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    Rituximab appears to cure Mooren’s ulcers in 5 patients

     

    Tapering therapy

    Clinicians gradually tapered the patients’ system of rituximab, with total withdrawal in 2 to 11 months, and also tapered the topical steroids and ciclosporin over 12 months.

    Two of the patients relapsed with stromal infiltration and an epithelial defect, 1 at 53 months and 1 at 13 months after the first rituximab infusions. Both underwent another round of 3 intravenous corticosteroid pulses followed by oral corticosteroid, local steroids and local ciclosporin then a new cycle of rituximab.

    This treatment led once again to complete healing within 2 weeks, and neither patient had relapsed 11 and 13 months after the last infusion of rituximab.

    No patient appeared to suffer any side effects to the rituximab. One patient developed a staphylococcal corneal ulcer 3 months after the lamellar keratoplasty on a loosened suture, but this was successfully treated with local fortified antibiotics and early replacement of the lamellar graft.

    A total of 4 eyes in 3 of the patients gained visual acuity following the treatment. Scleral lenses were adapted in the other 2, leading to significant improvement in visual acuity.

    Dr Guindolet and colleagues acknowledge that their small case series can hardly be considered definitive proof of the efficacy of rituximab for Mooren’s ulcers. But they point out that a randomised clinical trial would be difficult to achieve.

    In the meantime, this experience has altered their approach to the disease, they wrote. “This impressive therapeutic response led us to consider rituximab as a new therapeutic option when cyclophosphamide was previously proposed.”

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