We agree that in our study KOH sensitivity was low in comparison with studies elsewhere. However, we would like to draw the reader's attention that out of 121 cases that presented early after development of symptoms in the study, 47.1% (n = 58) had small-sized ulcers (<2 mm). Each sample in this group was subjected to culture in our study. Some of these cases yielded inadequate samples, which is the most probable reason for lowered sensitivity in KOH mount. Experience with KOH negativity in this group is similar elsewhere. KOH preparation is undoubtedly the most reliable diagnostic tool in all centers.
We agree to the second point raised in the letter. The limitation was inadequate donor corneas for therapeutic keratoplasty as mentioned in the article.
1. Bharthi MJ, Ramakrishnan R, Meenakshi R, Mittal S, Shivakumar C, Srinivasan M. Microbiological diagnosis of infective keratitis: Comparative evaluation of direct microscopy and culture results Br J Ophthalmol. 2006;90:1271–6