Clinical analysis of the treatment for refractory Mooren's ulcer combined with necroscleritis

Abstract

Objective To evaluate the efficacy of using immunosuppressive agents and surgery for refractory Mooren's ulcer combined with necroscleritis.Methods In a retrospective study,7 patients who were diagnosed with refractory Mooren's ulcer combined with necroscleritis between January 2004 and July 2011 at Shandong Eye Hospital were included.The treatment for the patients was determined by the following principles:first,oral cyclosporin A and prednisone were administered for half a year based on the condition,glucocoreicoid eye drops and cyclosporin A eye drops were used four times daily and reduced according to the condition; second,when the corneal ulcer area was smaller than half the area of the cornea,lamellar keratoplasty was performed; and when the area of the scleral necrosis was less than 1/4 quadrant,scleral neoplasty was performed; the remaining patients underwent conjunctival flap surgery.Patients were followed up twice a month for 3 months,once a month for 1 year and every two months thereafter.Results Three eyes were treated with conjunctival flap,and these 3 eyes recovered ocular surface stabilization.No recurrence was observed in these 3 patients during the follow-up period.The other 4 eyes were treated by lamellar keratoplasty combined with scleral neoplasty.In these patients,recurrence was discovered in 1 patient who had stopped using the systemic drugs.Scleral neoplasty was performed again on this patient,and postoperative medications were continued.No recurrence was observed.No significant complications related to drug use were observed in any patient during the study period.Conclusion The treatment of immunosuppresive agents and surgery are effective in patients with refractory Mooren's ulcer combined with necroscleritis.Using systemic and partial immunosuppresive agents can effectively decrease the incidence of recurrence. Key words: Mooren's ulcer; Necroscleritis; Ophthalmologic surgical procedures; Immunosuppressive agents