title: Immunosuppression for Mooren's ulcer: evaluation of the stepladder approach--topical, oral and intravenous immunosuppressive agents.
abstract: OBJECTIVE
  To evaluate a step ladder approach for immunosuppressive regimen for Mooren's ulcer.
  
  
  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.
authors.affiliation: Cornea and Anterior Segment Services, L V Prasad Eye Institute, , Hyderabad, Andhra Pradesh, India.
authors.forename: Jatin N
authors.initials: JN
authors.lastname: Ashar
authors.forename: Anurag
authors.initials: A
authors.lastname: Mathur
authors.forename: Virender S
authors.initials: VS
authors.lastname: Sangwan
mesh_terms: D000284:Administration, Oral; D000287:Administration, Topical; D000893:Anti-Inflammatory Agents; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007108:Immune Tolerance; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007275:Injections, Intravenous; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives; D011355:Prodrugs; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D011355:Prodrugs; C009935:prednisolone acetate; D011239:Prednisolone; D008727:Methotrexate
keywords: Cornea; Immunology