Mooren’s ulcer

Abstract

Mooren's ulcer (MU) is an inflammatory peripheral ulcerative keratopathy that occurs most commonly in the developing world. Recent evidence supports the notion that autoimmune mechanisms are involved in the pathogenesis of this disease. Patients with MU typically develop painful, progressive peripheral ulceration of the cornea that, if untreated, can lead to corneal perforation and blindness. Risk factors for the development of MU include HLA-DR17 haplotype expression, prior corneal surgery or trauma, and hookworm infestation. A thorough ocular and systemic history and clinical examination, together with directed laboratory testing, should be carried out to rule out other causes of corneal ulceration, including both infectious keratitis and peripheral ulcerative keratitis secondary to an underlying systemic autoimmune disease. Treatment of MU is often challenging, but typically includes local and/or systemic corticosteroids. Noncorticosteroid immunosuppressive agents, conjunctival resection or advancement and tectonic surgical repair have also been used with success in patients refractory to corticosteroid therapy.

Interplay of Immune Cells in Mooren Ulcer

“…1-3 However, an accumulating body of evidence indicates that Mooren ulcer is an autoimmune disease that exclusively targets the corneal stroma and is triggered by environmental factor(s) in genetically susceptible patients. [1][2][3] In addition, several studies suggest that Mooren ulcer is associated with helminthiasis, 6 hepatitis C virus infection, 7,8 ocular injuries, 5 surgical procedures (cataract extraction, PK, or lamellar keratoplasty), 5,[9][10][11][12] or human leukocyte antigen type DR17. 13 The precise pathophysiological mechanism of Mooren ulcer remains elusive.…”

“…[1][2][3] The etiology of Mooren ulcer is unclear, and with the conventional treatment, corneal perforation occurs in 11% to 13.3% of patients with Mooren ulcer. 4,5 Characterization of the cellular components involved in the progression of Mooren ulcer would provide a mechanistic insight and help develop an effective therapy for this fulminant disease.…”