Management of Perforated Mooren’s Ulcer with a Rotational Scleral Autograft in Abuja

Abstract

Mooren’s ulcer is a fairly common peripheral corneal melting disease in Nigeria. Cases presenting late with perforation and uveal prolapse are a serious challenge to management, particularly in a setting where corneal grafting is not routinely practiced. To describe the management of perforated Mooren’s ulcer using scleral rotational autograft. A case of bilateral Mooren’s ulcer with corneal melting and uveal prolapse in the left eye (LE) involving 1½ h was managed with a scleral rotational autograft at the Rachel Eye Center, Abuja. The patient was a 75‑year‑old female retiree with concomitant rheumatoid arthritis involving the knee and metacarpophalangeal joints. Following a 360° peritomy and cryotherapy in both eyes, a partial thickness scleral hinged autograft was developed and rotated over the uveal prolapse and corneal defect whereupon, it was fastened with interrupted 10/0 nylon sutures and secured with a bandage soft contact lens. The integrity of the globe was maintained for over 6 months with the scleral flap which became largely transparent from the 13th day after the surgery. The anterior chamber went flat temporarily, but this was reversed with firm pad over a contact lens. This technique is recommended as at least a stopgap before the availability of corneal grafts.

Key words: Corneal melting, cryotherapy, Mooren’s ulcer, peritomy, rotational flap, scleral autograft