Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting.
Prospective audit of the phenotype, causes and correlates of trachomatous and non- trachomatous trichiasis in a peri-elimination setting.
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DOI：
10.1371/journal.pntd.0011014
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发表时间：
2022-12
影响因子：
3.8
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中科院分区：
文献类型：
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探讨沙眼和非沙眼病因引起倒睫的负担、临床特征和相关性。纳入了2018年8月至2020年3月期间在新德里一家三级眼科护理医院的门诊部、角膜和眼成形术诊所就诊的任一眼睑（单眼或双眼）倒睫的确诊患者。进行了全面的检查，包括视力和眼前节评估和摄影。倒睫分级、偏侧性、睑内翻的存在和分级以及角膜混浊、结膜瘢痕、赫伯特陷窝和血管翳（如存在）的信息记录在病例记录表中。总共招募了302名倒睫患者（454只眼）。上睑倒睫（276例405眼）最常见的病因是沙眼（26%），其次是Stevens-Johnson综合征（23%）、睑角结膜炎（17%）和老年（10%）。共有296/405只眼（73%）有某种形式的角膜受累。在任何患有下眼睑疾病的眼睛中，沙眼都没有被确定为倒睫的原因。在这种围消除环境中，只有大约四分之一的上眼睑倒睫归因于沙眼。区分沙眼性倒睫和非沙眼性倒睫对于有意义地确定沙眼作为一个公共卫生问题是否已经消除是必要的。这些数据可能会对印度和其他接近消除环境中基于人口的TT流行率估计产生影响。“消除沙眼这一公共卫生问题”的部分定义是，表现出“沙眼倒睫”临床症状的人口比例非常低。倒睫是睫毛接触眼球的情况。但是确定倒睫是否起源于沙眼需要专业知识，而大多数参与实地调查的分级人员都不具备这些知识;因此，正确的方法一直存在争议。我们在新德里的一家三级眼科医院进行了一项为期20个月的倒睫前瞻性研究。这里的设置很重要，因为印度非常接近于使每个地区的上眼睑倒睫患病率低于商定的沙眼倒睫患病率消除阈值。我们的数据表明，只有26%的上睑倒睫在这种情况下是由于沙眼。在任何患有仅下眼睑疾病的眼睛中，沙眼都没有被确定为倒睫的原因，这支持了最近沙眼倒睫定义的变化，仅包括影响上眼睑的疾病。然而，仍然需要更好的方法来常规区分沙眼性倒睫和非沙眼性倒睫。
To explore the burden, clinical features and associations of trichiasis due to trachomatous and non-trachomatous aetiologies. Consenting patients presenting with trichiasis of either eyelid (of one or both eyes) attending the outpatient department, cornea and oculoplasty clinics of a tertiary eye care hospital in New Delhi between August 2018 to March 2020 were included. A comprehensive examination including visual acuity and anterior segment evaluation and photography was performed. Grade of trichiasis, laterality, presence and grade of entropion, and information on corneal opacity, conjunctival scarring, Herbert’s pits, and pannus, if present, were recorded in the case record form. Overall, 302 patients (454 eyes) with trichiasis were recruited. The most common attributed cause of upper eyelid trichiasis (276 patients, 405 eyes) was trachoma (26% of patients), followed by Stevens-Johnson syndrome (23%), blepharokeratoconjunctivitis (17%) and old age (10%). A total of 296/405 eyes (73%) had some form of corneal involvement. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease. Only about a quarter of upper eyelid trichiasis in this peri-elimination setting was attributed to trachoma. A distinction between trachomatous and non-trachomatous trichiasis is imperative to meaningfully determine whether elimination of trachoma as a public health problem has occurred. These data may have implications for population-based estimates of TT prevalence in India and other peri-elimination settings. “Elimination of trachoma as a public health problem” is defined in part by the presence of very low proportions of the population demonstrating the clinical sign “trachomatous trichiasis”. Trichiasis is the condition in which eyelashes touch the eyeball. But determining whether trichiasis is trachomatous in origin requires expertise that most graders who contribute to field-based surveys do not have; the right approach has therefore been debated. We undertook a twenty-month prospective study of trichiasis in a tertiary eye care hospital in New Delhi, using expert examiners. The setting is important here because India is very close to having each district demonstrate a prevalence of upper eyelid trichiasis lower than the agreed elimination threshold prevalence for trachomatous trichiasis. Our data suggest that only 26% of upper eyelid trichiasis in this setting was attributable to trachoma. Trachoma was not identified as the cause of trichiasis in any eye with lower eyelid-only disease, supporting the recent change in definition of trachomatous trichiasis to include only disease affecting the upper eyelid. However, better ways to routinely distinguish trachomatous from non-trachomatous trichiasis are still needed.