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Amniotic membrane transplantation ineffective as additional therapy in patients with aggressive Mooren's ulcer
Maurice Schallenberg1, Henrike Westekemper, Klaus-Peter Steuhl
1Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, D-45147 Essen, Germany. maurice.schallenberg@uk-essen.de.
Background:
Mooren's ulcer is a severe ulcerative inflammation of the cornea. The exact pathogenesis remains unclear. Therefore many therapies of Mooren's ulcer are recommended in literature. To shed more light on the ongoing question of optimal treatment of severe progressive Mooren's ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane transplantation.
Methods:
Medical records from seven patients (eleven eyes), 4 male and 3 female, with severe progressive Mooren's ulcer were analysed retrospectively. The mean follow up was 88.4 ± 80.8 months (range 12-232 month). A HLA-typing was performed in all patients. A systemic immunosuppressive therapy was administered in all patients. The amniotic membrane was transplanted after the base of the ulcer was resected.
Results:
Multiple amniotic membrane transplantations were necessary in six patients. The visual outcome of all patients was poor. No patient achieved a visual acuity better than 20/630 Snellen chart. Five patients were positive for HLA-DQ2 and four patients were positive for HLA-DR17(3).
Conclusions:
The aggressive and highly inflammatory form of Mooren's ulcer is difficult to treat and the progression of the disease is hard to influence positively even under systemic immunosuppressive therapy. Therefore, the main intention of therapy is to achieve a stable epithelialized corneal surface without the risk of perforation. Amniotic membrane transplantation is not able to cure severe forms of Mooren's ulcer. However it supports the immunosuppressive therapy in acute situations as in critical corneal thinning.
Insights
Systemic immunosuppressive therapy combined with amniotic membrane transplantation showed limited success for severe Mooren's ulcer, highlighting the challenge in treating this aggressive corneal inflammation.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Immunosuppression
Background:
- Mooren's ulcer is a severe, progressive ulcerative inflammation of the cornea with unclear pathogenesis.
- Optimal treatment strategies for severe progressive Mooren's ulcer remain a significant clinical challenge.
Purpose of the Study:
- To evaluate the efficacy of systemic immunosuppressive therapy (SIT) combined with amniotic membrane transplantation (AMT) for severe progressive Mooren's ulcer.
- To analyze treatment outcomes and identify factors influencing the prognosis of Mooren's ulcer.
Main Methods:
- Retrospective analysis of seven patients (eleven eyes) with severe progressive Mooren's ulcer.
- All patients received systemic immunosuppressive therapy; amniotic membrane transplantation was performed after ulcer debridement.
- HLA-typing was conducted, and patients were followed for a mean of 88.4 months.
Main Results:
- Poor visual outcomes were observed in all patients, with no patient achieving visual acuity better than 20/630.
- Multiple AMT procedures were required in six patients.
- HLA-DQ2 positivity was noted in five patients, and HLA-DR17(3) in four.
Conclusions:
- Severe progressive Mooren's ulcer is difficult to treat, with limited positive influence on disease progression even with SIT.
- The primary therapeutic goal is to achieve a stable, epithelialized corneal surface and prevent perforation.
- AMT supports SIT in acute situations, particularly in critical corneal thinning, but does not cure severe forms of Mooren's ulcer.
