{ "abstract": "Objective: To evaluate the clinical outcomes of a Severity-Based Surgical Algorithm for treating refractory Mooren’s ulcer. Methods: We retrospectively reviewed consecutive patients with Mooren’s ulcer who underwent surgical intervention between February 2016 and January 2024 after failing medical therapy. A predefined severity-based surgical algorithm was applied: amniotic membrane transplantation (AMT) for ulcers involving <2/3 stromal thickness; lamellar keratoplasty (LK) for ulcers ≥2/3 thickness or perforations ≤4 mm; and penetrating keratoplasty (PK) for perforations >4 mm or technical infeasibility of LK. All patients received postoperative systemic and local immunosuppression. Primary outcomes included primary healing, changes in best-corrected visual acuity (BCVA), recurrence, and anatomical success. Results: The cohort comprised 24 patients (24 eyes) with a mean follow-up of 30 months (range 12–84). Seven eyes underwent AMT, 15 LK, and 2 PK. Primary healing rates were 100% for AMT and PK, and 93.3% for LK (overall 95.8%). Although BCVA improved or stabilized in 71.4% of AMT and 86.7% of LK eyes, functional acuity (BCVA ≥ 0.3) was achieved in 71.4% (5/7) of the AMT group compared to only 13.3% (2/15) of the LK group. Conversely, PK outcomes were poor (HM to NLP). Recurrence rates were 28.6% (2/7) for AMT, 64.3% (9/14) for LK, and 100% (2/2) for PK. Kaplan-Meier analysis showed a median recurrence-free survival of 36 months for the LK group. Crucially, final anatomical success was achieved in 85.7% of AMT, 93.3% of LK, and 50.0% of PK eyes, resulting in an overall globe preservation rate of 87.5% (21/24). Conclusion: A severity-graded surgical approach effectively preserves globe integrity in refractory Mooren’s ulcer. While AMT provides excellent outcomes for less-severe cases, cases requiring keratoplasty demonstrate more aggressive disease biology with higher recurrence risks. Therefore, vigilant long-term follow-up and sustained immunomodulation are mandatory for severe cases.", "abstract_shown": true, "affiliations": [ "Department of Ophthalmology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China", "Nanning Aier Eye Hospital, Nanning, China" ], "article_type": "Research Article", "arxiv": null, "author_total": 7, "authors": [ { "affs": [ 0 ], "name": "Minghai Huang" }, { "affs": [ 1 ], "name": "Zhifeng Wu" }, { "name": "Dongmei Wei" }, { "name": "Jixiao Nong" }, { "name": "Zhuoyuan Zhang" }, { "name": "Thuthuy Hoang" }, { "name": "Guina Yin" } ], "bibtex": "https://research.draconitic.com/paper/8c16shjpjmx08.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0359413", "fulltext_url": null, "id": "8c16shjpjmx08", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0359413", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2731|Ocular Diseases and Behçet’s Syndrome" ], [ "plos", "/Biology and life sciences/Anatomy/Head/Eyes" ], [ "plos", "/Biology and life sciences/Anatomy/Ocular system/Eyes" ], [ "plos", "/Biology and life sciences/Anatomy/Ocular system/Ocular anatomy/Cornea" ], [ "plos", "/Biology and life sciences/Immunology/Immune suppression" ], [ "plos", "/Biology and life sciences/Neuroscience/Cognitive science/Cognitive psychology/Perception/Sensory perception/Vision/Visual acuity" ], [ "plos", "/Biology and life sciences/Neuroscience/Sensory perception/Vision/Visual acuity" ], [ "plos", "/Biology and life sciences/Psychology/Cognitive psychology/Perception/Sensory perception/Vision/Visual acuity" ], [ "plos", "/Medicine and health sciences/Anatomy/Head/Eyes" ], [ "plos", "/Medicine and health sciences/Anatomy/Ocular system/Eyes" ], [ "plos", "/Medicine and health sciences/Anatomy/Ocular system/Ocular anatomy/Cornea" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Immune suppression" ], [ "plos", "/Medicine and health sciences/Clinical medicine/Signs and symptoms/Ulcers" ], [ "plos", "/Medicine and health sciences/Immunology/Immune suppression" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Ophthalmic procedures/Keratoplasty" ], [ "plos", "/Medicine and health sciences/Surgical and invasive medical procedures/Ophthalmic procedures/Keratoplasty/Penetrating keratoplasty" ], [ "plos", "/Social sciences/Psychology/Cognitive psychology/Perception/Sensory perception/Vision/Visual acuity" ] ], "openalex": "W7214885334", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0359413&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-30", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/8c16shjpjmx08.ris", "sources": [ { "first_seen": "2026-10-30T12:17:37Z", "native_id": "10.1371/journal.pone.0359413", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0359413" } ], "subjects": [ { "field": "medicine", "origin": "plos:anatomy", "subfield": "physiology" }, { "field": "medicine", "origin": "plos:surgical and invasive medical procedures", "subfield": "surgery" } ], "title": "Evaluation of a severity-based surgical strategy for refractory Mooren’s ulcer: A retrospective series with long-term follow-up", "title_text": "Evaluation of a severity-based surgical strategy for refractory Mooren’s ulcer: A retrospective series with long-term follow-up", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:37Z", "url": "https://research.draconitic.com/paper/8c16shjpjmx08", "venue": "PLOS One", "versions": [] }