title: The application of in vivo confocal scanning laser microscopy in the diagnosis and evaluation of treatment responses in Mooren's ulcer.
abstract: OBJECTIVE
  To evaluate the extent of corneal inflammation and the response to treatment in patients with Mooren's ulcer, by in vivo confocal microscopy (IVCM).
  
  
  METHODS
  Twenty-two eyes of 15 patients with Mooren's ulcer were enrolled in this prospective study. All subjects underwent routine ophthalmic examinations, IVCM, and conjunctival histopathologic examination of specimens in patients undergoing conjunctival excision. Eyes with active ulcer were treated with topical corticosteroids and additional therapy, depending on the signs and symptoms. Eyes in remission continued to receive the previous treatment protocols. The relation between the severity of ulcer and inflammation status as assessed by IVCM was also studied. The endpoints were inflammatory cell density (ICD), counted by IVCM, and the extent of the limbal arc involved with ulcers.
  
  
  RESULTS
  Ten eyes had active corneal ulcers, and 12 eyes had been in remission for the past year. The mean ICD of eyes with active ulcers before treatment was 2092.7 ± 1538.6 cells/mm(2) (range, 835.3-7832.7; 95% CI, 3232.5-952.9). Nine of the eyes improved at 8 weeks, with a decrease in ICD to 249.1 ± 109.0 cells/mm(2) (range, 100.3-595.3; 95% CI, 329.8-168.3). One eye had corneal perforation, and ICD immediately before perforation was 1677.6 ± 247.6 cells/mm(2). The mean ICD of 12 eyes in remission was 357.5 ± 266.8 cells/mm(2) (range, 12.7-1127.0; 95% CI, 555.2-159.8). The correlation of the ICD and the extent of limbal involvement with ulcers was strong (R(2) = 0.8119).
  
  
  CONCLUSIONS
  ICD evaluated by IVCM is a useful and promising parameter for evaluation of the degree of inflammation in eyes with Mooren's ulcer and for assessment of response to treatment.
authors.affiliation: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. tr97469@zc4.so-net.ne.jp
authors.forename: Shin
authors.initials: S
authors.lastname: Hatou
authors.forename: Murat
authors.initials: M
authors.lastname: Dogru
authors.forename: Osama M A
authors.initials: OM
authors.lastname: Ibrahim
authors.forename: Tais
authors.initials: T
authors.lastname: Wakamatsu
authors.forename: Enrique Adan
authors.initials: EA
authors.lastname: Sato
authors.forename: Shigeto
authors.initials: S
authors.lastname: Shimmura
authors.forename: Kazuno
authors.initials: K
authors.lastname: Negishi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Tsubota
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count / Q000379:methods; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000473:pathology* / Q000601:surgery; D016572:Cyclosporine / Q000627:therapeutic use; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods*; D008875:Middle Aged; D008954:Models, Biological; D011446:Prospective Studies; D012074:Remission Induction
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine