes reportedly remained at nearly stable values during office hours (9 AM to 6 PM). Finally, some of our patients had systemic diseases such as diabetes and hypertension, which might affect the choroidal thickness. Regardless of such influential factors, many recent reports have confirmed our results.
Again, we appreciate the insightful and valuable comments from Drs Uzun and Pehlivan. Further studies are needed to elucidate the clinical significance of the decreased choroidal thickness after aflibercept therapy in eyes with neovascular age-related macular degeneration.