Bowman R J C, Faal H, Dolin P, Johnson G J
International Centre for Eye Health London, UK.
Eye (Lond). 2002 Jan;16(1):27-32. doi: 10.1038/sj.eye.6700027.
National blindness surveys conducted in the Gambia in 1986 and 1996 showed an increase in blindness and visual impairment from non-trachomatous opacity. This study aimed to investigate the aetiology of these opacities and to assess the resulting visual burden.
A population-based, randomised blindness survey was conducted in the Gambia in 1996. Patients with visual impairment or blindness were examined by an ophthalmologist with a slit lamp. Causes of corneal opacity were determined as accurately as possible by clinical history and examination.
A total of 154 patients with non trachomatous corneal opacity were examined of whom 39 had bilateral opacities and 115, unilateral. Causes included corneal infection, measles/vitamin A deficiency, harmful traditional practices and trauma (unilateral scarring). Overall, corneal pathology alone was responsible for bilateral visual impairment or blindness in 19 (12%) patients and unilateral visual impairment or blindness in 88 (57%) patients. Those patients with bilateral visual impairment or blindness (mean age 59, SD) were older (P= 0.003) than others (mean age 44, SD = 20). The use of harmful traditional eye practices was associated with bilateral corneal blindness or visual impairment (RR = 2.63, 95% CI 1.11-6.21, P = 0.04). Although none of the corneal scars reported here were attributed to trachoma, in patients over the age of 45, the prevalence of trachomatous conjunctival scarring in this group was 38.8% compared to 19.4% of the whole nationwide sample.
Strategies for the prevention (including the quest for cheaper anti-microbial drugs and co-operation with traditional healers) and surgical treatment of these corneal opacities are discussed.
1986年和1996年在冈比亚进行的全国性失明调查显示，非沙眼性混浊导致的失明和视力损害有所增加。本研究旨在调查这些混浊的病因，并评估由此产生的视觉负担。
1996年在冈比亚进行了一项基于人群的随机失明调查。视力损害或失明患者由眼科医生用裂隙灯进行检查。通过临床病史和检查尽可能准确地确定角膜混浊的原因。
共检查了154例非沙眼性角膜混浊患者，其中39例为双侧混浊，115例为单侧混浊。病因包括角膜感染、麻疹/维生素A缺乏、有害的传统习俗和外伤（单侧瘢痕形成）。总体而言，仅角膜病变导致19例（12%）患者双侧视力损害或失明，88例（57%）患者单侧视力损害或失明。那些双侧视力损害或失明的患者（平均年龄59岁，标准差）比其他患者（平均年龄44岁，标准差=20）年龄更大（P=0.003）。使用有害的传统眼部习俗与双侧角膜失明或视力损害相关（相对危险度=2.63，95%可信区间1.11-6.21，P=0.04）。尽管此处报告的角膜瘢痕均未归因于沙眼，但在45岁以上的患者中，该组沙眼性结膜瘢痕的患病率为38.8%，而全国样本的患病率为19.4%。
讨论了预防（包括寻求更便宜的抗菌药物以及与传统治疗师合作）和手术治疗这些角膜混浊的策略。
