Treating lepra of the eye

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

The total duration of treatment for patients with lepromatous and borderline leprosy is 5-10 years, and for tuberculoid and undifferentiated leprosy it is at least 3-5 years. In some cases, treatment for patients with lepromatous leprosy continues throughout their lives. Initially, treatment is carried out in a leprosarium. After the clinical signs of leprosy activity disappear, and there are multiple negative results of bacterioscopic and histological examinations of various areas of the skin and the mucous membrane of the nasal septum, the patient is transferred to outpatient treatment in a leprosarium or a dermatovenerologic dispensary at the place of residence. Treatment is carried out according to the leprologist's prescription. Upon completion of outpatient treatment, the patient remains under dispensary observation throughout his or her life. All patients discharged for outpatient treatment receive specialized care (including ophthalmological care) in general medical institutions.

Modern leprosy therapy is based on complex and combined treatment, which consists of the simultaneous use of several anti-leprosy drugs and the use of various means of pathogenetic, desensitizing, symptomatic, general strengthening therapy, psychotherapy, the prescription of vitamins, physiotherapy and other types of treatment, as well as measures aimed at restructuring the body's immunological reactivity. Treatment is carried out taking into account individual tolerance and contraindications to the prescribed medications.

For many decades, the main anti-leprosy drugs were chaulmoogra oil and its preparations - chaulmoograts, for example, its ethyl ester mugrol, etc. The use of sulfone series drugs opened a new era in the treatment of leprosy. Currently, the most widely used are diphenylsulfone, solusulfone and acedapsone.

Diaphenylsulfone (syn.: DDS, Dapsone, Avlosulfon, etc.) is used daily orally (daily dose 50-200 mg) or intramuscularly (its oil suspension) 1-2 times a week. Solusulfone (syn.: Sulfetrone, Novotrone, etc.) is administered intramuscularly 1, 2, 3, and then 3.5 ml of a 50% aqueous solution 2 times a week. Acedapsone (syn.: DADDS, Diacetyldapsone, etc.) is a prolonged-release sulfone - it is administered intramuscularly 225 mg 1 time per 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 simultaneously prescribe one of the following drugs: rifampicin, lamprene, prothionamide or ethionamide.

Rifampicin (synonyms: Rifadin, Benemycin, etc.) is a semi-synthetic antibiotic, a derivative of rifamycin. It is administered orally daily at 300-600 mg. The mycobactericidal drug Lamprene (synonyms: B 663, Clofazimine) is prescribed orally daily at 100 mg. Prothionamide (synonyms: Treventix, etc.) is a synthetic anti-tuberculosis drug; it is administered orally at 0.25 g 1-3 times a day. Ethionamide (synonyms: Nizotin, Trecator, etc.) is a synthetic anti-tuberculosis drug; it is prescribed orally at 0.25 g 2-3 times a day.

Specific treatment is carried out in courses lasting one month with breaks between them of 1-1.5 months. If there are clinical indications and the drugs are well tolerated, treatment is carried out continuously.

During reactive phases, patients are prescribed corticosteroids and symptomatic agents orally and intramuscularly. In the treatment of patients with leprosy, stimulants and tonics (vitamins, gamma globulin, lipotropic substances, blood transfusions, etc.), physiotherapy procedures, therapeutic gymnastics, and occupational therapy are widely prescribed. The effectiveness of the BCG vaccine, levamisole, leukocyte "transfer factor", allogeneic leukocyte suspension, etc. is being studied. According to indications, patients receive specialized surgical care.

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

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

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

If the vascular membrane of the eyeball is involved in the inflammatory process, instillations of 1% atropine sulfate solution, 0.25% scopolamine hydrobromide solution are also prescribed. If intraocular pressure increases, instillations of 1% pilocarpine solution, 1% adrenaline hydrotartrate solution, diacarb 0.125-0.25 g orally 2-3 times a day, 50% glycerol solution at a rate of 1.5 g of the drug per 1 kg of body weight are indicated.

To resolve corneal and vitreous opacities, instillations of ethylmorphine hydrochloride solution in increasing concentrations (from 1 to 6-8%) and subconjunctival administration of oxygen at 1-2 ml per course of 10-20 injections are recommended. For the same purpose, biogenic stimulants (liquid aloe extract, FnBS, vitreous body) are prescribed subcutaneously or intramuscularly at 1 ml per course of 30 injections.

In case of lagophthalmos, instillations of 0.01% citral solution, 0.02% riboflavin solution with glucose, vaseline oil or fish oil, introduction of 0.5% thiamipa ointment and 1% synthomycin emulsion into the conjuictive sac are indicated. General treatment is also carried out: nicotinic acid orally 100 mg 2 times a day after meals, vitamins B12, B6, B12; in addition, physiotherapeutic procedures are prescribed.

In some cases, surgical treatment is used to eliminate lagophthalmos, dacryocystitis, corneal leukoma, complicated cataracts and secondary glaucoma. Surgical treatment is performed at least 6-12 months after the cessation of general reactive phenomena and leprosy reactions of the visual organ.

In conclusion, it should be emphasized that timely initiation and systematic treatment of leprosy with the mandatory use of sulfones prevents the progression of the disease, the transformation of relatively mild clinical forms into more severe ones, the involvement of the visual organ in the leprosy process and contributes to more effective medical and social rehabilitation of patients.

Prevention of leprosy of the eye

Prevention of leprosy-related damage to the organ of vision is an integral part of leprosy prevention, which includes socio-economic, medical, sanitary-hygienic and sanitary-educational measures.

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

In endemic leprosy zones, the population is systematically and selectively examined. Family members and persons who have had long-term contact with patients with the lepromatous type of leprosy are given preventive treatment.

When developing measures to prevent leprosy, scientific and practical achievements in leprology and in a number of other sciences (microbiology, immunopathology, allergology) are taken into account, as well as in the study of other chronic infections, primarily tuberculosis.

As a result of the introduction of scientific achievements into practice over the past two to three decades, there has been a significant reduction in the incidence of leprosy and a change in its pathomorphosis, as well as a significant reduction in leprosy lesions of the organ of vision.

Our country has a socio-economic basis for successfully combating leprosy. This is facilitated by the constant growth of the material level, general and sanitary culture of the population, full coverage of dispensary services for all patients, members of their families and persons who have had long-term contact with them, as well as a number of government regulations aimed at social security for patients with leprosy and their families.