Surgical Options for Mooren Ulcer

When medical treatments like eye drops and pills cannot stop the “melting” process of a Mooren ulcer, surgery becomes necessary. It is crucial to understand that surgery is not a cure ^[1]. While an operation can repair the physical structure of your eye, it does nothing to stop the underlying immune system attack. Without continued management of the inflammation—often involving systemic immunosuppression—the new surgical tissue is at risk of recurring immune attacks just as it did your original cornea ^[2][3].

The choice of surgery depends on how deep the ulcer is, whether the cornea has developed a hole (perforation), and your specific anatomy ^[4].

Managing Inflammation: Conjunctival Resection

The conjunctiva is the thin, clear membrane covering the white part of your eye. In Mooren ulcer, this tissue often carries the immune cells and enzymes that attack the cornea ^[5].

A conjunctival resection involves surgically removing a small strip of this inflamed tissue next to the ulcer to slow down the attack ^[3]. This is often combined with cyanoacrylate glue (medical-grade tissue adhesive) and a bandage contact lens to protect the area ^[3].

• Success and Risks: While this can quiet the eye initially, the recurrence rate is very high without systemic drugs ^[3]. One study found that only a minority of patients remained recurrence-free after two years when treated with local measures alone, highlighting the need for ongoing medical therapy ^[3].

Repairing Shallow Damage: Amniotic Membrane Transplantation (AMT)

For shallower ulcers, doctors may use Amniotic Membrane Transplantation (AMT) ^[4]. This tissue, donated from a human placenta, acts as a “biological bandage.” It contains natural factors that help the eye heal and reduce inflammation ^[4][6].

• Outcomes: AMT has shown high success rates for healing shallow ulcers in some reports, and many patients achieve good functional vision afterward, though individual outcomes vary based on disease severity ^[4].

Addressing Deep Ulcers: Lamellar Keratoplasty (LK)

If the ulcer is deep or has a very small perforation, a Lamellar Keratoplasty (LK) may be performed ^[4]. This is a partial-thickness transplant where only the damaged layers of the cornea are replaced with healthy donor tissue ^[7].

• Outcomes: LK is effective at saving the structure of the eye (anatomical success), but it carries a risk of the ulcer returning in severe cases ^[4]. Vision improvement is often limited if the center of the cornea is scarred ^[4].

The Last Resort: Penetrating Keratoplasty (PK)

A Penetrating Keratoplasty (PK) is a full-thickness corneal transplant. This is generally reserved for severe cases, such as large perforations where the eye is at immediate risk of being lost, or when a partial transplant is technically infeasible ^[4][1].

• Outcomes: PK is a “tectonic” surgery, meaning its primary goal is to keep the eye intact rather than restore perfect vision ^[4]. It has a high risk of recurrence, graft failure, and rejection because the immune system can attack the entire thickness of the new graft ^[4][2]. In some severe cases, vision may be very limited post-operatively ^[4].

Managing Expectations

The success of any Mooren ulcer surgery depends on globe preservation—keeping the eye physically together ^[4]. A perforation or impending perforation may require urgent tectonic repair before the inflammation is fully quiet. Because many recurrences happen within the first year, your surgical team may keep you on immunosuppressants for many months after your operation ^[8][7]. Regular monitoring with tools like Anterior Segment OCT is essential to ensure the new tissue is not thinning ^[4].