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Triple Procedure for Bilateral Perforated

Mooren's Ulcer G. S. Lima; P. Ferreira; A. Figueiredo; F.

Ramalho

We have no finantial interest in this presentation.


INTRODUCTION

• Mooren's ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally. Mooren's ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as Terrien's degeneration


INTRODUCTION

• The etiology remains unknown. The response to medical and surgical intervention is typically poor, and the visual outcome can be devastating.The purpose of relating this case of bilateral perforation associated with cataracts is to share the difficulties and possible solutions in the manegement of this uncomon situation.


Diagnosis• A 86-year-old white male, presented with an

area of peripheral perforation of the left superior cornea, white cataract, already treated with a conjunctival patch. 3 weeks later a inferior peripheral thinning starts in the right eye.

OD OS


TREATMENTS IN YELLOW WERE USED

• Peritomy• Topical steroids• Topical ciclosporine• Immunosupression• Lamelar transplant• Penetracting

keratoplasty• Glue patch• Sub-conj triancinolone


SEGMENT

• In a 3 weeks period the patient underwent a 360 degrees peritomy, 2 glue patches, and despite the agressive sugical and clinical treatment a penetracting keratoplasty with complete removal of the receptor cornea at the limbus


PENETRACTING KERATOPLASTY+LENS

EXTRACTION• In this particulary case was difficult due to

manual scissors trepanation, but with no further problems.


5 months after diagnosis

OD was stable, under topical steroids qid.

OS went to primary graft failure probably due to tissue conditions


CONCLUSION

• Mooren's ulcers usually respond poorly to conventional therapy, as there is limited knowledge of the pathophysiology of the disease. The surgical treatment often fails due to the agressive nature of the disease. More clinical and surgical cases should be shared in order to obtain better results in the treatment of the disease.


REFERENCES

• Watson PG. Eye. 1997; (Pt 3):349-56.

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