Sir,

We experienced a rare case of acute corneal perforation following sterile corneal ulcer in chronic graft-versus-host disease (cGVHD) after bone marrow transplantation. The patient was a 53-year-old Japanese man who underwent allogenic BMT because of non-Hodgkin's lymphoma. Three years after BMT, a small corneal ulcer was developed at the paracentral region of the lower cornea, which progressed to sterile corneal perforation just 4 days after that examination. Subsequent lamellar keratoplasty (LKP) was failed by corneal melting and subsequently penetrating keratoplasty (PKP) was performed. Immunohistochemical study detected CD8-positive cells, but no CD4- and CD19-positive cells in both the lammellar graft and host corneal stroma, suggestive of immune reaction involving cGVHD. Sterile corneal perforation may be rare but should be noted as a severe complication after BMT. This case serves as a reminder that even the paracentral part of cornea might be target in BMT patients.

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