Ocular Leprosy Research Articles

Bilateral Ocular Leprosy An Effect By Erythema Nodusum Leprosum : A Case Report

Introduction : Leprosy or Hansen’s disease is an infection caused by Mycobacterium leprae that primarily affects the skin, the peripheral nerves and the eyes, causing chronic granulomatous inflammation.
 Case Illustration : We present a case of lepromatous leprosy with erythema nodosum leprosum of a 47 years old man with bilateral and asymmetrical ocular complications. One year ago patient consumed multidrug therapy for leprosy for one year but didn’t finish the medication. On the right eye diagnose with chronic anterior and intermediate uveitis, on the left eye with panuveitis. Best corrected visual acuity (BCVA) was 2/60 for right eye and light perception for left eye. Intraocular pressure were within normal limits. Madarosis and corneal hypoesthesia were found on both eyes. On the right eye was found cells, synechia anterior and posterior, iris pearls and vitreous haze. On the left eye was found plasmoid iridocyclitis and vitreous opacities from USG. Slit skin smear (SSS) result positif acid fast bacilli (AFB) dan granular. Patients were treated with multidrug therapy for leprosy, topical antibiotics, atropine and steroids, oral antibiotics and treatment from a dermatologist.
 Discussion : The diagnosis of lepromatous uveitis (LU) in this patient is made through skin tissue biopsy and ophthalmological examination. The effective management of ocular leprosy depends on early diagnosis and appropriate treatment. Hence it is imperative for ophthalmologist to recognize the ocular clinical signs associated with leprosy.
 Conclusion : Most blindness and impaired vision resulting from leprosy is preventable. A multidisciplinary approach is to be taken in order to improve the prognosis.

A satisfactory visual outcome following sequential oculoplastic procedures and small incision cataract surgery in an elderly patient with severe sequelae of ocular leprosy – A case report

A satisfactory visual outcome following sequential oculoplastic procedures and small incision cataract surgery in an elderly patient with severe sequelae of ocular leprosy – A case report

Ocular leprosy: from bench to bedside

Ocular manifestations of leprosy do occur despite advances in the areas of leprosy research. Understanding the nuances in the domain shall guide the clinician for effective patient-centered care. Despite the existence of microbiologic cure for leprosy, ocular manifestations of this disease do occur. Advances in genetic and genomic studies have better characterized the interaction that the bacteria has with the host. The ocular features vary with the spectrum of the disease. Its careful correlation can help to predict the bacillary load of the patient. Investigations are particularly relevant in multibacillary cases. The WHO suggests a treatment duration longer than the 2 years in ocular involvement. The isolation of lepra bacilli from the iris biopsy in negative skin smear patients and multidrug therapy completion highlights the potential role of bactericidal agents in the planned intraocular treatment. Lepra reactions need careful titration of oral steroids and appropriate antibacterial agents. Advances in phacoemulsification with in the bag implantation of intraocular lenses is a game changer in the management of the most common cause of blindness of leprosy. Advances in vaccine research in leprosy are promising.

Validation of assessment tools for the early detection of ocular involvement in leprosy

Objective: Ocular leprosy needs early detection to prevent blindness, but early detection tools for ocular leprosy vary. Thus, it is important to develop a valid and sensitive screening tool that physicians other than ophthalmologists who treat leprosy can use. This study aims to validate and measure the sensitivity of an early detection checklist that we created for ocular examination in patients with leprosy. Materials and Methods: We designed a checklist according to the symptoms and signs of ocular leprosy based on suggestions from dermatovenereologists and ophthalmologists. Leprosy patients at the Dermatology and Venereology Outpatient Clinic of Dr. Cipto Mangunkusumo General Hospital were examined by a general practitioner (nonophthalmologist) using the checklist as a screening tool; then, they were re-examined by an ophthalmologist as a gold standard. We conducted data analysis to validate and determine the sensitivity of the screening tool. Results: The checklist had good validity, reliability, and sensitivity, with a correlation value of 0.664 (P

The AFIP history of ocular leprosy

PurposeTo investigate the Armed Forces Institute of Pathology (AFIP) experience with Ocular Leprosy. MethodsThe AFIP data banks were screened for cases with diagnosis of ocular leprosy. Files and slides stained with Hematoxylin-eosin and acid-fast staining were reviewed by the Division of Ocular Pathology and by the Infectious Diseases Pathology Branch. ResultsTwenty-five cases were found from 1951 to 1985 and there were 15 males and 7 females and in 3 cases the sex was not given. The disease process ran from 4 months to 50 years in this series. Three patients also had systemic mycobacterium tuberculosis infections. The clinical manifestations of leprosy did not correlate with the histopathological findings. Clinically, corneal manifestations were the most common clinical presentation in 15 cases with only one perforation, iridocyclitis following in 9 patients and eyelid abnormalities ranging from ectropion to trichiasis in 7 patients. Two patients at autopsy had lepromatous cells in the ciliary body as the only ocular manifestation. ConclusionsIn summary, this paper represents a series of ocular leprosy cases from the AFIP which shows the severity of ocular involvement, the predilection of anterior segment involvement and a large number of histopathologic indeterminate cases. The current immigrant and refugee crisis warrants revisting this ancient disease in the differential diagnosis.

Ocular leprosy in institutionalized Nigerian patients.

This study was aimed at presenting the profile of ocular lesions observed in the in-mates on multidrug treatment, of a leprosy rehabilitation centre in Nigeria. Cross-sectional. One hundred patients were selected by systematic random sampling. Sixty-nine had ocular involvement and were the subjects of this study. The age range was 15 to 80 years with a mean age of 51 years. There were 57 males (82.6%) and 12 females (17.4%). The range of duration of treatment was two months to 30 years, with a mean of 15 years. Examination of the anterior and posterior segments of the globe and its adnexa was carried out using Penlight, magnifying loupe and direct ophthalmoscope. Visual acuity was recorded using the Snellen charts. Lepromatous leprosy patients had the greatest incidence of ocular lesions. Ocular lesions were more in patients who have had leprosy for ≥ 15 years. Madarosis (72.5%) and lagophthalmos (29.0%) were the commonest lesions. Corneal involvement was seen in 36.2%. Conjunctivitis in 14.5% . Trichiasis in 10.1% and ectropion in 8.7% . 17.4% were legally blind (VA≤3/60) in the better eye, and 17.4% had cataract in at least one eye. There was no statistically significant difference in the incidence of ocular lesions among males and females, and between patients with Lepromatous and Tuberculoid leprosy. Ocular complications are common and sight threatening in leprosy patients. Regular screening and outreach by eye care providers should be incorporated into leprosy care programmes.

Intra and post operative complications and visual outcomes following cataract surgery in leprosy patients

The occurrence of intra and post operative complications was compared in different groups of leprosy patients. The association between post operative and intra operative complications was studied, and how visual outcomes were affected by these complications. We also share our medical management and surgical techniques that might help minimise intra operative complications and improve visual outcomes. A retrospective analysis of 1024 cataract operations in 786 leprosy patients over an 11 year period from 1995 to 2006 at Kothara Community Hospital, a rural hospital belonging to The Leprosy Mission Trust India, located in the Amravati district of Maharashtra. 3.5% of eyes had intra operative complications and 22% of eyes had post operative complications, with no appreciable difference in incidence of intra operative complications in the various groups of patients studied. Post operative uveitis was higher in the MB (3.2%), smear positive (6.5%), UT (6%), eyes with leprosy related ocular disease (6.4%) and lepra reaction (12%) groups. Overall, eyes with leprosy related complications and eyes operated on during lepra reactions had more post operative complications compared to the group without. Visual outcomes for eyes with intra and post operative complications were poorer than the groups without. Cataract surgery in the hands of a careful and well trained surgeon, who is familiar with ocular leprosy and can modify the surgical technique as necessary, is safe and associated with minimal intra operative and post operative complications.

Detection of Mycobacterium leprae in Ocular Tissues by Histopathology and Real-Time Polymerase Chain Reaction

Aim: To report detection of leprosy in ocular tissue by histopathology and its confirmation by genetic analysis. Methods: Excised tissue from a clinically-suspected ocular leprosy patient was processed and analyzed histopathologically. The DNA from the paraffin-embedded tissue was extracted, an 85 A-C intergenic region of Mycobacterium leprae was amplified using specific primers and analyzed by conventional as well as real-time polymerase chain reaction (RT-PCR). Results: With periodic acid-Schiff-hematoxylin (PAS-H) staining the specimen showed presence of a thin fibrinous layer of inflammatory cells. The majority of the tissue was fibrovascular with extensive infiltration by histiocytes having reticulated cytoplasm. Modified PAS-H and acid-fast staining (AFS) showed the presence of several acid-fast organisms within the cytoplasm of histiocytes and mast cells. Conventional PCR showed a 250-bp DNA from excised conjunctival tissue, which was in agreement with the positive controls for M. leprae. Through RT-PCR, it was calculated that the suspected tissue had 44.68 pg of M. leprae DNA, which is 8937.06 genome copies of M. leprae. Conclusions: Presence of inflammatory cells and AFS bacilli in tissue presented a typical picture of leprosy. M. leprae DNA can be detected using RT-PCR in ocular tissues when acid-fast bacteria are seen in histopathological sections. And when the diagnosis of leprosy is inconclusive and acid-fast bacteria are seen, RT-PCR for M. leprae DNA could be used as a rapid confirmatory test to identify the presence of M. leprae and, therefore, the diagnosis of leprosy.

A Overview of Ocular Leprosy After 2 Decades of Multidrug Therapy

A Overview of Ocular Leprosy After 2 Decades of Multidrug Therapy

Eye disease in multibacillary leprosy patients at the time of their leprosy diagnosis: findings from the Longitudinal Study of Ocular Leprosy (LOSOL) in India, the Philippines and Ethiopia

Existing prevalence surveys do not provide adequate information to estimate the magnitude of ocular pathology or vision loss in leprosy patients. We sought to determine the prevalence of ocular findings and related risk factors in leprosy patients at the time of their disease diagnosis. We also sought to determine if there were geographic differences and whether these were due to different demographic characteristics of the populations. The study was undertaken at Schieffelin Leprosy Research & Training Centre (Karigiri, India), Leonard Wood Memorial Leprosy Institute (Cebu, Philippines), and (for 3 years only) ALERT (Addis Ababa, Ethiopia). Newly diagnosed multibacillary (MB) leprosy patients as well as MB cases relapsed after dapsone monotherapy were eligible for enrollment. In each study site, the target population was 300. Standardized examinations were conducted between 1991 and 1998. Patient enrollment included 301 patients in Karigiri, 289 patients in Cebu, and 101 patients in Addis Ababa. The age-adjusted prevalence of blindness (< 6/60 in the better eye) and visual impairment (6/24-6/60) was 2.8% and 5.2%, respectively. Lagophthalmos and leprosy related uveal changes were detected in 3.3% (95% CI 2.0-4.7%) and 4.1% (95% CI 2.4-5.7) of patients, respectively. Overall, 11% (95% CI 8.5-13.2%) of newly enrolled MB patients had potentially blinding leprosy related ocular pathology. Lagophthalmos was associated with increasing age, a short duration between onset and diagnosis, and a previous reaction involving the face. Uveal conditions were associated with increasing age. Overall, eye disease was more common in Indian and Ethiopian patients compared to Filipino patients; however, differences were not significant when controlling for age and clinical (non-ocular) factors. Patients with potentially blinding leprosy related pathology were over three times more likely to have other (hand and foot) disabilities than patients without pathology. Differences in the prevalence of blindness and potentially blinding leprosy related ocular pathology between the sites could be accounted for by the differences in age and other clinical factors of the patients at the different sites. Findings suggest that, even in the face of active leprosy control efforts, around 11% of patients will have potentially blinding pathology at the time of their diagnosis and 2.8% will be blind. If those patients with lagophthalmos or blindness are considered appropriate for referral for more detailed assessment, approximately 4% of newly diagnosed leprosy patients will require active follow-up for eye care; including those with reaction involving the face will result in 9.4% of patients requiring active follow-up. These people are likely to be older, with a reaction involving the face, and/or with other disabilities than those not requiring active follow-up.

Dapsone-Induced Neutropenia in Patients Treated for Ocular Cicatricial Pemphigoid.

Background: Dapsone is used widely in treating ocular cicatricial pemphigoid, leprosy, and dermatologic disorders. Hemolysis is a well-known complication of dapsone therapy. Rarely, neutropenia or agranulocytosis may occur, resulting in up to a 50% mortality rate. To the authors' knowledge, agranulocytosis has not been reported in patients treated with dapsone for ocular cicatricial pemphigoid. Methods: The authors report two cases of dapsone-induced neutropenia with bone marrow suppression in patients with ocular cicatricial pemphigoid. Results: Neutropenia was detected on routine laboratory examination 8 and 10 weeks after initiating dapsone therapy. Bone marrow biopsy showed acellular or hypocellular marrow. Leukocyte count returned to baseline value after cessation of dapsone. Conclusion: Patients with ocular cicatricial pemphigoid who were treated with dapsone are at increased risk for agranulocytosis. Dapsone-induced neutropenia may not be a dose-dependent phenomenon. The authors indicate that there is a need for routine monitoring of leukocyte counts, especially 8 to 10 weeks after initiating therapy. Signs or symptoms of infection require immediate investigation.

Relapse of Mycobacterium leprae Infection with Ocular Manifestations

A case of ocular leprosy as the manifestation of persistent or relapsed Mycobacterium leprae infection approximately 20 years following treatment is reported. The clinical and pathological features of this case are described, and the molecular methods needed to arrive at the definitive diagnosis are examined. If blindness is to be averted, clinicians must have a high index of suspicion for the diagnosis of ocular leprosy when anterior segment changes are noted during ophthalmologic examination of a patient from an area in which M. leprae is endemic. The indolent nature of ocular leprosy may require lifelong surveillance and therapy to insure sight preservation.

Dapsone-induced Neutropenia in Patients Treated for Ocular Cicatricial Pemphigoid

Dapsone is used widely in treating ocular cicatricial pemphigoid, leprosy, and dermatologic disorders. Hemolysis is a well-known complication of dapsone therapy. Rarely, neutropenia or agranulocytosis may occur, resulting in up to a 50% mortality rate. To the authors' knowledge, agranulocytosis has not been reported in patients treated with dapsone for ocular cicatricial pemphigoid. The authors report two cases of dapsone-induced neutropenia with bone marrow suppression in patients with ocular cicatricial pemphigoid. Neutropenia was detected on routine laboratory examination 8 and 10 weeks after initiating dapsone therapy. Bone marrow biopsy showed acellular or hypocellular marrow. Leukocyte count returned to baseline value after cessation of dapsone. Patients with ocular cicatricial pemphigoid who were treated with dapsone are at increased risk for agranulocytosis. Dapsone-induced neutropenia may not be a dose-dependent phenomenon. The authors indicate that there is a need for routine monitoring of leukocyte counts, especially 8 to 10 weeks after initiating therapy. Signs or symptoms of infection require immediate investigation.

Ocular Manifestations of Leprosy in a Noninstitutionalized Community in the United States

Our goal was to delineate the epidemiologic and clinical patterns of ocular leprosy in an outpatient setting in the United States. Examinations were performed in 61 consecutive outpatients seen in a Midwestern leprosy clinic. Forty-three male and 18 female patients were examined. The patients' origins included Southeast Asia (24 patients [39%]), Latin America (23 patients [38%]), India (nine patients [15%]), Europe or North America (two patients [3%]), Africa (two patients [3%]), and the Middle East (one patient [2%]). Thirty-nine percent of patients were classified as having polar lepromatous leprosy; 18%, borderline lepromatous leprosy; 3%, borderline borderline leprosy; 36%, borderline tuberculoid leprosy; 2%, polar tuberculoid leprosy; and 2%, indeterminate leprosy. Ninety-six percent of patients had a best-corrected visual acuity of 20/40 or better. Ocular findings included madarosis (28 patients [46%]), subconjunctival fibrosis (18 patients [30%]), punctate epithelial keratopathy (17 patients [28%]), posterior subcapsular cataract (10 patients [16%]), corneal hypesthesia (10 patients [16%]), lagophthalmos (seven patients [11%]), corneal pannus (six patients [10%]), entropion (five patients [8%]), prominent or beaded corneal nerves (four patients [7%]), iridocyclitis (four patients [7%]), focal avascular keratitis (three patients [5%]), scleritis (three patients [5%]), interstitial keratitis (two patients [3%]), iris pearls (two patients [3%]), and ocular clofazimine crystals (two patients [3%]). Madarosis, corneal hypesthesia, and posterior subcapsular cataracts were significantly associated with disease duration (P < .05). We report herein a relatively low frequency of visual impairment attributable to leprosy in our series compared with that seen among institutionalized leprous patients. However, since 48% of subjects had one or more sight-threatening complications as a result of their disease, a program of regular ophthalmic follow-up is strongly advocated for all patients with leprosy.

Considerations in the integration of eye care into leprosy care services.

Little attention has been directed to the development, management and evaluation of eye care programmes for leprosy patients. This paper examines when an eye care programme for leprosy patients is needed, methods for integrating eye care into leprosy control programmes and lists of available ocular leprosy teaching materials.

Ocular leprosy ? the continuing challenge

Ocular leprosy ? the continuing challenge

Ocular manifestations of systemic granulomatous diseases

Many systemic granulomatous diseases may affect the eye. This review emphasizes those diseases that have been found more frequently in recent years and that have become a major problem to ophthalmologists because of the difficulties in early diagnosis and adequate treatment. Today, we face a resurgence of ocular syphilis, especially the acquired form associated with neurologic involvement and human immunodeficiency virus infection. More severe, atypical forms of the disease have recently appeared. Ocular toxoplasmosis represents a clinical challenge, especially in the immunocompromised patient, in whom the severity of the chorioretinitis, the frequency of complications, and the treatment difficulty become major problems. Ocular sarcoidosis frequently is the initial presentation of the systemic disease, and its early detection and treatment may prevent late, severe complications. In the case of Lyme disease, the incidence and both the number and variety of ocular manifestations have increased in recent years, and Wegener's granulomatosis represents a major diagnostic problem. The detection of antineutrophil cytoplasmic antibodies facilitates the early diagnosis and prevents disastrous complications of the disease. Finally, ocular leprosy, a major cause of blindness, especially in Africa, Asia, and South America, and ocular tuberculosis are important mycobacterial infections that affect the eye with fatal consequences if not detected and treated early in their course. Current Opinion in Ophthalmology 1991, 2:181-189

Corneal sensitivity and correlations between decreased sensitivity and anterior segment pathology in ocular leprosy.

Leprosy is one of the leading causes of corneal hyposensitivity. In this article the corneal sensitivity of 143 leprosy patients was examined, and correlations between corneal hyposensitivity and anterior segment pathology were detected. Twenty four healthy volunteers were examined as controls. Various degrees of corneal loss of sensitivity were found in 46.2% of leprosy patients. Lagophthalmos, chronic lepromatous granulomatous uveitis, iris atrophy, and social blindness were found 4.5-16.6 times more frequently in eyes which developed severe corneal hyposensitivity.

The continuing challenge of ocular leprosy.

The continuing challenge of ocular leprosy.

Pupil cycle time and early autonomic involvement in ocular leprosy.

Ocular complications of leprosy patients often develop insidiously and with few if any symptoms. This study involves measurement of the pupil cycle time (PCT) to evaluate the autonomic nerve system of the iris to determine the presence of subclinical intraocular involvement. The study included 19 lepromatous (LL), 19 borderline lepromatous (BL), and five borderline tuberculoid (BT) leprosy patients and involved 25 healthy volunteers, 10 patients with pulmonary tuberculosis and eight with Duhring disease. The PCT was measured in these groups. In all leprosy groups included in the study the PCT was higher than in the control groups. Moreover, the PCT of the leprosy patients without any intraocular involvement was higher than in the controls. These results show that in the ophthalmic examination of leprosy patients without any symptoms the fact that autonomic nerve system of the eye is affected by the leprosy can often be determined by measuring the PCT.