Incidence of ocular morbidity among multibacillary leprosy patients during a 2 year course of multidrug therapy

Abstract

Aim: To evaluate the incidence of and risk factors for ocular complications in multibacillary (MB) leprosy patients during their 2 year, fixed duration, multidrug therapy (MDT). Methods: Periodic eye examinations were conducted prospectively on a cohort of 301 consecutive newly diagnosed MB patients every 6 months during their 2 year course of MDT. Incidence of ocular pathology was calculated as the number of events per person year of event free follow up of patients who did not have the specific finding at baseline. Results: 292 (97%) patients had one or more follow up visits. The incidence of lagophthalmos was 1.2%/patient year (95% CI 0.5% to 2.8%); corneal opacity was 7.4%/patient year (95% CI 5.1% to 10.6%); uveal involvement was 5.1%/patient year (95% CI 3.3% to 7.8%), and cataract that reduced vision to 6/18 or less was seen in 4.3%/patient year (95% CI 2.7% to 6.9%) of patients. Overall, 23 individuals (5.8%/patient year, 95% CI 3.9 to 8.8) developed leprosy related potentially blinding pathology during the 2 years of MDT. Conclusions: Approximately 20% of patients with MB leprosy can be expected to develop ocular complications of leprosy during a 2 year course of MDT, many (11%) of which are potentially vision threatening. Ophthalmological monitoring to detect and treat ocular complications at defined intervals during MDT is indicated. L eprosy is a chronic infection that can be classified clinically into paucibacillary leprosy (PB), in which patients have a relatively intact cellular immune function against Mycobacterium leprae and consequently low bacillary loads, and multibacillary leprosy (MB), in which patients have markedly impaired cellular immunity and high bacillary loads.Antileprosy multidrug therapy (MDT), given until recently as a standard regimen of 2 years' duration, has revolutionised the management of leprosy worldwide. While there are indications that the incidence of leprosy may be declining, the number of people taking MDT worldwide remains large (407 791 in 2004).1 Accompanying the reduction in prevalence there has been a gradual shift in the proportion of the type of leprosy from the PB to the MB form, as well as a shift to an older age at diagnosis of disease.2 The expansion of MDT programmes at a global level has given rise to hopes that disability and the other complications of leprosy need not occur as long as a person completes the required duration of therapy. However, monitoring of disability rates following diagnosis and treatment has been problematic because of the changes in definitions, particularly for ocular disabilities in leprosy patients. In particular, the extent to which complications of leprosy continue to occur during MDT has been unclear. Our previous work demonstrated that at the time of leprosy diagnosis, about 11% of MB leprosy patients have one or more significant leprosy related eye complications.5 These complications were more common with increasing age, a short duration between onset and diagnosis, and when a previous reaction involving the face had been ...

Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy

“…The characteristics of this cohort have previously been reported. 10 During the 2 year MDT treatment period there were 14 deaths and nine migrations; thus, the analysis after completion of MDT is based on 278 patients (92%), who were followed until their last examination visit in 2004 or until death or migration, whichever occurred earliest. Between completion of MDT and the last examination visit in June 2004, a further 28 (9.3%) patients died and 30 (10%) migrated to distant places.…”

“…It could be speculated that the pathophysiology of these opacities is different from those that occur in MB patients during the time that they are taking MDT. 10 They could result from minor injuries and ocular exposure: females do less outdoor work in rural India. Patients with fewer deformities were less likely to develop these opacities, consistent with the fact that patients with more deformed extremities are more likely to injure their eyes while rubbing them.…”

A Overview of Ocular Leprosy After 2 Decades of Multidrug Therapy

“…Eleven percent had potentially blinding leprosy-related conditions. 4 During the course of MDT, approximately 6% of patients developed potentially blinding leprosyrelated pathology 11 and in the 5 years after the completion of MDT another 4% developed such pathology. 12 This means that approximately 20% of patients with MB disease, even if treated with MDT will end up with potentially blinding leprosy-related eye conditions.…”

“…In the newly diagnosed LOSOL MB patients, chronic uveitis (diagnosed with slit lamp examination) was recognized in 4.1% of patients at the time of their leprosy registration 4 and the 2-year cumulative incidence was 5.8% (27/463). 11 Among MB patients who have a history of prior dapsone monotherapy, the prevalence of chronic uveitis is high, from 12% to 27%, depending on the population under study. Among the cured Korean MB patients, the cumulative incidence (over 11 y) of posterior synechiae was 9.3% [95% confidence interval (CI) 4.8-15.8].…”

Kelainan Mata Pada Pasien Kusta

“…4 Sekitar 11% penderita kusta multibasiler (MB) memiliki satu atau lebih komplikasi kusta pada mata. 5 Perubahan okular dan ekstra okular pada pasien kusta lepromatosa yang tidak diobati yaitu madarosis, keratitis (karena gabungan trikhiasis, lagoftalmus dan hilangnya sensibilitas di kornea), konjungtivitis, skleritis dan episkleritis. 6 Tingginya insidens kelainan mata dan kemungkinan kebutaan pada pasien kusta, maka diperlukan pemahaman terhadap patogenesis cacat mata, sehingga dapat dilakukan pencegahan kecacatan pada mata.…”