Customised crescentic corneal transplant with conjunctival resection in an atypical case of malignant Mooren's ulcer.

Urkude J, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220973 Description Mooren’s ulcer is a painful peripheral ulcerative keratitis of unknown aetiology. It is rapidly progressive inflammatory destruction of the juxtalimbal corneal stroma with no associated scleritis. Mooren’s ulcer is a diagnosis of exclusion, after ruling out all the relevant systemic and local causes that lead to peripheral ulcerative keratitis. It usually present as bilateral disease with male to female distribution of 1:0.74 being more common in older age group. Mooren’s ulcer has been seen to be associated with human leucocyte antigen (HLA)DR17(3) and DQ2. A 20-year-old male patient presented with complaints of sudden onset pain, redness and watering in the left eye. History revealed recurrent episodes of similar complaints for the last 2 years. On examination, the visual acuity in the left eye was counting finger at 2 m and 20/20 in the right eye. The slit-lamp biomicroscopic examination showed juxtalimbal severe congestion associated with 2×2 mm of perforation between 8 and 9 clock hours with uveal tissue prolapsed (figure 1A). Peripheral corneal thinning extending from 4 to 11 clock hours involved 90% of the Customised crescentic corneal transplant with conjunctival resection in an atypical case of malignant Mooren’s ulcer