We thank Drs Brijesh and Shorya for their interest in our article, and we welcome this opportunity to address their concerns.
As suggested, we analyzed changes in sectors diagonally opposite. Comparison of mean choroidal thickness for neovascular sectors vs diagonally opposite non-neovascular sectors showed no significance (respectively, 164.89 ± 91.03 μm vs 184.87 ± 101.78 μm, P = .51 at baseline; 146.84 ± 83.96 μm vs 169.89 ± 94.22 μm, P = .33 at month 3; and 145.48 ± 90.5 μm vs 167.88 ± 90.43 μm, P = .29 at month 6). Similarly for most of the sectors, we did not find significant changes between neovascular sectors and diagonally opposite non-neovascular sectors (data not shown).
Analysis of mean sectorial choroidal thickness over time at internal and external sectors in study eyes revealed a significant reduction in neovascular sectors from baseline (164.89 ± 91.03 μm) to month 3 (146.84 ± 83.96 μm, P = .0004) and to month 6 (145.48 ± 90.5 μm, P < .0001), but not between month 3 and month 6 ( P = .64). Similarly, there was a remarkable decrease in mean choroidal thickness for diagonally opposite non-neovascular sectors from baseline (184.87 ± 101.78 μm) at both 3 months (169.89 ± 94.22 μm, P = .0043) and 6 months (167.88 ± 90.43 μm, P = .0007), but not between month 3 and month 6 ( P = .67). These results further strengthen our original hypothesis on hyperpermeability of the exudative choroid rather than shrinkage of the neovascular membrane itself.
Drs Brijesh and Shorya claim that the comparison of choroidal thickness of 2 eyes in the same patient may be error prone because of baseline differences on the bases of 2 recent publications. However, our findings in fellow eyes are in agreement with previous publications: Kim and associates found that in nonexudative age-related macular degeneration (AMD), mean choroidal thickness was 186 μm, while in exudative AMD it was 226 μm. Therefore, we believe that the absence of gross differences gives power to our analysis comparing exudative to nonexudative fellow eyes. Moreover, the paper of Ruiz-Medrano and associates cited by the authors revealed subfoveal choroidal thickness and temporal choroidal thickness not to be different between eyes.
In our study, choroidal thicknesses of study and fellow eyes were significantly different only at baseline owing to exudative AMD. Because of the effect of intravitreal ranibizumab, the analysis of choroidal thickness between study and fellow eyes might be more prone to cause difference error at baseline than during follow-up; however, in our study there was no significant difference at month 3 and month 6.
Further studies are required to confirm our preliminary results.