Systematic review of the incidence of post-operative trichiasis in Africa
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RESEARCH ARTICLE
Open Access
Systematic review of the incidence of postoperative trichiasis in Africa Grace Mwangi1* , Paul Courtright2 and Anthony W Solomon3
Abstract Background: Surgery for trichiasis is one of the pillars of the World Health Organization’s strategy for global elimination of trachoma as a public health problem. A high incidence of post-operative trichiasis or other poor surgical outcomes could jeopardize these efforts. In this review, we aimed to summarize the reported incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa. Methods: We conducted a systematic literature search using PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science, and the Cochrane Central Register of Controlled Trials. Reference lists of included studies were also reviewed to identify further potentially relevant publications. All observational and interventional studies that measured post-operative trichiasis in Africa as an outcome of trichiasis surgery were included. Results: Thirty-five papers reporting on 22 studies (9 interventional,13 observational; total 13,737 participants) met the inclusion criteria. The reported incidence of post-operative trichiasis in the included studies ranged from 2% (at 6 weeks after bilamellar tarsal rotation) to 69% (at 3 weeks after anterior lamellar repositioning). The incidence varied by surgical procedure, study design, and length of follow-up. Conclusion: Trichiasis surgical outcomes should be improved. National trachoma programmes could benefit from identifying and adopting strategies to improve the performance and quality of their surgical service. Keywords: Trachoma, Trichiasis, Entropion, Post-operative trichiasis, Incidence, Eyelid diseases, Surgery
Background Trachoma is the leading infectious cause of blindness worldwide. It is caused by particular strains of the intracellular bacterium Chlamydia trachomatis, believed to be transmitted through infected eye and nose secretions carried on fingers, fomites and eye-seeking flies [1, 2]. Repeated infection leads to scarring of the tarsal conjunctiva, which can then lead to trichiasis (eyelashes touching the eyeball) [3]. Left untreated, trachomatous trichiasis can result in the formation of corneal opacities, which irreversibly impair vision [4]. * Correspondence: [email protected] 1 Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa Full list of author information is available at the end of the article
Surgery is an integral part of the SAFE strategy (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) advocated by World Health Organization (WHO) for elimination of trachoma as a public health problem [5]. Surgery for trichiasis aims to re-position the eyelid margin by externally rotating it so that eyelashes no longer touch the eyeball. Not all cases of trichiasis are due to trachoma and not all cases of trachomatous trichiasis involve entrop
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