Progression of eye disease in "cured" leprosy patients: implications for understanding the pathophysiology of ocular disease and for addressing eyecare needs

Abstract

Background-Ocular damage in leprosy is due either to nerve damage or infiltration by mycobacteria. There is currently little information about the magnitude and nature of incident ocular pathology in cured leprosy patients. This information would increase our understanding of the pathophysiology of ocular involvement in leprosy and help in developing programmes to address the eyecare needs of leprosy patients who have been released from treatment. The cumulative incidence of leprosy related ocular pathology and cataract was measured during an 11 year follow up period in cured leprosy patients released from treatment in Korea. Conclusion-This study demonstrates that leprosy related ocular pathology progresses in some patients even after they are cured mycobiologically. The progressive leprosy related lesions are the result of chronic nerve damage; ocular lesions due to infiltration by Mycobacterium leprae did not develop. Based on the factors found to be associated with development of the most visually significant findings (posterior synechia, keratitis, and cataract) certain patients should be targeted at discharge for active follow up eye care. We suggest that patients with lagophthalmos (even in gentle closure), trichiasis, small pupils, and posterior synechiae should be screened regularly for the development of lagophthalmos in forced closure, keratitis, and cataract. (Br J Ophthalmol 2000;84:817-821) Methods-In

Ocular Complications of Leprosy in Yemen = مضاعفات العين عند المصابين بالجذام في اليمن

“…[14][15][16][17] In this study, out of 384 eyes, 97% of the patients had ocular complications, which is comparable to results in Iran (98.53%) 18 and India (87%), 19 but a much higher than that reported in Nepal (57%), 20,21 Brazil (31.5%), 22 or South Korea (34%). 23 This could be explained by the fact that a higher proportion of Yemeni patients usually present late for treatment and have more limited access to medical care.…”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Out of these blind eyes, 37 patients (19%) were completely disabled due to binocular blindness.…”

“…1,29 Cataracts ranked as the second most common cause of blindness (31.3%) in this study, while it was the most common cause in Nigeria (46%) and South Korea (87%). [23][24][25][26][27][28][29][30][31][32] In Nepal, uveitis with secondary glaucoma was a primary cause of blindness in the past but with increased knowledge of the disease and its complications, and the introduction of new treatments, these causes have declined dramatically. 20 In contrast, in the current study, uveitis was found to be the third most common blinding condition (23.4%).…”

Prevention of blindness in leprosy and the role of the Vision 2020 Programme

“…It may develop or progress even long after completion of MDT. 5 Treatment is not satisfactory. Pupils can hardly be dilated, due to the accompanying atrophy of the iris dilator muscle and synechiae formation.…”

“…Four recent larger studies on elderly patients with long histories of leprosy, mostly living in leprosy settlements, all indicate that blindness in such patients is much higher, even today. [5][6][7][8] If blindness among the general population above 50 years in developing countries is roughly taken as 5% (VAo0.1), these data show that blindness among leprosy patients is at least 50% higher in a country like S Korea, with welldeveloped health services, free for leprosy patients, and two to three times higher in leprosy settlements in Nigeria and China. In China alone, there may be as many as 40 000 blind, among the approximately 300 000 currently living patients who have suffered from leprosy.…”