Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery

Trachoma: protective and pathogenic ocular immune responses to Chlamydia trachomatis.

Trachoma, caused by Chlamydia trachomatis (Ct), is the leading infectious blinding disease worldwide. Chronic conjunctival inflammation develops in childhood and leads to eyelid scarring and blindness in adulthood. The immune response to Ct provides only partial protection against re-infection, which can be frequent. Moreover, the immune response is central to the development of scarring pathology, leading to loss of vision. Here we review the current literature on both protective and pathological immune responses in trachoma. The resolution of Ct infection in animal models is IFNγ-dependent, involving Th1 cells, but whether this is the case in human ocular infection still needs to be confirmed. An increasing number of studies indicate that innate immune responses arising from the epithelium and other innate immune cells, along with changes in matrix metalloproteinase activity, are important in the development of tissue damage and scarring. Current trachoma control measures, which are centred on repeated mass antibiotic treatment of populations, are logistically challenging and have the potential to drive antimicrobial resistance. A trachoma vaccine would offer significant advantages. However, limited understanding of the mechanisms of both protective immunity and immunopathology to Ct remain barriers to vaccine development