Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial upper eyelid entropion / Rotação anterior de retalho tarsal combinada com reposição laminar anterior no reparo do entrópio cicatricial das pálpebras superiores

ABSTRACT Purpose: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. Methods: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. Results: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. Conclusion: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure.

RESUMO Objetivo: Compartilhar os resultados dos pacientes submetidos à rotação de retalho tarsal anterior, combinados com a reposição lamelar anterior devido à entrópio cicatricial da pálpebra superior e determinar a eficácia e a confiabilidade desta técnica cirúrgica. Métodos: Foram incluídos neste estudo quinze olhos de 11 pacientes em quem realizamos cirurgia de rotação de retalho tarsal anterior combinada com reposição lamelar anterior devido ao entrópio cicatricial. Os registros médicos dos pacientes foram analisados retrospectivamente e as causas da entrópio cicatricial, bem como os achados do exame oftalmológico pré-operatório e pós-operatório foram registrados. A integridade anatômica e funcional da pálpebra foi considerada como sucesso cirúrgico. Resultados: A idade média foi de 59,81 ± 18 anos. O período médio de seguimento foi de 21,72 ± 14 meses (intervalo 5-43 meses). As causas da entrópio cicatricial foram o desenvolvimento de cicatrizes pós-operatórias devido a eletrólises múltiplas para triquíase e/ou distiquiase em 7 olhos, tracoma em 6 olhos e trauma em 2 olhos. Todos os pacientes foram tiveram irritação e lacrimejamento pré-operatório, enquanto que 10 pacientes apresentavam opacidade e erosão da córnea e 1 paciente apresentava apenas erosão epitelial. O sucesso total anatômico e funcional foi alcançado em todos os casos. Conclusão: A rotação do retalho tarsal anterior combinada com a reposição lamelar anterior no reparo da entrópio cicatricial é um procedimento cirúrgico alternativo efetivo e confiável.

Prevalencia de tracoma entre escolares brasileiros / Prevalencia de tracoma entre escolares brasilenos / Prevalence of trachoma in Brazilian schoolchildren

OBJETIVO: Estimar a prevalência e descrever a distribuição do tracoma entre escolares em municípios brasileiros. MÉTODOS: Estudo de corte transversal, usando amostragem por conglomerados, da população escolar dos municípios brasileiros com Índice de Desenvolvimento Humano-Municipal menor que a média nacional. O inquérito de prevalência de tracoma foi realizado pelo Ministério da Saúde entre 2002 e 2007. Foram selecionados 119.531 alunos de 2.270 escolas localizadas em 1.156 municípios. Os alunos foram submetidos ao exame ocular externo, com lupa (2,5X), para detecção de sinais clínicos de tracoma segundo critérios da OMS. Estimou-se a prevalência de tracoma segundo estado e em nível nacional, e seus respectivos intervalos de 95% de confiança. Para a comparação de variáveis categóricas foram usados os testes do Qui-quadrado e do Qui-quadrado de tendência linear. RESULTADOS: Foram detectados 6.030 casos de tracoma, resultando em prevalência de 5,0% (IC95% 4,5;5,4). Não foi encontrada diferença significante entre os sexos. A prevalência de tracoma foi de 8,2% entre menores de cinco anos de idade, diminuindo nas faixas etárias mais altas (p < 0,01). Houve diferença significante entre as prevalências de tracoma na zona urbana e rural, 4,3% versus 6,2%, respectivamente (p < 0,01). Foram detectados casos em 901 municípios (77,7% da amostra), em todas as regiões do País. Em 36,8% dos municípios selecionados a prevalência foi superior a 5%. CONCLUSÕES: O estudo mostra que o tracoma é um importante problema de saúde pública no Brasil, contradizendo a crença de que a endemia estaria controlada no País. O inquérito realizado apresenta uma linha de base para avaliação das intervenções ...

OBJETIVO: Estimar la prevalencia y describir la distribución de tracoma entre escolares en municipios brasileños MÉTODOS: Estudio de corte transversal, usando muestreo por conglomerados, de la población escolar de los municipios brasileños con Índice de Desarrollo Humano-Municipal menor que el promedio nacional. La pesquisa de prevalencia de tracoma fue realizada por el Ministerio de la Salud entre 2002 y 2007. Se seleccionaron 119.531 alumnos de 2.270 escuelas localizadas en 1.156 municipios. Los alumnos fueron sometidos a examen ocular externo, con lupa (2,5X), para detección de señales clínicas de tracoma según criterios de la OMS. Se estimó la prevalencia de tracoma según estado y a nivel nacional, y sus respectivos intervalos de 95% de confianza. Para la comparación de variables categóricas se usaron las pruebas de Chi-cuadrado y de Chi-cuadrado de tendencia linear. RESULTADOS: Se detectaron 6.030 casos de tracoma, resultando en prevalencia de 5,0% (IC95% 4,5;5,4). No se encontró diferencia significativa entre los sexos. La prevalencia de tracoma fue de 8,2% entre menores de cinco años de edad, disminuyendo en los grupos etarios más altos (p0,01). Hubo diferencia significativa entre las prevalencias de tracoma en la zona urbana y rural, 4,3% vs. 6,2%, respectivamente (p0,01). Se detectaron casos en 901 municipios (77,7% de la muestra), en todas las regiones del País. En 36,8% de los municipios seleccionados la prevalencia fue superior a 5%. CONCLUSIONES: El estudio muestra que el tracoma es un importante problema de salud pública en Brasil, contradiciendo la creencia de que la endemia estaría controlada en el País. La pesquisa realizada presenta una línea de base para evaluación de las intervenciones planeadas con miras a alcanzar la meta mundial de certificación de eliminación del tracoma como ...

OBJECTIVE: To estimate the prevalence and describe the distribution of trachoma among schoolchildren in Brazilian municipalities. METHODS: Cross-sectional study, using cluster sampling, of the schoolchildren population of the Brazilian municipalities with Human Development Index - Municipal lower than the national average. This trachoma prevalence survey was conducted by the Ministry of Health, in the period 2002-2007. There were 119,531 schoolchildren selected from 2,270 schools located in 1,156 municipalities. The selected schoolchildren underwent an external ocular examination, with a magnifying glass (2.5X), to detect clinical signs of trachoma according to the WHO criteria. The prevalence of trachoma, by state and national level, and their respective 95% confidence intervals were estimated. Chi-square and Chi-square for trends tests were used to compare categorical variables. RESULTS: There were 6,030 cases of trachoma detected, resulting in a prevalence of 5.0% (95%CI 4.5;5.4). There was no significant difference between the sexes. The prevalence of trachoma was 8.2% among children under 5 years of age, decreasing among higher age groups (p < 0.01). There was a significant difference in prevalence between urban and rural areas, 4.3% versus 6.2% respectively (p < 0.01). Cases were detected in 901 municipalities (77.7% of the sample), in all regions of the country. In 36.8% of the selected municipalities, the prevalence was higher than 5%. CONCLUSIONS: The study shows that trachoma is a significant public health problem in Brazil, contradicting the belief that the disease had been controlled in the country. The survey provides a baseline for evaluating planned interventions aimed at achieving the goal of global certification of elimination of trachoma as a cause of blindness in Brazil by 2020. .

Tracoma: ainda uma importante causa de cegueira / Trachoma: still being an important blinding disease

O Tracoma é uma doença milenarmente conhecida e que persiste como causa de cegueira entre nós. As autoras chamam a atenção para os fatores relacionados com a transmissão, apresentam dados históricos e de distribuição da doença no Brasil e no mundo, comentam sobre o agente, os sinais e os sintomas desta conjuntivite crônica. Ainda reforçam a necessidade de capacitar os profissionais para o diagnóstico, o que possibilitará a detecção e tratamento. O reflexo destas atitudes será a contribuição para a eliminação desta importante causa de cegueira do nosso meio.

Trachoma is a disease known thousand years ago and still as a potential blindness disease all over the world. The authors call attention to the factors related with the transmission, present historical data and distribution of the disease in Brazil and in the world, comment on the agent, the signs and symptoms of this chronic conjunctivitis. Still, reinforce the need to enable professionals for the diagnosis, detection and treatment.The reflection of these attitudes will be the contribution to the elimination of this important disease as a blindness cause among us.

Tracoma em pacientes com conjuntivite alérgica / Trachoma in patients with allergic conjunctivitis

Objetivos: Este trabalho teve o objetivo de identificar possível associação entre conjuntivite alérgica e infecção por Chlamydia trachomatis. Método: Realizamos um estudo prospectivo em 104 olhos de 52 pacientes com hipótese diagnóstica de conjuntivite alérgica primaveril e atópica. Os pacientes foram examinados no Núcleo Especializado em Oftalmologia de João Pessoa - NEO. Foi realizada em todos os 52 pacientes, a citologia conjuntival, uma vez que pode evidenciar a presença de eosinófilos e corpúsculos de inclusões no esfregaço do raspado conjuntival, como também a imunofluorescência direta por ser o exame de escolha para confirmação de infecção por Chlamydia trachomatis. Todos os procedimentos foram aprovados pelo Comitê de Ética em pesquisa. Resultados: Dos 52 pacientes, 41 (78,8 por cento) apresentou conjuntivite primaveril e 11 (21,2 por cento) conjuntivite atópica. Quarenta e um (78,8 por cento) eram do sexo masculino e 11 (21,2 por cento) do feminino. As idades variaram de 3 a 19 anos, com uma média de 9,8 anos. Quanto à distribuição racial, 16 (30,8 por cento) pacientes eram brancos, 14 (26,9 por cento) eram negros e 22 (42,3 por cento) eram pardos. Pacientes com doença alérgica sistêmica observou-se que 25 (48,1 por cento) pacientes apresentaram asma brônquica, 20 (38,5 por cento) rinite alérgica e 5 (9,6 por cento) dermatite atópica. Os principais sintomas relatados pelos pacientes foram coriza (59,6 por cento), prurido ocular (98,1 por cento), ardor ou queimação (61,5 por cento), lacrimejamento (65,3 por cento) e fotofobia (61,5 por cento). Os principais sinais clínicos foram: hiperemia ocular (100 por cento), bilateralidade (100 por cento), papilas no tarso (92,3 por cento) e secreção mucosa (82,7 por cento). A citologia do raspado conjuntival encontrou o eosinófilo em 86,5 por cento dos casos. Apenas 7 pacientes não apresentaram eosinófilos no raspado conjuntival. Observamos que 3 pacientes (5,8 por cento) apresentou imu...

Purpose: The aim of this paper was to identify a possible association between allergic conjunctivitis and Chlamydia trachomatis infection. Methods: A prospective study was carried out in 104 eyes of 52 patients with diagnosis of vernal conjunctivitis and atopic keratoconjunctivitis. Conjunctival cytology was performed in all the 52 patients, once it can evidence eosinophils presence and inclusions corpuscles in the conjunctival scraping smear, as well as the direct immunofluorescence that is the choice exam for Chlamydia trachomatis infection confirmation. All procedures were approved by the Institutional Review Board Ethics Committee. Results: Of the 52 patients, 41 (78.8 percent) presented vernal conjunctivitis and 11 (21.2 percent) atopic keratoconjunctivitis. Forty-one patients (78.8 percent) were male and 11 (21.2 percent) female. The ages varied from 3 to 19 years, with an average of 9.8 years. Regarding racial distribution, 16 (30.8 percent) patients were caucasian, 14 (26.9 percent) were black and 22 (42.3 percent) were brown. Regarding systemic allergic diseases, it was observed that 25 (48.1 percent) patients presented asthma, 20 (38.5 percent) allergic rhinitis and 5 (9.6 percent) atopic dermatitis. The main symptoms complained by the patients were coryza (59.6 percent), ocular itching (98.1 percent), burning (61.5 percent), tearing (65.3 percent) and photophobia (61.5 percent). The main clinical signs were: ocular hyperemia (100 percent), bilaterality (100 percent), superior tarsal papilla (92.3 percent) and mucous secretion (82.7 percent). The cytology of the conjunctival scrapings found eosinophil in 86.5 percent of the cases. Only seven patients did not present eosinophils in the conjunctival scrapings. Three patients (5.8 percent) presented positive immunofluorescence for Chlamydia, evidencing an association between allergic conjunctivitis and trachoma. Conclusion: It is important to determine the simultaneous coexistence ...

Eradicating blinding trachoma: what is working?

Trachoma remains the leading cause of preventable corneal blindness in developing countries. The disease is contracted in early childhood by repeated infection of the ocular surface by C. traehomatis. Initial clinical manifestation is a follicular conjunctivitis which if not treated on timely basis, may lead to conjunctival and eyelid scarring that may eventually result in corneal scarring and loss of vision. Over the past two decades, a remarkable reduction in the prevalence of active trachoma has occurred due to the World Health Organization's [WHOs] program GET 2020 for the elimination of trachoma with adoption of the SAFE strategy incorporating Surgery, Antibiotic treatment, Facial cleanliness and Environmental hygiene. However, patients who already had infection at young age may present with adnexal-related complications of trachomatous scarring that may cause corneal scarring and visual loss. These patients may present with evidence of trichiasis/entropion as well as eyelid retraction. Lacrimal complications may include nasolacrimal-duct obstruction, dacryocystitis and canaliculitis requiring intervention. In addition to the increased risk for corneal scarring, trichiasis/entropion may further increase the risks for microbial keratitis in patients who may have unrecognized dacryocystitis and canaliculitis. Female patients may have more trachomtous-related complications and may present at an early age. Available evidence indicates that SAFE strategy may be effective and on the right track towards achieving GET 2020 goal for the eradication of trachoma

Gender inequality in vision loss and eye diseases: Evidence from the Sultanate of Oman.

Purpose: The data from surveys of vision loss and monitoring of services were used to assess changes in gender inequality in Oman. Study Design: Retrospective review of data collection instruments. Materials and Method: The data sets of 12 years between 1996 and 2007 were abstracted to assess the gender equality for vision loss, eye disease prevalence, and service use. They included two surveys (1996 and 2005), Health Information from eye units (1998 and 2007), and eye screening in schools. Results: In 1996, the prevalence of bilateral blindness in ≥ 40 years of age was higher in females [Odd's Ratio (OR) = 0.36 (95% Confidence Interval (CI) 0.24 – 0.53)]. Gender differences in the prevalence of cataract [OR = 0.82 (95% CI 0.63 – 1.03)] were not significant while trachomatous trichaisis (TT) was less in males [OR = 0.33 (95% CI 0.22-0.48)]. In 2005, gender differences in the prevalence of bilateral blindness [OR = 0.97 (95% CI 0.71 – 1.34)] and TT [OR = 0.66 (95% CI 0.42- 1.04)] were not statistically significant. But males were associated with higher prevalence of cataract [OR = 1.26 (95% CI 1.00 – 1.59)]. Surgery rates for cataract, glaucoma and TT were not different by gender. More male compared to female patients with diabetic retinopathy were treated. Myopia was significantly higher in girls. Compliance of spectacle wear was higher in girls. Conclusions: Gender inequality for eye care seems to have reduced in the last 10 years in Oman. However, apart from TT and glaucoma patients the difference in service utilization by gender was not statistically significant.

Trachoma in Libya

Trachoma in Libya is reviewed for the period 1920 to 2007. During this period the prevalence dropped from 80% to zero% in the coast cities and 3% [in a very mild form] in Kufra in the deep desert. A great improvement in the control of active disease is noted but few of the complications of the disease are still prevalent in the older population, again no more than 2.27%. This improvement is mainly due to the changes in socio-economic status of the population and also due to development of health care system in Libya

Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen

This study described the pattern of trichiasis, active trachoma and trachoma risk factors in 9 governorates of Yemen plus Socotra Island, using a rapid assessment during October and February 2004. A total of 3169 children aged 1- 9 years were examined in a central meeting point or at home. Active trachoma was found in a high percentage of children in Al-Jawf, Mareb and Shabwah governorates and the SAFE strategy [Surgery, Antibiotic treatment, Facial cleanliness, Environmental improvement] should be directed toward these governorates. Trichiasis cases were also found in Hadramout and Taiz, suggesting that eyelid surgery should be provided in these governorates

Prevalence of trachoma in thar desert area of Sindh

To determine the prevalence of trachoma in a given population. A cross - sectional study. Department of Ophthalmology, Civil Hospital, Mirpurkhas - Sindh from January to December 2001. A total of four thousand [4000] patients of different age groups undergone a clinical examination of anterior eye during study period. Those with the clinical findings of trachoma underwent further detailed examination including visual acuity, tonometry and dilated ophthalmoscopy. The diagnosis of different stages of trachoma was confirmed clinically using simplified trachoma grading system of World Health Organization. Out of 4000 patients, 515 [12.87%] were found having clinical findings of trachoma. Among these, 215 [41.74%] were male and 300 [58.25%] female patients. The prevalence of active trachoma was higher in female children. Trachoma has become endemic in the increasing poor population of District Tharparkar. The disease is increasing due to deficient water supply, poor sanitation and unhygienic living standards of the people of area

Tratamento cirúrgico da triquíse maior / Surgical treatment for larger trichiasis

O objetivo deste trabalho foi conhecer as características dos portadores de triquíse maior e a resposta ao tratamento (cirurgia de Van Millingen). Foram avaliados 100 pacientes portadores da patologia e observou-se que a doença foi mais frequente em pacientes acima da sexta década de vida, portadores de tracoma cicatricial, cirurgia palpebral prévia, blefarite e meibomite. A pálpebra superior e a inferior foram acometidas nas mesmas proporçöes. A resposta ao tratamento cirúrgico foi pior nos portadores de triquíase associada ao entrópio, havendo necessidade de nova cirurgia em 23,1 p/c dos pacientes. Os autores responsabilizam o caráter crônico-evolutivo das patologias de base pelas falhas do tratamento

Nouvelle technique de tarsotomie dans le traitement du trichiasis post trachomateux: a propos de 3000 cas

Transverse tarsotomy and lid margin rotation is a simple method that is effective in repositioning the entropion lid without requiring external incisions or grafting. We report the results of this procedure in 3000 lids of 2000 patients with trachomatous trichiasis, from the south of Tunisia. We obtain excellent cosmetic and functional results, 97% of success rate. We recommend it as the initial procedure and in second intention

Salud ocular comunitaria: en busqueda de soluciones; primera parte / Ocular community health: in search of solutions; first part

Enfermedades como la catarata, tracoma, glaucoma, oncocercosis, xeroftalmia, degeneracion macular, retinopatia diabetica y lepra son las principales causas de ceguera en el mundo. El 93% de los ciegos estan distribuidos en Asia, Africa y Latinoamerica como resultante de las desfavorables condiciones socio-economicas, ambientales, culturales y el limitado acceso da la atencion oftalmologica de sus habitantes. De acuerdo con las estadisticas presentadas en Colombia es prioridad desarrollar un programa nacional de salud ocular, que ademas de realizar acciones para la prevencion de la ceguera, incluya la atencion adecuada de otros problemas visuales como los defectos refractivos y de patologias oculares que, a pesar de no ser causa de limitacion visual permanente, necesitan tratamiento medico o quirurgico. A nivel departamental, la Fundacion Oftalmologica de Santander -FOS, con el apoyo de organismos internacionales, avanza en la planeacion de actividades de investigacion basica y en el desarrollo de programas de prevencion y tratamiento para las poblaciones mas necesitadas

Incidencia de Chlamydia trachomatis en el embarazo / Incidence of Chlamydia trachomatis in pregnacy

Motivados por las cifras de frecuencia de Chlamydia trachomatis publicadas en la literatura, efectuamos un estudio de este micro organismo en 100 embarazadas, a través de un cultivo en células de Mc Coy complementado con un estudio citológico. Las cifras de prevalencia fueron de 5,4% en la muestra estudiada con un 40% de citologías que predijeron la infección, existiendo 66,6% de citologías positivas falsas. Se efectuó seguimiento de los RN del grupo chlamydia positiva, comprobándose que un 60% desarrolló una conjuntivitis clínica y ninguno de ellos presentó neumonía. Se analizan estos dos cuadros del RN se efectúa una breve reseña de los métodos de diagnóstico

modified kettesy's tarsal rotation operation for cicatricial enteropion of the lower lid

A modified Kettesy's tarsal rotation operation for correction of cicatricial entropion of the lower lid, even recurrent cases, was described above. A modified method of suturing and incision which is different from the original Kettesy's operation and its modified method of suturing suggested by Farag, 1963, is added and adviced by us. Modified Kettesy's tarsal rotation operation is recommended for correction of cicatricial entropion of the lower lid, even in recurrent cases because of its favourable surgical and cosmetic results