Interventions for Mooren's ulcer

Mooren's ulcer is inflammation that occurs at the edge of the cornea (clear part of the front of the eye). Its cause is unknown. It is very painful and can or will lead to loss of vision if untreated. It occurs worldwide and affects all age groups. It is diagnosed by excluding other causes of ulcerations at the edge of the cornea such as chronic inflammation of the joints due to rheumatoid arthritis. Mooren's ulcer can be treated both medically and surgically. Medical treatment includes the use of drugs such as steroids and non-steroidal anti-inflammatories. Surgical methods include resection of the conjunctiva (the thin clear tissue that covers the surface of the eye) from the cornea, removal of dead cornea tissue and cornea transplant. We set out to determine the best available intervention for the treatment of Mooren’s ulcer by looking for randomised controlled trials (RCTs) comparing one form of treatment to another; and treatment versus no treatment. The electronic database searches did not find any RCTs on the treatment of Mooren’s ulcer. This review recommends the need for well conducted RCTs for both medical and surgical interventions for Mooren’s ulcer. These trials should look at outcomes such as number of participants that healed against those that did not, what percentage of area healed and the speed at which healing took place.

Authors' conclusions: 

We found no evidence in the form of RCTs to assess the treatment effect for the various interventions for Mooren's ulcer. High quality RCTs that compare medical or surgical interventions across different demographics are needed. Such studies should make use of various outcome measures, (i.e. healed versus not healed, percentage of area healed, speed of healing etc.) as well as ensuring high quality randomisation and data analysis, as highlighted in this review .

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Background: 

Mooren's ulcer is a chronic, painful peripheral ulcer of the cornea. Its cause is unknown but it can or will lead to loss of vision if untreated. Severe pain is common in patients with Mooren's ulcer and the eye(s) may be intensely reddened, inflamed and photophobic, with tearing. The disease is rare in the northern hemisphere but more common in southern and central Africa, China and the Indian subcontinent. There are a number of treatments used such as anti-inflammatory drugs (steroidal and non-steroidal), cytotoxic drugs (topical and systemic), conjunctivectomy and cornea debridement (superficial keratectomy). There is no evidence to show which is the most effective amongst these treatment modalities.

Objectives: 

The aim of this systematic review is to assess the effectiveness of the various interventions (medical and surgical) for Mooren's ulcer.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2013), EMBASE (January 1980 to June 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 4 June 2013.

Selection criteria: 

We planned to include randomised controlled trials (RCTs) or discuss any prospective non-RCTs in the absence of any RCTs. The trials included would be of people of any age or gender diagnosed with Mooren's ulcer and all interventions (medical and surgical) would be considered.

Data collection and analysis: 

Two authors screened the search results independently; we found no studies that met our inclusion criteria.

Main results: 

As we found no studies that met our inclusion criteria, we highlighted important considerations for conducting RCTs in the future in this area.

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