Posters

Mooren's ulcer: treatment by surgical excision of limbal conjunctiva

Poster Details

First Author: V.Sobot SERBIA

Co Author(s):    N. Lukic   D. Lukic                 

Abstract Details

Purpose:

Mooren`s ulcer is a rare, but severe disease, most likely caused by autoimmune response directed against corneal stromal antigens. This disease is not associated with any sistemic autoimmune disorder and diagnosis is made by exclusion of other causes of peripheral ulceration. It has been hypothesized that the limbal conjunctiva may contain antibodies that react with antigens in the corneal stroma, thus conjunctival resection can cause remision. The purpose of this poster is to present a case of Mooren`s ulcer treated with limbal conjunctival excision as an adjunct to standard treatment.

Setting:

Eye Department, JZU ,,Mladen Stojanovic`` Prijedor, BIH

Methods:

Case report A 39-year-old female patient presented with red inflamed eye, photophobia, epiphora and mild pain in her left eye. Slit-lamp examination revealed small epithelial paralimbal corneal defect. The patient was treated only with topical corticosteroids and eye lubricants. At folow-up visits, circumferential progresion of the ulceration parallel to limbus was registered, as well as, deepening of stromal defect. After several months, the ulceration affected 2/3 of the corneal circumference with a threatening perforation. The central part of cornea was clear, sclera was not affected and visual acuity was preserved, but intense limbal inflammation and photophobia was present.

Results:

All available laboratory tests were done and showed no evidence of any sistemic or autoimmune disorder. Microbiologic analysis of the lesion were also negative and a thorough physical examination was performed to rule out any other cause of periferal ulceration. Considering that the treatment with topical corticosteroids was uneffective, it was decided to remove adjacent conjunctiva. The 4 mm ring of adjacened conjunctiva was excised under local anaesthesia and bandage contact lens was applied. Medical treatment included topical corticosteroids and topical 1% cyclosporine A.

Conclusions:

One week after the removal of conjunctiva, healing of defect was noted and the inflammation was less pronounced. At one month follow-up visit defect was almost completely re-epithelized, mild photophobia was present and visual acuity was 1.0. After two years of follow-up there was no signs of recidive. Removal of adjacent limbal conjunctiva in Mooren`s ulcer is effective and can be used as an adjunct to medical treatment with topical corticosteroids and cyclosporine A.

Financial Disclosure:

None