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Abstract

We thank Chiang and Tsai for their interest in our study. They suggest that the 3 cases of immune ring formation described in our study may have been a result of herpes simplex stromal keratitis rather than cytomegalovirus (CMV). 1 Chee S.P. Jap A. Immune ring formation associated with cytomegalovirus endotheliitis. Am J Ophthalmol. 2011; 152: 449-453 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar We agree that it may be clinically difficult to distinguish between different viral entities; hence, testing for viral DNA is necessary. We adhere to a stringent clinical protocol in our uveitis clinic at the Singapore National Eye Centre in which every patient suspected of having viral uveitis initially undergoes aqueous analysis for herpes simplex virus, varicella zoster virus, and CMV by polymerase chain reaction, as stated in the Methods section of our article. If the results were positive for CMV, the viral load then was determined by real-time polymerase chain reaction. These 3 patients demonstrated positive results only for CMV, and demonstrated negative results for herpes simplex virus and varicella zoster virus. Immune Ring Formation Associated with Cytomegalovirus EndotheliitisAmerican Journal of OphthalmologyVol. 154Issue 2PreviewWe read with great interest the article “Immune Ring Formation Associated with Cytomegalovirus Endotheliitis,” by Chee and associates.1 In their series of 72 cases of cytomegalovirus (CMV) infection, they found corneal immune rings (IR) in 3 CMV endotheliitis cases. Although the IR often is related to herpes simplex stromal keratitis, they suggested that their cases with IR were caused by the CMV infection. Their diagnosis was based on DNA of CMV detected in the aqueous by real-time polymerase chain reaction, not on the direct histopathologic evidence of CMV particles or antigen in the corneal tissue. Full-Text PDF