Bilateral Mooren's Ulcer With Corneal Perforation in Two Women of Different Ethnicities: A Report of Two Cases.

We present two patients with bilateral Mooren's ulcer complicated by corneal perforation and describe their surgical and systemic management. A 55-year-old Caucasian woman (Case 1) and a 55-year-old African woman (Case 2) presented with bilateral Mooren's ulcer. Both had corneal perforation in the right eye and impending perforation in the left eye. Visual acuity in the right eye was reduced due to nasal pupillary displacement and posterior capsular opacification in Case 1 and cataract in Case 2. Both patients had previously undergone a corneal-conjunctival patch procedure in the right eye, but the diagnosis of Mooren's ulcer had not been established prior to referral. Surgical management included lamellar keratoplasty in Case 1 and penetrating keratoplasty with selective conjunctival resection in Case 2. Systemic immunosuppression with mycophenolate mofetil (MMF) was administered in both cases. In Case 1, posterior capsulotomy improved visual acuity to 20/50 with spectacles and to 20/30 with scleral contact lenses. At follow-up, Case 1 showed stability in both eyes, 2 years after lamellar keratoplasty in the right eye and 20 months after conjunctival resection in the left eye. Case 2 had a shorter follow-up, with stability at six months in the right eye and at three months in the left eye. These cases highlight the aggressive bilateral nature of Mooren's ulcer, particularly in the African population, and underscore the importance of individualized surgical and systemic management. Early recognition and combined therapy, including keratoplasty, conjunctival resection, and systemic immunosuppression, can stabilize the disease and optimize visual outcomes despite the initial severe presentation.