Clinical course and outcomes in patients with Mooren ulcer who had cataract surgery

Abstract

To report outcomes of cataract surgery in patients with Mooren ulcer. L.V. Prasad Eye Institute, Hyderabad, India. Retrospective case series. The medical records of patients with Mooren ulcer who had cataract surgery between 2000 and 2015 were assessed. The main outcome measures were the role of preoperative immunosuppression and disease inactivity, cataract surgery safety, visual outcomes, and postoperative ulcer recurrence. Of 22 patients (26 eyes), the mean corneal ulceration was 6.8 clock hours±2.9 (SD). Corticosteroids were the most commonly used (84.6% of the 26 eyes) preoperative immunosuppression agents and 38.5% of the 26 eyes were under maintenance immunosuppression. The median disease inactivity before surgery was 7months. Cataract surgery was extracapsular in 10 patients, small incision in 3 patients, and phacoemulsification in 13 patients. Twenty-two eyes had scleral incisions. The median follow-up was 6months (interquartile range, 10months). The median corrected distance visual acuity (CDVA) improved from 1.48 logarithm of minimum angle of resolution (logMAR) before surgery to 0.30 and 0.35 logMAR at 1month and at the last follow-up after surgery, respectively (P≤.0001). Mooren ulcer recurred in 5 eyes between 3months and 7years after surgery. No disease activity was seen in the immediate postoperative period. No significant risk factors for disease recurrence were noted. With adequate immunosuppression, cataract surgery in eyes with Mooren ulcer was safe and CDVA improved significantly with no disease reactivation immediately after surgery. No proven role of maintenance immunosuppression was observed. The type of cataract surgery had no influence on ulcer reactivation. Patients with a disease-free interval of 6months or more before surgery and those who had scleral incisions had favorable outcomes.