[Mooren ulcer. 4 severe bilateral disease courses with systemic cyclosporin A therapy]

Mooren's ulcer is a rare autoimmunologic disease of the cornea. Many forms of medical and surgical treatments have been proposed in the past, but none of them was regularly successful. Severe progressive cases of Mooren's ulcer are therefore still a blinding disease. Only the use of systemic cyclosporin A (CSA) treatment appears for the first time to have a significant positive effect on the outcome.

One male (30 years old) and three female (52 y, 68 y, 84 y) patients with severe progressive bilateral Mooren's ulcer were treated with cyclosporin A systemically.

On the male patient constant blood levels of CSA were not achievable and he became blind suffering basically from a severe proliferative diabetic retinopathy. The 52-year-old female patient got a relapse of Mooren's ulcer in the graft after penetrating keratoplasty à chaud. With increased blood levels of CSA the progression of the relapsing of Mooren's ulcer could be stopped. Also only with high-dose CSA further progression of the rapidly progressive colliquation of both corneas of a 68-year-old female could be stopped. A definitive improvement with some residual activity could be achieved in a 84-year-old female after only three months of follow-up.

High-dose systemic CSA treatment with plasma trough levels of 150-200 ng/ml is recommended as initial treatment of choice and should be started immediately. For what period of time after clinical healing this high-dose therapy must be contained without the risk of a relapse of Mooren's ulcer remains to be seen.