The Application of in vivo Confocal Scanning Laser Microscopy in the Diagnosis and Evaluation of Treatment Responses in Mooren’s Ulcer

Abstract

Purpose: : The severity of Mooren’s ulcers and the response to therapy can be judged subjectively by conventional slit-lamp microscopic examination. It is important to quantify the degree of inflammation and the changes with treatment in patients with Mooren’s ulcer. In this study, we used in vivo laser scanning confocal microscopy (the Rostock Corneal Softwear Version 1.2 of the Heidelberg Retina Tomograph II: RCM/HRT II) to evaluate the degree of inflammation in the cornea and conjunctiva of patients with Mooren’s ulcer and also studied the changes in confocal microscopy parameters with anti-inflammatory treatment.

Methods: : Subjects and Methods: 11 eyes from 7 Mooren’s ulcer patients (4 males, 3 females, mean age: 63.3±18.5 years) were recruited in this prospective study. 5 eyes had active corneal ulcers, and 6 eyes were in remission for the past year. Confocal scanning by RCM/HRT II was performed, and the mean of inflammatory cell densities (ICD) was calculated from sequences with excellent image resolution from the basal cell layer of the corneal epithelium by the help of an attached software. 5 eyes with active ulcer were treated with topical betamethasone every hour and topical cyclosporin 3 times a day, and two out of these 5 subjects received additional systemic methylpredonisolone and systemic cyclosporin. 5 of 6 eyes in remission were treated with topical betamethasone 3-6 times a day, and one eye was free of therapy.

Results: : The mean ICD in the 5 eyes with active ulcer before treatment was 3319±2373 cells/mm². 4 of these eyes responded to subsequent treatment at 8 weeks with improvement of conjunctival injection and corneal reepithelization along with a decrease of ICD to 350±194 cells/mm². The other one eye had corneal perforation, and ICD immediately before perforation was 1834 cells/mm². The mean ICD of 6 eyes in remission was 395±328 cells/mm².

Conclusions: : ICD scoring by RCM/HRT II seems to be a useful and a promising parameter for evaluation of the degree of inflammation in Mooren’s ulcer and assessment of treatment responses.

Keywords: cornea: clinical science • imaging/image analysis: clinical • inflammation