Triple Procedure for Bilateral Perforated Mooren's Ulcer G' S' Lima P' Ferreira A' Figueiredo F' Ram

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Triple Procedure for Bilateral Perforated
Mooren's Ulcer ?G. S. Lima P. Ferreira A.
Figueiredo F. Ramalho

• We have no finantial interest in this
  presentation.

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INTRODUCTION

• Mooren's ulcer is a rapidly progressive, painful,
  ulcerative keratitis which initially affects the
  peripheral cornea and may spread
  circumferentially and then centrally. Mooren's
  ulcer can only be diagnosed in the absence of an
  infectious or systemic cause and must be
  differentiated from other corneal abnormalities,
  such as Terrien's degeneration

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INTRODUCTION

• The etiology remains unknown. The response to
  medical and surgical intervention is typically
  poor, and the visual outcome can be
  devastating.The purpose of relating this case of
  bilateral perforation associated with cataracts
  is to share the difficulties and possible
  solutions in the manegement of this uncomon
  situation.?

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Diagnosis

• A 86-year-old white male, presented with an area
  of peripheral perforation of the left superior
  cornea, white cataract, already treated with a
  conjunctival patch. 3 weeks later a inferior
  peripheral thinning starts in the right eye.

OD
OS
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TREATMENTS IN YELLOW WERE USED

• Peritomy
• Topical steroids
• Topical ciclosporine
• Immunosupression
• Lamelar transplant
• Penetracting keratoplasty
• Glue patch
• Sub-conj triancinolone

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SEGMENT

• In a 3 weeks period the patient underwent a 360
  degrees peritomy, 2 glue patches, and despite the
  agressive sugical and clinical treatment a
  penetracting keratoplasty with complete removal
  of the receptor cornea at the limbus

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PENETRACTING KERATOPLASTYLENS EXTRACTION

• In this particulary case was difficult due to
  manual scissors trepanation, but with no further
  problems.

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5 months after diagnosis

• OD was stable, under topical steroids qid.

OS went to primary graft failure probably due to
tissue conditions
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CONCLUSION

• Mooren's ulcers usually respond poorly to
  conventional therapy, as there is limited
  knowledge of the pathophysiology of the disease.
  The surgical treatment often fails due to the
  agressive nature of the disease. More clinical
  and surgical cases should be shared in order to
  obtain better results in the treatment of the
  disease.

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REFERENCES

• Watson PG. Eye. 1997 (Pt 3)349-56.