Recurrence of trachomatous trichiasis 17 years after bilamellar tarsal rotation procedure.

PURPOSE: In 1989, World Health Organization consultant operated on trachomatous trichiasis (TT) cases in Dhakhiliya region of Oman. We evaluated their current ocular status. DESIGN: This was an historic cohort study. METHODS: This study was conducted in an in-house setting. Ninety-one patients with TT who underwent operation by the bilamellar tarsal rotation procedure (BTR) were our study population. Their preoperative, operative, and immediate postoperative data were retrieved from the register. Staff members located and visited these patients. They examined the eyes and determined their visual, TT, and corneal status. They interviewed participants with a close-ended questionnaire to assess the quality of life and satisfaction for the TT services that were offered. RESULTS: Sixty-three patients could be followed. Among 72 eyes that had undergone operation 17 years earlier, the recurrence rate was 47.2% (95% CI, 35.7-58.8). In 21 unoperated eyes (55%), TT was noted. The association of TT recurrence to age, gender, type of TT, conjunctivitis, and active trachoma was tested. The BTR for minor trichiasis was the risk factor for recurrence of TT (adjusted odds ratio, 3.9; 95% CI, 1.4-10.8). CONCLUSION: The high recurrence rate of TT, 17 years after BTR surgery and high rates of TT in eyes that did not undergo surgical procedure earlier suggest that the causes of high recurrence should be identified and addressed. The ongoing pathologic condition of scarring of upper lids of both operated and unoperated eyes could be responsible for lid status after 17 years of BTR surgeries. High percentage of refusals because of long-term high recurrence could pose a challenge to reach the "elimination of blinding trachoma" by 2020.

Refractive error and visual functions in children with special needs compared with the first grade school students in oman.

BACKGROUND: We evaluated the refractive status and visual function of children with special needs (other handicap) in 2010 and compared them with healthy 1(st) grade school students in Oman. MATERIALS AND METHODS: This was a cohort study. Optometrists recorded vision using a logarithm of minimum angle of resolution (LogMAR) chart. Preferential looking method was used for testing 31 children. Cycloplegic refraction was performed on all children. Contrast sensitivity was tested using 2.5%, 10%, and 100% contrast charts. Ocular movement, alignment, and anterior segment were also assessed. A pediatrician reviewed the health records of all the children at the time of their enrollment in this study to determine if the child had been diagnosed with a systemic condition or syndromes. The visual functions were assessed by study investigators. We estimated the rates and the risk of different visual function defects in children with special needs. RESULT: The prevalence of refractive error in 70 children (4.7 ± 0.8 years) with special needs (group 1) and 175 normal healthy first grade students (group 2) were 58.5% and 2.9%, respectively. The risk of refractive error was significantly higher in children with special needs [relative risk, 48.1 (95% confidence interval, 17.54-131.8)]. Hyperopia (>1.00 D), myopia (≥ 1.00D) and astigmatism (≥ ±1.00 D) were found in 18.6%, 24.3%, and 27.1%, respectively, in group 1. Six children in this group had defective near vision. Sixteen (80%) children with Down syndrome had refractive error. Seven (50%) children with developmental disorder showed decreased contrast sensitivity. CONCLUSION: Prevalence of uncorrected refractive error was much higher in children with special needs. Prevalence of strabismus, nystagmus, and reduced contrast sensitivity was also higher in children with special needs. Early vision screening, visual function assessment, correction of refractive error, and frequent follow-up are recommended.

Oman's progress towards reaching "Ultimate Intervention Goals" for the surgery "S" component of SAFE strategy for the elimination of blinding trachoma in 2008.

BACKGROUND: A community based survey for Trachomatous Trichiasis (TT) was conducted in the high (TT >5% in 1997) and meso endemic areas (TT 1% to 5% in 1997) of Oman during 2008-09. METHODS: Investigators examined Omanis 40 age years and older from randomly selected villages. Eyes were examined for TT and vision. The medical history of surgery and advice given for TT surgery were recorded. The TT cases that were unadvised by health staff were defined as un-approached cases. Cluster adjusted prevalence of TT and risk of TT by gender were estimated. RESULT: We examined 4,951 of 5,268 persons in high-endemic areas and 965 of 993 (97.2%) persons in meso-endemic areas. The cluster adjusted prevalence of TT in the high and meso endemic areas were 7.54% (95% Confidence Interval [CI] 6.78-8.30) and 1.69% (95% CI 0.88-2.50) respectively. There were 5 TT patients in high endemic areas and none in meso-endemic areas who were not approached or managed in the past. The prevalence of TT across all ages was less than 1 per 1,000 of the population in all wilayats of Oman. Females had a significantly higher risk of cluster adjusted TT compared to males (Odds Ratio = 1.87 [95% CI 1.85-1.89]). The prevalence of blindness was 0.5% among TT cases in high endemic areas. CONCLUSION: Oman seems to have reached the Ultimate Intervention Goals (UIGs) of the "S" (Surgery) component in 2008 in high and meso-endemic areas. The efforts of existing eye services could be better evaluated if un-approached TT cases are used to calculate the TT prevalence. Oman needs to focus more on females with TT to reach the UIGs.