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

OBJECTIVES: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.

Visual outcome of extracapsular cataract extraction and intraocular lens replacement in leprosy patients.

The study was carried out in Meshed, Islamic Republic of Iran, from 1998 to 2000 to explore the visual outcome of eye surgery with extracapsular cataract extraction and intraocular lens replacement on 18 leprosy patients (20 eyes). The most common complications of leprosy were madarosis (90%) and partial or total corneal opacity (90%). Visual acuity before surgery ranged from 'light perception' to 1/10, and this improved after surgery to 5/10-8/10 for 55% of patients. Postoperative infection leading to endophthalmitis occurred in only 1 patient and was treated with drugs; this patient's visual acuity remained at 10 cm finger count. Posterior synechia due to chronic uveitis in leprosy was diagnosed in 70% of eyes, obstructed iris in 25%, keratic precipitates in 25% and moderate iris atrophia in 10%.

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.