Dear Sir,
I was fascinated by Cheng and colleagues' article on Mooren's ulcer in China. During the past 6 years I have worked for 3 years as an ophthalmologist in rural Cameroun. I submit to you my experiences of Mooren's ulcer there :

Patients: 5 (4 male, 1 female).
Age: 1 patient aged 48 years, the rest all late teens and twenties.

Out of 3 patients we tested (following a histology report on excised conjunctiva), 2 had positive skin-snips for Onchocerca volvulus. None of the predisposing factors referred to in Cheng's article applied to any of these patients.

All ulcers were unilateral, and totally resistant to any medical treatment that was available (topical prednisolone sodium phosphate 1%, oral cyclophosphamide). I tried various surgical treatments and found that the only one that gave satisfactory results was excision of a 3 mm-wide band of conjunctiva next to the ulcer, and covering the ulcer and bared sclera with a free conjunctival graft (conjunctival flaps simply retracted and separated), followed by chloramphenicol and prednisolone drops for a month. This became my first-line treatment. Corneal grafting was not a possibility. One ulcer recurred by circumferential extension from the original site.