Nonspecific mitogen responses of peripheral lymphocytes in levamisole-treated patients with herpetic stromal keratitis.

For the purpose of determining the effect of levamisole on cell-mediated immunity of patients with herpetic stromal keratitis, the response of peripheral lymphocytes to three mitogens (PHA, Con A and PWM) was examined in a total of 19 cases of herpetic stromal keratitis (16 effective cases) including 12 patients undergoing levamisole administration. As controls, a similar study was made on 35 healthy individuals without any ocular disease and on 19 patients with herpetic stromal keratitis who underwent steroid therapy. The response of lymphocytes to the three types of mitogens in cases undergoing levamisole therapy did not show any significant difference from that of healthy individuals. The response of peripheral lymphocytes to PHA and Con A in cases more than 7 months after cessation d levamisole administration and in cases undergoing steroid therapy was significantly elevated when compared with that of healthy cases. These results suggest that levamisole posseses the action of modulating the function of chiefly T-cells among the lymphocytes, through which it is effective against herpetic stromal keratitis. INTRODUCTION SUBJECTS 813 Corticosteroids in combination with antiviral drug have been recommended in treating herpetic stromal keratitis, but complete control is not achieved in all cases. Levamisole, an immunomodulating drug, has recently been reported to be effective for this condition5 7l, but the mechanism by which levamisole exerts its therapeutic effect has not been completeley elucidated. The present investigation was carried out to evaluate the effect of levamisole on the cellular immune response of peripheral lymphocytes of patients with herpetic stromal keratitis. A total of 19 patients with herpetic stromal keratitis composed of 12 patients undergoing levamisole therapy and 7 cases more than 7 months after cessation of levamisole treatment were examined. Of these patients, 13 were diagnosed as a type of disciform keratitis, 2 as localized parenchymatous keratitis, 2 as diffuse parenchymatous keratitis, 1 as keratouveitis and 1 as corneal deep ulcer. The age of the patients ranged from 22 to 68 years with an average of 39. 3 years. In 9 of 19 patients, mitogen reponses were pairly measured at the pretreatment stage and during treatment. 16 (84%) *> t&EBJ.t:Jtr:, 13 0-1 ~. J.!I$f9~~. 3¥JllM=, "EEBJWA : ~~W~/~""'1L--""'7-.,f,1rr0) mitogen response ~;:_"JI, '--C Reprint request: Hiroshi Sakata, M. D. Department 0£ Ophthalmology Hiroshima University School 0£ Medicine 1-2-3 Kasumi Hiroshima 734 Japan 814 H. Sakata et al. of 19 patients, so far with stromal keratitis, responded to levamisole therapy. Levamisole at dose of 100 mg was given orally three consecutive days every week until keratitis disappeared, and once every week for three months after corneal inflammation became inactive. As controls, a similar study was made on 35 healthy individuals (mean age of 41. 5 years and age range from 21 to 64 years), and on 19 patients with herpetic stromal keratitis who were receiving steroid therapy (mean age 44. 4 years and age range from 21 to 64 years).