Background High incidence of post-operative trichiasis and other poor outcomes after surgery in most trachoma-endemic settings poses a major challenge to global elimination of trachoma. This systematic review aimed to assess the incidence of post-operative trichiasis and other poor outcomes of trichiasis surgery in Africa, based on findings of observational and interventional studies. Search methods We searched PubMed, Academic Search Premier, Africa-Wide Information, CINAHL and Health Source Nursing through EBSCOhost, Web of Science [all databases], and Cochrane Central Register of Controlled Trials for relevant studies on the subject. We also searched the reference lists of included studies to identify further potentially relevant studies. We included all observational and interventional studies that measured post-operative trichiasis as one of the primary outcomes. Only studies conducted in Africa were included in this review. Data collection and analysis Two reviewers independently screened the titles and abstracts, selected and assessed the articles for inclusion in this review. Any disagreements were resolved through discussion or by consulting a third reviewer. Where necessary, the corresponding authors of included studies were contacted to provide any missing data. Our primary outcome was post-operative trichiasis, which was defined as any eyelash touching the globe at different time points after surgery. Main results Thirty-five studies, including 12,943 participants, met the inclusion criteria. A number of the studies included in this review utilized the same data to measure the incidence of post-operative trichiasis and other poor outcomes over different follow-up periods. Overall, a review of the included studies revealed a pattern of high incidence of post-operative trichiasis and other poor outcomes ranging from 2.3 at 6 weeks to 65% at 7 years. This incidence varied by type of study design, surgical procedure and technique used as well as the follow up period among other factors.

Submitted by RAQUEL GALVAO BEZERRA (raquelgbezerra@gmail.com) on 2018-08-20T03:48:26Z No. of bitstreams: 1 Dissertação Corrigida Pela Banca Pós Defesa.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) / Approved for entry into archive by Sulamita Selma C Colnago null (sulamita@btu.unesp.br) on 2018-08-20T18:10:40Z (GMT) No. of bitstreams: 1 bezerra_rg_me_bot.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) / Made available in DSpace on 2018-08-20T18:10:40Z (GMT). No. of bitstreams: 1 bezerra_rg_me_bot.pdf: 818740 bytes, checksum: a1ecb695e00e0b5ca1cb59e7fb07b2dd (MD5) Previous issue date: 2018-07-17 / Objetivo: estabelecer valores-padrão para a aplicação do laser de diodo verde para o tratamento da triquíase menor e maior, assim como avaliar a taxa de sucesso com o tratamento realizado. Método: estudo prospectivo, com intervenção, realizado nos anos de 2016 e 2017, envolvendo portadores de triquíase com até 10 cílios alterados por pálpebra e que foram submetidos ao tratamento de termoablação dos cílios utilizando o laser de diodo Zeiss Visulas 532s com emissão de luz verde com comprimento de onda de 532nm. Os parâmetros utilizados foram definidos empiricamente, com tempo de aplicação de 200 ms, mira de 50 μm, intervalo de 150 a 200 ms, potência de 600 a 750 mW. O número de tiros aplicados foi definido pela a profundidade de ablação de 2,5 mm para cílios na pálpebra superior e 1,5 mm para os da pálpebra inferior. Os pacientes foram seguidos por até 15 meses, com reavaliações a cada 3 ou 4 meses. Dados demográficos, características da triquíase, bem como a taxa de sucesso no tratamento foram analisados estatisticamente. Resultados: Noventa e oito pacientes, 130 olhos, 135 pálpebras acometidas e 337 cílios triquiáticos foram estudados. A média de idade dos pacientes foi de 72,1 ± 12,3 anos, a maioria do sexo masculino (54,1%), da raça branca (98%), com triquíase menor (91,8%), unilateral (67,3%), sendo o olho direito (54,6%) e a pálpebra inferior (85,9%) os mais acometidos. A causa mais comum da triquíase foi a blefarite (64,3%), seguida de causas idiopáticas (15,3%). Não houve significância estatística na comparação das variáveis idade, sexo, raça, olho acometido e etiologia com a presença ou quantidade de cílios triquiáticos (p>0,05). Houve perda de seguimento em 11,2% dos pacientes. Utilizando os parâmetros citados, do total que permaneceu até o final do estudo, 69% obtiveram cura com 1 sessão, 13,8% com 2 e 1,1% com 3 ou 4 sessões. Considerando apenas os indivíduos que concluíram o tratamento e excluindo os que perderam seguimento, a taxa de cura foi de 85%. Houve redução de 2,5 para 0,7 cílios triquiáticos por pálpebra com apenas 1 sessão (p<0,001) e o número médio de tiros por cílio foi de 60,7. Pacientes submetidos a tratamentos prévios e com etiologia idiopática tiveram as maiores taxas de cura, 98,1% e 91,7% respectivamente. Conclusão: a termoablação com laser de diodo, usando os parâmetros observados neste estudo, é efetiva, apresentando altas taxas de cura no tratamento da triquíase. / Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with the presence or quantity of the trichiatic eyelashes (p>0,05). Around 11.2% of patients lost follow-up. Using the mentioned parameters, of the total remaining until the end of study, 69% of patients achieving cure with 1 session, 13.8% with 2 and 1.1% with 3 or 4 sessions. Considering only the individuals who completed the treatment and excluding those who lost follow-up, the cure rate was 85%. There was a reduction of 2.5 to 0.7 trichiatic eyelashes per eyelid with only 1 session (p<0,001) e the average number of shots per eyelash was 60.7. Patients submitted to previous treatments and with idiopathic etiology had the highest cure rates, 98.1% and 91.7%, respectively. Conclusion: thermoablation with diode laser, using the parameters observed in this study, is effective, with high cure rates in the treatment of trichiasis.

Orientador: Silvana Artioli Schellini / Resumo: Objetivo: estabelecer valores-padrão para a aplicação do laser de diodo verde para o tratamento da triquíase menor e maior, assim como avaliar a taxa de sucesso com o tratamento realizado. Método: estudo prospectivo, com intervenção, realizado nos anos de 2016 e 2017, envolvendo portadores de triquíase com até 10 cílios alterados por pálpebra e que foram submetidos ao tratamento de termoablação dos cílios utilizando o laser de diodo Zeiss Visulas 532s com emissão de luz verde com comprimento de onda de 532nm. Os parâmetros utilizados foram definidos empiricamente, com tempo de aplicação de 200 ms, mira de 50 μm, intervalo de 150 a 200 ms, potência de 600 a 750 mW. O número de tiros aplicados foi definido pela a profundidade de ablação de 2,5 mm para cílios na pálpebra superior e 1,5 mm para os da pálpebra inferior. Os pacientes foram seguidos por até 15 meses, com reavaliações a cada 3 ou 4 meses. Dados demográficos, características da triquíase, bem como a taxa de sucesso no tratamento foram analisados estatisticamente. Resultados: Noventa e oito pacientes, 130 olhos, 135 pálpebras acometidas e 337 cílios triquiáticos foram estudados. A média de idade dos pacientes foi de 72,1 ± 12,3 anos, a maioria do sexo masculino (54,1%), da raça branca (98%), com triquíase menor (91,8%), unilateral (67,3%), sendo o olho direito (54,6%) e a pálpebra inferior (85,9%) os mais acometidos. A causa mais comum da triquíase foi a blefarite (64,3%), seguida de causas idiopáticas (15,3%). Não hou... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Purpose: to establish standard parameters for laser application as well as to evaluate the success rate of treatment of minor and major trichiasis using green diode laser. Method: a prospective study with intervention, was carried out in the years 2016 and 2017, involving trichiasis carriers with up to 10 misdirected lashes per eyelid that were submitted to the thermoablation treatment of the misdirected lashes using Zeiss Visulas 532s diode laser with green light emission with wavelength of 532nm. The parameters used were empirically defined, with an application time of 200 ms, 50 μm size, range of 150 to 200 ms and power of 600 to 750 mW. The number of shots applied was defined by the depth of ablation of 2.5 mm for upper eyelid lashes and 1.5 mm for lower eyelid lashes. The patients were followed for up 15 months, with revaluations every 3 or 4 months. Demographic data, trichiasis characteristics, as well as the success rate with treatment were statistically analyzed. Results: ninety eight patients, 130 eyes, 135 affected eyelids and 337 trichiatic eyelashes were studied. The mean age was 72.1 ± 12.3 years old, the majority male (54.1%), Caucasian (98%), with minor trichiasis (91,8%) unilateral (67,3%), being the right eye (54,6%) and the lower eyelid (85,9%) the most affected. The most common etiology was blepharitis (64.3%), followed by idiopathic causes (15.3%). There was no statistical significance in the comparison of age, gender, race, affected eye, and etiology with... (Complete abstract click electronic access below) / Mestre

The secondary analysis undertaken for this MPH dissertation examines the global prevalence of trichiasis in relation to gender in trachoma endemic countries. Part A is the research protocol which outlines the background and the process of this research. This study is a population-based analytical study using data from the Global Trachoma Mapping Project (GTMP). GTMP was a standardized population-based trachoma prevalence survey undertaken to provide trachoma prevalence estimates. GTMP data was collected using the World Health Organisation–recommended population based prevalence survey methodology. Trachoma suspect district were identified for inclusion and multistage random sampling was used to sample households for examination of residents for clinical trachoma. Part B presents the background and highlights the importance of this research by exploring the existing theoretical and empirical literature relevant to the topic. It describes how trachoma is transmitted, its clinical manifestations, and the way it can lead to blindness. Results from previous studies on gender and trichiasis are presented. Part C presents the research project in a format suitable for journal submission. The background of this research project is summarized and the meta-analysis is conducted at the global level, at the country level, the regional level, the state level and at the EU level but all in accordance to prevalence of trichiasis in the EUs. The implications of the findings are discussed and limitations in interpretation presented.