title: Amniotic membrane transplantation ineffective as additional therapy in patients with aggressive Mooren's ulcer.
abstract: BACKGROUND
  Mooren's ulcer is a severe ulcerative inflammation of the cornea. The exact pathogenesis remains unclear. Therefore many therapies of Mooren's ulcer are recommended in literature. To shed more light on the ongoing question of optimal treatment of severe progressive Mooren's ulcer, we here report on a retrospective case series of patients treated with systemic immunosuppressive therapy and additional amniotic membrane transplantation.
  
  
  METHODS
  Medical records from seven patients (eleven eyes), 4 male and 3 female, with severe progressive Mooren's ulcer were analysed retrospectively. The mean follow up was 88.4 ± 80.8 months (range 12-232 month). A HLA-typing was performed in all patients. A systemic immunosuppressive therapy was administered in all patients. The amniotic membrane was transplanted after the base of the ulcer was resected.
  
  
  RESULTS
  Multiple amniotic membrane transplantations were necessary in six patients. The visual outcome of all patients was poor. No patient achieved a visual acuity better than 20/630 Snellen chart. Five patients were positive for HLA-DQ2 and four patients were positive for HLA-DR17(3).
  
  
  CONCLUSIONS
  The aggressive and highly inflammatory form of Mooren's ulcer is difficult to treat and the progression of the disease is hard to influence positively even under systemic immunosuppressive therapy. Therefore, the main intention of therapy is to achieve a stable epithelialized corneal surface without the risk of perforation. Amniotic membrane transplantation is not able to cure severe forms of Mooren's ulcer. However it supports the immunosuppressive therapy in acute situations as in critical corneal thinning.
authors.affiliation: Department of Ophthalmology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr 55, D-45147 Essen, Germany. maurice.schallenberg@uk-essen.de.
authors.forename: Maurice
authors.initials: M
authors.lastname: Schallenberg
authors.forename: Henrike
authors.initials: H
authors.lastname: Westekemper
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Steuhl
authors.forename: Daniel
authors.initials: D
authors.lastname: Meller
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000650:Amnion / Q000637:transplantation*; D003131:Combined Modality Therapy; D003320:Corneal Ulcer / Q000628:therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D016572:Cyclosporine / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020551:Pulse Therapy, Drug; D012189:Retrospective Studies; D017211:Treatment Failure; D014792:Visual Acuity
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003520:Cyclophosphamide