title: Mooren's ulcer and evidence of stromal graft rejection after penetrating keratoplasty.
abstract: A Mooren's ulcer developed in a 6-year-old girl after a penetrating keratoplasty for Peters' anomaly. A destructive, circumferential, and centripetal stromal ulceration recurred despite conjunctival resection, corneal gluing, topical and systemic administration of corticosteroids, and repeat graftings. Results of a systemic and a rheumatologic examination were unremarkable. Histopathologic evaluations of donor grafts consistently disclosed a lymphocytic and a plasma cell infiltrate. Indirect immunofluorescent staining using a normal donor cornea substrate was positive at the level of Bowman's membrane and stroma. The patient's lymphocytes were stimulated by a partially purified bovine corneal antigen and a positive antibody titer was found in the patient's sera to the same corneal antigen. These results suggest humoral and cell-mediated immune mechanisms can be involved in the initiation and perpetuation of a stromal rejection process after penetrating keratoplasty.
authors.affiliation: Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: J D
authors.initials: JD
authors.lastname: Gottsch
authors.forename: S H
authors.initials: SH
authors.lastname: Liu
authors.forename: W J
authors.initials: WJ
authors.lastname: Stark
mesh_terms: D002387:Cataract Extraction; D002648:Child; D003315:Cornea / Q000276:immunology; D003319:Corneal Stroma / Q000276:immunology / Q000473:pathology*; D003320:Corneal Ulcer / Q000209:etiology*; D005136:Eye Proteins / Q000276:immunology; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007634:Keratitis / Q000276:immunology; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008213:Lymphocyte Activation; D012008:Recurrence; D012086:Reoperation
chemical_list: D005136:Eye Proteins