PREVENTION OF IMMUNE-MEDIATED CORNEAL GRAFT DESTRUCTION WITH THE ANTILYMPHOCYTE MONOCLONAL-ANTIBODY, CAMPATH-1H

We report a patient with peripheral rheumatoid corneal melting who dev eloped a corneal perforation in one eye requiring tectonic keratoplast y. Nine consecutive corneal grafts were rapidly destroyed despite syst emic immunosuppression with corticosteroid, cyclophosphamide, azathiop rine and cyclosporin A. A rejection episode was observed in one graft before it melted and allograft rejection may have contributed to the d estruction of other grafts. Corneal graft survival was ultimately achi eved by systemic immunosuppression with the anti-lymphocyte monoclonal antibody, CAM-PATH-1H. A single episode of rejection developed in the early post-operative period which was easily reversed by topical cort icosteroid. Corneal melting has not recurred and the graft has now rem ained intact and clear for 24 months. Anti-lymphocyte monoclonal antib odies may therefore provide effective immunosuppression in the treatme nt of refractory ocular disorders.