Ocular leprosy: from bench to bedside.

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.

O uso de lentes intra-oculares em pacientes portadores de hanseníase / Use of intraocular lenses in patients with leprosy

Objetivo: Avaliar as alteraçöes oculares decorrentes da cirurgia de catarata com implante de lentes intra-oculares (LIO) em pacientes portadores de mal de Hansen (MH) e compará-las às dos pacientes näo-portadores de Hanseníase. Métodos: Neste estudo, 122 olhos de 80 pacientes portadores de MH e 71 olhos de 71 pacientes näo hansenianos foram submetidos à facectomia extracapsular e/ou à facoemulsificaçäo com implante de LIO e examinados periodicamente durante o pós-operatório. Resultado:Foram constatadas alteraçöes oculares decorrentes da cirurgia e da presença da LIO mais freqüentes no grupo portador de hanseníase.Conclusäo: O uso da LIO em pacientes com hanseníase, mesmo ocorrendo algumas alteraçöes inflamatórias, é indicado devido ao benefício que propicia a esses pacientes em face das mutilaçöes decorrentes da doença.

[Phacoemulsification-aspiration technique with intraocular lens implantation in leprosy patients].

The author analyzed the results of cataract surgery performed in 25 eyes of 22 leprosy patients. All the eyes were treated by phacoemulsification-aspiration technique with intraocular lens implantation. The subjects consisted of 15 eyes of 14 leprosy patients with past history of uveitis and 10 eyes of 8 leprosy patients without uveitis. The mean follow-up time after surgery was 20 months and 23 months, respectively. In 93% of eyes with uveitis and 90% of eyes without uveitis, the postoperative vision improved by 2 lines or more. Postoperative complications were higher among patients with uveitis (93%) compared with patients without uveitis (40%). But no serious complications were encountered in patients with uveitis.

Lente intra-ocular em portadores de Hansen / Intraocular lens in patients bearing Hansen's disease

Os autores tiveram a oportunidade de implantar lente intra-ocular de câmara posterior em 39 olhos de portadores de Hansen, com os mais variados tipos de atrofias de iris e com miose paralítica. Os resultados deste tratamento mostraram que a lente intra-ocular, nesta doença, näo traz complicaçöes diferentes das usualmente observadas em pacientes normais