The Clinical Manifestations and Prognostic Factors of Autoimmune-Related Peripheral Corneal Ulcers

PURPOSE: To investigate clinical manifestations and prognostic factors of autoimmune-related peripheral corneal ulcers. METHODS: Nineteen eyes in 18 patients who were diagnosed with autoimmune-related peripheral corneal ulcer from November 1999 to August 2010 were enrolled in the present study. Clinical manifestations and treatment results were investigated retrospectively. RESULTS: The average age at presentation was 64.6 years with female (66.7%) and unilateral (94.4%) dominance. The main etiologies were Mooren's ulcer (53.6%) and rheumatoid arthritis (26.3%). The ulcer depth was greater than 75% of the corneal thickness in more than half of the cases (57.9%) and the mean extent of the ulcer was 69.5degrees. There were no significant improvements in visual acuity after treatment (p = 0.789) and no significant differences in treatment outcomes among etiologies or treatment modalities. The patients who underwent ulcer recurrence (p = 0.048) or treatment failure (p = 0.005) had poorer final visual acuity than those patients who did not. The ulcer depth correlated with treatment failure (p = 0.037). The final visual acuity showed positive correlations with visual acuity at presentation (p = 0.031) and negative correlations with the number of recurrences (p = 0.042). CONCLUSIONS: The visual acuity at presentation and ulcer depths were significant prognostic factors. These factors appeared to be helpful in the treatment of marginal keratitis depending on the depth of the ulcer.

Peripheral Corneal Ulcer after Simultaneous Surgery for Cataract and Pterygium: Secondary Mooren's Ulcer

PURPOSE: To report a previously unreported secondary Mooren's ulcer associated with simultaneous sur-gery for cataract and pterygium. METHODS: Case report. Five days after simultaneous surgery for cataract and pterygium, an 86-year-old woman developed severe pain and a superior and inferior peripheral corneal ulcer that had the characteristic clinical appearance of Mooren's ulcer. RESULTS: Peripheral corneal ulcer is rapidly progressive, painful, beginning at the limbus with a gray, overhanging, infiltrated edge at its central border. She had no history of collagen-vascular disease, negative serologic test result, and negative culture for pathogen. Surgical trauma may have been the inciting factor in development of the ulcer. She was treated with topical and systemic steroids. After complete control of the inflammation, the patient remained in remission.