Characteristics of Mooren's Ulcer in Surgical vs. Non–Surgical Patients

Abstract

Abstract: : Purpose: To describe the epidemiology and clinical characteristics of Mooren's ulcer following extracapsular cataract extraction as compared to Mooren's patients without a history of surgery. Methods: A retrospective case–control study of 166 consecutive patients with Mooren's ulcers seen in the cornea clinic at Aravind Eye Hospital in Madurai, India was conducted. Patients with a history of extracapsular cataract extraction prior to development of Mooren's ulcer were considered cases, and patients with Mooren's and no history of ocular surgery were considered controls. The medical records were reviewed to determine demographic data and clinical characteristics of the ulcer. Results: One hundred sixty–six patients with Mooren's ulcers were studied, with a total of 242 eyes. Thirty–seven eyes had a history of extracapsular cataract extraction, and two hundred and five had no history of surgery. The mean age in the group with prior surgery was 68 years and 60 years in the non–surgical group (p=0.01). Eighty–four percent of the patients were male, and 16% female, and the proportion of males to females was not significantly different in the surgery vs. non–surgery group (p=0.22). The overall distribution of quadrants affected by post–surgical ulcers versus other ulcers was significantly different (p<0.01). Post–surgical ulcers were twice as likely to be superior in location (2.1–fold, 95% CI 0.97–4.6) and half as likely to be inferior (0.54, 95% CI 0.26–1.1). There was no significant difference in the final visual acuity of post–surgical ulcers (p=0.15) or in the rate of perforations with post–surgical ulcers (p=0.57). Conclusions: Mooren's ulcer patients with a history of cataract surgery were significantly more likely (two–fold increase) to have ulceration in the superior quadrant compared to non–surgical patients. Since all of the cataract surgeries were performed by extracapsular cataract extraction with a superior wound, these results suggest an association between development of Mooren's ulcer and location of surgical wound. However, the final visual acuity and rate of corneal perforation was not significantly different in the surgical vs. non–surgical groups. Surgery may be a possible risk factor for the development of Mooren's ulcer, but continued study is needed to further elucidate this relationship.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • keratitis • cornea: clinical science