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

E Daniel^1,2, T J ffytche³, J H Kempen⁴, P S S Sundar Rao⁵, M Diener-West⁶ and P Courtright^7,8

¹ Schieffelin Leprosy Research and Training Centre, Vellore, Tamil Nadu, India
² Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
³ Department of Ophthalmology, The Hospital for Tropical Diseases, London, UK
⁴ Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
⁵ Research Resource Center, The Leprosy Mission, New Delhi, India
⁶ Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
⁷ Kilimanjaro Centre for Community Ophthalmology, Tumaini University, Moshi, Tanzania
⁸ BC Centre for Epidemiologic and International Ophthalmology, University of British Columbia, 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 following completion of 2 year, fixed duration, multidrug therapy (MDT).

Methods: Biannual eye examinations were conducted prospectively on a cohort of MB patients who had completed MDT and followed up for 5 years. The 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 before completion of MDT.

Results: 278 patients had one or more follow up visits after completion of MDT. The incidence of lagophthalmos was 0.24%/patient year (95% CI 0.10% to 0.37%); corneal opacity, 5.35%/patient year (95% CI 4.27% to 6.70%); uveal involvement, 3.78%/patient year (95% CI 2.96% to 4.83%); and cataract that reduced vision to 6/18 or less, 2.4%/patient year (95% CI 1.77% to 3.26%). Overall, 5.65%/patient year (95% CI 4.51% to 7.09%) developed leprosy related ocular disease and 3.86%/patient year (95% CI 3.00% to 4.95%) developed leprosy related, potentially blinding ocular pathology during the period following MDT. Age and other disability also predicted incident eye disease.

Conclusions: Every year, approximately 5.6% of patients with MB who have completed MDT can be expected to develop new ocular complications of leprosy, which often (3.9%) are potentially vision threatening. Because many of these complications cannot be detected without slit lamp examination, periodic monitoring, particularly of older patients and those with other disability, is recommended, in order to detect and treat ocular complications satisfactorily.

Abbreviations: LROP, leprosy related ocular pathology; MB, multibacillary; MDT, multidrug therapy; PBLROP, potentially blinding leprosy related ocular pathology

Keywords: eye manifestations; leprosy; risk factors

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