Lewallen S, Tungpakorn N C, Kim S H, Courtright P
British Columbia Centre for Epidemiologic and International Ophthalmology, University of British Columbia, Vancouver, Canada.
Br J Ophthalmol. 2000 Aug;84(8):817-21. doi: 10.1136/bjo.84.8.817.
Ocular damage in leprosy is due either to nerve damage or infiltration by mycobacteria. There is currently little information about the magnitude and nature of incident ocular pathology in cured leprosy patients. This information would increase our understanding of the pathophysiology of ocular involvement in leprosy and help in developing programmes to address the eyecare needs of leprosy patients who have been released from treatment. The cumulative incidence of leprosy related ocular pathology and cataract was measured during an 11 year follow up period in cured leprosy patients released from treatment in Korea.
In 1988 standardised eye examinations were performed on 501 patients in eight resettlement villages in central South Korea. In May 1999 standardised eye examinations were repeated in this population.
Among the patients in whom there was no sight threatening leprosy related ocular disease (lagophthalmos, posterior synechia, or keratitis) in 1988, 14.7% developed one or more of these conditions. Overall, among those with no vision reducing cataract in 1988, 26.4% had developed a vision reducing lens opacity in at least one eye. Among patients examined in both 1988 and 1999, 14.3% developed visual impairment and 5.7% developed blindness.
This study demonstrates that leprosy related ocular pathology progresses in some patients even after they are cured mycobiologically. The progressive leprosy related lesions are the result of chronic nerve damage; ocular lesions due to infiltration by Mycobacterium leprae did not develop. Based on the factors found to be associated with development of the most visually significant findings (posterior synechia, keratitis, and cataract) certain patients should be targeted at discharge for active follow up eye care. We suggest that patients with lagophthalmos (even in gentle closure), trichiasis, small pupils, and posterior synechiae should be screened regularly for the development of lagophthalmos in forced closure, keratitis, and cataract.
麻风病导致的眼部损害要么是神经损伤，要么是分枝杆菌浸润所致。目前，关于已治愈麻风病患者眼部病变的发生率及性质的信息较少。这些信息将增进我们对麻风病眼部受累病理生理学的理解，并有助于制定方案以满足已结束治疗的麻风病患者的眼保健需求。在韩国，对已结束治疗的治愈麻风病患者进行了11年的随访，以测量麻风病相关眼部病变和白内障的累积发病率。
1988年，对韩国中部8个安置村的501名患者进行了标准化眼科检查。1999年5月，对该人群再次进行了标准化眼科检查。
在1988年没有威胁视力的麻风病相关眼病（兔眼、虹膜后粘连或角膜炎）的患者中，14.7%出现了一种或多种此类病症。总体而言，在1988年没有视力下降性白内障的患者中，26.4%至少一只眼睛出现了视力下降性晶状体混浊。在1988年和1999年都接受检查的患者中，14.3%出现了视力损害，5.7%出现了失明。
本研究表明，即使在生物学上已治愈，一些患者的麻风病相关眼部病变仍会进展。进行性麻风病相关病变是慢性神经损伤的结果；未出现因麻风分枝杆菌浸润导致的眼部病变。基于发现的与最具视力影响的病变（虹膜后粘连、角膜炎和白内障）发生相关的因素，某些患者在出院时应作为积极随访眼保健的目标人群。我们建议，对于有兔眼（即使是轻度闭眼时）、倒睫、小瞳孔和虹膜后粘连的患者，应定期筛查是否出现强迫闭眼时的兔眼、角膜炎和白内障。
