Abstract
We describe 6 bilateral cases of progressive Mooren's ulcer treated by performing conjunctival excision (regional or 360° peritomy). The histopathological study of the conjunctiva adjacent to the lesion showed an hyperaemic and edematous stroma infiltrated mainly by plasma cells and lymphocytes without signs of vasculitis. The peripheral portion of the ulcer was characterized by necrobiotic and hemorrhagic elements along with an absence of the overlying epithelium and Bowman's membrane. Inflammation of the corneal stroma was present in the peripheral but absent in the central edge of the ulcer, a characteristic sign of a rodent ulcer. Therefore, the histopathological study was very useful for the final diagnosis and the differential diagnosis of Mooren's ulcer from other cases of peripheral ulcerative keratitis. In all 6 cases conjunctival excision appeared to be an effective procedure in halting the progression of the disease: absence of recurrences during a follow-up period of 1–2 years provided an essential healing of the cornea.
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References
Wood TO, Kaufman HE. Mooren's ulcer. Am J Ophthalmol 1971;71: 417–422.
Robin JB, Dugel R. Immunologic disorders of the cornea and conjunctiva. In: Kaufman H, Barron B, McDonald M, Waltman S, eds. The Cornea. New York, Edinburgh, London, Melbourne: Churchill Livingstone, 1988, pp. 511–561.
Robin JB, Schanzlin DJ, Verity SM, Barron BA, Arffa RC, Suarez E, Kaufman HE. Peripheral corneal disorders. Surv Ophthalmol 1986;31: 1–36.
Young RD, Watson PG. Light and electron microscopy of corneal melting syndrome (Mooren's ulcer). Br J Ophthalmol 1982;66: 341–356.
Mondino BJ. Inflammatory diseases of the peripheral cornea. Ophthalmology 1988;95: 463–472.
Duke-Elder S, Leigh AG. Diseases of the outer eye: In: Duke-Elder S, ed. System of Ophthalmology. London: Kimpton,1965; 8(2), pp. 916–920.
Zegans ME, Srinivasan M, McHugh T, Whitcher JP, Margolis TP, Lietman T et al. Mooren ulcer in South India: Serology and clinical risk factors. Am J Ophthalmol 1999; 128(2): 205–210.
Brown SI. Mooren's ulcer. Histopathology and proteolytic enzymes of adjacent conjunctiva. Br J Ophthalmol 1975;59: 670–674.
Murray PI, Rahi AH. Pathogenesis of Mooren's ulcer: Some new concepts. Br J Ophthalmol 1984;68: 182–187.
Foster CS, Kenyon KR, Greiner J et al. The immunopathology of Mooren's ulcer. Am J Ophthalmol 1979;88: 149–159.
Tabbara KF, Ostler HB. Mooren's ulcer. In: Trevor-Roper P, ed. Procceding of the 6th Congress of European Ophthalmology. London: Academic Press and Royal Society of Medicine, 1980, pp. 269–273.
Gottsch JD, Liu SH, Minkovitz JB, et al. Autoimmunity to a cornea-associated stromal antigen in patients with Mooren's ulcer. Inv Ophthalmol Vis Sci 1995;36: 1541–1547.
Taylor CJ, Smith SI, Morgan CH, Stephenson SF, Key T, Srinivasan M et al. HLA and Mooren's ulceration. Br J Ophthalmol 2000; 84(1): 72–75.
Brown SI, Mondino BJ. Therapy of Mooren's ulcer. Am J Ophthalmol 1984;98: 1–6.
Foster CS. Systemic immunosuppressive therapy for progressive bilateral Mooren's ulcer. Ophthalmology 1985;92: 1436–1439.
Donzis PB, Mondino BJ. Management of noninfectious corneal ulcers. Surv Ophthalmol 1987;32: 94–110.
Tiev KP, Borderie VM, Briant M, Ziani M, Morvant C, Baret M, et al. Ulcères de Mooren sévères: efficacité du traitement par cyclophosphamide en bolus intraveineux mensuels. Rev Med Int 2002; 24(2): 118–122.
Wakefield D, Robinson LP. Cyclosporin therapy in Mooren's ulcer. Br J Ophthalmol 1987;71: 415–417.
Stammen J, Althaus C, Sundmacher R. Mooren ulcer. 4 severe bilateral disease courses with systemic cyclosporin A therapy. Klin Monatsbl Augenheilkd 1997; 211(5): 306–311.
Brown SI. Mooren's ulcer: Treatment by conjunctival excision. Br J Ophthalmol 1975;59: 675–682.
Martin NF, Stark WJ, Maumenee AE. Treatment of Mooren's and Mooren's-like ulcer by lamellar keratectomy: Report of six eyes and literature review. Ophthalmic Surg 1987;18: 564–569.
Florine CW, Dwyer M, Holland EJ. Wegener's granulomatosis presenting with sclerokeratitis diagnosed by antineutrophil cytoplasmic autoantibodies (ANCA). Surv Ophthalmol 1993; 37: 373–376.
Akova YA, Jabbur NS, Foster CS. Ocular presentation of polyarteritis nodosa: Clinical course and management with steroid and cytotoxic therapy. Ophthalmology 1993;100: 1775–1781.
Messmer EM, Foster CS. Vasculitic peripheral ulcerative keratitis Surv Ophthalmol 1999;43: 379–396.
Sainz de la Maza M, Foster CS. Peripheral ulcerative keratitis and malignancies. Cornea 1994;13: 364–367.
Wilson SE, Lee WM, Murakami C, et al. Mooren-type Hepatitis C virus-associated corneal ulceration. Ophthalmology 1994;101: 736–745.
Pouliquen Y, Dhermy P, Renard G, Goichot-Bonnat L, Foster G, Savoldelli M. Terrien's disease: Clinical and ultrastructural studies, five case reports. Eye 1989;3: 791–802.
Bloomfield SE. Clinical allergy and immunology of the external eye. In: Tasman W, Jaeger EA, eds. Duane's Clinical Ophthalmology, Revised edition, Vol 4, Chap. 2. Philadelphia: Lippincott, 1993, pp. 20–22.
Wilson FM II, Grayson M, Ellis FD. Treatment of peripheral cornea ulcers by limbal conjunctivectomy. Br J Ophthalmol 1976;60: 713–719.
Aviel E. Combined cryoapplications and peritomy in Mooren's ulcer. Br J Ophthalmol 1972;56: 48–51.
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Kalogeropoulos, C.D., Malamou–Mitsi, V.D., Aspiotis, M.B. et al. Bilateral Mooren's Ulcer in Six Patients: Diagnosis, Surgery and Histopathology. Int Ophthalmol 25, 1–8 (2004). https://doi.org/10.1023/B:INTE.0000018510.06715.c9
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DOI: https://doi.org/10.1023/B:INTE.0000018510.06715.c9