EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78712
April 2012 Corneal diagnoses and systemic disease February 2011 EW FEATURE Mooren's ulcer vs. PUK: The difference can mean life or death by Enette Ngoei EyeWorld Contributing Editor AT A GLANCE • While Mooren's ulcer is by definition not associated with any systemic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of life-threatening diseases • In ulcerative processes, if the ulcers are primarily located at the periph- ery of the cornea and there is no separation, it becomes an indicator that you should investigate for collagen vascular diseases • A very thorough systemic evalua- tion is mandatory in any patient that is believed to have Mooren's ulcer. In fact, the diagnosis should be PUK from the beginning, then if the aggressive systemic evaluation is negative and the adjacent sclera is not involved, it's appropriate to hang the label of Mooren's ulcer on this patient • The overall prognosis is good (for Mooren's ulcer) if it's treated in a stepwise manner. In 70-80% of patients, you can save their eyesight or the globe Telling the difference between Mooren's ulcer and early signs of something deadly W hile Mooren's ulcer is by definition not as- sociated with any sys- temic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of life-threaten- ing diseases, said C. Stephen Foster, M.D., founder and president, Massa- chusetts Eye Research and Surgery Institute, Cambridge, and clinical professor of ophthalmology, Harvard Medical School, Boston. Therefore, the general ophthal- mologist ought to hear alarm bells ring if the peripheral corneal disease has the following characteristics: It is a real ulcer, that is, the epithelium is not intact, there is some loss of stroma, it is a real keratitis, so in- flammation is present, and white blood cells have infiltrated into the peripheral cornea. This, by defini- tion, is peripheral ulcerative keratitis (PUK), Dr. Foster said. According to Prashant Garg, M.D., L.V. Prasad Eye Institute, Hy- derabad, India, "In ulcerative processes, if the ulcers are primarily located at the periphery of the cornea and there is no separation, it becomes an indicator that you should investigate for collagen vascular diseases." continued on page 42 41 An ASCRS Membership For every stage of your career Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Mentors and Innovators As an experienced anterior segment ophthalmologist, you've come to understand the importance of innovation and collaboration. It's through collaboration that ophthalmology improves and expands—at times in great leaps and at times through subtle change. Through its many educational and networking services, ASCRS provides an effective forum for the debate of new ideas and the incremental improvement of technique and outcomes. ASCRS offers the means and the unrestricted opportunity to advance the profession and yourself. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org