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Peter J. McDonnell, MD; David J. Schanzlin, MD; Narsing A. Rao, MD

Arch Ophthalmol. 1988;106(10):1423-1425.

Abstract
• 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 and 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.

Author Affiliations
From the Doheny Eye Institute and the University of Southern California School of Medicine, Los Angeles (Drs McDonnell and Rao); and the Bethesda Eye Institute, St Louis University (Dr Schanzlin).

Footnotes
Accepted for publication July 8, 1988.

Reprint requests to Doheny Eye Institute, 1355 San Pablo St, Los Angeles, CA 90033 (Dr McDonnell).

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