Abstract
BackgroundMooren’s ulcer is a severe ulcerative inflammation of the cornea. The exact pathogenesis remains unclear. Therefore many therapies of Mooren’s ulcer are recommended in literature. To shed more light on the ongoing question of optimal treatment of severe progressive Mooren’s ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane transplantation.MethodsMedical records from seven patients (eleven eyes), 4 male and 3 female, with severe progressive Mooren’s ulcer were analysed retrospectively. The mean follow up was 88.4 ± 80.8 months (range 12–232 month). A HLA-typing was performed in all patients. A systemic immunosuppressive therapy was administered in all patients. The amniotic membrane was transplanted after the base of the ulcer was resected.ResultsMultiple amniotic membrane transplantations were necessary in six patients. The visual outcome of all patients was poor. No patient achieved a visual acuity better than 20/630 Snellen chart. Five patients were positive for HLA-DQ2 and four patients were positive for HLA-DR17(3).ConclusionsThe aggressive and highly inflammatory form of Mooren’s ulcer is difficult to treat and the progression of the disease is hard to influence positively even under systemic immunosuppressive therapy. Therefore, the main intention of therapy is to achieve a stable epithelialized corneal surface without the risk of perforation. Amniotic membrane transplantation is not able to cure severe forms of Mooren’s ulcer. However it supports the immunosuppressive therapy in acute situations as in critical corneal thinning.
Highlights
Mooren’s ulcer is a severe ulcerative inflammation of the cornea
One eye was affected by severe aggressive Mooren’s ulcer with large deep ulcerations, the other eye was not affected in three cases, and only mild affected in the other three cases, respectively
Five patients were treated with intravenous cyclophosphamide as pulsetherapy and 2 patients with ciclosporin A orally as continuous therapy under drug monitoring
Summary
Mooren’s ulcer is a severe ulcerative inflammation of the cornea. Many therapies of Mooren’s ulcer are recommended in literature. To shed more light on the ongoing question of optimal treatment of severe progressive Mooren’s ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane transplantation. Mooren’s ulcer is a severe ulcerative, uni- or bilateral inflammation of the cornea. The inflammation starts in the peripheral cornea and the ulcer enlarges centrally and circumferentially – commonly associated with severe ocular pain. In late stages of the disease the destruction of the peripheral corneal stroma results in a conjunctivalized descemet membrane and in some cases corneal perforations occur. Taylor and coworkers identified an association of HLADR17(3) and HLA-DQ2 to Mooren’s ulceration [6]
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