Efficacy of conjunctival resection with cyanoacrylate glue application in preventing recurrences of Mooren's ulcer

Lal, Ikeda; Shivanagari, Srinivas B; Ali, Mohammed; Vazirani, Jayesh

doi:10.1136/bjophthalmol-2015-307350

Cited by 17 publications

(15 citation statements)

References 12 publications

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“…Stepwise approach involving; conjunctival resection, amniotic membrane graft and corneal patch graft with concurrent systemic and topical immunosuppressant, manage to control the disease activity. Conjunctival resection is known to remove the presence of complements, immunoglobulins and inflammatory cells [6]. Two patients underwent conjunctival resection together with cornea patch grafting.…”

Section: Discussionmentioning

confidence: 99%

Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Chendran

Yong

Halim

2019

Case Reports in Ophthalmological Medicine

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Incidence of cornea melting or perforation is commonly seen in variety of cornea conditions. It can cause debilitating vision loss and impair patient's daily activity. Several techniques have been described to surgically treat cornea perforation and melting. In this article, a series of corneal diseases treated with corneal patch graft are highlighted to relate different approach of cornea patch graft surgery. Post-operative management and complications are discussed.

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Section: Discussionmentioning

confidence: 99%

Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Chendran

Yong

Halim

2019

Case Reports in Ophthalmological Medicine

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“…The glue remains for at least a month until it spontaneously dislodges due to underlying epithelial healing. 40 , 41 Resolution of ulcer has been reported from 42% to 83% of cases. 33 , 40 , 41 …”

Section: Surgical Techniquesmentioning

confidence: 99%

“…31 The use of this glue in treating PUK with impending or actual perforation has been well documented in literature. 33,[38][39][40][41] The role of cyanoacrylate glue in healing PUK is twofold; firstly, for tectonic strength, and secondly for acting as a barrier to the influx of inflammatory cells from the conjunctiva into the adjacent corneal stroma. [41][42][43][44] In Mooren's ulcer, the standard procedure for surgery is the trimming of the overhanging necrotic ulcer lip and conjunctival resection adjacent to the ulcer followed by application of cyanoacrylate glue, with placement of bandage contact lens over the cornea.…”

Section: Use Of Tissue Adhesivesmentioning

confidence: 99%

“…33,[38][39][40][41] The role of cyanoacrylate glue in healing PUK is twofold; firstly, for tectonic strength, and secondly for acting as a barrier to the influx of inflammatory cells from the conjunctiva into the adjacent corneal stroma. [41][42][43][44] In Mooren's ulcer, the standard procedure for surgery is the trimming of the overhanging necrotic ulcer lip and conjunctival resection adjacent to the ulcer followed by application of cyanoacrylate glue, with placement of bandage contact lens over the cornea. The glue remains for at least a month until it spontaneously dislodges due to underlying epithelial healing.…”

Section: Use Of Tissue Adhesivesmentioning

confidence: 99%

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Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome

Sabhapandit¹,

Murthy²,

Sharma³

et al. 2022

OPTH

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Peripheral ulcerative keratitis (PUK) is an inflammatory, necrotic condition in the peripheral cornea which may end in corneal perforation and visual morbidity if not treated adequately. PUK can occur due to infectious or non-infectious causes. Early cases need medical therapy, both locally and systemically (for some cases). However, advanced PUK may necessitate surgical removal of inciting cause of the pathology and maintaining tectonic stability. Such surgical treatment, including corneal transplantations, may be used in an emergency setting or for visual rehabilitation following preliminary stabilization of the affected cornea. The outcome of these surgeries need to be analyzed to understand the long-term visual prognosis of such eyes. This is an attempt to analyze surgical modalities in the management of PUK and their outcomes.

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“…4,5 Surgery is usually the last option, only considered in cases of acute severe corneal necrosis or risk of imminent perforation. 1 Conjunctival resection, 6 conjunctival flap, 7 or amniotic membrane transplantation 8 have been suggested. However, these techniques do not target the underlying disease, and therefore provide only a temporary solution to the problem and their success without immunomodulation is oftentimes low.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Boston keratoprosthesis type 1 in a case of severe Mooren’s ulcer

Jerez-Peña

Salvador-Culla

Paz

et al. 2020

European Journal of Ophthalmology

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Introduction: Mooren’s ulcer is a painful, inflammatory chronic keratitis that affects corneal periphery, progressing centripetally, ultimately ending in perforation. The first line of treatment includes systemic immunomodulators, with surgery being the last option. We present a case of bilateral Boston keratoprosthesis implantation for severe Mooren’s ulcer that responded differently in each eye. Clinical case: A 32-year-old male with corneal opacification, anterior staphylomas, vision of hand movement, was started on systemic immunosuppression with cyclosporine. After two failed penetrating keratoplasties in each eye, high intraocular pressure despite diode cyclophotocoagulation, and cystic macular edema, we performed Boston keratoprosthesis type 1 in both eyes. The right eye responded initially well, with a best-corrected visual acuity of 20/80 and normal intraocular pressure. The left eye presented high intraocular pressure, which required cyclophotocoagulation, ultimately resulting in hypotony. Boston keratoprosthesis was performed but had peripheral corneal necrosis that progressed despite amniotic membrane transplantation and aggressive intensive treatment with medroxyprogesterone, autologous platelet-rich-in-growth-factors eye drops, and oral doxycycline. Thus, replacement of the semi-exposed Boston keratoprosthesis with tectonic penetrating keratoplasty was necessary. However, both eyes developed phthisis bulbi with final visual acuity of perception of light with poor localization. Conclusion: Mainstay treatment of Mooren’s ulcer is systemic immunomodulation. Surgical treatment must be considered only when risk of perforation, preferably with inflammation under control. Penetrating keratoplasty frequently fails, and Boston keratoprosthesis may be a viable option. However, postoperative complications, especially uncontrolled high intraocular pressure, corneal necrosis, and recurrence of Mooren’s ulcer may jeopardize the outcomes and need to be addressed promptly with intensive topical and systemic treatment.

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Efficacy of conjunctival resection with cyanoacrylate glue application in preventing recurrences of Mooren's ulcer

Abstract: Conjunctival resection and cyanoacrylate glue application are not effective in avoiding recurrences and halting the disease progression in cases of Mooren's ulcer. Systemic immunosuppression remains the mainstay of therapy.

Cited by 17 publications

References 12 publications

Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Multifacet of Cornea Patch Graft in Anterior Segment Diseases

Surgical Management of Peripheral Ulcerative Keratitis: Update on Surgical Techniques and Their Outcome

Bilateral Boston keratoprosthesis type 1 in a case of severe Mooren’s ulcer

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