Thanh T T K, Khandekar R, Luong V Q, Courtright P
Eye and Ear Health Care, DGHA, Ministry of Health, Sultanate of Oman, POB 393, Pin 113, Muscat.
Br J Ophthalmol. 2004 Sep;88(9):1114-8. doi: 10.1136/bjo.2003.039834.
Recurrence of trichiasis following surgery remains unacceptably high, regardless of the surgical procedure. Few prospective studies of sufficient size are available to assess the rate of recurrence and the factors contributing to recurrence. A prospective study of the modified Cuenod Nataf surgical procedure was conducted in Vietnam to determine recurrence and co-factors.
The prospective study of Cuenod Nataf surgery for trachomatous trichiasis took place in four districts of Vietnam. All patients from identified villages who had surgery were followed for a period of 1 year. 10 Surgeons using standard techniques and recording procedures carried out the surgery. The presence of an eyelash touching the eyeball in the operated eye was considered as recurrence. Information on all subjects was recorded preoperatively, intraoperatively, and postoperatively. An independent examiner recorded postoperative information. Relative risks were calculated to assess the contribution of various risk factors to recurrence (by eye and by person). Cox proportional hazards modelling was used to assess the independent contribution of relevant factors to the outcome.
471 individuals had trichiasis surgery; 463 were followed for a period of 1 year. Overall, the recurrence rate was 10.8% (95% CI 8.0 to 13.6). Among people having surgery recurrence (one or both eyes) was most common in the most elderly (relative risk (RR) 2.49) and among those with a history of previous surgery (RR = 2.49). Cox proportional hazards analysis (by eye) revealed that visual acuity, conjunctival scarring, and suture adjustment were associated with recurrence at 1 year.
The Cuenod Nataf procedure, which is well accepted in the community and by eye care providers in Vietnam, has an acceptable 1 year success rate. Individuals with severe conjunctival scarring have the highest rate of recurrence suggesting that other surgical approaches are needed to manage these patients or that these patients need to be educated regarding the risk of recurrence. Active follow up of these patients would be warranted. The association with suture adjustment requires further investigation.
无论采用何种手术方式，倒睫手术后的复发率仍然高得令人难以接受。目前几乎没有足够规模的前瞻性研究来评估复发率以及导致复发的因素。在越南开展了一项关于改良的屈诺德·纳塔夫手术的前瞻性研究，以确定复发情况和相关因素。
针对越南四个地区的沙眼性倒睫患者开展了屈诺德·纳塔夫手术的前瞻性研究。对所有来自已识别村庄且接受手术的患者进行为期1年的随访。10名外科医生采用标准技术和记录程序实施手术。将手术眼出现睫毛触及眼球的情况视为复发。术前、术中和术后记录所有受试者的信息。由一名独立检查人员记录术后信息。计算相对风险以评估各种风险因素对复发的影响（按眼和按人）。采用Cox比例风险模型评估相关因素对结果的独立影响。
471例患者接受了倒睫手术；463例患者接受了为期1年的随访。总体而言，复发率为10.8%（95%可信区间8.0至13.6）。在接受手术的人群中，复发（一只眼或双眼）在年龄最大的人群中最为常见（相对风险（RR）为2.49），且在有既往手术史的人群中也较为常见（RR = 2.49）。Cox比例风险分析（按眼）显示，视力、结膜瘢痕形成和缝线调整与1年后的复发有关。
屈诺德·纳塔夫手术在越南社区和眼科护理人员中得到广泛认可，其1年成功率尚可接受。结膜瘢痕严重的个体复发率最高，这表明需要采用其他手术方法来治疗这些患者，或者需要对这些患者进行复发风险教育。对这些患者进行积极随访是有必要的。缝线调整与复发之间的关联需要进一步研究。
