The Application of In Vivo Confocal Scanning Laser Microscopy in the Diagnosis and Evaluation of Treatment Responses in Mooren's Ulcer

PURPOSE. To evaluate the extent of corneal inflammation and the response to treatment in patients with Mooren's ulcer, by in vivo confocal microscopy (IVCM). METHODS. Twenty-two eyes of 15 patients with Mooren's ulcer were enrolled in this prospective study. All subjects underwent routine ophthalmic examinations, IVCM, and conjunctival histopathologic examination of specimens in patients undergoing conjunctival excision. Eyes with active ulcer were treated with topical corticosteroids and additional therapy, depending on the signs and symptoms. Eyes in remission continued to receive the previous treatment protocols. The relation between the severity of ulcer and inflammation status as assessed by IVCM was also studied. The endpoints were inflammatory cell density (ICD), counted by IVCM, and the extent of the limbal arc involved with ulcers. RESULTS. Ten eyes had active corneal ulcers, and 12 eyes had been in remission for the past year. The mean ICD of eyes with active ulcers before treatment was 2092.7 +/- 1538.6 cells/mm(2) (range, 835.3-7832.7; 95% CI, 3232.5-952.9). Nine of the eyes improved at 8 weeks, with a decrease in ICD to 249.1 +/- 109.0 cells/mm2 (range, 100.3-595.3; 95% CI, 329.8 - 168.3). One eye had corneal perforation, and ICD immediately before perforation was 1677.6 +/- 247.6 cells/mm2. The mean ICD of 12 eyes in remission was 357.5 +/- 266.8 cells/mm(2) (range, 12.71127.0; 95% CI, 555.2-159.8). The correlation of the ICD and the extent of limbal involvement with ulcers was strong (R(2) = 0.8119). CONCLUSIONS. ICD evaluated by IVCM is a useful and promising parameter for evaluation of the degree of inflammation in eyes with Mooren's ulcer and for assessment of response to treatment. (Invest Ophthalmol Vis Sci. 2011; 52: 6680-6689) DOI: 10.1167/iovs.10-5906