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Combined cryoapplications and peritomy in Mooren's ulcer.

1972; BMJ; Volume: 56; Issue: 1 Linguagem: Inglês

10.1136/bjo.56.1.48

1468-2079

E Aviel,

Inflammatory Myopathies and Dermatomyositis

Mooren's ulcer is described as a marginal ulceration occurring mainly in elderly people.The ulcer is superficial, has a typically undermined edge, and does not tend to perforate.The course is slowly progressive and eventually the whole cornea may be involved.Pain is an outstanding feature of the condition.The disease may lead to blindness when extensive areas of the cornea are involved.It is bilateral in over a quarter of the cases, but the involvement of both eyes may not be simultaneous.Nothing definite is known about the aetiology of the disease.Since the condition was first described by Albert Mooren in I867, various lines of treatment have been tried without great success or uniformity of results (see Bibliography).Cautery, by either chemical or thermal methods, was the procedure traditionally employed.Excision of the ulcer edges and covering of the area with conjunctival flaps has been tried with some measure of success.Peritomy was also tried with temporary relief of symptoms.In recent years lamellar keratoplasty has not proved effective in the treatment of Mooren's ulcer.This is a report on a small number of cases of Mooren's ulcer in which the course of the disease seems to have been favourably affected by cryoapplications to the ulcer edges combined with peritomy.The cases were diagnosed and treated at the Eye Department of the Queen Elizabeth Central Hospital in Blantyre. Case reportsCase I, a female African aged 2I years, was admitted to the Eye Department on March 3I, I970, because of severe pain in the left eye of 4 months' duration.There was no history of trauma and there had been no previous medications to the eye.The visual acuity was 6/7.5 in the right eye and 6/i8 in the left, which was markedly injected.A Mooren's ulcer with a typically under- mined edge involved almost the whole corneal periphery (Fig. i).Only a small area from 9 to i I o'clock was free from ulceration.The central part of the cornea was not involved.The right eye was normal. TreatmnentOn April I 7, 1970, cryotherapy of the ulcer edges combined with peritomy was performed on the left eye.The instrument used was the Amoils cryosurgical unit with a cryoprobe tip with an operating temperature of -40 to -o0C.Each application was continued for 20 seconds, and the applications were made in the line of both the central and peripheral edges of the ulcer.A peritomny was per- formed adjacent to the ulcer edges and the bloodvessels reaching the ulcer area were coagulated with heat cautery using a battery-operated instrument.