Immunoglobulin deposition in the cornea after application of autologous serum
P. J. McDonnell, D. J. Schanzlin and N. A. Rao
Doheny Eye Institute, Los Angeles, CA 90033.
A 47-year-old man with a history of multiple corneal allografts for
recurrent herpes simplex keratitis developed a subtotal nonhealing corneal
epithelial defect. The patient was treated with hourly drops of autologous
serum. A ringlike infiltrate was subsequently observed, followed by
reepithelialization of the graft. The patient later suffered allograft
rejection of the cornea and recurrence of the epithelial defect, and a
repeated penetrating keratoplasty was performed. Examination of the excised
button demonstrated a total epithelial defect, changes compatible with
allograft rejection, and, in addition, eosinophilic granular deposits
within the superficial corneal stroma that corresponded to the "immune
ring" observed clinically. Immunoperoxidase staining was positive for IgG,
IgM, IgA, and kappa and lambda light chains. These pathologic changes lend
credence to the hypothesis that the precorneal tear film may be a source of
immunoglobulin that becomes deposited within the stroma.
