Is leprosy blindness avoidable? The effect of disease type, duration, and treatment on eye damage from leprosy in Uganda.
Is leprosy blindness avoidable? The effect of disease type, duration, and treatment on eye damage from leprosy in Uganda.
复制标题
麻风病失明可以避免吗？
DOI：
10.1136/bjo.79.3.250
复制
发表时间：
1995
影响因子：
4.1
通讯作者：
P. Saunderson
中科院分区：
文献类型：
--
作者：
K. Waddell;P. Saunderson
本研究旨在测量麻风患者眼部受累的患病率、范围和严重程度;将其与疾病类型、持续时间和治疗联系起来，以确定风险因素;并为项目管理人员和现场工作人员提供预防失明的实用指南。方法：在乌干达卡塞塞地区随访长达20年的基于人群的患者样本中评估视力结果，并与疾病特征和治疗相关。自1973年以来，在2715名登记的患者中，共有678名患者对邀请做出了回应。结果：4.4%的人视力低下，1.3%的人失明，其中1.5%和0.6%的人是麻风病造成的。约12.4%的患者有虹膜炎，其中33%的患者单眼或双眼视力丧失，3.7%的患者有兔眼，11.7%的患者有透镜混浊。对于多杆菌（PB）病例，调整后的比值比为：虹膜炎4.6（95% CI 2.6-8.2），兔眼1.4（0.6-3.2），透镜混浊1.7（1.0-3.0）。16.8%的患者存在潜在视力威胁（PST）病变（95% CI 14.0-19.6）。结论：与许多调查相比，本研究中的眼部受累程度较低。视力丧失并不常见，更常见的是由其他疾病引起的;在目前的多药治疗（MDT）时代，它不太可能由麻风病引起。随着年龄的增长，这种情况更为常见。PST病变，特别是虹膜炎，可能发生在PB和MB的情况下，即使麻风病的早期诊断和MDT立即开始，他们也可能发生在MDT完成后。但是，如果及时治疗，眼部并发症不一定会导致失明，失明是可以避免的。因此，培训一线工作人员至关重要。
AIMS--The study was designed to measure the prevalence, range, and severity of eye involvement in leprosy patients; to relate this to disease type, duration, and treatment to identify risk factors; and to provide practical guidelines for programme managers and field staff on the prevention of blindness. METHODS--The visual outcome was assessed in a population based sample of patients in Kasese District, Uganda followed for up to two decades, and related to disease features and treatment. A total of 678 patients responded to an invitation out of 2715 registered since 1973. RESULTS--Low vision was present in 4.4% of people and blindness in 1.3%, with 1.5% and 0.6% respectively being due to leprosy. Some 12.4% of patients had iritis, of whom 33% had visual loss in one or both eyes, 3.7% of patients had lagophthalmos, and 11.7% had lens opacity. For multi-bacillary (PB) cases, the adjusted odds ratios were: for iritis 4.6 (95% CI 2.6-8.2), for lagophthalmos 1.4 (0.6-3.2), and for lens opacity 1.7 (1.0-3.0). Potentially sight threatening (PST) lesions were present in 16.8% of patients (95% CI 14.0-19.6). CONCLUSION--Levels of eye involvement in this study are low compared with many surveys. Visual loss is uncommon and is more often caused by other diseases; in the present era of multidrug therapy (MDT) it is very unlikely to be caused by leprosy. It is more common with advancing age. PST lesions, especially iritis, may occur in both PB and MB cases, even if the diagnosis of leprosy is made early and MDT started immediately; they may occur also after completion of MDT. But eye complications need not proceed to loss of sight if treated promptly, and blindness can be avoided. Training of front line staff is therefore crucial.