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.
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Surgical Video from Rajan Eye Care Hospital
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