Immunosuppression for Mooren's ulcer: evaluation of the stepladder approach—topical, oral and intravenous immunosuppressive agents
- Correspondence to Dr Virender S Sangwan, Cornea and Anterior Segment Services, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad 500034, Andhra Pradesh, India;
- Received 13 September 2012
- Revised 14 February 2013
- Accepted 2 March 2013
- Published Online First 27 March 2013
Aim To evaluate a step ladder approach for immunosuppressive regimen for Mooren's ulcer.
Material and methods We retrospectively analysed patients of Mooren's ulcer presenting to a tertiary care centre in south India from 1987 to 2010. Patients were analysed for the age, disease severity at time of presentation in terms of the quadrants of peripheral corneal involvement and amount of peripheral corneal thinning. According to the disease severity, patients were instituted either topical steroids (prednisolone acetate 1%) single agent or in combination with oral steroids (prednisolone 1–1.5 mg/kg/day), oral immunomodulators (methotrexate 7.5–12.5 mg/week), intravenous pulsed methyl prednisolone 1 g or pulsed cyclophosphamide 1 g. The main outcome measure was control of disease activity.
Results Topical steroids as a single therapy had a disease resolution rate in 76% of the cases. Cases that required oral steroids, oral methotrexate, intravenous pulsed methyl prednisolone and combination of pulsed methyl prednisolone and cyclophosphamide had a resolution rate of 86%, 78.5%, 71.4% and 73.3%, respectively. The most common complication was secondary infection. Most of the cases that failed therapy had perforation of the cornea and required corneal transplantation.
Conclusions An aggressive immunosuppressive regimen that is tailor made based on disease severity as a first line of therapy improves the chances of disease control even in cases of aggressive Mooren's ulcer.