Cataract surgery in a leprosy population in Liberia.

In Liberia, 43 eyes of 30 patients with ocular leprosy underwent cataract extraction; 33 eyes had extracapsular cataract extraction (ECCE) and 10 eyes had intracapsular cataract extraction (ICCE). ICCE was performed in eyes with poor visualization of the anterior chamber. In 95% of the eyes, the postoperative vision improved by 2 Snellen lines or more, but functional visual acuity (better than 20/200) was achieved in only 65% (82% post-ECCE and 10% post-ICCE). Fewer postoperative complications were observed after ECCE. These findings may have been related to less ocular involvement by leprosy preoperatively. ECCE should be attempted when the visualization of the anterior chamber is fair.

Glaucoma in Hansen's disease.

Glaucoma is considered to be an uncommon complication of Hansen's disease (leprosy). This study determined the prevalence and characteristics of glaucoma in a large institutionalised leprosy population. All 193 patients currently residing at the Gillis W Long Hansen's Disease Center received a complete ophthalmic examination and review of their records. All had been previously treated with dapsone and/or clofazimine. Based on the strict definition of a recorded intraocular pressure greater than or equal to 22 mm Hg and characteristic optic nerve pathology, 19 patients (10%) were found to have glaucoma. Glaucoma secondary to uveitis was noted in 11 of these patients. These findings suggest that the chronic inflammatory process of Hansen's disease, even when treated, may be followed by secondary glaucoma. We recommend that all patients with Hansen's disease receive regular periodic examinations, including slit-lamp biomicroscopy to detect low-grade iridocyclitis and measurement of intraocular pressure.