1. Efficacy of Conjunctival Resection with Cyanoacrylate Glue Application in the Treatment of Mooren’s Ulcer Jayesh Vazirani Merle Fernandes L V Prasad Eye Institute Visakhapatnam, India Jayesh Vazirani Merle Fernandes L V Prasad Eye Institute Visakhapatnam, India The authors have no financial interests to disclose

2. Purpose To study the efficacy of conjunctival resection with cyanoacrylate glue application in the treatment of Mooren’s ulcer

3. 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

4. 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

5. 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%).

6. Results Case No. Age (Years) GenderEyeLaterality Baseline Visual Acuity Clock hrs of involvement 1 38MODBilateral20/504 2 38MOSBilateral20/1005 3 60MODUnilateralCF 4 4 74MOSBilateralPL1 5 74MODBilateral20/1003 6 60MOSUnilateralPL2 7 60MOSBilateral20/2006 8 60MODBilateralCF 11 9 31MODUnilateralCF 6 10 59MOSUnilateral20/PL3 11 39FOSUnilateral20/604 12 65MODBilateral20/1002 13 65MOSBilateral20/1255 14 44MODUnilateral20/402 15 64MODUnilateralCF 7 16 40MODUnilateral20/4005

7. Results Case No. Follow up (Days)Recurrence Time to recurrence (Days) Recurrence-free Survival (Days) 1 30No30 2 No30 3 68No68 4 85No85 5 No85 6 133No133 7 134Yes55 8 134Yes55 9 138Yes130 10 140No140 11 142No142 12 266Yes99 13 266Yes130 14 309No309 15 456No456 16 630No630

8. 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)

9. Survival Curve

10. 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.

11. 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.

12. Thank You L V Prasad Eye Institute www.lvpei.org Excellence  Equity  Efficiency