Ulcus Rodens: Management

𝐒𝐭𝐞𝐩𝐰𝐢𝐬𝐞 𝐀𝐩𝐩𝐫𝐨𝐚𝐜𝐡⁣⁣⁣ ⁣⁣⁣

The goal of therapy is to ​arrest the destructive process and to promote healing and reepithelialization of the corneal surface⁣⁣⁣ ⁣⁣⁣

1. 𝘛𝘰𝘱𝘪𝘤𝘢𝘭 𝘤𝘰𝘳𝘵𝘪𝘤𝘰𝘴𝘵𝘦𝘳𝘰𝘪𝘥𝘴 to control the inflammation⁣⁣⁣ ⁣⁣⁣

2. 𝘊𝘰𝘯𝘫𝘶𝘯𝘤𝘵𝘪𝘷𝘢𝘭 𝘳𝘦𝘴𝘦𝘤𝘵𝘪𝘰𝘯⁣⁣⁣

● Conjunctiva adjacent to the ulcer contains inflammatory cells that may be producing antibodies against the cornea and cytokines which amplify the inflammation and recruit additional inflammatory cells.⁣⁣⁣

● Conjunctival excision to bare sclera extending at least 2 clock hours to either side of the peripheral ulcer, and approximately 4 mm posterior to the corneoscleral limbus and parallel to the ulcer. The overhanging lip of the ulcerating cornea can also be removed.⁣⁣⁣ ⁣⁣⁣

3. 𝘚𝘺𝘴𝘵𝘦𝘮𝘪𝘤 𝘪𝘮𝘮𝘶𝘯𝘰𝘴𝘶𝘱𝘱𝘳𝘦𝘴𝘴𝘪𝘰𝘯⁣⁣⁣

● Those cases of bilateral or progressive Mooren's ulcer that fail the preceding therapeutic attempts will require systemic chemotherapy.⁣⁣⁣

4. 𝘈𝘥𝘥𝘪𝘵𝘪𝘰𝘯𝘢𝘭 𝘴𝘶𝘳𝘨𝘪𝘤𝘢𝘭 𝘱𝘳𝘰𝘤𝘦𝘥𝘶𝘳𝘦𝘴⁣⁣⁣

● Superfical lamellar keratectomy ⁣

● Application of tissue adhesive (cyanoacrylate glue) creates a biological barrier between the host cornea and re-epithelializing conjunctiva and the immune components it carries⁣⁣⁣

● Amniotic membrane transplantation allows for rapid healing of epithelial defect⁣⁣⁣

● Small perforations can be sealed with glue and bandage contact lens⁣⁣⁣

● Patch graft/ Partial penetrating keratoplasty in larger perforations⁣⁣⁣ ⁣⁣⁣

5. 𝘙𝘦𝘩𝘢𝘣𝘪𝘭𝘪𝘵𝘢𝘵𝘪𝘰𝘯⁣⁣⁣

● Two stage surgical therapy → Initial lamellar tectonic grafting in the quiescent stage of disease followed by central PK in advanced cases.⁣⁣⁣

● Lamellar Keratoplasty is widely done - to remove necrotic cornea and to reconstruct the anatomical structure of the cornea⁣⁣

The video shows conjunctival resection being done in the area of the ulcer and tissue adhesive being applied to create a barrier followed by application of a BCL.⁣⁣⁣

www.ophthalmobytes.com​⁣⁣⁣⁣⁣⁣

Surgical Video from Rajan Eye Care Hospital

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