Rapid deterioration of Mooren’s ulcers after conjunctival flap: a review of 2 cases

BACKGROUND: Conjunctival flaps are a widely used treatment for numerous corneal ulcers that are caused by microorganismal infections. However, whether it can be performed on immune-mediated corneal ulcers is controversial. CASE PRESENTATION: We present two cases of Mooren’s ulcer that were treated using conjunctival flap in an attempt to prevent further corneal perforation at their local hospital. A rapid acceleration in ulcer progression was observed after a conjunctival flap was applied. Ultimately, the two patients underwent corneal transplantation, which required the postoperative use of topical immunosuppressants and resulted in a final cure. In the current report, we also discussed this incorrect surgical choice via a review of conventional interventions that are used to treat Mooren’s ulcer. CONCLUSIONS: These two cases demonstrate that keratoplasty combined with topical immunosuppressants is effective in treating Mooren’s ulcer. Application of conjunctival flaps or autografting could promote progression of ulceration in Mooren’s ulcers.