Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
The Carter Center, Addis Ababa, Ethiopia.
PLoS Negl Trop Dis. 2020 Dec 14;14(12):e0008882. doi: 10.1371/journal.pntd.0008882. eCollection 2020 Dec.
WHO endorsed the use of epilation as an alternative treatment to surgery for the management of both minor unoperated TT (UTT) and postoperative TT (PTT). However, some trachoma control programmes hesitated to implement epilation citing concerns that it would hamper TT surgical acceptance and result in larger numbers of and stiffer trichiatic eyelashes than the original TT lashes. We investigated the burden and phenotypes of post-epilation trichiatic eyelashes, and willingness to accept surgical management separately in unoperated and postoperative TT cases.
METHODOLOGY/PRINCIPAL FINDINGS: We recruited cases with minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) UTT (170) and PTT (169) from community-based screenings in Amhara Region, Ethiopia. Participants eyes were examined and data on present and future willingness to accept surgical management collected at baseline and every month for 6-months. Eyelashes touching the eye were counted and their phenotypes documented. Participants were trained on how to epilate. Epilation was done by the participants at home and by the examiner during follow-ups when requested by the participant. Follow-up rates were ≥97%. There was evidence of a significant reduction in the burden of trichiatic eyelashes in unoperated (mean difference = -0.90 [-1.11- -0.69]; RR = 0.50 [95% CI, 0.40-0.62]; p<0.0001), and postoperative (mean difference = -1.16 [-1.36- -0.95]; RR = 0.38 [95% CI, 0.31-0.48]; p<0.0001) cases 6-month after frequent epilation. Post-epilation trichiatic eyelashes at 6-months had higher odds of being thin (40.2% vs 55.8%, OR = 1.88 [95% CI, 1.21-2.93]; p = 0.0048), weak (39.8% vs 70.8%, OR = 3.68 [95%CI,2.30-5.88]; p<0.0001), and half-length (30.9% vs 43.3%, OR = 1.71 [1.09-2.68]; p = 0.020) than the pre-epilation trichiatic eyelashes in unoperated cases. There was a significant increase in the proportion of weak trichiatic eyelashes (OR = 1.99 [95% CI, 1.03-3.83; p = 0.039) in postoperative cases. In all 6 follow-up time points, 120/164 (73.2%) of unoperated and 134/163 (82.2%) of postoperative cases indicated that they would accept surgery if their trichiasis progressed.
CONCLUSIONS/SIGNIFICANCE: In this study setting, frequent epilation neither hampers surgical acceptance nor results in more damaging trichiatic eyelashes than the pre-epilation lashes; and can be used as an alternative to the programmatic management of minor unoperated and postoperative TT cases.
世界卫生组织（WHO）支持使用拔除法作为手术治疗未手术的 TT（UTT）和术后 TT（PTT）的替代方法。然而，一些沙眼控制项目犹豫不决地实施拔除法，理由是担心这会阻碍 TT 手术的接受度，并导致更多和更硬的睫毛，比原来的 TT 睫毛更硬。我们调查了未手术和术后 TT 病例中拔除法后睫毛的负担和表型，以及分别对手术管理的接受意愿。
方法/主要发现：我们从埃塞俄比亚阿姆哈拉地区的社区筛查中招募了患有小（≤5 根睫毛从上眼睑触碰到眼睛，或在上眼睑的 <1/3 处有拔毛的证据）UTT（170 例）和 PTT（169 例）的病例。在基线和 6 个月的随访期间，对参与者的眼睛进行检查，并收集目前和未来接受手术治疗的意愿的数据。计数触碰到眼睛的睫毛，并记录其表型。参与者接受了如何拔毛的培训。参与者在家中自行拔毛，参与者要求时，由检查者在随访期间进行拔毛。随访率≥97%。未手术（平均差异=-0.90[-1.11- -0.69]；RR=0.50[95%CI，0.40-0.62]；p<0.0001）和术后（平均差异=-1.16[-1.36- -0.95]；RR=0.38[95%CI，0.31-0.48]；p<0.0001）病例在频繁拔毛后 6 个月，睫毛负担明显减轻。术后 6 个月，拔除法后的睫毛更有可能变薄（40.2% vs 55.8%，OR=1.88[95%CI，1.21-2.93]；p=0.0048）、脆弱（39.8% vs 70.8%，OR=3.68[95%CI，2.30-5.88]；p<0.0001）和半长（30.9% vs 43.3%，OR=1.71[1.09-2.68]；p=0.020），与未手术病例的术前睫毛相比。术后病例中，脆弱睫毛的比例显著增加（OR=1.99[95%CI，1.03-3.83]；p=0.039）。在所有 6 次随访时间点，164 例未手术病例中有 120 例（73.2%）和 163 例术后病例中有 134 例（82.2%）表示，如果他们的倒睫进展，他们将接受手术。
结论/意义：在本研究环境中，频繁的拔毛既不会阻碍手术的接受度，也不会导致比术前睫毛更具破坏性的睫毛；并且可以作为未手术和术后 TT 病例的替代方案。
