Case of bilateral Mooren's ulcers following filtering surgery using EX-PRESS glaucoma filtering devices

Abstract

Purpose: To report our findings in a case of bilateral Mooren's ulcer that developed after filtering surgeries using the EX-PRESS glaucoma filtering device (EX-PRESS surgery).

Patients and methods: A 71-year-old Japanese man with primary open angle glaucoma underwent EX-PRESS surgery first in his left eye and 1 month later in his right eye. He developed Mooren's ulcer in his right eye at 7 months and in his left eye at 10 months after the initial EX-PRESS surgery. Systemic examinations showed no collagen vascular disease, and he did not have a history of bacterial or viral infections. He was not allergic to metallic materials. Before the EX-PRESS surgery, he had underdone cataract surgery combined with trabeculotomy in both eyes, and a reoperation of trabeculotomy in his left eye. He had not developed Mooren's ulcer after these surgeries. The Mooren's ulcer after the EX-PRESS surgery was treated with oral prednisolone (30 mg tapering) in combination with topical 0.1% betamethasone sodium. The ulcers were responsive and healed well in three months.

Conclusions: The EX-PRESS devices were most likely the cause of the Mooren's ulcers considering that they were located close to the site of EX-PRESS insertion and no peripheral corneal ulcer developed after prior intraocular surgeries.

Keywords: Autoimmune reaction; EX-PRESS glaucoma filtering device; Glaucoma implant surgery; Mooren's ulcer; Surgical injury.

Fig. 1

Slit-lamp photograph of the right eye at 7 months after the EX-PRESS surgery. A marginal corneal ulcer can be seen close to the site of the EX-PRESS implantation with severe conjunctival injection. Arrow indicates the site of EX-PRESS implantation.

Fig. 2

Slit-lamp photograph of the left eye at 10 months after the EX-PRESS surgery. A marginal corneal ulcer close to the site of the EX-PRESS implantation with conjunctival and scleral injection. Arrow indicates the site of EX-PRESS insertion.

Fig. 3

Slit-lamp photograph of the right eye (3a) and left eye (3b) taken during topical steroid therapy. Bilateral progressive thinning of the ulcers with a steep undermined leading edge can be seen.

Fig. 4

Slit-lamp photograph of the right eye (3a) and left eye (3b) of the patient at 2 years after the onset of the ulcer in the right eye. The corneal epithelium has healed with thinning of corneal stroma after the systemic steroid therapy. Betamethasone sodium phosphate 0.1% is being continued.