RESUMO
Amidst the plethora of ocular complications of leprosy, involvement of the posterior segment or optic nerve is extremely rare. The mechanism of optic neuritis in leprosy is poorly understood. A 47 year-old man presented with a single lesion suggestive of mid-borderline (BB) leprosy over left periorbital region; the histology showed borderline lepromatous (BL) leprosy with a BI of 3+. After initial improvement with WHO MDT-MB and prednisolone (40 mg/d) he developed sudden and painless diminished vision in the left eye, about 3 weeks later. His visual acuity was 6/9 in the left and 6/6 in the right eye, and there was left optic disc edema, hyperemia and blurred disc margins. Treatment with prednisolone (60 mg/d) along with WHO MDT-MB continued. A month later he returned with painless diminished vision in the other eye as well. Visual acuity was 6/6 in the right and 6/12 in the left eye, and there was right optic disc edema and left optic disc atrophy. CT of the head and MRI of the brain were normal. Inflammatory edema of the orbital connective tissue or other surrounding structures, or direct infiltration of vasa nervosa with resultant vascular occlusion leading to optic nerve ischemia, seems the most plausible explanation of optic nerve involvement in this case.
Assuntos
Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/patologia , Nervo Óptico/patologia , Prednisolona/administração & dosagem , Anti-Inflamatórios/administração & dosagem , Clofazimina/administração & dosagem , Dapsona/administração & dosagem , Quimioterapia Combinada , Humanos , Índia , Hanseníase Dimorfa/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Disco Óptico/patologia , Rifampina/administração & dosagem , Acuidade Visual , Testes de Campo VisualRESUMO
PURPOSE: To determine the prevalence of glaucoma in a population of patients with multibacillary Hansen disease who had completed treatment. PATIENTS AND METHODS: The authors examined 386 of 446 patients with treated multibacillary Hansen disease residing in a geographically limited area. A complete ophthalmic examination including slit-lamp, applanation tonometry, gonioscopy, ophthalmoscopy, and stereobiomicroscopic examination of the optic disc was performed in all subjects. Glaucoma suspects were invited to the base hospital for further examination including automated perimetry. RESULTS: The overall prevalence of glaucoma was 3.6% (CI 1.9-5.3); 1.3% had primary open-angle glaucoma, 7% were primary angle-closure suspects (occludable angles), 1.8% had primary angle-closure glaucoma, and 0.5% had secondary glaucoma. CONCLUSION: The prevalence of primary glaucoma in patients with treated multibacillary Hansen disease was similar to that in the general population, and secondary glaucoma was rare.
Assuntos
Glaucoma de Ângulo Fechado/epidemiologia , Glaucoma de Ângulo Aberto/epidemiologia , Hanseníase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Cloroquina/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Gonioscopia , Humanos , Índia/epidemiologia , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Oftalmoscopia , Disco Óptico/patologia , Prevalência , Tonometria OcularRESUMO
PURPOSE: To determine the prevalence of glaucoma in a population of patients with multibacillary Hansen disease who had completed treatment. PATIENTS AND METHODS: The authors examined 386 of 446 patients with treated multibacillary Hansen disease residing in a geographically limited area. A complete ophthalmic examination including slit-lamp, applanation tonometry, gonioscopy, ophthalmoscopy, and stereobiomicroscopic examination of the optic disc was performed in all subjects. Glaucoma suspects were invited to the base hospital for further examination including automated perimetry. RESULTS: The overall prevalence of glaucoma was 3.6 per cent (CI 1.9-5.3); 1.3 per cent had primary open-angle glaucoma, 7 per cent were primary angle-closure suspects (occludable angles), 1.8 per cent had primary angle-closure glaucoma, and 0.5 per cent had secondary glaucoma. CONCLUSION: The prevalence of primary glaucoma in patients with treated multibacillary Hansen disease was similar to that in the general population, and secondary glaucoma was rare.
Assuntos
Masculino , Feminino , Humanos , Criança , Adulto , Pessoa de Meia-Idade , Idoso , Adolescente , Idoso de 80 Anos ou mais , Cloroquina/uso terapêutico , Disco Óptico/patologia , Glaucoma de Ângulo Aberto/epidemiologia , Glaucoma de Ângulo Fechado/epidemiologia , Glucocorticoides/uso terapêutico , Gonioscopia , Hanseníase/epidemiologia , Hanseníase/tratamento farmacológico , Manometria , Oftalmoscopia , Índia/epidemiologia , PrevalênciaRESUMO
A total of 116 patients in Nepal with advanced leprosy were examined in an ophthalmological survey. All patients were older than 20 years and none had suffered from leprosy for less than 10 years. Abnormal ocular findings occurred in 69.8% of all patients and 9.3% of the eyes were blind. The results are compared with those of other authors.