Gender differences in the surgical management of trachomatous trichiasis: an exploratory analysis of global trachoma survey data, 2015-2019.

BACKGROUND: Trachomatous trichiasis (TT) is a painful, potentially blinding eye condition that can be managed through epilation or surgery. Women are affected by TT approximately twice as often as men and are believed to face gendered barriers to receiving surgical care to prevent vision loss. METHODS: We used data from 817 cross-sectional surveys conducted during 2015-2019 in 20 African countries to estimate the prevalence difference (PD) between female and male eyes for four outcomes potentially indicating gender-related differences in TT management: (1) received surgery and developed postoperative TT (PTT), (2) never offered surgery, (3) offered surgery but declined it, and (4) offered epilation but never offered surgery. RESULTS: The prevalence was modestly elevated among female eyes compared with male eyes for having PTT (PD:1.8 [95% confidence limits (CL): 0.6, 3.0]) and having declined surgery for the eye (PD: 6.2 [95% CL: 1.8, 10.7]). The proportion offered epilation was similar by gender (PD:0.5 [95% CL: -0.4, 1.3]), while never having been offered surgery was somewhat more prevalent among male eyes (PD: -2.1 [95% CL: -3.5, -0.7]). CONCLUSIONS: Our results suggest potential gender differences in TT management. More research is needed to determine the causes and implications of the observed differences.

Global progress toward the elimination of active trachoma: an analysis of 38 countries.

BACKGROUND: Global elimination of trachoma as a public health problem was targeted for 2020. We reviewed progress towards the elimination of active trachoma by country and geographical group. METHODS: In this retrospective analysis of national survey and implementation data, all countries ever known to be endemic for trachoma that had either implemented at least one trachoma impact survey shown in the publicly available Trachoma Atlas, or are in Africa were invited to participate in this study. Scale-up was described according to the number of known endemic implementation units and mass drug administration implementation over time. The prevalence of active trachoma-follicular among children aged 1-9 years (TF1-9) from baseline, impact, and surveillance surveys was categorised and used to show programme progress towards reaching the elimination threshold (TF1-9 <5%) using dot maps, spaghetti plots, and boxplots. FINDINGS: We included data until Nov 10, 2021, for 38 countries, representing 2097 ever-endemic implementation units. Of these, 1923 (91·7%) have had mass drug administration. Of 1731 implementation units with a trachoma impact survey, the prevalence of TF1-9 had reduced by at least 50% in 1465 (84·6%) implementation units and 1182 (56·4%) of 2097 ever-endemic implementation units had reached the elimination threshold. 2 years after reaching a TF1-9 prevalence below 5%, most implementation units sustained this target; however, 58 (56·3%) of 103 implementation units in Ethiopia showed recrudescence. INTERPRETATION: Global elimination of trachoma as a public health problem by 2020 was not possible, but this finding masks the great progress achieved. Implementation units in high baseline categories and recrudescent TF1-9 might prolong the attainment of elimination of active trachoma. Elimination is delayed but, with an understanding of the patterns and timelines to reaching elimination targets and a commitment toward meeting future targets, global elimination can still be achieved by 2030. FUNDING: None.

[Characteristics of ophthalmic symptoms in the 278 patients with human immunodeficiency virus].

OBJECTIVE: To investigate the characteristics of ophthalmic symptoms of patients with human immunodeficiency virus (HIV) and to provide reference for early diagnosis and treatment of HIV. METHODS: The clinical data of 278 patients with HIV, including ophthalmic symptoms and general condition collected from September 2002 to July 2004, were analyzed retrospectively. These patients were from the Central African Republic. RESULTS: Among the 278 patients with HIV, 102 had pathologic changes in the eyes and were accompanied with chronic dissipative symptoms and decreased CD4 cell counts. The pathogen of 278 patients with HIV at the initial reception were airway infection (n = 87, 31.3%), digestive tract infection (n = 65, 23.4%), skin symptoms (n = 55, 19.8%), multiple organ failure (n = 51, 18.4%) and ophthalmic symptoms (n = 20, 7.2%). Ophthalmic symptoms manifested as opportunistic infection and sarcoma formation, such as HIV retinopathy, chronic uveitis, external ophthalmoplegia, ocular herpes, and Kaposi's sarcoma in the eyelid. HIV-related retinopathy was not specific, which manifested as retinal hemorrhage, cotton wool spots, vascular occlusion, retinal necrosis, retinal detachment and ocular nerve atrophy. CONCLUSIONS: Many kinds of ophthalmic symptoms might appear in patients with HIV. Severe retinopathy and uveitis are the main causes of ablepsia. Because of neglecting the ophthalmic symptoms in the early stage, many HIV patients suffer from decreased visual acuity, which may severely affect the quality of their lives. Consequently, ophthalmologists should pay more attention to patients in the early stage of HIV.