The Association Between the Severity of Trachomatous Scarring and Trachomatous Trichiasis Severity in Surgical Patients in Tanzania

To determine the association between the severity of trachomatous conjunctival scarring (TS) of the upper eyelid conjunctiva and trachomatous trichiasis (TT) severity in TT surgical patients. A cross-sectional study was conducted amongst adults with TT who were referred to surgical camps in Bahi District, Tanzania, for TT surgery. Participants underwent ocular examination. The presence and severity of TS was evaluated in photographs of the everted upper eyelid. TT severity was assessed at the time of the ocular exam based on the number of lashes touching the globe and/or evidence and extent of epilation. Ordinal logistic models were used to examine the association between the severity of TS and TT severity. A total of 627 eyes of 388 participants were included. Mean age was 65 years (ranging from 21–98), 81% were females, and 62% had bilateral TT. 93% of eyes with any TT had at least moderate TS; 62% of eyes had severe TS. An increase in TS severity was associated with an increase in the severity of TT. Using as a reference eyes with none to mild TS, in eyes with moderate TS the odds of increased severity of TT was 1.30 (95% CI 0.67–2.51), in eyes with severe TS the odds was 4.20 (95% CI 2.23–7.92). In cases of trachomatous trichiasis presenting for surgery, the severity of TT was significantly associated with the severity of TS with almost all cases of TT having moderate or severe scarring.

本研究旨在探讨接受沙眼性倒睫（trachomatous trichiasis, TT）手术的患者中，上睑结膜沙眼性结膜瘢痕（trachomatous conjunctival scarring, TS）严重程度与TT严重程度的关联。研究针对转诊至坦桑尼亚巴希区手术义诊点接受TT手术的成年受试者开展了一项横断面研究。所有受试者均接受眼部检查：通过翻转上睑的结膜照片评估TS的存在与否及严重程度；TT严重程度则依据检查时接触眼球的睫毛数量、睫毛拔除的迹象及范围进行判定。本研究采用有序logistic回归模型分析TS严重程度与TT严重程度的相关性。本研究共纳入388名受试者的627只患眼，受试者平均年龄为65岁（年龄范围21~98岁），其中女性占比81%，62%的受试者存在双侧TT。93%的患眼至少合并中度TS，62%的患眼存在重度TS。TS严重程度升高与TT严重程度升高显著相关：以无TS或轻度TS的患眼为参照，中度TS患眼的TT严重程度升高优势比为1.30（95%置信区间：0.67~2.51），重度TS患眼的优势比为4.20（95%置信区间：2.23~7.92）。综上，在就诊手术的沙眼性倒睫患者中，TT严重程度与TS严重程度显著相关，且几乎所有TT患者均合并中度或重度结膜瘢痕。