Ulcus Rodens! Part 2

𝐌𝐨𝐨𝐫𝐞𝐧’𝐬 𝐔𝐥𝐜𝐞𝐫 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 #ophthalmology #ophthal #doctor #health #medical #vision #education #optometry #medicalstudent #optometrist #medicine #eye #ophtho #ophthalmologist #ophthalmo #med #medicaleducation #ophthalmologyresident #ophthalmologyresidency #moorensulcer #moorens #puk #peripheralulcerativekeratitis #autoimmune #cornea #cornealulcer #perforation #conjunctivalresection #glueBCL #tissueadhesive #steroids #immunosuppressants