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Evolution of vision-reducing cataract in skin smear positive lepromatous patients; Does it have an inflammatory basis?
  1. Ebenezer Daniel (edaniel4{at}jhmi.edu),
  2. PSSS Rao (psssrao2002{at}yahoo.co.in)
  1. Johns Hopkins University School of Medicine, United States
  2. The Leprosy Mission, India

    Abstract

    Purpose: To describe the incidence and risk factors of vision-reducing cataract in skin smear positive lepromatous patients.

    Methods and Patients: Prospective longitudinal cohort study. 212 newly diagnosed lepromatous 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 vision-reducing (<=6/18) cataract was calculated as the number of patients with cataract per person-year of cataract-free follow-up among those who did not have cataract at baseline.

    Results: Cataract was present in 27(11%) of lepromatous patients at diagnosis. Forty-nine patients (2.87%/PY 95% CI 2.17% -3.80%) developed cataract during a total follow-up period of 1704 person years. 45 of them were 41 years or older and were followed up for a total of 638 person-years with an incident rate of 0.070 (95% CI 0.0523 - 0.094). Stepwise multiple regression confirmed the association of age (per decade) (HR 2.50 95% CI 1.82 - 2.78 p<0.001), clofazimine crystals on the cornea (HR 49.92 95% CI 5.48 - 454.82 p=0.001), grade 2 deformity in all limbs (HR 3.17 95% CI 1.12 - 8.97 p=0.029) and uveal inflammation (HR 3.52 95% CI 1.42 - 8.67 p=0.006). No significantly association was found with oral steroids.

    Conclusions: Cataract develops at the rate of 7%/person year in lepromatous patients over 40 years. It is associated with increasing age, sub-clinical intraocular inflammation and grade 2 deformity.

    • Cataract
    • Incidence
    • Lepromatous leprosy
    • Ocular Inflammation
    • Risk Factors

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