Iris atrophy in newly diagnosed multi-bacillary leprosy patients; at diagnosis, during and after completion of multi-drug therapy.
- Ebenezer Daniel (edaniel4{at}jhmi.edu),
- PSS Sundar Rao (psssrao2002{at}yahoo.co.in),
- Timothy J Ffytche (t.ffytche{at}thelondonclinic.co.uk),
- Shirley Chacko (rabin{at}cmcvellore.ac.in),
- Hannah R Prasanth (drranjee{at}hotmail.com),
- Paul Courtright (pcourtright{at}kcco.net)
- Johns Hopkins University School of Medicine, United States
- The Leprosy Mission, India
- The Hospital for Tropical Diseases, United Kingdom
- Schieffelin Leprosy Research and Training Center, India
- Schieffelin Leprosy Research and Training Center, India
- Kilimanjaro Centre for Community Ophthalmology, Tanzania, United Republic of
- Published Online First 15 November 2006
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.
