Ocular Manifestation in Treated Multibacillary Hansen's Disease

Received 2 August 2008; received in revised form 28 March 2009; accepted 7 April 2009. published online 22 September 2009.

Purpose

To report the prevalence of ocular morbidity in patients with treated multibacillary Hansen's disease (HD) using modern ophthalmic diagnostic techniques in a rural community endemic for HD.

Design

Cross-sectional, observation study.

Participants

All patients with multibacillary HD who had completed their multidrug therapy and who resided in 4 defined geographical areas in Vellore, Tamil Nadu, India.

Methods

All participants underwent a complete eye examination that included slit-lamp examination, esthesiometry, gonioscopy, applanation tonometry, and dilated fundus examination, including a stereobiomicroscopic examination of the fundus at an ophthalmic center set up for that purpose. Glaucoma suspects underwent automated perimetry using a Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA).

Main Outcome Measures

The prevalence of various ocular disease parameters were reported as mean value with 95% confidence interval. The difference of disease prevalence between various leprosy groups was compared using an unpaired t test. The association between eye symptoms and potentially sight-threatening complications was analyzed using the chi-square test.

Results

Three hundred eighty-six of the 446 patients with multibacillary HD residing in the defined areas were evaluated. Four patients (1.04%; 95% confidence interval [CI], 0.0%–2.0%) were bilaterally blind; 33 (8.55%; 95% CI, 5.8%–11.3%) had unilateral blindness. Mean intraocular pressure was 12 mmHg (standard deviation, 4.1 mmHg), and prevalence of glaucoma was 3.6% (95% CI, 1.8%–5.5%). Potentially sight-threatening (PST) pathologic features (corneal anesthesia, lagophthalmos, uveitis, scleritis, and advanced glaucoma) were present in 10.4% (95% CI, 7.4%–13.4%) of patients. Significant cataracts occurred 3 times more frequently in those with polar lepromatous leprosy. The odds ratio for PST pathology in the presence of patient-reported symptoms (pain, redness, inability to close eye, burning, and irritation) was 2.9 (95% CI, 1.34–6.26).

Conclusions

Patients who have completed treatment for multibacillary HD continue to have significant ocular morbidity. A history of specific eye symptoms can be the basis for referral by field staff.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Available online: September 19, 2009.

1 Bombay City Eye Institute and Research Center, Mumbai, India

2 Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India

3 Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India

4 Lotus Eye Hospital, Mumbai, India

5 Queensland Eye Institute and the University of Queensland, Brisbane, Australia, and the L. V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India

Correspondence: Ravi Thomas, Queensland Eye Institute, Brisbane Australia

Manuscript no. 2008-928.

Financial Disclosure(s): The author(s) have made the following disclosure(s):

Ravi Thomas - Funding - Prevent Blindness Foundation through Viertels Vision, Inc. No other authors have financial interests or conflicts of interest.

PII: S0161-6420(09)00374-1

doi:10.1016/j.ophtha.2009.04.021

6 of 48