This Article Full Text Full Text (PDF) All Versions of this Article: bjo.2006.112953v1 91/8/1011    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Daniel, E. Articles by Sundar Rao, P S S Search for Related Content PubMed PubMed Citation Articles by Daniel, E. Articles by Sundar Rao, P S S

Evolution of vision reducing cataract in skin smear positive lepromatous patients: does it have an inflammatory basis?

¹ Schieffelin Leprosy Research and Training Centre, Vellore, India, and Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
² Research Resource Centre, The Leprosy Mission, New Delhi, India

Correspondence to:
Correspondence to:
Dr Ebenezer Daniel
Division of Ocular Immunology, Department of Ophthalmology, The Johns Hopkins University School of Medicine, 1620 McElderry Street, Reed Hall, 4th Floor, Baltimore, MD 21205, USA; edaniel4{at}jhmi.edu

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

Methods: Prospective longitudinal cohort study: 212 newly diagnosed lepromatous patients were followed during the two years of treatment with multidrug 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%/person year (95% confidence interval (CI), 2.17% to 3.80%)) developed cataract during a total follow up period of 1704 person years; 45 of these were 41 years old and were followed for a total of 638 person years with an incident rate of 0.070 (95% CI, 0.0523 to 0.094). Stepwise multiple regression confirmed the association of age (per decade) (hazard ratio (HR) = 2.50 (95% CI, 1.82 to 2.78), p<0.001), clofazimine crystals on the cornea (HR = 49.92 (5.48 to 454.82), p = 0.001), grade 2 deformity in all limbs (HR = 3.17 (1.12 to 8.97), p = 0.029), and uveal inflammation (HR = 3.52 (1.42 to 8.67), p = 0.006). No significant association was found with oral steroids.

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

Abbreviations: MB, multibacillary; MDT, multidrug therapy

Keywords: incidence; cataract; risk factors; lepromatous leprosy