title: Management of severe and refractory Mooren's ulcers with rituximab.
abstract: Management of severe and refractory Mooren's ulcers is challenging as it encompasses tectonic surgical treatment and aggressive immunosuppressive therapies. Efficacy of rituximab in the management of severe Mooren's ulcers has never been reported.
  
  
  
  Five patients (six eyes) from the Cornea and External Disorders department at the Rothschild Ophthalmologic Foundation (Paris, France) were treated for severe Mooren's ulcer unresponsive to conventional treatments between 2008 and 2016. Conventional treatment included topical steroid and ciclosporin 2%, high doses of systemic corticosteroids and/or cyclophosphamide and conjunctival resection with amniotic membrane graft. These patients received two infusions of 1000 mg of rituximab at 2 weeks interval. Epithelial healing, inflammation, additional surgery, systemic corticosteroids and rituximab-related side effects were reported.
  
  
  
  The mean follow-up was 46.8 months. Following rituximab treatment, we observed a complete healing of Mooren's ulcer within 2 weeks in all patients. Peripheral lamellar keratoplasty was associated when peripheral corneal perforation occurred (5/6 affected corneas). Systemic corticosteroids had been discontinued in all patients. Two recurrences occurred 13 and 53 months after the first rituximab infusion and where successfully treated with a new infusion. No rituximab-related adverse events were reported.
  
  
  
  Rituximab was effective in the management of severe Mooren's ulcers and could be an alternative to cyclophosphamide. Additional studies should assess the role of this biotherapy in the management of immunological corneal ulcer.
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.|Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.|Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Damien
authors.identifier: 0000-0001-9206-1270
authors.initials: D
authors.lastname: Guindolet
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.|Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.|Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Clotilde
authors.initials: C
authors.lastname: Reynaud
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.
authors.forename: Gaelle
authors.initials: G
authors.lastname: Clavel
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.
authors.forename: Georges
authors.initials: G
authors.lastname: Belangé
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.
authors.forename: Maycene
authors.initials: M
authors.lastname: Benmahmed
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.|Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Doan
authors.affiliation: Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Hayem
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.|Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.|Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Cochereau
authors.affiliation: Fondation A. de Rothschild, Paris, 75019, France.|Hôpital Bichat Claude Bernard 46 Rue Henri Huchard, Paris, 75018, France.|Université Paris Diderot, Sorbonne Paris Cité, France.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Gabison
mesh_terms: D000328:Adult; D057112:Corneal Perforation / Q000000981:diagnostic imaging / Q000473:pathology* / Q000517:prevention & control; D003320:Corneal Ulcer / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D000072776:Slit Lamp Microscopy; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab
keywords: Cornea; Drugs; Inflammation; Treatment Medical; Treatment Surgery