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 43 of any type but particularly antineu- trophil cytoplasmic antibody." If it's Mooren's ulcer, the systemic prognosis is excellent. Otherwise, aggressive systemic immunomodulatory medication is mandatory if the patient's PUK is found to be a consequence of polyarteritis nodosa or microscopic polyangiitis and granulomatosis with polyangiitis, he said. "If not treated, the patient will die," he said. Treating Mooren's ulcer A patient with unilateral Mooren's ulcer may do just fine with the re- moval of the adjacent conjunctiva, Dr. Foster said. Virender S. Sangwan, M.D., associate director, L.V. Prasad Eye Institute, agreed: "The overall prog- nosis is good if it's treated in a step- wise manner. In 70-80% of the patients, you can save their eyesight or the globe." He continued, "Essentially the first step that we take for these pa- tients is conjuctival resection in the area of involvement within 1 clock hour on either side of the whole area followed by tissue adhesive applica- tion with intense topical steroids." Medical treatment would not be sufficient for most of the Mooren's ulcer patients unless it's very mild, like less than 1 or 2 clock hours; then the physician can try intense topical steroids like prednisolone acetate, Dr. Sangwan said. Many of these patients will also need sys- temic steroids and immunosuppres- sants, he added. There is also a bilateral form of Mooren's ulcer, Dr. Foster said. "If [the patient has] it in both eyes, things change. The odds of a conjunctival resection and aggres- sive topical steroid use putting the problem into remission go way down. In those bilateral cases, it's very common to need systemic im- munosuppressant chemotherapy," he said. While there have been some reports linking Mooren's ulcer with hepatitis C, according to Dr. Sangwan, "There is no consensus on this issue as there are only a few case reports that talk of association, and no good prospective study has shown this to be true." Most of the experts in the corneal area do not believe in such an association and don't treat these patients with anti-hepatitis treat- ment, he added. Along similar lines, Dr. Foster said Mooren's ulcer is by definition not associated with any systemic autoimmune disease; however it may be triggered by a myriad of things including infection like hepatitis C, salmonella, and intestinal parasites. "One must take a proper history and do diagnostic tests and then move along therapeutically. Treat systemically as indicated. An infec- tious disease specialist should assess and render an opinion about inter- feron therapy or otherwise for the hepatitis C," he added. All of these diseases require the support of the internist, Dr. Garg said. "It is important that we work closely with the internist, for the care of the general health and ocular management is only successful if the systemic disease is brought under control," he said. EW Contact information Foster: 617-797-0849, sfoster@mersi.com Garg: 91-40-3061-2446, prashant@lvpei.org Sangwan: 91-40-3061-2632, vsangwan@lvpei.org Editors' note: The doctors mentioned have no financial interests related to this article.