Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Surv Ophthalmol. 2024 Jan-Feb;69(1):93-102. doi: 10.1016/j.survophthal.2023.02.008. Epub 2023 Mar 5.
Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.
在眼部感染中，沙眼是导致失明的主要原因。反复的结膜沙眼衣原体感染会导致倒睫、角膜混浊和视力损害。手术通常是缓解不适和保护视力所必需的；然而，在各种情况下，术后沙眼性倒睫（PTT）的发生率都很高。我们想知道原因是什么，PTT 率是否可以降低，以及如何处理发生的 PTT。我们对文献进行了检索。在筛选出的 217 篇论文中，有 59 项研究被确定为可能相关的研究，但大多数研究因与人类 PTT 无关而被排除在外。预防 PTT 是一个主要挑战。只有一项发表的试验，即埃塞俄比亚的 STAR 试验，报告了手术后一年累积 PTT 率<10%。关于 PTT 管理的文献很少。虽然没有 PTT 管理指南，但为 PTT 患者提供高质量且不良结局发生率低的手术可能需要对一小部分技能高超的外科医生进行强化培训。基于手术的复杂性和作者自己的经验，应该进一步研究 PTT 患者的治疗途径以进行改进。
