Effect of Amniotic Membrane Transplantation on Mooren's Ulcer Combined with Corneal Perforation

1
Effect of Amniotic Membrane Transplantation on
Mooren's Ulcer Combined with Corneal Perforation

Moon Jung Kim1.2, Mee Kum Kim1.2, Won Ryang
Wee1.2, Jin Hak Lee1,3
Department of Ophthalmology, Seoul National
University College of Medicine 1 Seoul
Artificial Eye Center, Seoul National University
Hospital Clinical Research Institute, Seoul,
South Korea 2 2Department of Ophthalmology, Seoul
National University Bundang Hospital 3
2
Background

• Poor prognosis after corneal transplantation in
  case of corneal perforation with Moorens ulcer
• Foster CS, Azar DT, Dohlman CH.
  Moorens ulcer. In Smolin and Thoft, eds. The
  Cornea, 4th ed. Philadelphia Lippincott Williams
  Wilkins, 2005 v. 1. chap.24
• Amniotic membrane transplantation(AMT) for
  controlling active inflammation in Moorens
  ulcer Lambiase et al reported one case of
  successful result of conjunctival recession with
  AMTLambiase A, Sacchetti M, Sgrulletta R et al.
  Amniotic membrane transplantation associated with
  conjunctival peritomy in the management of
  Mooren's ulcer a case report. Eur J Ophthalmol
  200515274-6
• Multilayered AMT is effective for both corneal
  ulcer and perforationHanada K, Shimazaki J,
  Shimmura S et al. Multilayered amniotic membrane
  transplantation for severe ulceration of the
  cornea and sclera. Am J Ophthalmol
  2001131324-31

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Purpose

• To report the results of an amniotic membrane
  transplantation (AMT) and cryotherapy in 4
  patients with corneal perforation due to Moorens
  ulcer

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Case 1 (82/M)
20/200,OD20/200,OS Diagnosis Moorens ulcer
(OU), 360 peripheral corneal melting with
perforation (arrow)
A right eye, B left eye
Surgery (OD) Scleral allograft, permanent AMT,
cryotherapy, overlaying AMT (OS) multilayer AMT,
cryotherapy, overlaying AMT
Surgical steps in case 1. The donor sclera was
cut using a 7.5 mm corneal trephine, placed over
the ulcer, and secured to the recipient bed with
10-0 nylon interrupt sutures. The amniotic
membrane with the epithelial side-up was located
over the scleral allograft and cornea, and
sutured with 10-0 nylon. The central portion of
the amniotic membrane was cut round to expose the
central cornea.
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Case 1 (82/M)
Medication 1 methyl-prednisolone OU bid, 0.5
levofloxacin OU qid Autoserum OU bid, Oral
prednisolone 20mg po qd
Complete epithelialization postoperative 24 days
(OD), 37 days (OS)
No evidence of active inflammation postoperative
102 days (OU)
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Case 2 (78/F)
20/40, OD History Descemetocele with Moorens
ulcer after cataract surgery s/p AMT at the
referring hospital no epithelialization over the
graft
Surgery (OD) conjunctival recession, multilayer
AMT, cryotherapy, overlaying AMT
Medication 1 prednisolone acetate OD every 2
hours 0.5 levofloxacin OD qid
Autoserum OD every 2 hours
Doxycycline 50mg po bid, Oral
prednisolone 30mg po qd
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Case 2 (78/F)
Complete epithelialization postoperative 34 days
(OD)
No evidence of active inflammation
postoperative 97 days (OD)
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Case 3 (65/F)
20/100, OD History4 years ago corneal
perforation with Moorens ulcer, and then treated
with scleral allograft and cryotherapy 2 weeks
ago cataract surgery and scleral allograft
transplantation ? wound leakage and ulceration
developed
Surgery (OD) scleral graft removal, multilayer
AMT, cryotherapy, overlaying AMT
Medication 1 methyl-prednisolone OD bid, 0.5
levofloxacin OD bid Autoserum OD
bid, oral prednisolone 20mg po qd
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Case 3 (65/F)
Complete epithelialization postoperative 49 days
(OD)
No evidence of active inflammation
postoperative 75 days (OD)
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Results

• The perforated corneal lesion was sealed
  successfully by the amniotic membrane in 4 eyes
• Complete epithelialization postoperative 3610.3
  days
• Complete remission postoperative 9413.0 days
• Average final best-corrected visual acuity 20/60
• During 212.7 months of F/U
• No recurrence in 3 eyes
• Right eye of Case 1 recurrent inflammation with
  impending corneal perforation at the
  postoperative 9 months ? limbal transplantation
  with amniotic membrane re-transplantation ?
  achieved a complete remission after 13 months
  

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Conclusion

• Amniotic membrane transplantation with
  cryotherapy may be useful and successful in
  treating corneal perforation associated with
  active inflammation of Moorens ulcer.