title: Iris atrophy in patients with newly diagnosed multibacillary leprosy: at diagnosis, during and after completion of multidrug treatment.
abstract: OBJECTIVE
  To describe the prevalence and incidence of iris atrophy in patients with multibacillary (MB) leprosy.
  
  
  METHODS
  Prospective longitudinal cohort study. 301 newly diagnosed patients with MB leprosy were followed up during the 2 years of treatment with multidrug therapy (MDT) and for a further 5 years with biannual ocular examinations. Incidence of iris atrophy was calculated as the number of patients with iris atrophy per person-year (PY) of follow-up among those who did not have iris atrophy at baseline. Stepwise multiple regression confirmed the presence of specific associations of demographic and clinical characteristics (p<0.05) with iris atrophy, detected by univariate analysis.
  
  
  RESULTS
  Iris atrophy was present in 6 (2%) patients at enrolment. During MDT, with 445 PYs of follow-up, 9 patients developed iris atrophy (IR 0.02, 95% CI 0.01 to 0.04) that was associated with cataract (HR 15.13, 95% CI 3.71 to 61.79, p<0.001) and corneal opacities (HR 6.83, 95% CI 1.62 to 28.8, p = 0.009). After MDT, with 2005 PYs of follow-up, 60 patients developed iris atrophy (IR 0.03, 95% CI 0.023 to 0.039) that was associated with age (per decade; HR 1.40, 95% CI 1.10 to 1.78, p = 0.006), skin smear positivity (HR 3.50, 95% CI 1.33 to 9.24, p = 0.011), cataract (HR 3.66, 95% CI 1.85 to 7.25, p<0.001), keratic precipitates (HR 2.76, 95% CI 1.02 to 7.47, p = 0.046) and corneal opacity (HR 3.95, 95% CI 1.86 to 8.38, p<0.001).
  
  
  CONCLUSIONS
  Iris atrophy continues to develop in 3% of patients with MB leprosy every year after they complete a 2-year course of MDT, and is associated with age, increasing loads of mycobacteria, subclinical inflammation, cataract and corneal opacity.
authors.affiliation: Division of Ocular Immunology, Department of Ophthalmology, The Johns Hopkins University School of Medicine, 1620 McElderry Street, Reed Hall, 4th Floor, Baltimore, MD 21205, USA. edaniel4@jhmi.edu
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Daniel
authors.forename: P S S
authors.initials: PS
authors.lastname: Sundar Rao
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ffytche
authors.forename: Shirley
authors.initials: S
authors.lastname: Chacko
authors.forename: Hannah Ranjee
authors.initials: HR
authors.lastname: Prasanth
authors.forename: Paul
authors.initials: P
authors.lastname: Courtright
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D007194:India; D007223:Infant; D007499:Iris Diseases / Q000209:etiology* / Q000382:microbiology; D007917:Leprostatic Agents / Q000627:therapeutic use*; D007918:Leprosy / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D007917:Leprostatic Agents