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    Rituximab appears to cure Mooren’s ulcers in 5 patients


    Diving deeper

    The researchers reported on 5 patients who presented with severe Mooren’s ulcers at the Cornea and External Disorders department of the Rothschild Ophthalmologic Foundation between October 2008 and January 2016.

    The patients underwent extensive examinations and workup, including testing for parasitic infections, with patients from endemic areas treated with ivermectin prior to immunosuppressive infusions.

    One of the patients had schistosomiasis and another had helminthiasis. A third patient was diagnosed with obsessive-compulsive disorder involving iterative corneal abrasion. A fourth patient had a history of chronic corneal Dellen linked with a prominent filtering bleb.

    The patients then underwent hourly administration of local corticosteroids, topical 2% ciclosporin A 3 times a day, systemic immunosuppression, conjunctival resection, and amniotic membrane graft.

    Two patients underwent 3 intravenous cyclophosphamide pulses (600 mg/m2 weekly) which did not stop their corneas from melting.

    Intravenous corticosteroid in 3 to 6 pulses (500 mg/pulse) followed by oral corticosteroid (1 mg/kg/day) also could not stop the ulcers from progressing.

    When these 2 patients’ corneas continued thinning after these treatments, they were offered rituximab in the form of 2 infusions of 1,000 mg at 2-week intervals. They healed completely within 15 days.

    Seeing this, the clinicians skipped cyclophosphamide and went directly to rituximab in the other 3 patients, and these patients also healed within 15 days.

    Patients with corneal keratoplasty also underwent lamellar keratoplasty, receiving rituximab the next day.

    Tapering therapy

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