We thank Epstein and colleagues for their valuable comment. As we showedin our study, there was a statistically significant thickening in centralcorneal thickness in patients with low endothelial cell counts after a 24-hourapplication of dorzolamide hydrochloride. However, the corneal thickeningof 12 µm is probably not clinically relevant. We agree that with prolongeddorzolamide treatment, the cornea may show a further increase in thickness.On the other hand, as we mentioned in the "Comment" section of our article,it is also possible that the corneal thickness would not increase any furtheror possibly even return to baseline thickness as a result of counterregulatoryprocesses on the cellular level. We simply cannot say from our data. To answerthis question, we are currently carrying out a trial with a similar studydesign but with long-term application of dorzolamide in patients with a lowendothelial cell count.
Findl O, Wirtitsch M, Kiss B, Petternel V, Heinzl H, Drexler W. Endothelial Changes Associated With Topical Dorzolamide Do Appear toBe Significant—Reply. Arch Ophthalmol. 2004;122(7):1090. doi:10.1001/archopht.122.7.1090-a