Incidence of ocular morbidity among multibacillary leprosy patients on two–year multi–drug therapy

Abstract

Abstract: : Purpose: To determine incidence of ocular morbidity among multi–bacillary leprosy patients on two–year multi– drug therapy. Methods: At two well–established leprosy institutes (in India and the Philippines) all newly diagnosed MB leprosy patients starting multi–drug therapy were invited to participate in a prospective study of eye disease in leprosy. A complete eye examination was conducted on all patients every six months during their two–year course of MDT. Incidence of ocular pathology was calculated from those patients who did not have the specific finding at baseline Results: Among the 590 patients enrolled, two–year follow up was available on 463 patients. The incidence of lagophthalmos was 1.7%; lagophthalmos was associated with being male, duration of leprosy less than one year, and pre–existing reaction or incident reaction. Uveal conditions were recognized in 5.2% of patients and associated with duration of leprosy less than one year and a pre–existing reaction. Overall, 32 individuals (6.9%, 95% CI 4.6–9.2) developed leprosy related potentially blinding pathology during the two years that they were on MDT. Leprosy related uveitis accounted for the largest proportion of the patients with leprosy related eye diseases, suggesting that there is continued M leprae activity in the host tissues in the eye. Pre–existing or incident leprosy reactions was the primary predictor of the various conditions in our study population, suggesting that proper identification and management of reactions is a critical component of leprosy control activities for prevention of disability. Older age at leprosy diagnosis predicts incident ocular pathology; these individuals should be targeted for educational, counseling, and clinical care services Conclusions: In MB patients leprosy related eye disease will not be eliminated by MDT and eye care should remain a component of prevention of disability services during and after completion of MDT.

Keywords: bacterial disease • clinical (human) or epidemiologic studies: prevalence/incidence • clinical (human) or epidemiologic studies: risk factor assessment