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Huang J, Du K, Guan H, Ding Y, Zhang Y, Wang D, Wang H. The Role of Village Doctors in Residents' Uptake of Eye Screening: Evidence from Ageing Residents in Rural China. Healthcare (Basel) 2022; 10:healthcare10071197. [PMID: 35885723 PMCID: PMC9317018 DOI: 10.3390/healthcare10071197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
The lack of formal eye screening is the main reason for insufficient eye care utilization in rural China. Cataract, in particular, is increasingly prevalent with the aging population, but the treatment rate is relatively low. Village doctors are the most accessible health care resource for rural residents, receiving few empirical investigations into their role in eye care. This study aims to assess the role of village doctors in residents’ uptake of eye screening (vision and cataract screening), the first step of cataract treatment. Data come from a community-based, cross-sectional survey conducted in 35 villages of a county of the Gansu Province, Northwestern China, in 2020. Among 1010 residents aged ≥ 50 and 35 village doctors, the multivariate logistic regression shows that village doctors’ age, time spent on public health service, and service population were positively associated with residents’ uptake of vision and cataract screening. Village doctors were capable of playing an active role in primary eye health services due to their richer knowledge about cataracts than residents (accuracy rate 86.75% vs. 63.50%, p < 0.001), but less than half of them were willing to undertake eye screening. This study highlights the positive role of village doctors in aging residents’ eye screening and the potential role in improving the uptake of eye screening by offering health education.
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Affiliation(s)
- Juerong Huang
- College of Economics and Management, China Agricultural University, Beijing 100083, China;
| | - Kang Du
- College of Economics, Xi’an University of Finance and Economics, Xi’an 710100, China;
| | - Hongyu Guan
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
- Correspondence: ; Tel.: +86-186-9188-9621
| | - Yuxiu Ding
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
| | - Yunyun Zhang
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an 710119, China; (Y.D.); (Y.Z.)
| | - Decai Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou 510060, China;
| | - Huan Wang
- Center on China’s Economy and Institution, Stanford University, Stanford, CA 94305, USA;
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Iraha S, Kondo S, Yamaguchi T, Inoue T. Bilateral corneal perforation caused by neurotrophic keratopathy associated with leprosy: a case report. BMC Ophthalmol 2022; 22:42. [PMID: 35093062 PMCID: PMC8800195 DOI: 10.1186/s12886-022-02265-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Neurotrophic keratopathy (NK) is a rare degenerative corneal disease caused by damage to the trigeminal nerve. We hereby describe a severe case with bilateral corneal perforation due to leprosy (Hansen’s disease)-associated NK. Case presentation An 89-year-old man with a history of leprosy treated 40 years previously in our sanatorium developed bilateral corneal perforation due to NK. He had a history of bilateral persistent epithelial defects and bacterial keratitis. Although epithelialization was obtained with the use of autologous serum eye drops, progressive corneal thinning concomitant with stromalysis led to bilateral perforation. Over one month treatment with topical antibiotics, anti-inflammatory and lubricants resulted in healing of the epithelial defects and corneal perforations. A Cochet-Bonnet esthesiometer demonstrated a total absence of corneal sensation in both eyes. Conclusions The present case indicated the irreversible nerve damage due to leprosy that had been cured 23 years ago, which can progress over the years and cause bilateral corneal perforations.
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Abstract
PURPOSE OF REVIEW 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. RECENT FINDINGS 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. SUMMARY 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.
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Duran Merino CE, Ortiz Úsuga MC, Jaramillo MJ, Rodríguez AM. Chronic Unilateral Uveitis as a Manifestation of Leprosy: A Case Report and Literature Review. Ocul Immunol Inflamm 2020; 29:1121-1125. [PMID: 32159415 DOI: 10.1080/09273948.2020.1720256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To describe a case of leprosy presenting chronic anterior uveitis associated with other systemic lesions.Methods: Case report and systematic literature review.Results: We describe the case of a 65-year-old patient presenting clinical features of chronic uveitis and poor response to topical and intravitreal steroid treatment. Upon ocular examination, diffuse iris atrophy and macular edema were observed and laboratory tests for autoimmune and infectious diseases were within normal range. Physical examination revealed the presence of skin lesions on trunk and extremities, which were biopsied and identified as positive for leprosy.Conclusion: The case reported herein presented atypical characteristics of uveitis due to the involvement of the posterior segment of the eye. Leprosy diagnosis could be a challenge, a systematic approach is mandatory to achieve adequate treatment.
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Affiliation(s)
| | - María Camila Ortiz Úsuga
- Ophthalmology Residency Program, School of Medicine, Pontifical Bolivarian University, Medellín, Colombia
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dos Santos OAL, dos Santos DF, Antunes DE, da Cunha BA, Goulart IMB. Ocular conditions in newly diagnosed and post-treatment leprosy patients at a National Reference Center in Brazil. LEPROSY REV 2020. [DOI: 10.47276/lr.91.1.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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de Oliveira MF, Antunes DE, dos Santos DF, Goulart IMB. Evaluation of the cutaneous sensation of the face in patients with different clinical forms of leprosy. PLoS One 2019; 14:e0213842. [PMID: 30870498 PMCID: PMC6417732 DOI: 10.1371/journal.pone.0213842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 03/02/2019] [Indexed: 11/28/2022] Open
Abstract
Background Leprosy can be considered to be the most common peripheral neuropathy of infectious etiology and constitutes a public health problem. The standard routine examination for assessing sensory impairment in leprosy neuropathy basically evaluates hands, feet and eyes. However, evaluation of facial cutaneous sensation is not routinely performed. Objectives The aim of this study was to evaluate facial cutaneous sensation in patients with different clinical forms of leprosy and compare the findings with those from healthy individuals. Methodology 19 healthy controls and 71 leprosy patients who were being treated at a national reference center for leprosy in Brazil underwent facial sensation assessment using the Semmes-Weinstein monofilament test. This test was applied over the facial areas corresponding to the ophthalmic, maxillary and mandibular distal branches of the trigeminal nerve. Results The predominant clinical form in terms of changes to facial cutaneous sensation was lepromatous leprosy (LL), followed by the borderline-borderline (BB), and borderline-lepromatous (BL) forms, in comparison with healthy individuals. The distal branches most affected were the zygomatic (28.2%; 20/71), buccal (23.9%; 17/71) and nasal (22.5%; 16/71). There was asymmetrical sensory impairment of the face in 62.5% (20/32) of the cases. Conclusion The face is just as impaired in leprosy as are the feet, hands and eyes, but facial impairment is underdiagnosed. Our evaluation on the different sensory branches and evidence of asymmetrical impairment of the face confirm the classically described pattern of leprosy neuropathy, i.e. consisting of asymmetrical and predominantly sensory peripheral neuropathy.
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Affiliation(s)
- Marlice Fernandes de Oliveira
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- University Center of Cerrado, Patrocínio, Minas Gerais, Brazil
| | - Douglas Eulálio Antunes
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Diogo Fernandes dos Santos
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Isabela Maria Bernardes Goulart
- Postgraduate Program on Health Sciences, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- National Reference Center for Sanitary Dermatology and Leprosy, University Hospital, School of Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
- * E-mail:
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Jue MS, Yoo J, Kim MS, Park HJ. The Lateral Tarsal Strip for Paralytic Ectropion in Patients with Leprosy. Ann Dermatol 2017; 29:742-746. [PMID: 29200763 PMCID: PMC5705356 DOI: 10.5021/ad.2017.29.6.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 03/08/2017] [Accepted: 04/05/2017] [Indexed: 12/03/2022] Open
Abstract
Background In patients with leprosy, paralysis of the facial nerve results in the lower eyelid ectropion and lagophthalmos as a sequela even when the leprosy is cured. Paralytic ectropion causes many functional and cosmetic eye problems, leading to blindness if left untreated. Objective The purpose of this retrospective study is to evaluate the efficacy of surgical correction of paralytic ectropion, the lateral tarsal strip, in patients with leprosy. Methods Between 2010 and 2015, 40 Korean patients (44 eyelids) with paralytic ectropion who had visited Korean Hansen Welfare Association Hospital were treated with the lateral tarsal strip. Four-point patients' global assessment scale, local complications, and recurrence were assessed at the end of follow-up period. The average follow-up period was 12 months. Results In the 44 eyelids, recurrence was observed in 5 cases (5/44, 11.4%). There were no serious postoperative complications except mild size discrepancy of both eyes. Most patients were satisfied with the results and mean satisfaction scale was 2.6/3. Conclusion The lateral tarsal strip is a simple, safe, and effective treatment method for the dermatologic surgeon to correct paralytic ectropion of mild to moderate degree in patients with leprosy.
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Affiliation(s)
- Mihn-Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea.,Division of Dermatology, Department of Medicine, Hanyang University Graduate School, Seoul, Korea
| | - Jisook Yoo
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Min-Soo Kim
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyang-Joon Park
- Department of Dermatology, Gachon University Gil Medical Center, Incheon, Korea
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Abstract
Ocular involvement in leprosy is estimated to be 70-75%, about 10-50% of leprosy patients suffer from severe ocular symptoms, and blindness occurs in about 5% of patients. The disease leads to many ophthalmologic symptoms and signs in the range of the eyeball itself, as well as of the bulb adnexa, ie, eyebrows, eyelids with eyelashes, and lacrimal drainage system. Especially dangerous are complications of lagophthalmos and corneal hypoanesthesia, neurotrophic or infectious keratitis, and iridocyclitis and cataract formation, which may lead to significant decrease of visual acuity or even blindness. Multidrug treatment rapidly interrupts transmission of Mycobacterium leprae by infectious patients, but even after being completed, it does not guarantee the withholding of ocular complications.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, Poznań City Hospital, ul. Szwajcarska 3, 61-285 Poznań, Poland; Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.
| | - Małgorzata Nita
- Domestic and Specialized Medicine Centre "Dilmed" Katowice, Poland
| | - Marcos Virmond
- Research Department, Instituto Lauro de Souza Lima, Bauru, Brazil
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Lastória JC, Abreu MAMMD. Leprosy: review of the epidemiological, clinical, and etiopathogenic aspects - part 1. An Bras Dermatol 2014; 89:205-18. [PMID: 24770495 PMCID: PMC4008049 DOI: 10.1590/abd1806-4841.20142450] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/21/2013] [Indexed: 12/01/2022] Open
Abstract
Leprosy is caused by Mycobacterium leprae and has been known since biblical times. It
is still endemic in many regions of the world and a public health problem in Brazil.
The prevalence rate in 2011 reached 1.54 cases per 10,000 inhabitants in Brazil. The
mechanism of transmission of leprosy consists of prolonged close contact between
susceptible and genetically predisposed individuals and untreated multibacillary
patients. Transmission occurs through inhalation of bacilli present in upper airway
secretion. The nasal mucosa is the main entry or exit route of M. leprae. The deeper
understanding of the structural and biological characteristics of M. leprae, the
sequencing of its genome, along with the advances in understanding the mechanisms of
host immune response against the bacilli, dependent on genetic susceptibility, have
contributed to the understanding of the pathogenesis, variations in the clinical
characteristics, and progression of the disease. This article aims to update
dermatologist on epidemiological, clinical, and etiopathogenic leprosy aspects.
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Affiliation(s)
- Joel Carlos Lastória
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
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Tremblay F, Albert M. Arthritis, progressive maculopapular rash and severe peripheral neuropathy in a 60-year-old man. Diagnosis: Leprosy. CMAJ 2014; 186:206-9. [PMID: 24366896 PMCID: PMC3928212 DOI: 10.1503/cmaj.130688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- François Tremblay
- Department of Medicine, Hôpital du Sacré-Coeur de Montréal, and Faculty of Medicine, University of Montréal, Montréal, Que
| | - Martin Albert
- Department of Medicine, Hôpital du Sacré-Coeur de Montréal, and Faculty of Medicine, University of Montréal, Montréal, Que
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Salem RAA. Ocular complications of leprosy in yemen. Sultan Qaboos Univ Med J 2012; 12:458-464. [PMID: 23275842 PMCID: PMC3523995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 06/01/2012] [Accepted: 06/27/2012] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVES This study was conducted to identify the main ocular- and vision-threatening complications of leprosy in Yemen. METHODS This is a cross-sectional observational study which took place from February to July 2010. Leprosy patients attending the Skin and Venereal Diseases Hospital in the City of Light in Taiz, Yemen, who consented to participate in the study, were enrolled. Detailed demographic and medical histories were taken and clinical examination findings were recorded. A detailed eye examination, including visual acuity (VA), slit-lamp, and fundus examinations, was conducted on each patient by a qualified ophthalmologist. RESULTS A total of 192 patients (180 male, 12 female, with a male to female ratio of 15:1) were included in the study. The majority of the patients (157; 81.8%) were over 40 years. Over two-thirds of the patients (129; 67.2%) had had leprosy for more than 20 years. Ocular complications were found in 97% of cases; 150 (39.1%) of the patients' eyes had at least one pathology. Eyelid involvement was the most common problem observed in 102 (26.5%) patients. Half of the eyes (192; 50%) had a VA of <6/60. The main cause of blindness among these patients was corneal opacity detected in 69 out of 192 patients (35.9%). CONCLUSION Ocular complications are frequent among leprosy patients in Yemen. They are true vision-threatening lesions. It is important to prevent these lesions through early diagnosis and adequate treatment.
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Malik ANJ, Morris RW, Ffytche TJ. The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years. Eye (Lond) 2011; 25:740-5. [PMID: 21423140 DOI: 10.1038/eye.2011.43] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom. METHODS Observational prospective study. RESULTS A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ≥ 6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14-35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15-19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0-1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81-20.24). CONCLUSION There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.
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Berbos ZJ, Krachmer JH. Infectious Disease. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00073-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lewallen S, Courtright P. A overview of ocular leprosy after 2 decades of multidrug therapy. Int Ophthalmol Clin 2007; 47:87-101. [PMID: 17667278 DOI: 10.1097/iio.0b013e318074e3eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Susan Lewallen
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
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Hogeweg M, Keunen JEE. Prevention of blindness in leprosy and the role of the Vision 2020 Programme. Eye (Lond) 2006; 19:1099-105. [PMID: 16304590 DOI: 10.1038/sj.eye.6701984] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Leprosy control programmes are highly successful. As a result, leprosy control will be more and more integrated into the general health services. The existing vertical, specialized control programmes will be dismantled. Eye complications in leprosy have decreased. This is a result of earlier diagnosis and highly effective multidrug treatment (MDT) of leprosy, combined with timely treatment of secondary nerve damage by steroids. Most ocular morbidity is now found among elderly and disabled leprosy patients who were diagnosed before effective MDT treatment became available. Many of these patients live in leprosy settlements. Age-related cataract has become the leading cause of blindness in leprosy. The second cause of blindness is corneal opacification, mainly as a result of neglected exposure keratitis and corneal anaesthesia. The miotic pupils in late multibacillary leprosy, in combination with small central lens opacities, may also lead to blindness. The Vision 2020 Initiative prioritises cataract surgery. Leprosy patients should be actively included. Disabled leprosy patients can also benefit from screening programmes for refractive errors and the provision of spectacles and low vision aids. Determining the most feasible surgical methods for lagophthalmos surgery remains a challenge. For all health and eye care staff, training in leprosy and its eye complications is needed, as well as a change in attitude towards leprosy patients. Staff must be prepared to welcome them in the general health services.
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Affiliation(s)
- M Hogeweg
- Department of Opthalmology, Leiden University Medical Centre, Leiden, The Netherlands
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Mpyet C, Solomon AW. Prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. Br J Ophthalmol 2005; 89:417-9. [PMID: 15774916 PMCID: PMC1772607 DOI: 10.1136/bjo.2004.048777] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2004] [Indexed: 11/04/2022]
Abstract
AIMS To determine the prevalence and spectrum of ocular pathology, and the prevalence and causes of blindness and low vision in leprosy villages of north eastern Nigeria. METHODS People affected by leprosy, aged 30 years and above, resident in eight leprosy villages were invited to participate. Ocular examination was undertaken of each consenting individual. RESULTS 480 people were examined. 456 (48%) of 960 eyes had at least one ocular lesion, but only 37% of all lesions were leprosy related and potentially sight threatening. The prevalence of blindness (VA<3/60 with available correction) was 10.4%. An additional 7.5% of subjects were severely visually impaired (3/60< or =VA<6/60). Cataract was the commonest cause of blindness. Other major causes were non-trachomatous corneal opacity and trachoma. CONCLUSIONS Blindness and low vision are highly prevalent among leprosy patients in this setting. Only a third of the burden of ocular pathology is related to the direct effects of leprosy. Efforts to reduce the backlog of cataract and trichiasis, to improve early detection and management of lagophthalmos, and to provide refractive services are urgently required.
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Affiliation(s)
- C Mpyet
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria
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Nepal BP, Shrestha UD. Ocular findings in leprosy patients in Nepal in the era of multidrug therapy. Am J Ophthalmol 2004; 137:888-92. [PMID: 15126154 DOI: 10.1016/j.ajo.2003.12.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2003] [Accepted: 12/11/2003] [Indexed: 11/21/2022]
Abstract
PURPOSE Detailed ophthalmic evaluation was performed to determine the prevalence of ocular complications among leprosy patients on multidrug therapy and those released from multidrug treatment. DESIGN Observational case series. METHODS Leprosy patients at Tribhuvan University Teaching Hospital from April 1, 2001, through September 30, 2002, underwent detailed ophthalmic evaluation including slit-lamp biomicroscopy, dilated funduscopy, and applanation tonometry. RESULTS We evaluated 58 leprosy patients. A majority (72%) was receiving treatment for multibacillary leprosy; 14% belonged to posttreatment multibacillary and paucibacillary groups. Ocular involvement was found in 57% of patients. In the multibacillary group, 55% had ocular involvement, which was more than double that found in the paucibacillary group (25%), although this finding was not statistically significant (P =.187). Among patients with ocular complications, 48% had visual disability and another 45% had threatened vision; 9% met World Health Organization guidelines for blindness. Uveitis and its complications were the predominant causes of visual disability (88%). CONCLUSION Ocular complications and visual disability are high among leprosy patients in Nepal even after completing multidrug therapy.
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Affiliation(s)
- Bhagavat P Nepal
- BP Koirala Lions Center for Ophthalmic Studies, PO Box 8750, Maharajgunj, Kathmandu, Nepal
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Abstract
PURPOSE To determine the prevalence of glaucoma in a population of patients with multibacillary Hansen disease who had completed treatment. PATIENTS AND METHODS The authors examined 386 of 446 patients with treated multibacillary Hansen disease residing in a geographically limited area. A complete ophthalmic examination including slit-lamp, applanation tonometry, gonioscopy, ophthalmoscopy, and stereobiomicroscopic examination of the optic disc was performed in all subjects. Glaucoma suspects were invited to the base hospital for further examination including automated perimetry. RESULTS The overall prevalence of glaucoma was 3.6% (CI 1.9-5.3); 1.3% had primary open-angle glaucoma, 7% were primary angle-closure suspects (occludable angles), 1.8% had primary angle-closure glaucoma, and 0.5% had secondary glaucoma. CONCLUSION The prevalence of primary glaucoma in patients with treated multibacillary Hansen disease was similar to that in the general population, and secondary glaucoma was rare.
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Affiliation(s)
- Ravi Thomas
- L.V. Prasad Eye Institute, Hyderabad, Andhra Pradesh, India.
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Abstract
Leprosy, also known as Hansen's disease, remains a significant cause of disability worldwide. After the introduction of treatment regimens using a combination of dapsone, rifampin, and clofazimine, the prevalence of the disease declined from 5.4 million registered cases in 1985 to less than a million in 1999. However, the incidence of new cases has remained stable due at least in part to a population of asymptomatic carriers. Immune-mediated nerve damage can occur during treatment or after treatment is completed and mandates continued careful follow-up of patients. Patient education and rehabilitation are crucial aspects of disease management and prevention of disability. In the US, patient care and medications are available through regional clinics sponsored by the Department of Health and Human Services. Patients should contact the National Hansen's Disease Program at 1770 Physician's Park Drive, Baton Rouge, Louisiana 70816; 1-800-642-2477.
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Affiliation(s)
- Sharon P. Nations
- *Department of Neurology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8897, USA.
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Courtright P, Lewallen S, Tungpakorn N, Cho BH, Lim YK, Lee HJ, Kim SH. Cataract in leprosy patients: cataract surgical coverage, barriers to acceptance of surgery, and outcome of surgery in a population based survey in Korea. Br J Ophthalmol 2001; 85:643-7. [PMID: 11371479 PMCID: PMC1723998 DOI: 10.1136/bjo.85.6.643] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Cataract is the leading cause of blindness in leprosy patients. There is no population based information on the cataract surgical coverage, barriers to use of surgical services, and outcome of surgery in these patients. We sought to determine these measures of cataract programme effectiveness in a cured leprosy population in South Korea. METHODS The population consisted of residents of six leprosy resettlement villages in central South Korea. All residents were invited to participate in a study of eye disease and interviewed regarding use of surgical services and reasons for not using these services. RESULTS The cataract surgical coverage in this population was 55.4% when <6/18 was used as the cut off and increased to 78.3% when the cut off was <6/60. Barriers reported by patients included being told by the doctor that the cataract was not mature and a perception by the patient that there was no need for surgery. Among patients who had aphakic surgery, 71% were still blind in the operative eye while among patients who had pseudophakic surgery, 14% were still blind (presenting vision). Blindness in pseudophakic patients could be reduced to 3% with spectacle correction. CONCLUSION Cataract prevalence in leprosy patients will increase as life expectancy continues to increase. Leprosy control programmes will need to develop activities aimed at reducing the burden of cataract. Recommendations include establishing collaborative agreements with ophthalmological services to provide high quality IOL surgery to these patients, training of health staff to identify and refer patients in need of surgery, monitoring the uptake of cataract surgery among patients needing services, and monitoring the outcome of surgery to improve refractive outcome.
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Affiliation(s)
- P Courtright
- British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, BC, Canada.
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