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Published on: October 29, 2014
Mooren'S ulcer in ibadan, southwest Nigeria
Background:
Mooren's ulcer has been described as an idiopathic, painful, relentless, peripheral, chronic ulcerative keratitis that progresses circumferentially and centrally, with an unusual geographical presentation and distribution.
Aim:
To review the demographic and clinical characteristics of patients with Mooren's ulcer at University College Hospital, Ibadan, Nigeria over seven years, and, the outcome of treatment.
Study Design:
A retrospective case series.
Methods:
Medical records of all patients with Mooren's ulcer seen in the Eye Clinic, University College Hospital, Ibadan, South-west Nigeria between January 2007 and December 2013 were reviewed.
Results:
Thirty-one eyes of 23 patients, (18 males, overall mean age of all patients 30.9 ±16.6 years) were affected with Mooren's ulcer. The right eye was involved in nine (39.1%) patients while eight (34.8%) patients had bilateral lesions. Most common presenting symptoms were redness and pain, with an average of 6.8 clock hour-limbal involvement. All patients received topical and systemic steroids, while eight patients with severe disease, or poor response to treatment with steroids, received systemic methotrexate or cyclophosphamide. Surgical treatment with conjunctivectomy and cryotherapy was undertaken in 14 (60.9%) patients (21 eyes) who had a minimum follow-up period of eight weeks, while those presenting with perforation also had scleral patch graft or direct repair. The ulcer healed with varying degrees of corneal opacity in 18 (85.7%) of the 21 eyes, while the remaining three eyes developed descemetocele, anterior staphyloma or corneal perforation. Large proportion (76.2%) of eyes maintained their presenting acuity.
Conclusion:
Mooren's ulcer remains an uncommon disease in Ibadan, South-west Nigeria, and the clinical presentation is as recorded in other parts of the West African sub-region. Systemic immunosuppression with methotrexate and scleral patch graft appear to give good outcome in patients presenting with severe ulceration and/or perforation.
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