We are grateful to Dr Alfonso for his comments. Reynolds and Alfonso1 highlight the importance of cryotherapy, lamellar or penetrating corneoscleral grafts, in addition to antimicrobial treatment in infectious keratoscleritis.Surgery did indeed play a major role in our patients.2 In 11 patients, seven had full-thickness penetrating keratoplasties either for incipient or frank perforation or to control overwhelming infection. A graft would have been performed in another patient had he not declined. Three patients required further grafts since infection failed to be eradicated. These were three fungal cases in which an initial graft was necessary for frank perforation but before adequate antifungal therapy. The chronicity of these fungal cases was particularly troublesome, and as we point out,2 viable fungal elements were still present in tissue from two patients despite grafting and 3 and 6 months antifungal treatment, respectively.We received communication from several ophthalmologists with
Moriarty AP, Crawford GJ, McAllister IL, Constable IJ. Surgical Intervention in Infectious Keratoscleritis-Reply. Arch Ophthalmol. 1994;112(8):1017–1018. doi:10.1001/archopht.1994.01090200019006
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