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Management of severe and refractory Mooren's ulcers with rituximab
  1. Damien Guindolet1,2,3,
  2. Clotilde Reynaud1,2,3,
  3. Gaelle Clavel1,
  4. Georges Belangé1,
  5. Maycene Benmahmed1,
  6. Serge Doan1,2,
  7. Gilles Hayem2,
  8. Isabelle Cochereau1,2,3,
  9. Eric E Gabison1,2,3
  1. 1Fondation A. de Rothschild, Paris, 75019, France
  2. 2Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France
  3. 3Université Paris Diderot, Sorbonne Paris Cité, France
  1. Correspondence to Professor Eric E Gabison, Cornea and External Disorders, Cataract and Refractive Surgery Department, Hôpital Bichat and Fondation A. de Rothschild, Université Paris VII, Diderot, Paris, France; egabison{at}for.paris

Abstract

Purpose Management of severe and refractory Mooren's ulcers is challenging as it encompasses tectonic surgical treatment and aggressive immunosuppressive therapies. Efficacy of rituximab in the management of severe Mooren's ulcers has never been reported.

Methods Five patients (six eyes) from the Cornea and External Disorders department at the Rothschild Ophthalmologic Foundation (Paris, France) were treated for severe Mooren's ulcer unresponsive to conventional treatments between 2008 and 2016. Conventional treatment included topical steroid and ciclosporin 2%, high doses of systemic corticosteroids and/or cyclophosphamide and conjunctival resection with amniotic membrane graft. These patients received two infusions of 1000 mg of rituximab at 2 weeks interval. Epithelial healing, inflammation, additional surgery, systemic corticosteroids and rituximab-related side effects were reported.

Results The mean follow-up was 46.8 months. Following rituximab treatment, we observed a complete healing of Mooren's ulcer within 2 weeks in all patients. Peripheral lamellar keratoplasty was associated when peripheral corneal perforation occurred (5/6 affected corneas). Systemic corticosteroids had been discontinued in all patients. Two recurrences occurred 13 and 53 months after the first rituximab infusion and where successfully treated with a new infusion. No rituximab-related adverse events were reported.

Conclusions Rituximab was effective in the management of severe Mooren's ulcers and could be an alternative to cyclophosphamide. Additional studies should assess the role of this biotherapy in the management of immunological corneal ulcer.

  • Cornea
  • Drugs
  • Inflammation
  • Treatment Medical
  • Treatment Surgery

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