Bowman R J, Jatta B, Cham B, Bailey R L, Faal H, Myatt M, Foster A, Johnson G J
International Centre for Eye Health, London, England, UK.
Ophthalmology. 2001 Dec;108(12):2219-24. doi: 10.1016/s0161-6420(01)00645-5.
The sight-threatening complications of trachoma are trichiasis and corneal opacity, and these remain the world's most common cause of preventable blindness. The aim of the study was to investigate the rate of progression of trachomatous conjunctival scarring to trichiasis and corneal opacity and to investigate risk factors for such progression.
A 12-year, longitudinal study of the incidence and risk factors for the development of trichiasis and corneal opacity in a cohort of patients initially identified with trachomatous scarring in The Gambia.
Six hundred thirty-nine subjects with some degree of trachomatous scarring were identified from the 1986 survey, and attempts were made to trace all these subjects.
Successfully traced subjects were interviewed, examined, and graded for trachoma.
(1) Twelve-year rates of progression. (2) Risk factors for progression of disease.
Three hundred twenty-six of six hundred thirty-nine (51%) subjects were traced and examined, 108 (17%) had died, and 205 (32%) were lost to follow-up. After 12 years, 6.4% (95% confidence interval [CI], 4.0-9.97) of scarred subjects had trichiasis develop, 5.96% (95% CI, 3.67-9.42) had corneal opacity develop, 16.51% (95% CI, 12.71-21.13) had visual impairment/blindness develop, and 2.5% (95% CI, 1.2-5.0) had corneal visual impairment/blindness develop. Mandinka ethnicity was a risk factor for trichiasis (odds ratio [OR], 4.3; 95% CI, 1.3-14.4), and trichiasis at baseline was a risk factor for corneal opacity (OR, 8.4; 95% CI, 1.8-39.2). History of lid surgery for trichiasis was associated with corneal opacity at follow-up (OR, 4.4; 95%CI, 1.4-14.0). Older age was a significant risk factor for development of trichiasis, corneal opacity, and visual loss (OR, 1.07; 95% CI, 1.01-1.12). Bilateral cataract was present in 40% of traced subjects and was associated with the incidence of visual impairment/blindness (OR, 9.4; 95%CI, 4.5-19.6)
This is the first study to demonstrate the link between trichiasis and future corneal opacity, and it provides the rationale for performing lid rotation surgery on patients with trichiasis who do not yet have corneal opacity. The association between corneal opacity at follow-up and previous surgery among trichiasis patients suggests late presentation as a problem. The planning of surgical services will be aided by the incidence figures generated by this study.
沙眼的致盲性并发症为倒睫和角膜混浊，它们仍是全球可预防失明的最常见原因。本研究的目的是调查沙眼性结膜瘢痕进展为倒睫和角膜混浊的发生率，并探究这种进展的危险因素。
一项针对冈比亚一组最初被诊断为沙眼性瘢痕的患者进行的为期12年的倒睫和角膜混浊发生情况及危险因素的纵向研究。
从1986年的调查中确定了639名有一定程度沙眼性瘢痕的受试者，并尝试追踪所有这些受试者。
对成功追踪到的受试者进行访谈、检查，并对沙眼进行分级。
（1）12年的进展率。（2）疾病进展的危险因素。
639名受试者中有326名（51%）被追踪到并接受了检查，108名（17%）已经死亡，205名（32%）失访。12年后，6.4%（95%置信区间[CI]，4.0 - 9.97）的瘢痕化受试者出现了倒睫，5.96%（95%CI，3.67 - 9.42）出现了角膜混浊，16.51%（95%CI，12.71 - 21.13）出现了视力损害/失明，2.5%（95%CI，1.2 - 5.0）出现了角膜性视力损害/失明。曼丁哥族是倒睫的一个危险因素（比值比[OR]，4.3；95%CI，1.3 - 14.4），基线时的倒睫是角膜混浊的一个危险因素（OR，8.4；95%CI，1.8 - 39.2）。因倒睫进行眼睑手术的病史与随访时的角膜混浊相关（OR，4.4；95%CI，1.4 - 14.0）。年龄较大是发生倒睫、角膜混浊和视力丧失的一个重要危险因素（OR，1.07；95%CI，1.01 - 1.12）。在追踪到的受试者中40%存在双侧白内障，且与视力损害/失明的发生率相关（OR，9.4；95%CI，4.5 - 19.6）。
这是第一项证明倒睫与未来角膜混浊之间联系的研究，它为尚未出现角膜混浊的倒睫患者进行眼睑旋转手术提供了理论依据。倒睫患者随访时角膜混浊与既往手术之间的关联表明就诊延迟是一个问题。本研究得出的发生率数据将有助于手术服务的规划。
