1. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br Triple Procedure for Bilateral Perforated Mooren's Ulcer G. S. Lima; P. Ferreira; A. Figueiredo; F. Ramalho We have no finantial interest in this presentation.

2. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br INTRODUCTION Mooren's ulcer is a rapidly progressive, painful, ulcerative keratitis which initially affects the peripheral cornea and may spread circumferentially and then centrally. Mooren's ulcer can only be diagnosed in the absence of an infectious or systemic cause and must be differentiated from other corneal abnormalities, such as Terrien's degeneration

3. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br INTRODUCTION The etiology remains unknown. The response to medical and surgical intervention is typically poor, and the visual outcome can be devastating.The purpose of relating this case of bilateral perforation associated with cataracts is to share the difficulties and possible solutions in the manegement of this uncomon situation.

4. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br Diagnosis A 86-year-old white male, presented with an area of peripheral perforation of the left superior cornea, white cataract, already treated with a conjunctival patch. 3 weeks later a inferior peripheral thinning starts in the right eye. OD OS

5. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br TREATMENTS IN YELLOW WERE USED Peritomy Topical steroids Topical ciclosporine Immunosupression Lamelar transplant Penetracting keratoplasty Glue patch Sub-conj triancinolone

6. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br SEGMENT In a 3 weeks period the patient underwent a 360 degrees peritomy, 2 glue patches, and despite the agressive sugical and clinical treatment a penetracting keratoplasty with complete removal of the receptor cornea at the limbus

7. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br PENETRACTING KERATOPLASTY+LENS EXTRACTION In this particulary case was difficult due to manual scissors trepanation, but with no further problems.

8. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br 5 months after diagnosis OD was stable, under topical steroids qid. OS went to primary graft failure probably due to tissue conditions

9. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br CONCLUSION Mooren's ulcers usually respond poorly to conventional therapy, as there is limited knowledge of the pathophysiology of the disease. The surgical treatment often fails due to the agressive nature of the disease. More clinical and surgical cases should be shared in order to obtain better results in the treatment of the disease.

10. drgustavolima@hotmail.com OFTALMOS® -SC-BRAZIL www.oftalmos.com.br REFERENCES Watson PG. Eye. 1997; (Pt 3):349-56.