Surgical options for refractory Mooren's ulcers and their impact on vision

Researchers from China have conducted a retrospective study to evaluate a surgical treatment algorithm for refractory Mooren's ulcers, based on the severity of the condition. The study, which spanned from February 2016 to January 2024, included 24 patients (24 eyes) who had not responded to conservative therapy.

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Операционная: подготовка стерильных инструментов на фоне хирургической бригады

The surgical approach was stratified according to the extent of corneal damage: amniotic membrane transplantation (AMT) was performed for lesions affecting less than two-thirds of the corneal thickness; lamellar keratoplasty (LK) was used for lesions affecting two-thirds or more of the thickness or perforations up to 4 mm; and penetrating keratoplasty (PK) was applied for perforations exceeding 4 mm.

Primary healing was achieved in 95.8% of the total patient group, with 100% success rates in the AMT and PK groups and 93.3% in the LK group. However, functional outcomes varied significantly. In the AMT group, 71.4% of patients maintained a best-corrected visual acuity (BCVA) of 0.3 or higher. In contrast, only 13.3% of patients in the LK group achieved this level of vision, and 73.3% developed significant graft opacity. Outcomes in the PK group were the most severe: despite initial healing, both patients eventually lost the eye (due to phthisis bulbi or non-functional perforation).

A major limitation of the algorithm was the high rate of recurrence, which correlated with the aggressiveness of the disease. Recurrence rates were 28.6% for AMT, 64.3% for LK, and 100% for PK. According to Kaplan-Meier analysis, the median time to the first recurrence in the LK group was 36 months, with recurrence-free survival dropping to 16.3% by 48 months. The authors noted that recurrences often coincided with the reduction or discontinuation of immunosuppressive therapy.

While the overall rate of anatomical success (preservation of the eyeball's integrity) was 87.5%, the researchers emphasize that surgery alone does not guarantee long-term remission due to the chronic autoimmune nature of Mooren's ulcer. For patients with severe forms requiring keratoplasty, long-term immunosuppressive maintenance and close monitoring are necessary.

The authors noted several limitations of the study, including its retrospective design, small sample size, and lack of randomization, stating that these results require confirmation through future prospective multicenter trials.