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Kanyi S, Hydara A, Sillah A, Mpyet C, Harte A, Bakhtiari A, Willis R, Jimenez C, Aboe A, Bailey R, Harding-Esch EM, Solomon AW, Joof BM. The Gambia Trachomatous Trichiasis Surveys: Results from Five Evaluation Units Confirm Attainment of Trachoma Elimination Thresholds. Ophthalmic Epidemiol 2023:1-9. [PMID: 37401113 DOI: 10.1080/09286586.2023.2213320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/12/2023] [Accepted: 05/09/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Trichiasis is present when in-turned eyelashes touch the eyeball. It may result in permanent vision loss. Trachomatous trichiasis (TT) is caused by multiple rounds of inflammation associated with conjunctival Chlamydia trachomatis infection. Surveys have been designed to estimate the prevalence of TT in evaluation units (EUs) of trachoma-endemic countries in order to help develop appropriate programme-level plans. In this study, TT-only surveys were conducted in five EUs of The Gambia to determine whether further intensive programmatic action was required. METHODS Two-stage cluster sampling was used to select 27 villages per EU and ~25 households per village. Graders assessed the TT status of individuals aged ≥15 years in each selected household, including the presence or absence of conjunctival scarring in those with TT. RESULTS From February to March 2019, 11595 people aged ≥15 years were examined. A total of 34 cases of TT were identified. All five EUs had an age- and gender-adjusted prevalence of TT unknown to the health system <0.2%. Three of five EUs had a prevalence of 0.0%. CONCLUSION Using these and other previously collected data, in 2021, The Gambia was validated as having achieved national elimination of trachoma as a public health problem. Trachoma is still present in the population, but as its prevalence is low, it is unlikely that today's youth will experience the exposure to C. trachomatis required to precipitate TT. The Gambia demonstrates that with political will and consistent application of human and financial resources, trachoma can be eliminated as a public health problem.
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Affiliation(s)
- Sarjo Kanyi
- The National Eye Health Programme, Ministry of Health, Banjul, Kanifing, The Gambia
| | - Abba Hydara
- Sheikh Zayed Regional Eye Care Center, Banjul, Kanifing, The Gambia
| | - Ansumana Sillah
- The National Eye Health Programme, Ministry of Health, Banjul, Kanifing, The Gambia
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos, Jos, Nigeria
- Sightsavers Nigeria Country Office, Kaduna, Nigeria
| | - Anna Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Rebecca Willis
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | | | - Agatha Aboe
- Department of Ophthalmology, University of Jos, Jos, Nigeria
| | - Robin Bailey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Emma M Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Bah MM, Sakho F, Goepogui A, Nieba LC, Cisse A, Courtright P, Harte AJ, Burgert-Brucker C, Jimenez C, Lama PL, Sagno M, Bakhtiari A, Boyd S, Solomon AW, Kelly M, James F, Tenkiano MS, Harding-Esch EM, Dicko BM. The Prevalence of Trachomatous Trichiasis in People Aged 15 Years and Over in Six Evaluation Units of Gaoual, Labé, Dalaba and Beyla Districts, Guinea. Ophthalmic Epidemiol 2023:1-8. [PMID: 37377215 PMCID: PMC10581669 DOI: 10.1080/09286586.2023.2192269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/04/2023] [Accepted: 03/14/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE Trachoma is a public health problem in 42 countries. Inflammation associated with repeated ocular infection with Chlamydia trachomatis can cause the eyelid to scar and turn inwards, resulting in the eyelashes rubbing against the eyeball, known as trachomatous trichiasis (TT). In Guinea, baseline surveys conducted in 2013 reported inflammatory trachoma prevalences below the World Health Organization (WHO) threshold for elimination, but TT prevalences above threshold. Given this epidemiological context and time since baseline survey, TT-only surveys were conducted in selected districts to determine current TT prevalence. The results of this study provide critical data for assessing Guinea's achievement of trachoma elimination targets. METHODS Four health districts, consisting of six evaluation units (EU), were surveyed. In each EU, field teams visited 29 clusters with a minimum 30 households included in each. Participants aged≥15 years were examined by certified graders trained to identify TT and determine whether management had been offered. RESULTS A total of 22,476 people were examined, with 48 TT cases across the six EUs identified. Five of six EUs had an age-and-gender adjusted TT-prevalence unknown to the health system less than 0.2%, whereas one EU, Beyla 2, had an adjusted TT prevalence of 0.24%. CONCLUSION These TT-only surveys, along with findings from other trachoma interventions, suggest that Guinea is close to achieving elimination of trachoma as a public health problem. This study demonstrates the value of undertaking TT-only surveys in settings where baseline surveys indicated active trachoma prevalences below WHO elimination threshold, but TT prevalences above it.
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Affiliation(s)
- Midiaou M. Bah
- Neglected Tropical Diseases, Sightsavers, Conakry, Guinea
| | - Fatoumata Sakho
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - André Goepogui
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Luc C. Nieba
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | | | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Anna J. Harte
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Clara Burgert-Brucker
- Neglected Tropical Diseases, RTI International, Washington, District of Columbia, USA
| | | | - Pierre L. Lama
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Michel Sagno
- Ministère de la Santé, National Programme for the Control of Neglected Tropical Diseases, Conakry, Guinea
| | - Ana Bakhtiari
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Sarah Boyd
- International Trachoma Initiative, Task Force for Global Health, Atlanta, Georgia, USA
| | - Anthony W. Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michaela Kelly
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | - Fiona James
- Neglected Tropical Diseases, Sightsavers, Haywards Heath, UK
| | | | - Emma M. Harding-Esch
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
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Mumford BP, Eisman S, Yip L. Acquired causes of eyebrow and eyelash loss: A review and approach to diagnosis and treatment. Australas J Dermatol 2023; 64:28-40. [PMID: 36320026 DOI: 10.1111/ajd.13947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 09/01/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
Eyebrows and eyelashes serve important anatomical and social functions, and hair loss at these sites can impact patients significantly. Acquired eyebrow and eyelash loss (madarosis) may be due to a variety of underlying local or systemic disease processes; in other cases it may be idiopathic. There is a dearth of literature relating to eyebrow and eyelash loss, and there is limited guidance to help clinicians treat these clinical presentations in comparison with scalp alopecia. Here, we discuss the acquired causes of eyebrow and eyelash alopecia, our clinical approach to diagnosis and review treatment options for clinicians.
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Affiliation(s)
| | | | - Leona Yip
- Skin Partners, Brisbane, Queensland, Australia
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Abstract
Trachoma is a neglected tropical disease caused by infection with conjunctival strains of Chlamydia trachomatis. It can result in blindness. Pathophysiologically, trachoma is a disease complex composed of two linked chronic processes: a recurrent, generally subclinical infectious-inflammatory disease that mostly affects children, and a non-communicable, cicatricial and, owing to trichiasis, eventually blinding disease that supervenes in some individuals later in life. At least 150 infection episodes over an individual's lifetime are needed to precipitate trichiasis; thus, opportunity exists for a just global health system to intervene to prevent trachomatous blindness. Trachoma is found at highest prevalence in the poorest communities of low-income countries, particularly in sub-Saharan Africa; in June 2021, 1.8 million people worldwide were going blind from the disease. Blindness attributable to trachoma can appear in communities many years after conjunctival C. trachomatis transmission has waned or ceased; therefore, the two linked disease processes require distinct clinical and public health responses. Surgery is offered to individuals with trichiasis and antibiotic mass drug administration and interventions to stimulate facial cleanliness and environmental improvement are designed to reduce infection prevalence and transmission. Together, these interventions comprise the SAFE strategy, which is achieving considerable success. Although much work remains, a continuing public health problem from trachoma in the year 2030 will be difficult for the world to excuse.
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Hydara A, Bastawrous A, Bell S, Boggs D, Bright T, Bobat H, Eaton J, Faal H, Jobe M, Kim MJ, Kirkpatrick B, McCormick I, Okoh JA, Olaniyan SI, Prentice AM, Ramke J, Taylor R, Burton M, Mactaggart I. The Gambia National Eye Health Survey 2019: survey protocol. Wellcome Open Res 2021; 6:10. [PMID: 34796273 PMCID: PMC8591516.2 DOI: 10.12688/wellcomeopenres.16531.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 01/12/2023] Open
Abstract
Two national surveys of vision impairment and blindness were undertaken in The Gambia in 1986 and 1996. These provided data for the inception of The Gambia's National Eye Health Programme (NEHP) within the Ministry of Health and Social Welfare. There have been important developments in the eye health services provided by the NEHP in the last 20 years. At the same time, the population has also undergone major demographic changes that may have led to substantial changes in the burden of eye disease. We conducted a National Eye Health Survey of vision impairment, blindness and its comorbidities in adults in The Gambia in 2019. We examined a nationally representative population-based sample of adults 35 years and above to permit direct comparison with the data available from the previous surveys. Alongside a comprehensive vision and eye examination, the survey provides nationally representative data on important comorbidities in this population: diabetes, hypertension, obesity, hearing impairment, disability and mental health. Secondly, it estimates access to assistive technologies and eye health services. Thirdly, it is powered to allow a five-year follow up cohort study to measure the incidence and progression of eye disease.
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Affiliation(s)
- Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dorothy Boggs
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
- CBM Global, Cambridge, UK
| | - Hannah Faal
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Modou Jobe
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - Min J. Kim
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - John Atta Okoh
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | | | - Andrew M. Prentice
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ruth Taylor
- East London NHS Foundation Trust, London, UK
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Hydara A, Bastawrous A, Bell S, Boggs D, Bright T, Bobat H, Eaton J, Faal H, Jobe M, Kim MJ, Kirkpatrick B, McCormick I, Okoh JA, Olaniyan SI, Prentice AM, Ramke J, Taylor R, Burton M, Mactaggart I. The Gambia National Eye Health Survey 2019: survey protocol. Wellcome Open Res 2021; 6:10. [PMID: 34796273 PMCID: PMC8591516 DOI: 10.12688/wellcomeopenres.16531.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/20/2022] Open
Abstract
Two national surveys of vision impairment and blindness were undertaken in The Gambia in 1986 and 1996. These provided data for the inception of The Gambia's National Eye Health Programme (NEHP) within the Ministry of Health and Social Welfare. There have been important developments in the eye health services provided by the NEHP in the last 20 years. At the same time, the population has also undergone major demographic changes that may have led to substantial changes in the burden of eye disease. We conducted a National Eye Health Survey of vision impairment, blindness and its comorbidities in adults in The Gambia in 2019. We examined a nationally representative population-based sample of adults 35 years and above to permit direct comparison with the data available from the previous surveys. Alongside a comprehensive vision and eye examination, the survey provides nationally representative data on important comorbidities in this population: diabetes, hypertension, obesity, hearing impairment, disability and mental health. Secondly, it estimates access to assistive technologies and eye health services. Thirdly, it is powered to allow a five-year follow up cohort study to measure the incidence and progression of eye disease.
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Affiliation(s)
- Abba Hydara
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Suzannah Bell
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Dorothy Boggs
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Tess Bright
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
- CBM Global, Cambridge, UK
| | - Hannah Faal
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Modou Jobe
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - Min J. Kim
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - John Atta Okoh
- Sheikh Zayed Regional Eye Care Centre, Kanifing, The Gambia
| | | | - Andrew M. Prentice
- Medical Research Unit The Gambia, London School of Hygiene & Tropical Medicine, Kanifing, The Gambia
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ruth Taylor
- East London NHS Foundation Trust, London, UK
| | - Matthew Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Effect of repeated epilation for minor trachomatous trichiasis on lash burden, phenotype and surgical management willingness: A cohort study. PLoS Negl Trop Dis 2020; 14:e0008882. [PMID: 33315876 PMCID: PMC7769600 DOI: 10.1371/journal.pntd.0008882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/28/2020] [Accepted: 10/12/2020] [Indexed: 11/19/2022] Open
Abstract
Background WHO endorsed the use of epilation as an alternative treatment to surgery for the management of both minor unoperated TT (UTT) and postoperative TT (PTT). However, some trachoma control programmes hesitated to implement epilation citing concerns that it would hamper TT surgical acceptance and result in larger numbers of and stiffer trichiatic eyelashes than the original TT lashes. We investigated the burden and phenotypes of post-epilation trichiatic eyelashes, and willingness to accept surgical management separately in unoperated and postoperative TT cases. Methodology/Principal findings We recruited cases with minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) UTT (170) and PTT (169) from community-based screenings in Amhara Region, Ethiopia. Participants eyes were examined and data on present and future willingness to accept surgical management collected at baseline and every month for 6-months. Eyelashes touching the eye were counted and their phenotypes documented. Participants were trained on how to epilate. Epilation was done by the participants at home and by the examiner during follow-ups when requested by the participant. Follow-up rates were ≥97%. There was evidence of a significant reduction in the burden of trichiatic eyelashes in unoperated (mean difference = -0.90 [-1.11– -0.69]; RR = 0.50 [95% CI, 0.40–0.62]; p<0.0001), and postoperative (mean difference = -1.16 [-1.36– -0.95]; RR = 0.38 [95% CI, 0.31–0.48]; p<0.0001) cases 6-month after frequent epilation. Post-epilation trichiatic eyelashes at 6-months had higher odds of being thin (40.2% vs 55.8%, OR = 1.88 [95% CI, 1.21–2.93]; p = 0.0048), weak (39.8% vs 70.8%, OR = 3.68 [95%CI,2.30–5.88]; p<0.0001), and half-length (30.9% vs 43.3%, OR = 1.71 [1.09–2.68]; p = 0.020) than the pre-epilation trichiatic eyelashes in unoperated cases. There was a significant increase in the proportion of weak trichiatic eyelashes (OR = 1.99 [95% CI, 1.03–3.83; p = 0.039) in postoperative cases. In all 6 follow-up time points, 120/164 (73.2%) of unoperated and 134/163 (82.2%) of postoperative cases indicated that they would accept surgery if their trichiasis progressed. Conclusions/Significance In this study setting, frequent epilation neither hampers surgical acceptance nor results in more damaging trichiatic eyelashes than the pre-epilation lashes; and can be used as an alternative to the programmatic management of minor unoperated and postoperative TT cases. Trachomatous Trichiasis (TT), the blinding stage of trachoma, ranges from few peripheral eyelashes touching the eye to all eyelashes scratching the cornea. TT is mainly treated with corrective eyelid surgery. However, not all TT cases require surgical correction, and some, particularly, those with few eyelashes decline surgery. Epilation, the repeated removal of eyelashes, is a very common clinical and traditional practice in many trachoma endemic settings. The World Health Organisation recommends that epilation can be offered as an alternative management strategy to surgery for patients with few eyelashes touching the eye or refusing surgery. However, some trachoma control programmes hesitated to implement epilation with the concern that it would hamper surgical acceptance and results in larger numbers of and stiffer eyelashes touching the eye than the original TT eyelashes. In this study, we explored if these concerns are true in epilating minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) unoperated (170) and postoperative TT (169) cases. We found, in the contrary to these concerns, the post-epilation eyelashes touching the eye were less damaging being fewer in number, thinner, weaker and shorter than the pre-epilation eyelashes. In addition, the majority of both unoperated and postoperative cases indicated that they are willing to accept surgery if their trichiasis progressed.
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Abdelaziz FM, Kamal MA, Said MM, Diab MM. Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial. Clin Ophthalmol 2020; 14:2043-2050. [PMID: 32801612 PMCID: PMC7383018 DOI: 10.2147/opth.s261783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/01/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose To compare the outcomes of anterior lamellar recession (ALR) versus posterior lamellar tarsal rotation (PLTR) procedure for the repair of lower eyelid trachomatous trichiasis (TT). Design Prospective randomized comparative trial. Methods Study Population and Interventions: Patients with lower eyelid TT were enrolled. Patients with a history of lower lid surgery, marked horizontal lid laxity, another evident cause for the trichiasis, and those under 18 years were excluded. Participants were randomized to either PLTR or ALR. The sequence was computer-generated by an independent statistician, and the allocation sequence was concealed in sealed opaque envelops. Patients were evaluated at 1 week and 1, 3, 6, and 12 months. Main Outcome Measures: postoperative trachomatous trichiasis (PTT) and cosmetic satisfaction. Results A total of 60 patients were randomly assigned with 30 patients in each group. Two (3.3%) participants in PLTR group did not follow up and were excluded from the analysis. At 1, 3, and 6 months, PTT was significantly more frequent in the PLTR group than the ALR group (14.3% vs 0%; p= 0.048, 25% vs 0%; p= 0.004, 35.7% vs 10%; p= 0.019, respectively). In the ALR group, 6 patients (20%) had PTT at their 12-month follow-up visit compared with 15 patients (53.6%) in the PLTR group (P = 0.008) with absolute risk reduction of 33.6% (95% (CI= 9% −58%)). Cosmetic dissatisfaction was significantly more frequent in the ALR group at the initial follow-up visits compared to the PLTR group. However, this difference was no longer significant at 6 and 12 months follow-up. Conclusion These data provide strong evidence that ALR is more effective in correction of lower eyelid trachomatous trichiasis with acceptable cosmesis compared with PLTR.
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Affiliation(s)
- Fatma M Abdelaziz
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mahmoud Ahmed Kamal
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mohamed M Said
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
| | - Mostafa M Diab
- Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt
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Avisar I, Nahum Y, Mimouni M, Kremer I, Malhotra R. Oculoplastic aspects of ocular surface disease and their management. Surv Ophthalmol 2019; 65:312-322. [PMID: 31837384 DOI: 10.1016/j.survophthal.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 10/25/2022]
Abstract
The normal structure and function of the eyelids, eyelashes, conjunctival fornices, and lacrimal system are essential for the health of the ocular surface, and abnormalities of these structures accompany many cases of ocular surface disease. We describe the role of oculoplastic intervention in the context of ocular surface disease, focusing on blink disorders, lagophthalmos, entropion, lid scarring and keratinization, trichiasis, and punctal and lacrimal sac disease.
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Affiliation(s)
- Inbal Avisar
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yoav Nahum
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Israel Kremer
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raman Malhotra
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
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Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis. PLoS Negl Trop Dis 2019; 13:e0007637. [PMID: 31589610 PMCID: PMC6797216 DOI: 10.1371/journal.pntd.0007637] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/17/2019] [Accepted: 07/17/2019] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE Trichiasis surgery programs globally have faced high rates of poor surgical outcomes. Identifying correctable risk factors for improving long-term outcomes is essential for countries targeting elimination of trachoma as a public health problem. OBJECTIVE To determine whether the location of trichiatic eyelashes prior to surgery influences development of post-operative trichiasis (PTT) within two years after surgery. DESIGN Secondary data analysis of four randomized clinical trials evaluating methods to improve trichiasis surgery outcomes. These include the Surgery for Trichiasis, Antibiotics for Recurrence (STAR) trial, Partnership for Rapid Elimination of Trachoma (PRET-Surgery), absorbable versus silk sutures trial, and epilation versus surgery for minor trichiasis trial. SETTING Primary trials were conducted in rural areas of Ethiopia and Tanzania. INTERVENTIONS OR EXPOSURES Trichiasis surgery performed with either the bilamellar tarsal rotation procedure or posterior lamellar rotation procedure. MAIN OUTCOMES Prevalence of PTT within two years after surgery, location of trichiatic eyelashes pre-operatively and post-operatively. RESULTS 6,747 eyelids that underwent first-time trichiasis surgery were included. PTT rates varied by study, ranging from 10-40%. PTT was less severe (based on number of trichiatic eyelashes) than initial trichiasis for 72% of those developing PTT, and only 2% of eyelids were worse at follow up than pre-operatively. Eyelids with central only-trichiasis pre-operatively had lower rates of PTT than eyelids with peripheral only trichiasis in each of the three trials that included severe TT cases. 10% of eyelids with peripheral trichiasis pre-operatively that develop PTT have central TT post-operatively. CONCLUSIONS AND RELEVANCE Pre-operative central trichiasis is less likely than peripheral trichiasis to be associated with subsequent PTT. Regardless of type of surgery, surgeon skill levels, or pre-operative trichiasis severity, the presence of peripheral trichiasis pre-operatively is associated with higher rates of PTT. Making an incision that extends the length of the eyelid and adequately rotating the nasal and temporal aspects of the eyelid when suturing may help to minimize the chance of developing peripheral PTT. TRIAL REGISTRATION ClinicalTrials.gov PRET: NCT00886015; Suture: NCT005228560; Epilation: NCT00522912.
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Talero SL, Muñoz B, West SK. Potential Effect of Epilation on the Outcome of Surgery for Trachomatous Trichiasis. Transl Vis Sci Technol 2019; 8:30. [PMID: 31489257 PMCID: PMC6707224 DOI: 10.1167/tvst.8.4.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 04/29/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate the association of epilation before surgery on the surgical outcome in trachomatous trichiasis (TT) patients. Methods As a secondary data analysis, 1452 patients enrolled in the STAR trial were categorized according to preoperative epilation status. The main outcome was recurrent trichiasis after surgery. We used multivariable analysis, time-to-event analysis, and Cox proportional hazards model. Results Those who epilated prior to surgery tended to be older and female, with worse entropion at baseline. The proportion with postoperative trichiasis was 7.7%, 8.8% in those who epilated versus 5.3% in those who did not (P = 0.03). Adjusting for age and sex, the risk of postoperative TT with epilation was 1.71 (P value = 0.02). Although entropion may be in the biological pathway from epilation to postoperative TT, we adjusted for entropion, and the risk of postoperative TT with epilation was 1.41 (P = 0.14). Conclusions The study suggests that preoperative epilation may increase the risk of postoperative trichiasis. Further research is needed to confirm the finding. Translational Relevance Patients with TT often self-treat, epilating their inturned eyelashes. The World Health Organization recommends surgery to treat TT, but when patients refuse the procedure or mild trichiasis is present, epilation is often recommended. There is some evidence that repetitive or improper epilation can be harmful to the lid and hair follicles. If there is damage to the lid margin, any subsequent surgery could have deleterious outcomes.
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Affiliation(s)
| | - Beatriz Muñoz
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
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Flueckiger RM, Giorgi E, Cano J, Abdala M, Amiel ON, Baayenda G, Bakhtiari A, Batcho W, Bennawi KH, Dejene M, Elshafie BE, Elvis AA, François M, Goepogui A, Kalua K, Kebede B, Kiflu G, Masika MP, Massangaie M, Mpyet C, Ndjemba J, Ngondi JM, Olobio N, Turyaguma P, Willis R, Yeo S, Solomon AW, Pullan RL. Understanding the spatial distribution of trichiasis and its association with trachomatous inflammation-follicular. BMC Infect Dis 2019; 19:364. [PMID: 31039737 PMCID: PMC6492377 DOI: 10.1186/s12879-019-3935-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 03/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst previous work has identified clustering of the active trachoma sign "trachomatous inflammation-follicular" (TF), there is limited understanding of the spatial structure of trachomatous trichiasis (TT), the rarer, end-stage, blinding form of disease. Here we use community-level TF prevalence, information on access to water and sanitation, and large-scale environmental and socio-economic indicators to model the spatial variation in community-level TT prevalence in Benin, Cote d'Ivoire, DRC, Guinea, Ethiopia, Malawi, Mozambique, Nigeria, Sudan and Uganda. METHODS We fit binomial mixed models, with community-level random effects, separately for each country. In countries where spatial correlation was detected through a semi-variogram diagnostic check we then fitted a geostatistical model to the TT prevalence data including TF prevalence as an explanatory variable. RESULTS The estimated regression relationship between community-level TF and TT was significant in eight countries. We estimate that a 10% increase in community-level TF prevalence leads to an increase in the odds for TT ranging from 20 to 86% when accounting for additional covariates. CONCLUSION We find evidence of an association between TF and TT in some parts of Africa. However, our results also suggest the presence of additional, country-specific, spatial risk factors which modulate the variation in TT risk.
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Affiliation(s)
| | - Emanuele Giorgi
- Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
| | - Jorge Cano
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mariamo Abdala
- Ophthalmology Department, Ministry of Health, Maputo, Mozambique
| | | | | | | | - Wilfrid Batcho
- Programme National de Lutte contre les Maladies Transmissibles, Ministère de la Santé, Cotonou, Benin
| | | | - Michael Dejene
- Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
| | | | - Aba Ange Elvis
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
| | - Missamou François
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | - André Goepogui
- Programmes National de Lutte contre l'Onchocercoses et les autres Maladies Tropicales Négligées, Ministère de la Sante, Conakry, Guinea
| | - Khumbo Kalua
- Blantyre Institute for Community Outreach, Blantyre, Malawi
| | | | - Genet Kiflu
- Federal Ministry of Health, Addis Ababa, Ethiopia
| | | | | | - Caleb Mpyet
- Sightsavers Nigeria, Kaduna, Nigeria.,Department of Ophthalmology, Jos University, Jos, Nigeria
| | - Jean Ndjemba
- Direction de Lutte contre la Maladie, Kinshasa, Ministere de la Santé Publique, Kinshasa, Democratic Republic of Congo
| | | | - Nicholas Olobio
- Nigeria Trachoma Elimination Program, Federal Ministry of Health, Abuja, Nigeria
| | | | | | - Souleymane Yeo
- Programme National de la Santé Oculaire et de la lutte contre l'Onchocercose, Abidjan, Côte d'Ivoire
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13
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Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Gashaw B, Roberts CH, Kello AB, Mabey DCW, Rajak SN, Callahan EK, Macleod D, Weiss HA, Burton MJ. Oral doxycycline for the prevention of postoperative trachomatous trichiasis in Ethiopia: a randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2018; 6:e579-e592. [PMID: 29653629 PMCID: PMC5912946 DOI: 10.1016/s2214-109x(18)30111-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/11/2018] [Accepted: 02/22/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Trachomatous trichiasis is treated surgically to prevent sight loss. Unfavourable surgical outcomes remain a major challenge. We investigated the hypothesis that doxycycline might reduce the risk of postoperative trichiasis following surgery in patients with trachomatous trichiasis through anti-matrix metalloproteinase and anti-inflammatory activity. METHODS In this randomised, double-blind, placebo-controlled trial, adults (aged >18 years) with upper lid trachomatous trichiasis in association with tarsal conjunctive scarring were recruited through community-based screening and surgical outreach campaigns in Ethiopia. Individuals who had previously had eyelid surgery were excluded. Participants were randomly assigned (1:1), with random block sizes of four or six, to receive oral doxycycline (100 mg once a day) or placebo for 28 days immediately after trichiasis surgery. Randomisation was stratified by surgeon. Patients, investigators, surgeons, and all other study team members were masked to study group allocation and treatment. Participants were examined at 10 days, and 1, 6, and 12 months after surgery. The primary outcome was the cumulative proportion of individuals who developed postoperative trichiasis by 12 months. Primary analyses were done in all participants who attended at least one of the four follow-up assessments. Safety analyses were done in all participants who attended either the 10 day or 1 month follow-up assessments. This trial is registered with the Pan African Clinical Trials Registry, number PACTR201512001370307. FINDINGS Between Dec 21, 2015, and April 6, 2016, 1000 patients with trichiasis were enrolled and randomly assigned to treatment (499 patients to doxycycline, 501 patients to placebo). All but one participant attended at least one follow-up assessment. Thus, 999 participants were assessed for the primary outcome: 498 in the doxycycline group and 501 in the placebo group. By month 12, 58 (12%) of 498 patients in the doxycycline group and 62 (12%) of 501 patients in the placebo group had developed postoperative trichiasis (adjusted odds ratio 0·91, 95% CI 0·61 to 1·34, p=0·63), with a risk difference of -0·5% (-4·5% to 3·5%). Significantly more patients in the doxycycline group had an adverse event than in the placebo group (18 [4%] of 498 vs six [1%] of 501; odds ratio 3·09, 95% CI 1·21-7·84; p=0·02). The most frequent adverse events in the doxycycline group were gastritis symptoms (n=9), constipation (n=4), and diarrhoea (n=4). INTERPRETATION Doxycycline did not reduce the risk of postoperative trichiasis and is therefore not indicated for the improvement of outcomes following trachomatous trichiasis surgery. Surgical programmes should continue to make efforts to strengthen surgical training and supervision to improve outcomes. FUNDING The Wellcome Trust.
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Affiliation(s)
- Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | | | | | | | | | | | - Chrissy H Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David C W Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Saul N Rajak
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - David Macleod
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
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14
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Macleod C, Yalen C, Butcher R, Mudaliar U, Natutusau K, Rainima-Qaniuci M, Haffenden C, Watson C, Cocks N, Cikamatana L, Roberts CH, Marks M, Rafai E, Mabey DCW, Kama M, Solomon AW. Eyelash Epilation in the Absence of Trichiasis: Results of a Population-Based Prevalence Survey in the Western Division of Fiji. PLoS Negl Trop Dis 2017; 11:e0005277. [PMID: 28114364 PMCID: PMC5256864 DOI: 10.1371/journal.pntd.0005277] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The WHO definition of trachomatous trichiasis (TT) is "at least one eyelash touching the globe, or evidence of recent epilation of in-turned eyelashes", reflecting the fact that epilation is used as a self-management tool for TT. In Fiji's Western Division, a high TT prevalence (8.7% in those aged ≥15 years) was reported in a 2012 survey, yet a 2013 survey found no TT and Fijian ophthalmologists rarely see TT cases. Local anecdote suggests that eyelash epilation is a common behaviour, even in the absence of trichiasis. Epilators may have been identified as TT cases in previous surveys. METHODS We used a preliminary focus group to design an interview questionnaire, and subsequently conducted a population-based prevalence survey to estimate the prevalence of epilation in the absence of trichiasis, and factors associated with this behaviour, in the Western Division of Fiji. RESULTS We sampled 695 individuals aged ≥15 years from a total of 457 households in 23 villages. 125 participants (18%) reported epilating their eyelashes at least once within the past year. Photographs were obtained of the eyes of 121/125 (97%) individuals who epilated, and subsequent analysis by an experienced trachoma grader found no cases of trachomatous conjunctival scarring or trichiasis. The age- and sex- adjusted prevalence of epilation in those aged ≥15 years was 8.6% (95% CI 5.7-11.3%). iTaukei ethnicity, female gender, and a higher frequency of drinking kava root were independently associated with epilation. CONCLUSION Epilation occurs in this population in the absence of trichiasis, with sufficient frequency to have markedly inflated previous estimates of local TT prevalence. Individuals with epilated eyelashes should be confirmed as having epilated in-turned eyelashes in an eye with scarring of the conjunctiva before being counted as cases of TT.
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Affiliation(s)
- Colin Macleod
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Chelsea Yalen
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Robert Butcher
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Umesh Mudaliar
- Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji
| | | | | | - Chris Haffenden
- Department of the History of Science and Ideas, Uppsala University, Uppsala, Sweden
| | - Conall Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Naomi Cocks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Luisa Cikamatana
- Ophthalmology Department, Lautoka Hospital, Lautoka, Fiji
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - Chrissy H. Roberts
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Michael Marks
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Eric Rafai
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - David C. W. Mabey
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mike Kama
- Department of Communicable Diseases, Ministry of Health, Suva, Fiji
| | - Anthony W. Solomon
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
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15
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Habtamu E, Rajak SN, Tadesse Z, Wondie T, Zerihun M, Guadie B, Gebre T, Kello AB, Callahan K, Mabey DCW, Khaw PT, Gilbert CE, Weiss HA, Emerson PM, Burton MJ. Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial. PLoS Negl Trop Dis 2015; 9:e0003558. [PMID: 25768796 PMCID: PMC4358978 DOI: 10.1371/journal.pntd.0003558] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
Abstract
Background Trachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity. Methodology/ Principal Findings 1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating (“epilation-only”). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years. Conclusions/ Significance Most minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment. Trachoma causes visual impairment through the effect of in-turned eyelashes (trichiasis) on the surface of the eye. Epilation is a common traditional practice of intermittent plucking of lashes touching the eye, however, its long-term effectiveness in preventing visual impairment is unknown. We conducted a randomized controlled trial of epilation versus eyelid surgery (the main treatment option) in 1300 people with mild trichiasis in Ethiopia. We defined mild trichiasis as fewer than six lashes touching the eye. We have previously reported results to two years and have now re-assessed these individuals at four years. Overall, we found no difference between the epilation and surgery groups in terms of change in vision and corneal opacity between baseline and four years. Most mild trichiasis participants randomised to the epilation arm continued epilating and controlled their trichiasis. This suggests that good quality epilation is a reasonable second-line alternative to surgery for mild trichiasis for individuals who either decline surgery or do not have immediate access to surgical treatment.
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Affiliation(s)
- Esmael Habtamu
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Carter Center, Addis Ababa, Ethiopia
| | - Saul N. Rajak
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Teshome Gebre
- International Trachoma Initiative, Addis Ababa, Ethiopia
| | | | - Kelly Callahan
- The Carter Center, Atlanta, Georgia, United States of America
| | - David C. W. Mabey
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peng T. Khaw
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - Clare E. Gilbert
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen A. Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul M. Emerson
- International Trachoma Initiative, Atlanta, Georgia, United States of America
| | - Matthew J. Burton
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
- * E-mail:
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16
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Abstract
Trachoma is the most common infectious cause of blindness. Repeated episodes of infection with Chlamydia trachomatis in childhood lead to severe conjunctival inflammation, scarring, and potentially blinding inturned eyelashes (trichiasis or entropion) in later life. Trachoma occurs in resource-poor areas with inadequate hygiene, where children with unclean faces share infected ocular secretions. Much has been learnt about the epidemiology and pathophysiology of trachoma. Integrated control programmes are implementing the SAFE Strategy: surgery for trichiasis, mass distribution of antibiotics, promotion of facial cleanliness, and environmental improvement. This strategy has successfully eliminated trachoma in several countries and global efforts are underway to eliminate blinding trachoma worldwide by 2020.
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Affiliation(s)
- Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.
| | - Matthew J Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Danny Haddad
- Global Vision Initiative, Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheila West
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Heathcote Wright
- Centre for Eye Research Australia, University of Melbourne, East Melbourne, VIC, Australia
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17
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Goyal T, Varshney A, Bakshi SK. Ectopia cilia with pedigree analysis: Second case report in the world. INDIAN JOURNAL OF HUMAN GENETICS 2014; 20:185-6. [PMID: 25400348 PMCID: PMC4228571 DOI: 10.4103/0971-6866.142897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a case of ectopia cilia in a 28-year-old male patient. Ectopia cilia was were seen in the outer third of left upper eyelid. The patient's maternal grandfather also had ectopia cilia of the left upper eyelid as reported by the patient's mother. Ectopia cilia is a rare condition seen in humans. Only 12 cases of ectopic cilia in humans have been reported so far in the world. The present case of ectopia cilia is the second case report in the world with pedigree analysis.
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Affiliation(s)
- Tarang Goyal
- Department of Dermatology, Venereology and Leprosy, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India
| | - Anupam Varshney
- Department of Pathology, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India
| | - S K Bakshi
- Department of Medicine, Muzaffarnagar Medical College and Hospital, Muzaffarnagar, Uttar Pradesh, India
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18
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Honavar SG, Manjandavida FP. Recent Advances in Ophthalmic Plastic Surgery: Part 1-Eyelid. Asia Pac J Ophthalmol (Phila) 2013; 2:328-40. [PMID: 26107037 DOI: 10.1097/apo.0000000000000003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to provide an update of the current literature in ophthalmic and facial plastic surgery, specifically related to disorders of the eyelid. DESIGN This was a review of published literature from January 2012 to June 2013 METHODS: The authors conducted a PubMed literature search of English-language articles published between January 2012 and June 2013 using the following search terms: eyelid, congenital, acquired, infection, inflammation, trauma, tumor, ptosis, entropion, ectropion, lagophthalmos, botulinum toxin, fillers, blepharoplasty, and miscellaneous topics related to the disorders of the eyelid. The authors included original articles, review articles, and case reports with relevant new information that is of potential clinical use to a comprehensive ophthalmologist as well as to the subspecialist. RESULTS Current literature on the disorders of the eyelid is replete with useful clinical information of relevance to a practicing ophthalmologist. Major advances have been reported in understanding of the surgical anatomy and its applications, ptosis, entropion, ectropion, lagophthalmos, infection, inflammation, trauma, and tumors. CONCLUSIONS There seems to be tremendous excitement in revisiting the anatomy and pathology and modifying the management protocols and surgical procedures to achieve optimal results, as the subspecialty continues to advance at a brisk pace.
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Affiliation(s)
- Santosh G Honavar
- From the *Department of Ophthalmic and Facial Plastic Surgery and Ocular Oncology, Centre for Sight, Hyderabad, India; and †Department of OphthalmicPlastic Surgery, Orbit and Ocular Oncology, C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
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19
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Rajak SN, Habtamu E, Weiss HA, Kello AB, Abera B, Zerihun M, Gebre T, Gilbert CE, Khaw PT, Emerson PM, Burton MJ. The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. PLoS Negl Trop Dis 2013; 7:e2392. [PMID: 23991241 PMCID: PMC3749971 DOI: 10.1371/journal.pntd.0002392] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/17/2013] [Indexed: 11/23/2022] Open
Abstract
Background Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings. Methodology/Principal Findings We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (<5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had >5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83–3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23–3.20), age over 40 years (OR 1.59, 95% CI 1.14–2.20) and specific surgeons (surgeon recurrence risk range: 18%–53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%). Conclusions/Significance Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation. Trachoma is the most common infectious cause of blindness worldwide. It causes trichiasis (inturning of the eyelashes to touch the eye), which can cause visual loss. Trachomatous trichiasis (TT) affects over eight million people, 1.2 of whom live in Ethiopia – the most affected country worldwide. Surgery is the mainstay of treatment for TT. However, results of surgery in the field are often very mixed. We investigated the surgical outcomes of one of the two most widely used surgical techniques (posterior lamellar rotation), in 1300 individuals in the Amhara Region of Ethiopia. We found that recurrence occurred frequently: 315/1276 (24.7%) participants. However, recurrence was rarely severe (greater than 5 lashes): 42 participants (3.3%). Recurrence occurred much more frequently in participants who had severe pre-operative disease and with specific surgeons. The high recurrence rates and inter-surgeon variation is concerning. Further research will be required to investigate factors such as surgical technique, surgeon training and immediate post-operative lid position, in order to improve surgical outcomes.
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Affiliation(s)
- Saul N Rajak
- The London School of Hygiene and Tropical Medicine, London, United Kingdom.
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20
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Hoffman J, Watson MP. Trachoma: is the end in sight? EXPERT REVIEW OF OPHTHALMOLOGY 2013. [DOI: 10.1586/eop.13.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW To review recent clinical and epidemiological studies regarding the prevention, diagnosis, and treatment of trachoma. RECENT FINDINGS Newer studies propose novel diagnostic tests that appear sensitive for the detection of ocular chlamydial infection. For example, recent studies with ribosomal RNA-based nucleic acid amplification tests (NAATs) have demonstrated improved sensitivities compared to DNA-based NAATs; and the progression of scarring has now been characterized with confocal microscopy. Immunologic studies have further explored the etiology of clinical sequelae, suggesting that chronic inflammation can lead to progressive scarring even in the absence of Chlamydia. Mass oral azithromycin distributions remain a mainstay of treatment; studies have assessed the appropriate frequency and duration of treatment programs. Current studies have also explored ancillary effects of azithromycin distribution on mortality and bacterial infections. SUMMARY Trachoma programs have had remarkable success at reducing chlamydial infection and clinical signs of trachoma. Recent work suggests improved methods to monitor infection and scarring, and better ways to distribute treatment. Whereas studies continue to demonstrate reduction in infection in hyperendemic areas, more work is necessary to achieve elimination of this blinding disease.
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Burton MJ, Rajak SN, Ramadhani A, Weiss HA, Habtamu E, Abera B, Emerson PM, Khaw PT, Mabey DCW, Holland MJ, Bailey RL. Post-operative recurrent trachomatous trichiasis is associated with increased conjunctival expression of S100A7 (psoriasin). PLoS Negl Trop Dis 2012; 6:e1985. [PMID: 23285311 PMCID: PMC3527350 DOI: 10.1371/journal.pntd.0001985] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 11/12/2012] [Indexed: 01/17/2023] Open
Abstract
Background Surgery for trachomatous trichiasis (TT) is a key component of the SAFE Strategy for trachoma control. Unfortunately, recurrent TT following surgery is common, probably due to various surgical and disease factors. To develop strategies to reduce recurrence rates it is necessary to understand its pathological basis. In this study we investigated the relationship between recurrent trichiasis and the expression of various cytokines and fibrogenic genes during a two-year follow-up period. Methodology/Principal Findings Individuals undergoing surgery for TT were examined at baseline (pre-operative), 6, 12, 18 and 24 months. Conjunctival swab samples were collected from the tarsal conjunctiva for RNA isolation on each occasion. Individuals who developed recurrent TT with at least 3 lashes touching the eye on one or more occasion were designated “cases” and an equal number of “controls” were randomly selected from those without recurrent TT, frequency matched for age and baseline TT severity. The expression of the following genes was measured by quantitative RT-PCR: S100A7, IL1B, CXCL5, TNFA, NOS2A, CTGF, MMP7, MMP9 and MMP12. Thirteen hundred individuals were enrolled and underwent surgery. By two years 122 had developed recurrent TT with at least 3 lashes touching the eye. Recurrent TT was consistently associated across multiple time points with about a 2-fold increase in S100A7 expression (p = 0.008). Clinically visible conjunctival inflammation was associated with increased S100A7, IL1B, CXCL5, MMP9 and MMP12 expression. Conclusions/Significance Increased S100A7 expression was associated with trachomatous conjunctival scarring and may be linked to the pathophysiology of recurrent TT. S100A7 expression could be a potential biomarker for this disease process. As part of the epithelial innate immune response S100A7 has multiple actions, potentially contributing to a chronic pro-inflammatory response, which may lead to ongoing tissue damage and increased scarring. Trachoma causes blindness through corneal damage from in-turned eyelashes (trachomatous trichiasis [TT]). Trichiasis is treated surgically to correct the anatomical abnormality. Unfortunately, TT frequently returns following surgery, which again puts the person at risk of sight loss. Recurrent trichiasis is multifactorial. We investigated the possible role of various immuno-fibrogenic factors. To do this we operated on 1300 people with TT and followed them up every six months for a two-year period. On each occasion a conjunctival swab was collected for human gene expression analysis. We measured various factors that are thought to be important in inflammation and scarring diseases. The gene expression profile of people who developed recurrent TT was compared to a sample of those that did not have a recurrence. Recurrent TT was associated with increased expression of psoriasin (S100A7) before surgery and on multiple occasions during a two-year follow-up period. S100A7 is able to promote inflammation and may contribute to the development of the scarring process in trachoma.
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Affiliation(s)
- Matthew J Burton
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial. PLoS Med 2011; 8:e1001136. [PMID: 22180731 PMCID: PMC3236738 DOI: 10.1371/journal.pmed.1001136] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 10/18/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (<six lashes touching eye). This trial investigated whether epilation is noninferior to surgery for managing minor trichiasis. METHODS AND FINDINGS 1,300 individuals with minor trichiasis from Amhara Regional State, Ethiopia were recruited and randomly assigned (1:1) to receive trichiasis surgery or epilation. The epilation group were given new forceps and epilation training. The surgical group received trichiasis surgery. Participants were examined every 6 months for 2 years by clinicians masked to allocation, with 93.5% follow-up at 24 months. The primary outcome measure ("failure") was ≥five lashes touching the eye or receiving trichiasis surgery during 24 months of follow-up, and was assessed for noninferiority with a 10% prespecified noninferiority margin. Secondary outcomes included number of lashes touching, time to failure, and changes in visual acuity and corneal opacity. Cumulative risk of failure over 24 months was 13.2% in the epilation group and 2.2% in the surgical group (risk difference = 11%). The 95% confidence interval (8.1%-13.9%) includes the 10% noninferiority margin. Mean number of lashes touching the eye was greater in the epilation group than the surgery group (at 24 months 0.95 versus 0.09, respectively; p<0.001); there was no difference in change in visual acuity or corneal opacity between the two groups. CONCLUSIONS This trial was inconclusive regarding inferiority of epilation to surgery for the treatment of minor trichiasis, relative to the prespecified margin. Epilation had a comparable effect to surgery on visual acuity and corneal outcomes. We suggest that surgery be performed whenever possible but epilation be used for treatment of minor trichiasis patients without access to or declining surgery. TRIAL REGISTRATION ClinicalTrials.gov NCT00522912.
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