VOL. 96, NO. 4 CORRESPONDENCE 557

include 15 patients, all of whom showed angiographie evidence of having had cystoid macular edema for six months to one year.

We hope that the publication of our initial results will lead others to conduct similar studies that include the neces­sary angiographie documentation. We would like to enlarge our study and con­tinue it for at least one year before pub­lishing our findings.

LEEDS E. KATZEN, M.D. JAMES A. FLEISCHMAN, M.D.

Baltimore, Maryland STEPHEN TROKEL, M.D.

New York, New York

Corneal Transplantation for Herpes Simplex Keratitis

EDITOR: In their article, "Corneal transplanta­

tion for herpes simplex keratitis" (Am. J. Ophthalmol. 95:645, May 1983), E. J. Cohen, P. R. Laibson, and J. J. Arentsen reported that approximately 8.5% of the penetrating keratoplasties performed each year at the Wills Eye Hospital are done because of herpes. This incidence agreed well with that at my clinic: in a series of 1,061 penetrat­ing keratoplasties performed between 1975 and 1979, 99 corneal grafts (9%) were done because of herpes.1

I agree with Cohen and associates that, "When comparing reports, it is necessary to consider the state of the herpetic disease at the time of corneal transplantation." However, their state­ment that "herpes simplex keratitis was inactive at the time of corneal transplan­tation" needs clarification. In another series of keratoplasties, my colleagues and I2 found some interesting discrepan­cies between the clinical and the histo-pathologic findings. Of 66 quiet eyes with corneal scars interpreted clinically as "inactive," we found that 16 had defi­

nite evidence of lymphocytic infiltration indicating chronic keratitis. Thus, I would appreciate knowing the histo-pathologic findings in the 100 "inactive" cases reported by Cohen and associates. This information would be useful in comparing the results of various reports, because the clinical impression of inac­tive keratitis is not completely reliable.

Also, the incidence of granulomatous reaction to Descemet's membrane would be of interest. This entity can often be recognized clinically, may pre­cede corneal perforation, and is an indi­cation for penet ra t ing keratoplasty.1'5

G. O. H. NAUMANN, M.D. Erlangen-Niirnberg, West Germany

REFERENCES 1. Kortum, G. F., Seibel, W., Volcker, H. E.,

and Naumann, G. O. H.: Zur Klinik der granulomatösen Reaktion gegen Descemet'sche Membran. In Sundmacher, R. (ed.): Herpetic Eye Disease. Munich, J. F. Bergmann Verlag, 1981, pp. 163-166.

2. Knöbel, H., Hinzpeter, E. N., and Naumann, G. O. H.: Keratoplastik bei Herpes corneae, Verleich zwischen klinischem und histologischem Befund an 100 Augen. In Sundmacher, R. (ed.): Herpetic Eye Disease. Munich, J. F. Bergmann Verlag, 1981, pp. 431-434.

3. Green, W. R., and Zimmerman, L. E.: Granu­lomatous reaction to Descemet's membrane. Am. J. Ophthalmol. 64:555, 1967.

4. Zimmerman, L. Ε. : New concepts in pathology of the cornea. In King, R. J., and McTigue, J. W. (eds.): The Cornea World Congress. London, Butter-worth, 1965, pp. 30-48.

5. Vogel, M. H., and Naumann, G. O. H.: Die granulomatöse Reaktion gegen die Descemet'sche Membran. Ber. Zusammenkunft Dtsch. Ophthalmol. Ges. 71:35, 1970.

Reply EDITOR:

We defined inactive disease on a clin­ical basis. Patients who had inactive herpes simplex keratitis were those who had quiet eyes with no evidence of con-junctival injection or anterior chamber reaction. We agree with Dr. Naumann's observation that eyes that clinically ap-