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A case of bilateral complete cryptophthalmos combined with other malformations is described. The clinical appearance, histology, and the results of computed tomography and electro-ophthalmological investigations are communicated.
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PURPOSE: To describe a patient with a tolerated cilium in the anterior chamber. METHODS: A 15-year-old girl, referred with a 5-year trauma history, was examined. A cilium was noted in the anterior chamber without any inflammation during routine ophthalmological examination. RESULTS: The cilium was removed surgically and the prognosis was excellent. CONCLUSION: The decision to remove a cilium surgically is controversial and must be based on the individual clinical examination.
AIM: This community-based cross-sectional study was conducted to determine the prevalence of trachoma in Dalocha District, Central Ethiopia. METHODS: A multistage sampling method was used to identify the peasant associations and households included in the study. The WHO clinical grading method for trachoma was used. RESULTS: Of the 619 sampled persons, 302 (48.8%) males and 317 (51.2%) females, 564 people were available for examination, yielding a response rate of 91.1%. More than half (51.1%) of the children aged 10 years or less had active trachoma (trachomatous inflammation, TI, in 16.5% and trachomatous follicles, TF, in 34.6%). On the other hand, active trachoma and trachomatous trichiasis (TT) were each found in 5.5% of individuals older than 10 years of age. CONCLUSIONS: According to the WHO, the findings of TI and TF in more than 5% and 20%, respectively, of children aged 10 years or less and TT in more than 1% of older individuals indicate that trachoma is a major public health problem in Dalocha community.
BACKGROUND: The prevalence of long-term trichiasis recurrence following tarsal rotation and electro-epilation procedures has not been determined. A non-concurrent prospective study of surgical cases of trichiasis was therefore undertaken in Oman. METHODS: A sample of 603 surgical cases of trichiasis (approximately half tarsal rotation and half electro-epilation) was followed for an average of 3.1 years to determine recurrence. Recurrence was defined as either mild (<5 lashes touching the globe) or severe (5 or more lashes touching the globe). RESULTS: Overall, 56% (95% confidence interval of 50.6%-61.0%) of all surgical cases recurred; ranging from 61.8% of tarsal rotation patients to 50.6% of electro-epilation patients. Severe recurrence was detected among 27% of tarsal rotation patients and 10% of electro-epilation patients. Recurrence was associated with female sex, residence in a high-risk region, and time since surgery. DISCUSSION: The risk of recurrence after electro-epilation and bilamellar tarsal rotation surgery is high; strategies that account for recurrence need to be introduced.
AIMS: A population-based cross-sectional survey for trachoma prevalence was conducted in a subdistrict of northern Nigeria. The objectives of the survey were to determine the magnitude and pattern of trachoma and the barriers to uptake of lid surgery in the area. METHODS: A total of 2903 people of all ages were examined out of 3715 registered eligible persons. The study population was chosen by a two-stage cluster random sampling technique. Each person was examined for signs of trachoma. The World Health Organization (WHO) simplified trachoma grading was used. Persons with trichiasis that had not attended hospital were asked why they had not sought hospital treatment. RESULTS: A blindness prevalence of 1.5% (95% CI 0.4%-2.7%) was found in the study population. About 20% of the blindness were due to trachoma. The prevalence of trichiasis among women 15 years and above was found to be 8.6% (95% CI 6.8%-10.7%). The prevalence of active trachoma among children was 11.8% (95% CI 10.1%-13.3%). Over 90% of people with trichiasis have not sought medical attention. The major identified factor that prevents people from accessing hospital treatment for trichiasis was cost (57%). CONCLUSION: This study suggests that trachoma is of public health significance in this area; as such, an effective trachoma control program with emphasis on lid surgery should be established.
PURPOSE: To test the validity and repeatability of a newly designed Trachoma Rapid Assessment (TRA) methodology. METHOD: Results from an initial TRA in 20 villages (TRA1) are compared with those of a second validation TRA (TRA2) after 6 weeks in 13 villages, randomly selected out of the original 20, conducted by different field staff. Findings of TRA1 and TRA2 are compared with those of a door-to-door survey of the entire population of all 13 villages. RESULTS: There is a considerable amount of variation between the results of TRA1 and TRA2 and between the results of both TRA's and the door-to-door survey. Even indicators that should have remained the same, like distance to Primary Health Centre or distance to trichiasis surgery facility, scored differently. CONCLUSIONS: The TRA methodology is easy to use and the results are quickly available. The scoring system indicates which intervention(s) of the SAFE strategy are needed and facilitates priority setting. The definition of some indicators, like availability and use of latrines, may need modification. In some cases, the scoring system seems to exaggerate differences between the actual findings. The consistency between two TRA's in the same village is low and the accuracy in measuring the actual situation is doubtful.
This article presents a methodology for the rapid assessment of trachoma that was validated against a prevalence survey, undertaken simultaneously in the same 12 villages in central Tanzania. The rapid assessment protocol suggests examinations for active trachoma in 50 children ages 1-10 in at least 20 households chosen from the high-risk neighborhoods in each village. Women over the age of 15 in the same households were examined for trichiasis. In the rapid assessment, 244 households were visited, with 691 children and 470 women examined. In the prevalence survey, 377 households were visited, with 1855 children and 1310 women examined. Rankings of the villages using population prevalence of active disease and rapid assessment prevalence of active disease are highly correlated (Spearman correlation = 0.59, p < 0.05). In fact, the three villages with the highest prevalence in the population data were identified as the villages with the highest prevalence by the rapid assessment. Although rankings of the villages using population prevalence of trichiasis and rapid assessment prevalence of trichiasis are positively correlated, this correlation is not significantly different from zero, the village with the highest trichiasis prevalence according to the random sample being ranked as 8th by the rapid assessment. The cost of the rapid assessment was roughly one-third the cost of the prevalence survey. Thus, it appears that the rapid assessment method can quickly and inexpensively determine which villages have the greatest amount of active disease in children, and roughly estimate the burden of trichiasis in the community.
AIM: A limited literature addresses the cost-effectiveness of the prevention and treatment of trachoma and its sequelae. The literature focuses on government costs. This paper motivates the inclusion of and details methods for measuring the costs for the target population. METHODS: Costs to the targeted population can be measured while studying efficacy or effectiveness. These costs can be added to the more frequently measured costs to the government to calculate costs for the entire society. This section indicates the types of costs to consider, refines the concept of costs, describes the necessary data, outlines how the methods of data collection fit with the methods that would be employed for a general effectiveness study, and describes the appropriate calculation of a cost-effectiveness ratio. RESULTS: The costs to the targeted population can be measured with few additional resources. Placing a value on villagers' time or translating clinical results into summary, preference-based health-related quality of life measures would increase the resources required more substantially. DISCUSSION: For theoretical and practical reasons, future cost-effectiveness analyses of the full SAFE strategy and the antibiotic component of the strategy should be done from a perspective that includes both the government and the targeted population. This can be useful in policy making and increase our understanding of reasons for less than universal participation.
Patients with respiratory tract allergy present certain auditory and visual signs which, when correlated with the history, aid substantially in arriving at a conclusive diagnosis. The physician should be alert to the signs that indicate allergic disease. Early recognition followed by modern allergy management will help to prevent progression of the allergic process.
PURPOSE: To report a case of poliosis arising from treatment with topical medications. DESIGN: Interventional case report. METHODS: A 37-year-old man was treated for fungal endophthalmitis arising from Aspergillus fumigatus keratitis with penetrating keratoplasty, lensectomy and vitrectomy together with systemic and prolonged topical medications. RESULTS: Recovery was complicated by retinal detachment, elevated intraocular pressure and bullous keratopathy. Unilateral poliosis developed eight months following keratoplasty and has persisted over 2(1)/(2) years. CONCLUSIONS: Topical medications are implicated in causing the poliosis.
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PURPOSE: To determine the barriers to therapeutic intervention in patients with trachomatous trichiasis or entropion. METHODS: Prospective study over one year in 60 patients with trachomatous trichiasis or entropion presenting to a teaching hospital. The outcome measure was reported barriers to uptake of intervention using a questionnaire. The data were analysed using chi-square and Fisher's exact tests. Patient characteristics were correlated with barriers using univariate and multivariate analysis. RESULTS: The major barriers (operative in > 60% of patients) were illiteracy (66.7%), ignorance regarding treatment (65.0%), and fear of surgery (63.3%). Duration of symptoms in 43 females and 17 males ranged from 0.5 to 240 months (mean 30.2 +/- 45.82). Females reported significantly more barriers (average 5.8 +/- 1.88) than males (average 4.6 +/- 1.97; p = 0.03). Shorter duration was significantly related to perceived expense (p = 0.008). Patients aged =55 years more often cited young children as a barrier (p = 0.02). CONCLUSIONS: Encouraging patients who have undergone intervention to share their experiences with community members, providing intervention in patients' villages, community involvement with patients who live alone and making gender-sensitive medical programmes might be useful in reducing the fear of surgery and enhancing awareness and uptake of intervention. Future studies must identify barriers in their regions so that attempts can be directed to overcoming them so as to reduce the blinding and non-blinding burden of trachoma.
PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.
Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.
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The FOX family of transcription factor genes is an evolutionary conserved, yet functionally diverse class of transcription factors that are important for regulation of energy homeostasis, development and oncogenesis. The proteins encoded by FOX genes are characterized by a conserved DNA-binding domain known as the forkhead domain (FHD). To date, disease-causing mutations have been identified in eight human FOX genes. Many of these mutations result in single amino acid substitutions in the FHD. We analyzed the molecular consequences of two disease-causing missense mutations (R121H and S125L) occurring in the FHD of the FOXC2 gene that were identified in patients with hereditary lymphedema with distichiasis (LD) to test the predictive capacity of a FHD structure/function model. On the basis of the FOXC2 solution structure, both FOXC2 missense mutations are located on the DNA-recognition helix of the FHD. A mutation model based on the parologous FOXC1 protein predicts that these FOXC2 missense mutations will impair the DNA-binding and transcriptional activation ability of the FOXC2 protein. When these mutations were analyzed biochemically, we found that both mutations did indeed reduce the DNA binding and transcriptional capacity. In addition, the R121H mutation affected nuclear localization of FOXC2. Together, these data indicate that these FOXC2 missense mutations are functional nulls and that FOXC2 haploinsufficiency underlies hereditary LD and validates the predictive ability of the FOXC1-based FHD mutational model.