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Iris atrophy in newly diagnosed multi-bacillary leprosy patients; at diagnosis, during and after completion of multi-drug therapy.
  1. Ebenezer Daniel (edaniel4{at}jhmi.edu),
  2. PSS Sundar Rao (psssrao2002{at}yahoo.co.in),
  3. Timothy J Ffytche (t.ffytche{at}thelondonclinic.co.uk),
  4. Shirley Chacko (rabin{at}cmcvellore.ac.in),
  5. Hannah R Prasanth (drranjee{at}hotmail.com),
  6. Paul Courtright (pcourtright{at}kcco.net)
  1. Johns Hopkins University School of Medicine, United States
  2. The Leprosy Mission, India
  3. The Hospital for Tropical Diseases, United Kingdom
  4. Schieffelin Leprosy Research and Training Center, India
  5. Schieffelin Leprosy Research and Training Center, India
  6. Kilimanjaro Centre for Community Ophthalmology, Tanzania, United Republic of

    Abstract

    Purpose: To describe the prevalence and incidence of iris atrophy in multibacillary (MB) leprosy patients.

    Methods and Patients: Prospective longitudinal cohort study. 301 newly diagnosed MB patients were followed up during the two years of treatment with multi-drug therapy and for a further five years with biannual ocular examinations. Incidence of iris atrophy was calculated as the number of patients with iris atrophy per person-year of atrophy-free follow-up among those who did not have iris atrophy at baseline. Step wise multiple regression confirmed the presence of specific associations according to demographic and clinical characteristics associated (p<0.05) with iris atrophy by univariate analysis.

    Results: Iris atrophy was present in 6 patients (2%) at enrollment. During MDT, with 445 person years (PY) follow-up, 9 patients developed iris atrophy (IR 0.02 95% CI 0.01, 0.04) that was associated with cataract (HR 15.13 95% CI 3.71-61.79 p<0.001) and corneal opacities (HR6.83 95% CI 1.62-28.8 p=0.009). After MDT, with 2005 person years (PY) follow-up 60 patients developed iris atrophy (IR 0.03 95% CI 0.023, 0.039) that was associated with age (per decade) (HR 1.40 95% CI 1.10-1.78 p=0.006), skin smear positivity (HR 3.50 95% CI 1.33-9.24 p=0.011), cataract (HR 3.66 95% CI 1.85-7.25 p<0.001), keratic precipitates (HR2.76 95% CI 1.02-7.47 p= 0.046) and corneal opacity (HR 3.95 95% CI 1.86-8.38 p<0.001).

    Conclusions: Iris atrophy continues to develop in 3% of MB leprosy patients every year after they complete a 2-year course of MDT and is associated with age, increasing loads of mycobacteria, sub-clinical inflammation, cataract and corneal opacity.

    • Incidence
    • Iris atrophy
    • Multibacillary Leprosy
    • Risk factors

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