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Evolution of affordable quality cataract surgery in leprosy over two decades

Introduction: Cataract surgery in leprosy is a challenge due to stigma, complications and lack of accessibility. Aim of the study is to find most suitable approach for cataract surgery. Blindness in leprosy occurs mostly due to cataract [1]. Most commonly these are age related as stigma towards leprosy affected people is the toughest barrier for surgical uptake. Besides this, complicated cataract with posterior synechiae or keratopathy is not infrequent in leprosy affected people as they are prone to frequent uveitis [2,3]. Risk of developing complicated cataract has not been measured in leprosy but studies have shown cataract arises three times more frequently when associated with uveitis [4]. Reports from southeast region like India and Philippines has evidenced that Multibacillary leprosy patients on multidrug therapy (MDT) continue to show up signs of chronic uveitis even after “release from treatment (RFT)”. Nearly 1.5 million people all over the world are still on MDT for leprosy [5]. The trends show an overall gradual decline from 265,661 in 2006 to 210,758 in 2015. Marginal increases in new cases were observed in 2015 in Africa from 18,597 (in 2014) to 20,004 (in 2015) and in South East Asian Region from 154,834 (in 2014) to 156,118 (in 2015). SEAR accounted for 74% of the global new case load; this was followed by America region with 14% and Africa Region with 9%. West Pacific Region and Eastern Mediterranean Region contributed 2% and 1% of the global new case load, respectively. The trends in new case detection showed an overall slow decline in all WHO regions. According to the 2015 survey under the national leprosy eradication program (NLEP), Jharkhand contributed to roughly 4% of India's fresh leprosy case load during 2014-15. Jharkhand ranks seventh in the country. Leprosy prevalence rate in children is high in Jharkhand with 444 children in 2014-15. Design: Prospective case control study. Cases include cataract surgery in leprosy whereas non- leprosy people undergoing surgery at Camps are taken as controls during 1996 - 2014. Results: Group 1: Non IOL cases (1996 to 2000). Vision improved to 6/12 in 120/160 cases in short term. Gr2: 2005 - 2009: IOL Cases (phaco and SICS). 210/ 250 cases 210 had more than 6/12. Worse in "cases" with Phaco. Gr3: 2010 to 2014: SICS with IOL was done in 242 cases. Vision in 235 "cases" > 6/12. Results were similar in both PALs and non-leprosy controls. Conclusions: Long term follow-up reveals SICS with IOL is the best in leprosy. But quality treatment should include all-round care involving different stake holders as this is a mixed problem: "ophthalmo -socio-economic”. More than a lakh new cases/year is huge burden which can be tackled with locally available resources.

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EC Ophthalmology
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