[Severe Moorens ulcer: efficacy of monthly cyclophosphamide intravenous pulse treatment].
OBJECTIVE
Mooren's ulcer (MU) is a chronic peripheral corneal ulceration featuring conjunctival immunoglobulin deposits. It is considered as the result of a limbic immune process with hyperactivation of T and B lymphocytes. The etiology remains unknown. The response to topical steroid therapy and surgical procedures usually poor and the visual outcome can be devastating.


METHODS
Clinical follow-up of 3 patients who had rebel MU to conventional therapy, and were treated with 1g monthly intravenous cyclophosphamide.


RESULTS
First patient was a 24-years-old man who had MU in his left eye. The response to surgical procedure and intravenous steroid treatment was poor and corneal perforation occurred. The affected cornea healed after 9 months of Cy treatment. The second patient was a 50-years-old man who had MU in his left eye, which did not improved with lamellar keratoplasty and topical steroid therapy. Corneal healing was obtained after 20 months of Cy treatment. The third patient was a 70-years-old man who presented with a furrowed MU in his right eye which healed with conjunctival resection and 4 months of Cy perfusion. No adverse effects of Cy was noted as opposed to Cy given orally.


CONCLUSIONS
We report the effectiveness of 1g monthly intravenous cyclophosphamide (Cy) treatment in rebel MU. We suggest that immunosuppressive therapy using IV monthly Cy may be proposed in severe rebel MU.
Tiev
K-P
KP
Service de médecine interne, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 cedex 12, Paris, France. kiet.tiev@sat.ap-hop-paris.fr <kiet.tiev@sat.ap-hop-paris.fr>
Borderie
V-M
VM
Briant
M
M
Ziani
M
M
Morvant
C
C
Baret
M
M
El Khattabi
A
A
Généreau
T
T
Laroche
L
L
Cabane
J
J
D000328:Adult; D000368:Aged; D003320:Corneal Ulcer / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide