Treatment of eye leprosy

In the treatment of leprosy damage to the organ of vision, the main thing is to conduct general specific therapy.

The total duration of treatment of patients with lepromatous and borderline type of leprosy is 5-10 years, with tuberculoid and undifferentiated - at least 3-5 years. In some cases, the treatment of patients with lepromatous leprosy continues throughout their life. Initially, the treatment is performed in the hospital of leprosarium. The disappearance of clinical signs of the activity of the leprosy process, multiple negative results of bacterioscopic and histological examinations of various parts of the skin and mucous membrane of the patient's nasal septum is transferred to outpatient treatment in the leprosarium or dermatovenerologic dispensary at the place of residence. Treatment is carried out according to the prescription of the leprologist. At the end of outpatient treatment, the patient remains under follow-up care throughout life. All patients prescribed for out-patient treatment receive specialized care (including ophthalmology) in the medical institutions of the general medical network.

At the heart of modern therapy of leprosy is complex and combined treatment, consisting in the simultaneous use of several antiepileptic drugs and the use of a variety of pathogenetic, desensitizing, symptomatic, restorative therapies, psychotherapy, the appointment of vitamins, physiotherapy and other treatments, as well as measures aimed at restructuring immunological reactivity of the body. Treatment is carried out taking into account individual tolerability and contraindications to prescribed medications.

For many decades, the main anti-leprosy drugs were chaulmugrovoe oil and its preparations - chaulmugrats, for example its ethyl ester mugrol, etc. The use of sulfonate drugs opened a new era in the treatment of leprosy. Currently, the most widely used are diphenylsulfone, solesulfone and acetadecone.

Diphenylsulfone (syn: DDS, Dapsone, Avlosulfon, etc.) is used daily inside (daily dose of 50-200 mg) or intramuscularly (its oil suspension) 1-2 times a week. Solesulfone (syn: Sulfetrone, Novotrone, etc.) is administered intramuscularly at 1, 2, 3, and then at 3.5 ml of 50% aqueous solution 2 times a week. Acedapsone (syn: DADDS, Diacetyldapsone, etc.) - a sulfon of prolonged action - is administered intramuscularly at 225 mg 1 raa in 72 days.

In order to prevent drug resistance and enhance the effectiveness of treatment, it is recommended to alternate the use of the listed sulfones and at the same time to prescribe one of the following drugs: rifampicin, luprene, protionamide or ethionamide.

Rifampicin (Sip: Rifadin, Benemycin, etc.) is a semisynthetic antibiotic, a derivative of rifamycin. Apply inside every day 300-600 mg. Mycobactericide Lamprene (syn: B 663, Clofazimine) is administered orally daily for 100 mg. Prothionamide (syn: Treventix, etc.) - a synthetic antituberculous drug; use inside by 0.25 g 1-3 times a day. Ethionamide (syn: Nizotin, Trecator, etc.) - a synthetic antituberculous drug; Assign the inside of 0.25 g 2-3 times a day.

Specific treatment is carried out by courses with a duration of one month with interruptions between them in 1-5 months. In the presence of clinical indications and with good tolerability of drugs, treatment is carried out continuously.

During the reactive phases, patients are given oral and intramuscular corticosteroids and symptomatic agents. In the treatment of leprosy patients, stimulant and restorative drugs (vitamins, gamma globulin, lipotropic substances, blood transfusions, etc.) are widely prescribed, physiotherapy procedures, therapeutic gymnastics, occupational therapy. The study of the effectiveness of the BCG vaccine, levamisole, leukocyte transfer factor, allogeneic leukocyte suspension, etc. Continues. According to the indications, the patients receive specialized surgical care.

In the case of specific inflammation of the anterior part of the eyeball, I. I. Garus (1961), simultaneously with systemic specific treatment, prescribed preparations of the sulfonic series locally: 5% aqueous solution of sulfetron 3 times a day for 1 month and administration of 15% 0.5-0.8 ml every other day (for a course of 20 injections). According to the indications, the courses of topical application of sulfetron were repeated.

In the treatment of leprosy, the organ of vision is also widely used pathogenetically-oriented means aimed at reducing inflammatory processes in the eye tissues and eliminating their consequences (opacity of the cornea, lens and vitreous humor), preventing secondary infection, development of dystrophic processes in the eye membranes and secondary glaucoma.

Of antibacterial agents, sulfonamide preparations and antibiotics (20% solution of sulfacyl sodium, 0.25% solution of levomycetin, 1% solution of penicillin or tetracycline, etc.) are usually locally prescribed. Expressed anti-inflammatory and desensitizing effect of corticosteroid hormones, which are used in the form of instillations and subconjunctival (0.5-2.5% suspension cortisone or hydrocortisone, 3% solution prednisolone, 0.1-0.4% solution dexamethasone).

When involved in the inflammatory process of the choroid of the eyeball, instillations of 1% solution of atropine sulfate, 0.25% solution of scopolamine hydrobromide are also prescribed. With increasing intraocular pressure, instillations of a 1% solution of pilocarpine, 1% solution of adrenaline hydrotartrate are shown inside diacarb 0,125-0,25 g 2-3 times a day, 50% glycerol solution at the rate of 1.5 g of preparation per 1 kg of body weight.

To resolve the opacities of the cornea and vitreous body, instillations of ethylmorphic hydrochloride solution are recommended in increasing concentrations (from 1 to 6-8%) and subconjunctival administration of oxygen 1-2 ml per course of 10-20 injections. For the same purpose, the subcutaneous or intramuscular biogenic stimulants (aloe liquid extract, FBS, vitreous) are prescribed 1 ml each, for a course of 30 injections.

In the case of a lagophthalmia, instillations of 0.01% citral solution, 0.02% riboflavin solution with glucose, vaseline oil or fish oil, introduction of 0.5% tiamido ointment into the conjunctival bag and 1% emulsion of shintomycin are shown. The general treatment is also conducted: inside nicotinic acid 100 mg twice a day after meals, vitamins Bi, Vb, B12; in addition, the prescriber of "physiotherapy procedures.

In some cases, resort to surgical treatment to eliminate lagophthalmia, dacryocystitis, corneal leukoma, complicated cataract and secondary glaucoma. Surgical treatment is carried out after at least 6-12 months after the cessation of general reactive phenomena and leprosy reactions of the organ of vision.

In conclusion, it must be emphasized that timely and systematically initiated leprosy treatment with mandatory use of sulfones prevents the progression of the disease, the transformation of relatively light clinical forms into heavier ones, involvement in the leprosy process of the organ of vision and contributes to more effective medical and social rehabilitation of patients.

Prevention of eye leprosy

Prevention of leprosy damage to the organ of vision is an integral part of the prevention of leprosy, which includes socioeconomic, medical, sanitary and hygiene and sanitary-educational measures.

The early detection and treatment of patients is of paramount importance in the prevention of leprosy, timely hospitalization of all patients with active manifestations of the disease in leprosarium, organization of dispensary care for patients, members of their families and persons who have been in contact with them for a long time.

In the endemic areas, the population is systematically and selectively surveyed. Family members and individuals who have been in contact with patients with lepromatous leprosy for a long time are given preventive treatment.

In the development of measures for the prevention of leprosy take into account scientific and practical achievements in both leprology and in a number of other sciences (microbiology, immunopathology, allergology), as well as in studying other chronic infections, primarily tuberculosis.

As a result of the introduction of scientific achievements into practice, during the last two to three decades, a significant reduction in leprosy disease and a change in its pathomorphosis have been observed, as well as a significant reduction in leprosy lesions in the organ of vision.

In our country there is a socio-economic basis for a successful fight against leprosy. This is facilitated by the constant growth of the material level, the general and sanitary culture of the population, the full coverage by dispensary care of all patients, their families and persons who have been in contact with them for a long time, as well as a number of government decrees aimed at social support for leprosy patients and their families.