| Purpose: To investigate the clinical features and treatment outcomes of Mooren’s ulcer,analyse the cumulative risk of first recurrence and discuss the risk factors of ulcer recurrence.Design: retrospective cohort study.Methods: Patients with Mooren’s ulcer came to our hospital from January 1993 to December 2015 were included.All patients were divided into two groups,recurrence and no recurrence,according to the condition of ulcer recurrence after treatment.The medical records were retrospectively reviewed to summarize and evaluate the clinical features and treatment outcomes.The cumulative risk of first recurrence was assessed with Kaplan–Meier analysis.Patient gender,age,course of the disease,laterality of the eyes involved,serum immune parameters,corneal perforation,treatment approaches,ulcer position and extent were analysed with univariate and multivariate logistic regressions to investigate the risk factors for ulcer recurrence.Results: A total of 139 patients(173 eyes)including 86 males and 53 females(1.62:1)were involved in this study,with an average age of 47.3±14.7 years(range:23~82 years)and an average disease course of 15.5±15.5 months(range: 1~240 months).The follow-up was between 4.5 and 122 months.Thirty-two of 106 patients >35 years and 5 of 33 younger patients,comprising 28 males and 9 females,had recurrence after treatment.Forty-one patients had bilateral disease(seven eyes removed prior to their visit to our hospital were excluded),and 98 patients had unilateral disease,with recurrence in10 and 27 of them,respectively.The lesions more often involved the interpalpebral limbus and inferior limbus than the superior limbus(p=0.022),and 30 eyes suffered recurrence around the primary lesion.Twenty eyes(20/173,11.56%)had corneal perforation preoperatively,in which 8 eyes(40%)recurred after treatment.The ulcer recurred within 12 months after treatment in 27 eyes(27/38,71.1%),and 92.1% of the eyes with recurrence were saved.At their final follow-up visit,97.7% of 173 eyes were saved,and 81.5% retained vision better than 0.05.The cumulative risk of first recurrence at 6,12,24,36,and 48 months after treatment was 10.4%,17.1%,22.5%,27.2% and28.6% respectively,while that percentages after surgical treatment was 13.5%,22.5%,27.6%,32.8% and 34.7%.Male patients(p=0.046)and surgical treatment(p=0.028)were significantly associated with an increased risk of recurrence,whereas patient age(p=0.095),laterality of the eyes involved(p=0.154),ulcer position(p=0.627)and extent(p=0.495),course of the disease(p=0.490),corneal perforation(p=0.103)and serum immune parameters(p=0.589)had no relativity with ulcer recurrence.Conclusion: This study provided the clinical characteristics and treatment outcomes of patients with recurrent and non-recurrent Mooren’s ulcer.The proportion of recurrence after treatment was 22.0% and of which 78.9% had recurrence around the primary lesion.The cumulative risk of first recurrence at four years after treatment was 28.6%.Lamellar keratoplasty was the main treatment approach for Mooren’s ulcer(65.3%)with a recurrent proporation of 28.3%.Male patients and patients with a severe ulcer that require surgical treatment had an increased risk of recurrence.97.7% of all patients recruited in this study had their eye globes saved,and 81.5% retained vision better than 0.05. |
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