Amniotic membrane transplantation for Mooren's ulcer

Background: To describe the outcome of surgery using amniotic membrane transplantation for Mooren's ulcer. Design: A prospective interventional case series from the Vietnam National Institute of Ophthalmology. Participants: Eighteen eyes of 14 patients with Mooren's ulcer. Seven eyes had recurrent episodes of ulceration, and 11 were not responsive to medical therapy or conjunctival resection. Methods: All eyes were treated with amniotic membrane grafts for Mooren's ulcer (10 eyes with multilayer grafts; 8 with a single layer graft). Five eyes with a 360° peripheral ulcer were treated with an overlay amniotic membrane graft, and 13 eyes were treated with a freehand graft tailored to fit the localized defect. Main Outcome Measures: Time to epithelial healing. Visual acuity outcome. Result: Sixteen of 18 eyes were treated by a single surgery with amniotic membrane with rapid healing of the epithelial defect (mean time to complete epithelialization 12.4 days). Two eyes required a second amniotic membrane graft: one eye required regrafting following a subgraft haemorrhage and another eye required regrafting for a persistent epithelial defect. Vision was stabilized in all eyes with 10 of 18 eyes obtaining vision of 6/12 or better. Conclusion: Amniotic membrane transplantation may be a useful treatment for selected patients with Mooren's ulcer especially where systemic immunosuppressive drugs are unavailable.