Analysis of Pathogenic Bacteria of Mooren’s Ulcer and T Lymphocyte Activation

To analyze the distribution and types of pathogenic bacteria of Mooren’s ulcer and the activation mechanism of T lymphocytes to provide reference for the treatment of Mooren’s ulcer, 156 patients (162 eyes) who were in the hospital were rolled into the observation group. During the same period, 134 healthy people were rolled into the control group. The distribution of infectious pathogens in the observation group was identified. Then, flow cytometry was adopted to separate and detect the peripheral blood lymphocytes of patients, and RT-PCR was used to detect levels of the transcription factor T-bet, GATA-3, and Stat5 in peripheral blood mononuclear cells (PBMCs). It was found that fungal pathogens accounted for 43.59%; the bacterial infection rate was 40.38%. In the observation group, the CD4, CD8, and C25 were expressed more (P < 0.01), and the CD45 and CD45R were expressed less than the control group (P < 0.05); the proportion of Th1 cells was obviously higher (P < 0.01); the expression of T-bet and GATA-3 was obviously higher (P < 0.05), the percentage of HLA-DR in CD4+ and HLA-DR, CD-25, and CD69 in CD8+ positive cells was obviously higher (P < 0.05). In conclusion, fungal infection rate of Mooren’s ulcer is relatively high, peripheral blood T cells and their subgroups are abnormally activated, and T cell activation is related to the pathogenesis of Mooren’s ulcer.

Noninfectious Corneal Disorders

This chapter discusses noninfectious corneal disorders, caused by an immune inflammation such as phlyctenular keratoconjunctivitis, marginal staphylococcal keratitis, peripheral ulcerative keratitis, Mooren's ulcer, interstitial keratitis, rosacea keratitis, etc. Mooren's ulcer, which is considered one of the most severe diseases, is presented with serial photos of follow-ups within 3 years with different complications, management of the condition, and results. A severe case of rosacea keratitis associated with anterior uveitis is included in this chapter too. Thygeson's superficial punctate keratitis case is shown as well, but the disease is very rare in Middle Eastern populations. The material in this chapter also includes filamentary, neurotrophic, and exposure keratitis. A rare disorder like anesthetic abuse keratopathy, caused by topical excess use of anesthetic drops, is presented with before and after treatment photos to illustrate that the condition, if treated appropriately, can leave minimal scarring.

Increased cGAS/STING signaling components in patients with Mooren’s ulcer

AIM: To explore the expression of cGAS/STING signaling components in Mooren’s ulcer (MU). METHODS: Samples were obtained from ten MU patients, and eight residual corneal-scleral rings of healthy donor corneas for controls. Human corneal epithelial cells (HCECs) were used to evaluate the effect of cGAS/STING signaling pathway. Immunohistochemistry (IHC) and Western blot were used to examine the expression of cGAS, STING, and phosphorylated interferon regulatory factor 3 (p-IRF3) in MU tissues. The expression of interferon-β (IFN-β) and interferon-stimulated genes (ISGs) was quantified by real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA). RESULTS: The protein levels of cGAS and STING in MU samples were significantly elevated when compared with the healthy controls by Western blot and IHC. After stimulation with cGAMP, real-time PCR and ELISA showed a dramatic increase of IFN-β and ISGs (containing CXCL10, IFIT1, and IL-6) in HCECs. Moreover, HCECs treated with cGAMP was characterized by increased phosphorylation and more nuclear translocation of IRF3. Meanwhile, increased p-IRF3 was observed in MU samples via IHC and Western blot. CONCLUSION: The pronounced expression of cGAS/STING signaling components in the patients with MU and probably contribute to the onset and development of MU.

Treatment of Mooren’s ulcer coexisting with a pterygium using an intrastromal lenticule obtained from small-incision lenticule extraction: case report and literature review

The coexistence of Mooren’s ulcer and a pterygium is an extremely rare ocular condition that has been infrequently reported in the literature to date. We herein present the first case of treatment of Mooren’s ulcer coexisting with a pterygium using a lenticule obtained by myopic small-incision lenticule extraction (SMILE). A 61-year-old woman presented with a 3-month history of recurrent ocular pain and red eye caused by Mooren’s ulcer coexisting with a pterygium. She received topical immunosuppressive and anti-infection treatments for almost 3 months. However, her ocular symptoms and signs did not substantially improve. Therefore, we performed lamellar keratoplasty with a corneal lenticule obtained by SMILE, followed by pterygium excision combined with conjunctival autografting. The patient recovered well with no complications or recurrence 1 year postoperatively. Our success suggests that combined surgery may be an effective management for coexistence of Mooren’s ulcer and a pterygium if conservative treatments fail. A corneal lenticule obtained by SMILE can be used as the lamellar keratoplasty graft in such patients.

MOOREN’S ULCER

Mooren's ulcer is chronic ulcerative keratitis that is generally painful, progressive starting peripherally and progressing in a circular and centralized manner, either unilateral or bilateral without scleritis and without systemic disease. Mooren's ulcer mostly idiopathic. Mooren's ulcer was divided into three type which is unilateral, bilateral progressive and bilateral indolent. Initial treatment for Mooren's ulcer consists of topical corticosteroids. If corticosteroids do not control inflammation, excision of the limbal conjunctiva can be performed. This case report describes the diagnosis and management of a case of mooren's ulcer without an obvious cause. This topic is important to discuss and requires prompt and adequate management because one of the complications is perforation which can lead to blindness.