Guindolet Damien, Reynaud Clotilde, Clavel Gaelle, Belangé Georges, Benmahmed Maycene, Doan Serge, Hayem Gilles, Cochereau Isabelle, Gabison Eric E
Fondation A. de Rothschild, Paris, 75019, France.
Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.
Br J Ophthalmol. 2017 Apr;101(4):418-422. doi: 10.1136/bjophthalmol-2016-308838. Epub 2016 Jul 22.
Management of severe and refractory Mooren's ulcers is challenging as it encompasses tectonic surgical treatment and aggressive immunosuppressive therapies. Efficacy of rituximab in the management of severe Mooren's ulcers has never been reported.
Five patients (six eyes) from the Cornea and External Disorders department at the Rothschild Ophthalmologic Foundation (Paris, France) were treated for severe Mooren's ulcer unresponsive to conventional treatments between 2008 and 2016. Conventional treatment included topical steroid and ciclosporin 2%, high doses of systemic corticosteroids and/or cyclophosphamide and conjunctival resection with amniotic membrane graft. These patients received two infusions of 1000 mg of rituximab at 2 weeks interval. Epithelial healing, inflammation, additional surgery, systemic corticosteroids and rituximab-related side effects were reported.
The mean follow-up was 46.8 months. Following rituximab treatment, we observed a complete healing of Mooren's ulcer within 2 weeks in all patients. Peripheral lamellar keratoplasty was associated when peripheral corneal perforation occurred (5/6 affected corneas). Systemic corticosteroids had been discontinued in all patients. Two recurrences occurred 13 and 53 months after the first rituximab infusion and where successfully treated with a new infusion. No rituximab-related adverse events were reported.
Rituximab was effective in the management of severe Mooren's ulcers and could be an alternative to cyclophosphamide. Additional studies should assess the role of this biotherapy in the management of immunological corneal ulcer.
严重且难治性蚕蚀性角膜溃疡的治疗具有挑战性，因为它包括结构性手术治疗和积极的免疫抑制疗法。利妥昔单抗治疗严重蚕蚀性角膜溃疡的疗效尚未见报道。
2008年至2016年间，法国巴黎罗斯柴尔德眼科基金会角膜与外眼疾病科的5例患者（6只眼）因严重蚕蚀性角膜溃疡接受治疗，这些溃疡对传统治疗无反应。传统治疗包括局部使用类固醇和2%环孢素、高剂量全身皮质类固醇和/或环磷酰胺以及结膜切除联合羊膜移植。这些患者每隔2周接受两次1000mg利妥昔单抗输注。报告了上皮愈合、炎症、额外手术、全身皮质类固醇以及利妥昔单抗相关的副作用。
平均随访时间为46.8个月。利妥昔单抗治疗后，所有患者在2周内蚕蚀性角膜溃疡均完全愈合。当周边角膜穿孔发生时（6只患眼中的5只），进行了周边板层角膜移植术。所有患者均已停用全身皮质类固醇。在首次利妥昔单抗输注后13个月和53个月分别发生了两次复发，再次输注后成功治愈。未报告与利妥昔单抗相关的不良事件。
利妥昔单抗治疗严重蚕蚀性角膜溃疡有效，可作为环磷酰胺的替代药物。进一步研究应评估这种生物疗法在免疫性角膜溃疡治疗中的作用。
