Successful visual rehabilitation with penetrating keratoplasty and doughnut amniotic membrane transplant for corneal scarring in advanced Mooren's ulcer

Purpose To report the association of conjunctival peritomy with amniotic membrane transplantation (AMT) at the limbus with the exclusion of the central cornea in order to preserve visual function in one case of bilateral Mooren's ulcer. Methods A 36-year-old man with bilateral Mooren's ulcer was unresponsive to conventional therapy. Surgical procedure was performed on his right eye, at impending risk of corneal perforation. A 20 × 20 mm piece of amniotic membrane (AM) was prepared by performing a central hole of 7.5 mm diameter with a manual trephine. A 360° conjunctival peritomy was performed and the AM was placed with the epithelium side facing up and the central hole was sutured on the paracentral cornea. Results Two weeks after surgery, while the right eye showed improvement of signs and symptoms and unchanged best-corrected visual acuity (BCVA), the left eye showed a peripheral corneal perforation with prolapsed iris that required conjunctival flap. At 7 months of follow-up, the right eye showed no ocular inflammation, a reduction of the lipid-like peripheral corneal infiltrates, an increased stromal thickness, and an unchanged BCVA. The progression of corneal thinning in the left eye led the authors to perform AMT (as described) in the left eye as well. Five months after the AMT in the left eye, neither eye shows signs of disease progression, and neither requires further therapy. Conclusions Conjunctival peritomy associated with AMT may be an alternative surgical approach in the management of Mooren's ulcers to control the inflammation and the progression of disease.

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Relapsing Mooren's ulcer after amniotic membrane transplantation combined with conjunctival autografting*1

Ophthalmology ◽

10.1016/j.ophtha.2003.06.024 ◽

2004 ◽

Vol 111 (4) ◽

pp. 792-795 ◽

Cited By ~ 12

Author(s):

K CHEN

Keyword(s):

Amniotic Membrane ◽

Amniotic Membrane Transplantation ◽

Mooren’S Ulcer ◽

Mooren's Ulcer ◽

Conjunctival Autografting

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Bilateral Boston keratoprosthesis type 1 in a case of severe Mooren’s ulcer

European Journal of Ophthalmology ◽

10.1177/1120672120909768 ◽

2020 ◽

pp. 112067212090976

Author(s):

Marta Jerez-Peña ◽

Borja Salvador-Culla ◽

María F de la Paz ◽

Rafael I Barraquer

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Penetrating Keratoplasty ◽

Hand Movement ◽

Amniotic Membrane Transplantation ◽

Eye Drops ◽

Boston Keratoprosthesis ◽

Mooren’S Ulcer ◽

Mooren's Ulcer

Introduction: Mooren’s ulcer is a painful, inflammatory chronic keratitis that affects corneal periphery, progressing centripetally, ultimately ending in perforation. The first line of treatment includes systemic immunomodulators, with surgery being the last option. We present a case of bilateral Boston keratoprosthesis implantation for severe Mooren’s ulcer that responded differently in each eye. Clinical case: A 32-year-old male with corneal opacification, anterior staphylomas, vision of hand movement, was started on systemic immunosuppression with cyclosporine. After two failed penetrating keratoplasties in each eye, high intraocular pressure despite diode cyclophotocoagulation, and cystic macular edema, we performed Boston keratoprosthesis type 1 in both eyes. The right eye responded initially well, with a best-corrected visual acuity of 20/80 and normal intraocular pressure. The left eye presented high intraocular pressure, which required cyclophotocoagulation, ultimately resulting in hypotony. Boston keratoprosthesis was performed but had peripheral corneal necrosis that progressed despite amniotic membrane transplantation and aggressive intensive treatment with medroxyprogesterone, autologous platelet-rich-in-growth-factors eye drops, and oral doxycycline. Thus, replacement of the semi-exposed Boston keratoprosthesis with tectonic penetrating keratoplasty was necessary. However, both eyes developed phthisis bulbi with final visual acuity of perception of light with poor localization. Conclusion: Mainstay treatment of Mooren’s ulcer is systemic immunomodulation. Surgical treatment must be considered only when risk of perforation, preferably with inflammation under control. Penetrating keratoplasty frequently fails, and Boston keratoprosthesis may be a viable option. However, postoperative complications, especially uncontrolled high intraocular pressure, corneal necrosis, and recurrence of Mooren’s ulcer may jeopardize the outcomes and need to be addressed promptly with intensive topical and systemic treatment.

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Use of amniotic membrane and autologous serum eye drops in Mooren’s ulcer

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v5i1.7839 ◽

2013 ◽

Vol 5 (1) ◽

pp. 120-123 ◽

Cited By ~ 2

Author(s):

P Lavaju ◽

M Sharma ◽

A Sharma ◽

S Chettri

Keyword(s):

Amniotic Membrane ◽

Autologous Serum ◽

Amniotic Membrane Transplantation ◽

Topical Steroids ◽

Eye Drops ◽

Cyanoacrylate Glue ◽

Mooren’S Ulcer ◽

The Right ◽

Mooren's Ulcer ◽

Serum Eye Drops

Introduction: The management of Mooren’s ulcer can be a challenge for clinicians. Objective: To report a case of Mooren’s ulcer treated with amniotic membrane transplantation supplemented with autologous serum eye drops. Case report: A 22-year-old male presented with history of pain, redness, watering and diminution of vision of the right eye for one year. Examination of his eyes revealed the best corrected visual acuity ( BCVA) of 6\60 and 6\6 in his right and left eyes respectively. Slit -lamp examination of the right eye showed a peripheral ulcer extending from 2’0 to 11’0 clock positions with peripheral thinning and the features suggestive of Mooren’s ulcer. The condition did not improve with topical steroids and cyclosporine A eye drops. Therefore, 360 degree conjunctival peritomy with cauterization of the base was performed. Since there was no obvious improvement, the amniotic membrane transplantation was done with supplementation of autologous serum eye drops 20% four times a day. The patient showed symptomatic improvement in a week. There was cessation of the progression of the ulcer and decreased vascularization. One month later, a small corneal perforation was noted and was managed well with cyanoacrylate glue and bandage contact lens application. At nine months of follow up, the patient was symptomatically better, the ulcer had healed, the vascularization had decreased and the anterior chamber was well formed. Conclusion: Amniotic membrane transplantation showed to be promising in treatment of Mooren’s ulcer refractory to immunosuppressive therapy. Addition of autologous serum eye drops seems to be an effective supplementary therapy. Nepal J Ophthalmol 2013; 5(9):120-123 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7839

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