J. Stammen et al., MOOREN ULCER - 4 SEVERE BILATERAL COURSES TREATED WITH SYSTEMIC CYCLOSPORINE-A, Klinische Monatsblatter fur Augenheilkunde, 211(5), 1997, pp. 306-311
Background Mooren's ulcer is a rare autoimmunologic disease of the cor
nea. Many forms of medical and surgical treatments have been proposed
in the past, but none of them was regularly successful. Severe progres
sive cases of Mooren's ulcer are therefore still a blinding disease. O
nly the use of systemic cyclosporin A (CSA) treatment appears for the
first time to have a significant positive effect on the outcome. Patie
nts One male (30 years old) and three female (52 y, 68 y, 84 y) patien
ts with severe progressive bilateral Mooren's ulcer were treated with
cyclosporin A systemically. Results On the male patient constant blood
levels of CSA were not achievable and he became blind suffering basic
ally from a severe proliferative diabetic retinopathy. The 52-year-old
female patient got a relapse of Mooren's ulcer in the graft after pen
etrating keratoplasty a chaud. With increased blood levels of CSA the
progression of the relapsing of Mooren's ulcer could be stopped. Also
only with high-dose CSA further progression of the rapidly progressive
colliquation of both corneas of a 68-year-old female could be stopped
. A definitive improvement with some residual activity could be achiev
ed in a 84-year-old female after only three months of follow-up. Concl
usions High-dose systemic CSA treatment with plasma trough levels of 1
50-200 ng/ml is recommended as initial treatment of choice and should
be started immediately. For what period of time after clinical healing
this high-dose therapy must be contained without the risk of a relaps
e of Mooren's ulcer remains to be seen.