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Incidence of ocular morbidity among multibacillary leprosy patients during a 2 year course of multidrug therapy
  1. E Daniel1,
  2. T J ffytche2,
  3. P S S Sundar Rao3,
  4. J H Kempen4,
  5. M Diener-West5,
  6. P Courtright6,7
  1. 1Schieffelin Leprosy Research and Training Centre, Vellore, India and Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. 2Department of Ophthalmology, The Hospital for Tropical Diseases, London, UK
  3. 3Research Resource Center, The Leprosy Mission, New Delhi, India
  4. 4Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
  5. 5Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  6. 6Kilimanjaro Center for Community Ophthalmology, Moshi, Tanzania
  7. 7BC Centre for Epidemiologic and International Ophthalmology, Vancouver, Canada
  1. 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

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.

  • 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
  • eye manifestations
  • leprosy
  • multidrug therapy
  • incidence
  • risk factors
  • 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
  • eye manifestations
  • leprosy
  • multidrug therapy
  • incidence
  • risk factors

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