Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, D-45147 Essen, Germany.
BMC Ophthalmol. 2013 Dec 17;13:81. doi: 10.1186/1471-2415-13-81.
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.
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.
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).
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.
Mooren 溃疡是一种严重的角膜溃疡性炎症。确切的发病机制仍不清楚。因此，文献中推荐了许多治疗 Moorens 溃疡的方法。为了更深入地探讨严重进行性 Moorens 溃疡的最佳治疗方法，我们在此报告了一组接受全身免疫抑制治疗和附加羊膜移植的患者的回顾性病例系列。
回顾性分析了 7 例（11 只眼）男性 4 例，女性 3 例严重进行性 Moorens 溃疡患者的病历。平均随访时间为 88.4 ± 80.8 个月（12-232 个月）。所有患者均进行 HLA 分型。所有患者均给予全身免疫抑制治疗。在溃疡基底切除后进行羊膜移植。
6 例患者需要多次羊膜移植。所有患者的视力结果均较差。没有患者的视力优于 20/630 Snellen 图表。5 例患者 HLA-DQ2 阳性，4 例患者 HLA-DR17(3)阳性。
Mooren 溃疡侵袭性和高度炎症性的形式很难治疗，即使在全身免疫抑制治疗下，疾病的进展也很难得到积极影响。因此，治疗的主要目的是在不穿孔的情况下，使角膜上皮化表面稳定。羊膜移植不能治愈严重的 Moorens 溃疡。然而，在急性情况下，如临界性角膜变薄时，它可以支持免疫抑制治疗。
