Drs Hooks and Kupfer suggest that because HSV DNA is found in the corneas of normal persons and of those with chronic nonviral diseases, its presence in ICE specimens is not unexpected. They claim that to establish an etiologic relationship, combined serologic and HSV DNA tests of patients with the ICE syndrome are mandatory. Until then, antiviral treatment proposals are premature.We use the same articles1,2 cited by Drs Hooks and Kupfer to make the following points: (1) the premise that HSV DNA is commonly found in corneal tissues is not supported by that literature; (2) the localization of HSV DNA intraocularly, together with its prevalence in corneas of patients with the ICE syndrome, is significant and supports a role for HSV in the ICE syndrome; and (3) serologic tests do not provide information additional to that yielded by HSV DNA assays in establishing an etiologic relationship.
Alvarado JA, Underwood JL, Murphy CG. Herpes Simplex Virus in Iridocorneal Endothelial Syndrome-Reply. Arch Ophthalmol. 1995;113(10):1227-1228. doi:10.1001/archopht.1995.01100100014007