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ARTICLES
Year : 1983  |  Volume : 31  |  Issue : 7  |  Page : 1047-1048

Peritomy in the management of mooren's ulcer-a preliminary report


Department of Ophthalmology, North Bengal Medical College & Hospital, Darjeeling, India

Correspondence Address:
B K Baidya
Deptt. of Ophthalmology, North Bengal Medical College & Hospital, Darjeeling
India
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Source of Support: None, Conflict of Interest: None


PMID: 6544255

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How to cite this article:
Baidya B K, Chattopadhyay D N, Basu B C. Peritomy in the management of mooren's ulcer-a preliminary report. Indian J Ophthalmol 1983;31, Suppl S1:1047-8

How to cite this URL:
Baidya B K, Chattopadhyay D N, Basu B C. Peritomy in the management of mooren's ulcer-a preliminary report. Indian J Ophthalmol [serial online] 1983 [cited 2020 May 24];31, Suppl S1:1047-8. Available from: http://www.ijo.in/text.asp?1983/31/7/1047/29743

Mooren's ulcer is a chronic marginal cor­neal ulcer of obscure aetiology occurring in elderly people. It starts in the corneal periphery and slowly progresses towards the centre, circumferentially as well as towards the sclera; with gradual thinning of substantia propria having a characteristic overhanging edge.

Several theories have been suggested to explain the aetiology; these include infective, degenerative, metabolic, nutritional and autoimmune. According to autoimmune theory autoantibodies are supplied by perilimbal vessels to corneal periphery where the antigen-antibody reaction sets up the des­tructive process.

Despite the availability of several modes of treatment, none proved to be satisfactory and the end result is almost invariably loss of the eye, Keeping in mind the autoimmume basis of the ulcer we have applied the process of peritomy in 7 cases in order to destroy the perilimbal blood vessels in the vicinity of ulcer, so as to stop further supply of antibodies to the affected peripheral cornea. The results were encouraging in all the cases.


  Material and methods Top


During the period from January 1982 to September 1982, 7 cases of marginal corneal ulcer attending the Eye O.P.D. of North Bengal Medical College and Hospital were treated by this method. The cases fulfilled the following criteria:

1. Elderly patients

2. Long standing manginal corneal ulcer not responding to any form of treatment.

3. Ulcer gradually progressing towards cor­nea as well as sclera.

4. characteristic overhanging edge of ulcer.

Incidentally all the patients were male.

One patient was aged 41 years, others were above 55 years of age, The ulcer was bilateral in one case.

Peritomy was performed under local anaesthesia. Xylocaine 4% was used as sur­face anaesthesia and Xylocaine 2% was infiltrated subconjunctivally in the selected area. A 3 mm broad strip of conjunctiva extending on either side 1 mm. beyond the extent of the ulcer [Figure - 1] was removed from the limbus.

The underlying bloodvessels were des­troyed thoroughly by heat cautery. Care was taken to avoid excessive cautery causing char­ring of sclera. An antibiotic eye drop was applied and the eye was patched for 3-4 days. The antibiotic eye drop was continued for further 10 days. The patients were subsequen­tly followed up once a week for 4 weeks and once a month thereafter. The average follow up period till now is 6 months.


  Observations Top


In all the cases the progress of the ulcer stopped after the peritomy. The eye became quiet in one week and ulcer was completely healed in 2 weeks period.

Only in one patient the ulcer recurred after 3 months. The procedure was repeated in the corresponding area and the ulcer healed again quickly. In all other cases there was no recurrence of ulcer till now.


  Summary and conclusions Top


The results of available modes of treatment of Mooren's ulcer are frustrating and the end result in most cases is loss of the eye. Partial peritomy with the destruction of correspond­ing Timbal blood vessels has shown encourag­ing results. With, further cases and longer follow up period we hope to came to a more definitive conlusion.


    Figures

  [Figure - 1]



 

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