[A case of peripheral corneal ulcer accompanied by progressive systemic sclerosis]

A 61-year-old woman with progressive systemic sclerosis developed bilateral peripheral corneal ulcer. The corneal lesions were resistant to daily systemic treatment with 15 mg steroid and 50 mg cyclophosphamide. Corneal perforation occurred in her right eye 11 months after the onset of Raynaud's phenomenon and 3 months after the scleritis. Lamellar keratoplasty accompanied with Brown's operation was performed on both eyes. Graft melt and cicatricial corneal opacity developed postoperatively. Removed conjunctival tissue was examined immunohistochemically. HLA-DR protein positive monocytes infiltrated subepithelial tissue, demonstrating that the inflammation of the lesions was in the active stage. Not only perforin but also suppressor/cytotoxic T cell positive reactions were observed, which revealed an involvement of the T cell immune system in the present case.