97th DOG Annual Meeting 1999
OCULAR CHANGES IN CUTANEOUS AND MUCOCUTANEOUS LEISHMANIASIS: EXAMINATION OF 55 PATIENTS IN PARAGUAY
I. I. H. Wunderle3, H. Mino de Kaspar3, E. Cabrera1, A. Rojas de Arias2,
N. S. Insfran1, V. Klauß3
Background: Up to the present moment only case reports of ocular changes in cutaneous and mucocutaneous leishmaniasis (CL/MCL) have been published. Only little is known about possible complications of the retina.
Purpose: The purpose was to examine a more numerous group of patients (PG) in order to estimate if alterations of the anterior segment are of epidemiological relevance and if manifestations in the retina can be observed.
Method: Between october 1997 and march 1998 55 cases of leishmaniasis were examined ophthalmologically; 33 of them with active lesions. A control group (CG) consisting of 39 persons was examined as well. The diagnose or its exclusion were confirmed with different serological methods.
Results: The results of this field-study confirm that the CL/MCL may cause ocular alterations above all of the anterior segment. These inflammatory findings are more frequent in the PG with active lesions than in the PG with healed lesions, i.d. a) blepharitis 18,2%/9,1%, b) madarosis 9,1%/0, c) conjunctival injections 24,2%/9,1%, d) alterations of the corneal stroma 12,1%/0. Significant differences in the following alterations exist comparing the PG with active lesions with the CG: blepharitis, alterations of the corneal stroma (both p<0,05) and conjunctival injections (p<0,025). In the fundus of 15 patients (45,5%, seven had active lesions) retinal defects of the pigment epithelium were diagnosed. No other leishmaniasis-associated changes could be shown. No significant loss of vision was found.
Conclusion: In patients with CL/MCL, above all in patients with active lesions, ocular changes can be observed, specifically in the anterior segment. Blepharitis, conjunctival injections and alterations of the corneal stroma were found significantly more often. In the fundus no striking findings besides non-specific changes in the pigment epithelium could be found. They can be interpreted as post-infectious or immunological reactions in the scope of leishmaniasis. Thus the ocular findings in CL/MCL differ from those in visceral leishmaniasis (kala-azar), where anterior uveitis and retinal hemorrhages are observed.
1. Eye hospital of the National University of Asunción,
2. Research institute of the National University of Asunción (IICS),
3. Eye hospital of the University (LMU) of Munich, Mathildenstr.8, 80336 Munich