Efficacy of Conjunctival Resection with Cyanoacrylate Glue Application in the Treatment of Mooren’s Ulcer

Jayesh VaziraniMerle Fernandes

L V Prasad Eye InstituteVisakhapatnam, India

The authors have no financial interests to disclose

Purpose

To study the efficacy of conjunctival resection with cyanoacrylate glue

application in the treatment of Mooren’s ulcer

Methods

• Study design: Retrospective, non-randomized, interventional case series

• Study population: Eyes with clinically determined Mooren’s ulcer, which underwent conjunctival resection with cyanoacrylate glue application

• Intervention: A 3-4 mm wide strip of conjunctiva extending at least 1 clock hour beyond the margin of ulcer on either side was resected and cyanoacrylate glue was applied to the peripheral cornea. Post-operative treatment included topical steroid in all cases

Methods• Outcome measures:

• Clinical quiescence, determined as cessation of further ulceration and infiltration, complete epithelization and no clinical evidence of inflammation.

• Survival rate, calculated from recurrence-free interval and total follow-up duration

• Statistical analysis: • A Kaplan-Meier survival curve was constructed and

survival probability was reported in percentages.

• Multivariate Cox proportional hazards model analysis was done to determine association between clinical factors and risk of recurrence

Results

• Sixteen eyes (eight unilateral cases and four bilateral cases) with Mooren’s ulcer underwent this procedure.

• Clinical quiescence was initially achieved in all eyes.

• Recurrence of disease was noted in 5 eyes (31.25%).

ResultsCase No.

Age (Years)

Gender Eye LateralityBaseline

Visual Acuity

Clock hrs of involvemen

t

1 38 M OD Bilateral 20/50 4

2 38 M OS Bilateral 20/100 5

3 60 M OD Unilateral CF CF 4

4 74 M OS Bilateral PL 1

5 74 M OD Bilateral 20/100 3

6 60 M OS Unilateral PL 2

7 60 M OS Bilateral 20/200 6

8 60 M OD Bilateral CF CF 11

9 31 M OD Unilateral CF CF 6

10 59 M OS Unilateral 20/PL 3

11 39 F OS Unilateral 20/60 4

12 65 M OD Bilateral 20/100 2

13 65 M OS Bilateral 20/125 5

14 44 M OD Unilateral 20/40 2

15 64 M OD Unilateral CF CF 7

16 40 M OD Unilateral 20/400 5

ResultsCase No.

Follow up (Days)

RecurrenceTime to

recurrence (Days)

Recurrence-free Survival

(Days)

1 30 No 30

2 30 No 30

3 68 No 68

4 85 No 85

5 85 No 85

6 133 No 133

7 134 Yes 5 5

8 134 Yes 5 5

9 138 Yes 130 130

10 140 No 140

11 142 No 142

12 266 Yes 99 99

13 266 Yes 130 130

14 309 No 309

15 456 No 456

16 630 No 630

Results

• Median follow-up• 136 days (Range 30-630days)

• Mean survival probability • 58.3% (standard error 14.81%)

• Median survival time • 114.5 days (Range 5-630 days)

Survival Curve

Results

• Multivariate analysis

• Bilaterality - only factor significantly affecting chances of recurrence

• Hazards ratio - 16.66 (95% confidence intervals 1.53-100) (p- 0.02)

• All recurrences were successfully treated with systemic steroid and/or immunomodulatory drugs.

Conclusions

• Conjunctival resection with cyanoacrylate glue application provides tectonic stability, but is of limited value in preventing recurrences of Mooren’s ulcer.

• Bilateral cases have a much higher risk of recurrence than unilateral cases.

Thank You

L V Prasad Eye Institutewww.lvpei.org

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