J Korean Ophthalmol Soc.  2014 Mar;55(3):437-442. 10.3341/jkos.2014.55.3.437.

A Case of Autologous Tragal Perichondrium Graft in a Patient with Mooren's Ulcer

• Lee DI
• Kim KW
• Kim JC

• KMID: 2218276
• DOI: http://doi.org/10.3341/jkos.2014.55.3.437

Abstract

PURPOSE
To report the effectiveness of an autologous tragal perichondrium graft for an active Mooren's ulcer.
CASE SUMMARY
A 49-year-old male was referred to our clinic with Mooren's ulcer in his left eye. On the first visit, the ulcer involved the entire 360 degrees of the peripheral cornea and the visual acuity was 0.04. As the ulcer did not respond to medical treatment and progressed rapidly, the authors decided on surgical treatment. First, the involved cornea and nearby conjunctiva were removed and the defect was successfully reconstructed with autologous tragal perichondrium and allogenic limbal graft. The progression of corneal ulceration ceased after surgery and the patient's symptoms remarkably improved. Additionally, the graft showed rapid vascularization and engraftment within a week. However, as the opacity evolved and progressed to the central cornea, penetrating keratoplasty (PKP) was performed 5 months after the perichondrial graft. There was no rejection and corneal translucency was kept clear with low-dose steroid eye drops until 6 months after PKP without any sign of limbal deficiency. The patient's final best corrected visual acuity was 0.125.
CONCLUSIONS
The present study shows that autologous tragal perichondrium graft is an effective method of treatment for active Mooren's ulcer by defect reconstruction and results in survival of the co-transplanted graft as well as maintaining corneal functions.

Keyword

Autologus tragal perichondrium graft; Mesenchymal stem cell; Mooren's ulcer

MeSH Terms

Conjunctiva
Cornea
Corneal Ulcer
Humans
Keratoplasty, Penetrating
Male
Mesenchymal Stromal Cells
Middle Aged
Ophthalmic Solutions
Transplants*
Ulcer*
Visual Acuity
Ophthalmic Solutions

Figure

• 

  Figure 1. Slit-lamp photographs of 49-year-old man with Mooren’s ulceration of his left eye. (A, B) Peripheral corneal ulceration was noted involving 360 degrees. (C) 15 days after surgery, vascularization and epithelization progressed over the grafted autologous perichondrium and allogenic limbus. (D) There was no sign of graft failure and inflammation after 5 months of previous perichondrial and limbal graft. However, the cornea healed with central opacity.

• 

  Figure 2. Photographs during surgery. (A) Harvested autologous perichondrium was cut to about 3.3 mm diameter, and placed 360 degrees around the peripheral cornea at 1/2 thickness of the ulcer depth. Prepared perichondrium was sutured interruptedly with #10-0 nylon. (B) Superficial to the perichondrium graft, a same sized allogenic limbal ring graft was made and sutured interruptedly to the peripheral cornea with #10-0 nylon.

• 

  Figure 3. Slit-lamp photographs after penetrating keratoplasty (PKP). (A, B) After 2 months of PKP, the graft remained clear but diffuse erosion was noted. (C, D) After 6 months of PKP. There was no sign of graft rejection and the corneal graft remained clear with low-dose steroid eye drops. Corneal epithelium recovered without any signs of limbal dysfunction.

Reference

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