Mooren’s Ulcer in Uganda: A Prospective Observational Case Series

Abstract

Purpose: Mooren’s ulcer is an aggressive, chronic, and painful ulceration of the cornea, commonly seen in adult men. It is difficult to treat, often resulting in poor visual outcomes. There is limited published evidence on its management. Our aim was to describe the presentation, treatment and outcomes of patients presenting with Mooren’s ulcer in Mbarara, Uganda over a defined time period.

 Methods: A prospective observational case series conducted over 3 months from August 2017 to November 2017, with scheduled reviews up to 3 months. Participants’ history, presentation, management and clinical course were captured. Laboratory investigations for underlying systemic diseases were performed, in addition to corneal microbiology testing.

Results: We enrolled a total of 8 patients (6 males). The median age was 26 years (IQR 22-27.5, full range 16-32). A history of trauma was present in 3 (38%) of cases. The earliest presenting time was 1 month after start of symptoms. At presentation, 2 (25%) patients had normal vision, 3 (38%) had moderate vision impairment (VI), 1 (12%) had severe VI, and 2 (25%) were blind. There was no systemic disease diagnosed on investigation, but corneal microbiology revealed 3 (38%) ulcers had fungal co-infections. At 3 months, 4 (50%) patients had normal vision, 1 (12%) had moderate VI, and 3 (38%) were blind. No patients required evisceration or enucleation.

Conclusion: Mooren’s ulcer is difficult to treat and further studies to assess risk factors would be beneficial in providing evidence for better management of this condition, particularly in resource limited settings.