Bilateral Mooren’S Ulcer Managed With Corneoscleral Keratoplasty: A Case Report

Mooren’s ulcer is a rare and challenging condition characterized by painful peripheral corneal ulcers that can lead to significant visual impairment if not managed promptly and effectively. The aim of this report is to present a bilateral and aggressive case of Mooren’s ulcer managed successfully with sequential bilateral corneoscleral keratoplasty.

The patient has undergone follow-up at the Barraquer Ophthalmology Center in the Ocular Surface and Cornea department over an eight year period since the initial visit.

A 32-year-old male of Senegalese origin, presented with progressive vision impairment and severe ocular pain over two years. At the time of the consultation visual acuity was hand movements in both eyes. Slit-lamp examination revealed a total corneal opacification and vascularization with marked corneal thinning and ectasia. Notably the patient has a first-degree relative with similar presentation, diagnosed with bilateral Mooren’s ulcer. The same diagnosis was stablished after extensive laboratory examination in order to exclude other conditions, and immunomodulatory treatment was initiated. Given the chronicity and severity of the disease the patient underwent combined cataract surgery with lens implantation, pupillary reconstruction, and corneoscleral keratoplasty in the right eye, followed by the same procedures in the left eye, six years later. The patient experienced significant resolution of pain and reduction in corneal inflammation postoperatively. Visual acuity improved from hand motion preoperatively to 20/50 in the right eye at four months follow up. However, the graft experienced failure two years later, necessitating reoperation with penetrating keratoplasty. Visual acuity after four years follow up is 20/40 in the right eye. The left eye improved from hand motion to 0,03 in the LogMAR scale at five months follow up, corresponding to the present time. Examination reveals graft clarity with no signs of recurrence.

This report highlights how a corneoscleral graft followed by systemic and local immunosuppressive treatment should be considered in monocular patients with aggressive Mooren's ulcer where there is serious damage to the corneal and scleral tissue. Despite the challenges encountered, the patient achieved significant improvement in visual acuity, highlighting the importance of timely and comprehensive management in such cases.