Mooren’s ulcer in Uganda: A prospective observational case series

Abstract

Background: Mooren’s ulcer is a progressive, chronic, and painful peripheral ulceration of the cornea, commonly
seen in adult men. In our set up, it has been observed to be aggressive and difficult to treat, often resulting in
poor visual outcomes. There is limited published evidence on its management.
Objective: 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 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: A total of eight patients (6 males and 2 females) were enrolled. 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 one
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: Most patients were below 30 years and presented late to the hospital, with advanced ulcers,
leading to outcomes ranging from good to poor. 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.