Resultados a corto y largo plazo de la técnica de evisceración de los cuatro pétalos: de 1 mes a 1 año de seguimiento

La pérdida del globo ocular por trauma, enfermedad o secuelas de cirugías previas es frecuente, la técnica quirúrgica utilizada y la colocación del implante, tienen como objetivo la mejoría cosmética de los pacientes. La evisceración es una técnica en la que se realiza el legrado minucioso del contenido ocular, preservando la esclera y los músculos extraoculares, con mínima manipulación del contenido orbitario, lo que a largo plazo permite una mejor movilidad del muñón y menor atrofia de los tejidos perioculares. La evisceración fue introducida en 1817 por Bear,1 Mules en 1885, mejoró el resultado cosmético post evisceración colocando una esfera de vidrio dentro de la esclera para adicionar volumen y soporte. En 1887, Frost reportó una serie de pacientes que desarrollaron oftalmía simpática post evisceración y el temor por esta complicación hizo que la técnica casi fuera abandonada. Se ha debatido ampliamente sobre los beneficios de la evisceración sobre la enucleación entre ellos se incluyen, mayor facilidad de la cirugía, mejor estabilidad, así como ventajas cosméticas y de motilidad. En este estudio, se describe la experiencia con 30 pacientes a quienes se les realizó la técnica de evisceración de los cuatro pétalos, con la colocación de un implante de metacrilato de metilo en la cavidad escleral, con buenos resultados cosméticos y funcionales así como mínimas complicaciones a corto y largo plaz

Association of vision impairment and blindness with socioeconomic status in adults 50 years and older from Alto Amazonas, Peru.

OBJECTIVE: To determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness. METHODS: In this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card. RESULTS: Overall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2-47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9-7.3) as blind. Belonging to the highest SES tercile had a protective effect on VI or blindness (OR 0.29, 95% CI 0.09 to 0.91, p = 0.034), with a linear trend across decreasing levels of SES (p = 0.019). This observed effect remained significant regardless of how SES groups were assigned. CONCLUSION: Belonging to a higher SES group resulted in a lower odds of VI or blindness compared to those in the lowest SES group. The observation of a dose response provides confidence in the observed association, but causality remains unclear. Blindness prevention programs could maximize impact by designing activities that specifically target people with lower SES

Integrated survey methodologies for neglected tropical diseases.

The 2021-2030 Neglected Tropical Diseases road map calls for intensified cross-cutting approaches. By moving away from vertical programming, the integration of platforms and intervention delivery aims to improve efficiency, cost-effectiveness and programme coverage. Drawing on the direct experiences of the authors, this article outlines key elements for successful integrated surveys, the challenges encountered, as well as future opportunities and threats to such surveys. There are multiple advantages. Careful planning should ensure that integration does not result in a process that is less efficient, more expensive or that generates data driving less reliable decisions than conducting multiple disease-specific surveys

Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania

BACKGROUND: Photography could be used to train individuals to diagnose trachomatous inflammation-follicular (TF) as trachoma prevalence decreases and to ensure accurate field TF grading in trachoma prevalence surveys. We compared photograph and field TF grading and determined the acceptability and feasibility of eyelid photography to community members and trachoma survey trainers. METHODS: A total of 100 children ages 1-9 y were examined for TF in two Maasai villages in Tanzania. Two images of the right everted superior tarsal conjunctiva of each child were taken with a smartphone and a digital single-lens reflex (DSLR) camera. Two graders independently graded all photos. Focus group discussions (FGDs) were conducted with community members and Tropical Data trainers. RESULTS: Of 391 photos, one-fifth were discarded as ungradable. Compared with field grading, photo grading consistently underdiagnosed TF. Compared with field grading, DSLR photo grading resulted in a higher prevalence and sensitivity than smartphone photo grading. FGDs indicated that communities and trainers found photography acceptable and preferred smartphones to DSLR in terms of practicalities, but image quality was of paramount importance for trainers. CONCLUSIONS: Photography is acceptable and feasible, but further work is needed to ensure high-quality images that enable accurate and consistent grading before being routinely implemented in trachoma surveys

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

PURPOSE: Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. METHODS: Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. RESULTS: Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. CONCLUSION: This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Potential Effect of Epilation on the Outcome of Surgery for Trachomatous Trichiasis = Efecto potencial de la depilación en el desenlace quirúrgico de la triquiasis tracomatosa

Abstract: Purpose: To evaluate the association of epilation before surgery on the surgical outcome in trachomatous trichiasis (TT) patients. Methods: As a secondary data analysis, 1452 patients enrolled in the STAR trial were categorized according to preoperative epilation status. The main outcome was recurrent trichiasis after surgery. We used multivariable analysis, time-to-event analysis, and Cox proportional hazards model. Results: Those who epilated prior to surgery tended to be older and female, with worse entropion at baseline. The proportion with postoperative trichiasis was 7.7%, 8.8% in those who epilated versus 5.3% in those who did not (P ¼ 0.03). Adjusting for age and sex, the risk of postoperative TT with epilation was 1.71 (P value ¼ 0.02). Although entropion may be in the biological pathway from epilation to postoperative TT, we adjusted for entropion, and the risk of postoperative TT with epilation was 1.41 (P ¼ 0.14). Conclusions: The study suggests that preoperative epilation may increase the risk of postoperative trichiasis. Further research is needed to confirm the finding. Translational Relevance: Patients with TT often self-treat, epilating their inturned eyelashes. The World Health Organization recommends surgery to treat TT, but when patients refuse the procedure or mild trichiasis is present, epilation is often recommended. There is some evidence that repetitive or improper epilation can be harmful to the lid and hair follicles. If there is damage to the lid margin, any subsequent surgery could have deleterious outcomes. Resumen: Objetivo: Evaluar la asociación de la depilación antes de la cirugía con el resultado quirúrgico en pacientes con triquiasis tracomatosa (TT). Métodos: Se realizó un análisis secundario de datos, 1452 pacientes del estudio STAR se clasificaron según el estado de depilación preoperatoria. El resultado principal fue la triquiasis recurrente después de cirugía. Utilizamos análisis multivariable, análisis de tiempo transcurrido hasta el evento y modelo de riesgos proporcionales de Cox. Resultados: Aquellos que se depilaron antes de la cirugía tendieron a ser mayores y mujeres, con entropión más severo al inicio del estudio. La proporción con triquiasis postoperatoria fue del 7,7%, 8,8% en los que se depilaron frente al 5,3% en los que no (P = 0,03). Ajustando por edad y sexo, el riesgo de TT postoperatoria con depilación fue de 1,71 (valor de p = 0,02). Aunque el entropión puede estar en la vía biológica desde la depilación hasta el TT posoperatorio, ajustamos el entropión y el riesgo de TT postoperatorio con depilación fue de 1,41 (p = 0,14). Conclusiones: El estudio sugiere que la depilación preoperatoria puede incrementar el riesgo de triquiasis postoperatoria. Se necesita más investigación para confirmar este hallazgo. Relevancia traslacional: los pacientes con TT a menudo se autotratan, depilando sus pestañas dirigidas hacia adentro. La Organización Mundial de la Salud recomienda la cirugía para tratar la TT, pero cuando los pacientes rechazan el procedimiento o hay una triquiasis leve, a menudo se recomienda la depilación. Existe alguna evidencia de que la depilación repetitiva o incorrecta puede ser dañina para el párpado y los folículos pilosos. Si hay daño en el margen del párpado, cualquier cirugía posterior podría tener resultados perjudiciales

Prevalence of trachoma and associated factors in the rural area of the department of Vaupés, Colombia.

OBJECTIVES:The objectives of the study were to estimate the prevalence of different clinical signs of trachoma and identify possible factors associated with TF. METHODOLOGY:Following the approval of the study protocol by the ethics committee, a cross-sectional study was conducted in Vaupés, a department of the Colombian Amazon, between the years 2012 and 2013 in two districts. Based on the records obtained from a standardized format for the clinical evaluation of the participants and the factors associated with follicular trachoma, an excel database was built and debugged, which was analyzed using IBM SPSS, Statistics Version 23 and Stata STATA (Version 14, 2015, StataCorp LLC, Texas, USA). RESULTS:The records of 13,091 individuals was collected from 216 rural indigenous communities, of which 12,080 were examined (92.3%); 7,274 in the Western and 4,806 in the Eastern districts. A prevalence of trachomatous inflammation-follicular (TF) of 21.7% (n = 599; 95% CI 20.2-23.3) in the Western and 24.9% (n = 483; 95% CI 23.1-26.9) in the Eastern district was found in children aged 1 to 9 years. Regarding trachomatous trichiasis (TT), 77 cases were found, of which 14 belonged to the Western district (prevalence 0.3%, CI 95% 0.2-0.5) and 63 to the Eastern district (1.8%, CI 95% 1.4-2.4). Children aged between 1 to 9 years were significantly more likely to have TF when there was the presence of secretions on the face (OR: 3.2; 95% CI: 2.6-3.9). CONCLUSIONS:Trachoma is a public health problem in Vaupés that requires the implementation of the SAFE strategy (S = Surgery, A = Antibiotics, F = Face Washing, E = Environment) in the Eastern and Western districts, for at least 3 consecutive years, in accordance with WHO recommendations

Association of vision impairment and blindness with socioeconomic status in adults 50 years and older from Alto Amazonas, Peru.

ObjectiveTo determine the relationship between socioeconomic status (SES) and visual impairment (VI) or blindness in the rural Peruvian Amazon, hypothesizing that higher SES would have a protective effect on the odds of VI or blindness.MethodsIn this cross-sectional study of 16 rural communities in the Peruvian Amazon, consenting adults aged ≥ 50 years were recruited from ~30 randomly selected households per village. Each household was administered a questionnaire and had a SES score constructed using principal components analysis. Blindness and VI were determined using a ministry of health 3-meter visual acuity card.ResultsOverall, 207 adults aged ≥ 50 were eligible; 146 (70.5%) completed visual acuity screening and answered the questionnaire. Of those 146 participants who completed presenting visual acuity screening, 57 (39.0%, 95% CI 30.2-47.1) were classified as visually impaired and 6 (4.1%, 95% CI 0.9-7.3) as blind. Belonging to the highest SES tercile had a protective effect on VI or blindness (OR 0.29, 95% CI 0.09 to 0.91, p = 0.034), with a linear trend across decreasing levels of SES (p = 0.019). This observed effect remained significant regardless of how SES groups were assigned.ConclusionBelonging to a higher SES group resulted in a lower odds of VI or blindness compared to those in the lowest SES group. The observation of a dose response provides confidence in the observed association, but causality remains unclear. Blindness prevention programs could maximize impact by designing activities that specifically target people with lower SES

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. Between 29 February 2016 and 24 April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets

Tropical Data: Approach and Methodology as Applied to Trachoma Prevalence Surveys

Population-based prevalence surveys are essential for decision-making on interventions to achieve trachoma elimination as a public health problem. This paper outlines the methodologies of Tropical Data, which supports work to undertake those surveys. Tropical Data is a consortium of partners that supports health ministries worldwide to conduct globally standardised prevalence surveys that conform to World Health Organization recommendations. Founding principles are health ministry ownership, partnership and collaboration, and quality assurance and quality control at every step of the survey process. Support covers survey planning, survey design, training, electronic data collection and fieldwork, and data management, analysis and dissemination. Methods are adapted to meet local context and needs. Customisations, operational research and integration of other diseases into routine trachoma surveys have also been supported. Between 29th February 2016 and 24th April 2023, 3373 trachoma surveys across 50 countries have been supported, resulting in 10,818,502 people being examined for trachoma. This health ministry-led, standardised approach, with support from the start to the end of the survey process, has helped all trachoma elimination stakeholders to know where interventions are needed, where interventions can be stopped, and when elimination as a public health problem has been achieved. Flexibility to meet specific country contexts, adaptation to changes in global guidance and adjustments in response to user feedback have facilitated innovation in evidence-based methodologies, and supported health ministries to strive for global disease control targets.</p