EXTENDED REPORT

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

E Daniel¹, T J ffytche², P S S Sundar Rao³, J H Kempen⁴, M Diener-West⁵ and P Courtright^6,7

¹ Schieffelin Leprosy Research and Training Centre, Vellore, India and Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
² Department of Ophthalmology, The Hospital for Tropical Diseases, London, UK
³ Research Resource Center, The Leprosy Mission, New Delhi, India
⁴ Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
⁵ Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
⁶ Kilimanjaro Center for Community Ophthalmology, Moshi, Tanzania
⁷ BC Centre for Epidemiologic and International Ophthalmology, Vancouver, Canada

Correspondence to:
Correspondence to:
Dr Ebenezer Daniel
Division of Ocular Immunology, Department of Ophthalmology, The Johns Hopkins University School of Medicine, 1620 McElderry Street, Reed Hall, 4th Floor, Baltimore, MD 21205, USA; edaniel4{at}jhmi.edu

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.

Abbreviations: BL, borderline lepromatous leprosy; LL, lepromatous leprosy; LROP, leprosy related ocular pathology; MB, multibacillary; MDT, multidrug therapy; PB, paucibacillary; PBLROP, potentially blinding leprosy related ocular pathology

Keywords: eye manifestations; leprosy; multidrug therapy; incidence; risk factors

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• Daniel, E., Sundar Rao, P S S, ffytche, T. J, Chacko, S., Prasanth, H. R., Courtright, P. (2007). Iris atrophy in patients with newly diagnosed multibacillary leprosy: at diagnosis, during and after completion of multidrug treatment. Br. J. Ophthalmol. 91: 1019-1022 [Abstract] [Full Text]  
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