Vinod Kumar Baranwal, Rajendra Prasad Gupta, K. Satyabala, Shikhar Gaur
BACKGROUND Mooren's ulcer is a chronic peripheral corneal ulceration featuring conjunctival immunoglobulin deposits. It is considered as the result of a limbic immune process with hyperactivation of T and B lymphocytes. The exact aetiology remains unknown. The response to topical steroid therapy, immunosuppressants and surgical procedures is usually poor and the visual outcome can be devastating. We report our good results in managing these cases with 3 days of intravenous methylprednisolone and 3-7 months of cyclosporine eyedrops. MATERIALS AND METHODS We treated 27 patients of Mooren’s ulcer with 1 g intravenous methylprednisolone for 3 days along with topical cyclosporine eyedrops for 3-7 months. RESULTS Six patients had Mooren’s ulcer in both eyes. Six patients had Mooren’s ulcer in their one eye. All these 12 cases had poor response to topical steroids and conjunctival peritomy and Mooren’s ulcer was progressing. Three patients had progressing Mooren’s ulcer in their eyes despite lamellar keratoplasty and topical steroids therapy. Twelve patients were freshly diagnosed as Mooren’s ulcer. All these twenty seven cases were treated by giving 3 doses of 1 g intravenous methylprednisolone over 3 days along with topical cyclosporine A (0.05%) eyedrops. They responded very well to the treatment and corneal healing was obtained in 5-7 months of treatment. No adverse effects of above treatment were seen in any case. CONCLUSION We report the effectiveness of 3 doses of 1 g intravenous methylprednisolone given over 3 days along with topical cyclosporine eyedrops in treatment of Mooren’s ulcer. We propose the above regime for treatment of Mooren’s ulcer. The benefit is most likely due to temporary switching off the immunodamaging process by short course of high-dose methylprednisolone followed by immunosuppression by cyclosporine A.
