Evaluation of a severity-based surgical strategy for refractory Mooren’s ulcer: A retrospective series with long-term follow-up
- 1Department of Ophthalmology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
- 2Nanning Aier Eye Hospital, Nanning, China
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.
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BibTeX
@article{huang2026evaluation,
title = {{Evaluation of a severity-based surgical strategy for refractory Mooren’s ulcer: A retrospective series with long-term follow-up}},
author = {Minghai Huang and Zhifeng Wu and Dongmei Wei and Jixiao Nong and Zhuoyuan Zhang and Thuthuy Hoang and Guina Yin},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0359413},
url = {https://doi.org/10.1371/journal.pone.0359413},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Evaluation of a severity-based surgical strategy for refractory Mooren’s ulcer: A retrospective series with long-term follow-up
AU - Minghai Huang
AU - Zhifeng Wu
AU - Dongmei Wei
AU - Jixiao Nong
AU - Zhuoyuan Zhang
AU - Thuthuy Hoang
AU - Guina Yin
PY - 2026
DA - 2026/09/30
JO - PLOS One
DO - 10.1371/journal.pone.0359413
UR - https://doi.org/10.1371/journal.pone.0359413
AB - 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.
SN - 1932-6203
ER -