Strategies for successful management of moderate and severe Mooren's ulcer at a rural center during the COVID-19 pandemic: Lessons learnt

Abstract

Purpose: This study aimed to report the strategies that evolved in managing Mooren's ulcer (MU) at a resource-limited center in rural India during the coronavirus disease 2019 (COVID-19) pandemic.

Methods: This study includes a retrospective analysis of clinically diagnosed MU cases from January 2021 to August 2021 wherein strategies for management were developed. The demographic profile, ulcer clinical features, treatment algorithms (medical and surgical), complications encountered, referral to a higher center, and compliance with medication and follow-up were studied.

Results: The mean age of presentation was 68.1 years (range, 62-73 years), and 90% were men. The median best-corrected visual acuity (BCVA) was 1.26 logarithm of the Minimum Angle of Resolution (LogMAR) (interquartile range (IQR), 0.00-5 logMAR) in the affected eye on presentation, which improved to 0.69 logMAR (IQR, 0.00-3 logMAR) at resolution ( P = 0.442). The first-line management was conjunctival resection and tissue adhesive application (90%). 70% of cases were unilateral, 50% of cases had less than 2 clock hours of involvement, and 50% had less than 50% stromal involvement. Confounding factors included infectious keratitis (2) and corneal perforation (3). The mean duration of follow-up was 96 (1-240) days. The average follow-up visits per patient were 8.8 (1-22). 90% of cases could be managed successfully at the secondary center level with two cases needing a tertiary care referral.

Conclusion: MU can be managed effectively by following a systemic strategy of early diagnosis, surgical therapy, and rapid institution of systemic immunosuppression in a remote location-based secondary center. The strategies developed can be a guide for ophthalmologists at remote centers managing patients or who are unable to travel to tertiary institutes.

Figure 1

Standard slit-lamp photograph of the right eye. (a) On presentation, CA and BCL are in situ and active infiltration at the edges from 4 to 5 o’clock nasally. (b) At 4 weeks, worsening of infiltrate was noted. (c) At 5 weeks, yellowish-white infiltrate adjacent to the leading edge and hypopyon was noted. (d) At 7 weeks, the resolution of infection and worsening of infiltrate along the leading edge and central spread were noted

Figure 2

Standard slit-lamp photograph of the right eye (a) At 9 weeks, consolidation of infiltrate was noted. (b) At 12 weeks, the resolution of edema and cellularity is the leading edge. (c) At 16 weeks, complete resolution of infiltrate was noted. (d) At 7 months from presentation, temporal scarring with vascularization and pseudophakia was noted