Mooren's ulcer after penetrating keratoplasty

Seventeen months after penetrating keratoplasty for pseudophakic bullous keratopathy, a patient developed severe pain and a peripheral corneal ulcer that had the characteristic clinical appearance of a Mooren's ulcer. We performed a 10-mm penetrating keratoplasty that extended from the superior margin of the previously placed graft to the inferior corneoscleral limbus to encompass the ulcerated cornea. Histopathologic examination of tissue removed at surgery disclosed that the peripheral corneal ulcer extended nearly through the entire stromal thickness and that the donor corneal stroma adjacent to the ulcer was infiltrated with lymphocytes, plasma cells, and neutrophils. The conjunctiva adjacent to the peripheral corneal ulcer was packed with plasma cells and also showed some lymphocytes and neutrophils.