OBJECTIVE: To present a novel modified medial canthoplasty (MCP) technique, the application in 601 dogs (1180 eyes), and a review of the early postoperative complications related to the technique.
BACKGROUND: Macroblepharon and nasal entropion is a common presentation in many brachycephalic dog breeds promoting chronic keratitis. The previously described MCP techniques limit the medial shortening of the eyelids to the location of the lacrimal puncta. A novel technique was developed allowing for a more extensive eyelid shortening nasally.
METHODS: The modification of the here described technique includes the longitudinal splitting of the lacrimal canaliculi allowing for an extensive shortening of the lids beyond the lacrimal puncta. Records of 601 dogs which underwent the modified MCP were reviewed regarding breed, indications for surgery, follow-up, and early postoperative surgical complications. Descriptive statistics were applied.
RESULTS: Six hundred one dogs (1180 eyes) were included in this study. Twenty-four different breeds underwent the simplified MCP with the Pug (n = 403) being the most represented breed. Indications were macropalpebral fissure, medial entropion, pigmentary keratitis, trichiasis by haired caruncle, strabismus after globe prolapse, and facial nerve paralysis. The overall complication rate was 1.01% (12/1180) and consisted of wound dehiscence 0.59% (7/1180), corneal ulceration caused by suture material 0.25% (3/1180), and wound infection (2/1180). None of the 601 operated dogs developed serious complications related to the surgical technique.
CONCLUSIONS: The simplified MCP is a novel technique with a very low complication rate.

One criterion for validation of trachoma elimination is the management of Trachomatous Trichiasis (TT) after Trachoma inflammation-follicular (TF) is eliminated in children ages 1-9 years at district level. No data exist on how long countries must have dedicated TT programs, as the timeline for progression to TT from trachomatous scarring is unknown. We used eight years of longitudinal data in women in Kongwa Tanzania to model progression from no scarring (S0) through grades of scarring severity (S1-S4) to TT. Markov models were used, with age, community prevalence of TF (CPTF), and household characteristics as co-variates. Adjusted for covariates, the incidence of S1 was estimated at 4∙7% per year, and the risk increased by 26% if the CPTF was between 5-10% and by 48% if greater than 10%. The transition from S4 to TT was estimated at 2∙6% per year. Districts, even after elimination of TF, may have some communities with TF ≥ 5% and increased risk of incident scarring. Once scarring progresses to S2, further progression is not dependent on CPTF. These data suggest that, depending on the district level of scarring and degree of heterogeneity in CPTF at the time of elimination, incident TT will still be an issue for decades.

OBJECTIVE: Heavy brows in Chow Chow and Shar-Pei dogs can be associated with pseudoptosis and trichiasis-entropion of the upper eyelids, causing vision impairment and ocular discomfort. This study describes the outcomes of brow rhytidectomy ± Stades-like procedure to address these anatomical abnormalities.
METHODS: Retrospective medical records review (2019-2022).
RESULTS: Twenty-seven dogs (n = 15 Chow Chow, n = 12 Shar-Peis) were included, aged 1.9 ± 1.5 years (0.5-6.5 years). Presenting complaints included recurrent episodes of ocular inflammation (n = 13, 48.1%), blepharospasm (n = 10, 37.0%), corneal ulcers (n = 8, 29.6%), entropion (n = 6, 22.2%), and impaired vision (n = 4, 14.8%). Brow skin was removed as follows: (i) First incision parallel and 10-15 mm dorsal to upper lid, slightly extending beyond medial/lateral canthi; (ii) second incision forming an arc with its apex 15-35 mm dorsal to the first incision; and (iii) standard two or three layers closure. In 22/27 dogs, a Stades-like procedure was performed by removing a 2-4 mm strip of skin above eyelid margin and leaving it to heal by secondary intention (no sutures). At last recheck (follow-up 354.5 ± 187.8 days), 19/27 dogs (70.4%) had an adequate eyelid conformation, 7/27 dogs (25.9%) were considered under-corrected, and 1/27 dogs (3.7%) was over-corrected. Most owners (81.5%) were satisfied with the surgical results. Most cases (96.3%) had no recurrence of the clinical signs during the entire follow-up period.
CONCLUSIONS: Brow rhytidectomy ± Stades-like procedure provide good cosmetic and clinical outcomes in Chow Chow and Shar-Pei dogs, although under correction may occur in severely affected dogs and with advancing time.

OBJECTIVE: To evaluate the surgical outcomes of a modified technique for treating congenital cilial entropion in children, which involves reducing tension step by step in the epicanthus and lower eyelid incision.
METHODS: The observational group consisted of 153 pediatric patients (81 males and 72 females) who were treated using the modified technique, whereas the control group included 124 patients (68 males and 56 females) who were treated using the rotating suture surgery. All the participants were bilateral. Surgical outcomes were classified as good, fair, or poor, and the recurrence rate, scar condition, inferior eyelid position, and patient satisfaction were also assessed.
RESULTS: The mean follow-up period was 9.13 ± 3.50 months (range: 3-14 months) for the observational group and 6.93 ± 4.51 months (range: 3-14 months) for the control group. In the observational group, surgical success with \"good\" outcomes was achieved in 300 eyes (98.04%), compared to 224 eyes (90.32%) in the control group. No recurrence occurred in the observational group, whereas the recurrence rate in the control group was 4.43%. Postoperative scar formation was mild in the observational group. The average scar score was 1.27 ± 0.96 in the observational group and 2.70 ± 0.99 in the control group, with a statistically significant difference (P < 0.001). Neither overcorrection nor postoperative ectropion was observed in both groups.
CONCLUSIONS: The modified technique effectively corrected medial entropion and trichiasis in the lower eyelid, resulting in stable postoperative outcomes, mild scar formation, quick recovery, flexible eyelid motility, and stable ocular surface. Therefore, it can be widely applied to children with congenital entropion and trichiasis.

Trachoma is targeted for elimination as a public health problem worldwide by 2030. In Nigeria, elimination activities are implemented at the local government area (LGA) level. They started in 2002 by conducting baseline population-based prevalence surveys (PBPSs), which continued in a systematic manner with engagement from the Global Trachoma Mapping Project in 2013, and subsequently Tropical Data. The results led to the development of Nigeria\'s first trachoma action plan and its subsequent revision with additional information. Following 449 baseline PBPSs, 122 LGAs had an active trachoma prevalence above the elimination threshold, requiring interventions, while 231 LGAs required community-based interventions for trichiasis management. By 2021, >34 million antibiotic treatments had been provided in 104 LGAs, with 89 LGAs eliminating active trachoma. Nationally, water and sanitation coverages increased by 3% and 18%, respectively, in 7 y. Systematic trichiasis case finding and management were carried out in 231 LGAs, resulting in the management of 102 527 people. Fifty-four LGAs decreased trichiasis prevalence unknown to the health system to <0.2% in persons ≥15 y of age. Where this elimination prevalence threshold was reached, trichiasis services were transitioned to routine eye/healthcare systems. Such progress relied on strong leadership and coordination from the national trachoma program and tremendous support provided by partners. Attaining elimination of trachoma as a public health problem in Nigeria by 2030 is feasible if funding support is sustained.

BACKGROUND: In Trachoma endemic countries, many people who underwent Trichiasis surgery faced a recurrence of the disease. Postoperative Trichiasis is a significant problem for patients and health care providers because it puts the eye at renewed risk of sight loss. Despite the low utilization of Trachomatous Trichiasis surgery and the high recurrence rate, evidence that elucidate why it recurs after surgery is limited. This study was aimed to assess the magnitude and associated factors of postoperative Trichiasis among 18 years and above individuals who underwent Trachomatous Trichiasis surgery between 2013 and 2019 in Ambassel District, Northeast Ethiopia, 2020.
METHODS: The community-based cross-sectional study design was conducted from March 10 to March 23/2020 in selected kebeles of Ambassel District. The required sample size (506) was calculated using EPI-INFO Version 7. A multi-stage sampling technique was used to employ study participants. Data were collected through the interviewer-administered structured pre-tested questionnaire and entered into EpiData version 3.1 and then exported to SPSS version 23.0 for analysis. Bi-variable and multivariable logistic regression models were fitted to identify associated factors of Postoperative Trachomatous Trichiasis.
RESULTS: Four hundred ninety two individuals participated in this study with a response rate of 97.2%. In Ambassel district, the prevalence of postoperative Trichiasis was 23.8% (95% CI = 19.9-27.8). Among associated factors of postoperative Trachomatous Trichiasis: age 50-59 (AOR = 3.34, CI = 1.38-8.1), 60-69 (AOR = 3.24, CI = 1.38-7.61), ≥70 years (AOR = 6.04, CI = 2.23-16.41), duration since surgery (AOR = 1.7, CI = 1.35-2.14), complication (AOR = 2.98, CI = 1.24-7.2), washing the face two times (AOR = 0.25, CI = 0.13-0.47), washing the face three and more times (AOR = 0.1, CI = 0.41-0.25), taking Azithromycin following surgery (AOR = 0.19, CI = 0.09-0.41), pre-operative epilation history (AOR = 2.11, CI = 1.14, 3.9) and having a knowledge about TrachomaTtrichiasis (AOR = 0.21, CI = 0.08-0.58) showed a statistical significant association.
CONCLUSIONS: The prevalence of postoperative Trichiasis in Ambassel District was higher than most Ethiopian studies. Age, frequency of face washing, medication following surgery, duration since the last surgery, knowledge about trachoma, pre-operative epilation history, and complication after surgery were identified to be independent factors. To minimize postoperative Trachomatous Trichiasis stakeholders need to consider health education for patients, provision of Azithromycin after surgery, and proper training for integrated eye care workers.

UNASSIGNED: To evaluate the outcomes of trichiasis (excluding entropion) management in non-trachomatous cicatricial ocular surface diseases.
UNASSIGNED: This is a multicenter, retrospective study of 59 patients with trichiasis who were managed using two different techniques: electroepilation using radiofrequency (RF) cautery and eyelash resection. The assessed outcomes were residual trichiasis at 6 weeks, 6, and 12 months of follow-up and the number of procedures needed.
UNASSIGNED: 41 patients (90 eyelids) underwent electroepilation, and 18 (41 eyelids) were managed with eyelash resection. All patients belonged to either Indian or Japanese ethnicity. Most patients in both groups had Stevens-Johnson Syndrome (63.4% vs. 88.9%). The mean age (43.2 vs. 46 years), disease duration (122 vs. 192.4 months), median trichiasis grade (2 vs. 2), and involvement of upper eyelids (53/90 vs. 23/41) were similar in the two groups. At six weeks, 48.9% of eyelids that underwent electroepilation had no trichiasis, and recurrences were managed with repeat electroepilation (6 eyelids) and mucous membrane grafting (10 eyelids), and 35 eyelids opted for manual epilation, giving 67.8% success at a mean follow-up of 20 months. The eyelash resection group had 75.6% success at 6 months, and recurrences were managed using lid splitting and eyelash resection, resulting in 100% success at a mean follow-up of 79 months. More interventions were needed in the electroepilation group compared to eyelash resection.
UNASSIGNED: Eyelash resection of the trichiatic eyelashes achieves a better success rate than electroepilation in cicatricial ocular surface disorders. Following electroepilation, one needs multiple interventions to resolve trichiasis.

Entropion, a common malposition of the eyelid, can lead to trichiasis and corneal damage. This article presents a clinical case in which, following initial surgery to correct entropion, the use of a dermatological punch was chosen to definitively eliminate persistent trichiasis. This relatively unknown yet effective approach proved to be a quick and straightforward alternative with positive outcomes, emphasizing the importance of considering innovative approaches to recurrent challenges in clinical practice.

UNASSIGNED: Repeated infection with Chlamydia trachomatis causes trachomatous trichiasis (TT). Surgery is the main and preferred method of treatment. However, many people decline surgery despite the availability of free services in nearby health facilities.
UNASSIGNED: To identify the determinants of surgery refusal among TT patients in Ethiopia.
UNASSIGNED: This community-based, case-control study was conducted among 338 cases and 338 controls from 5 October to 17 December 2018. Using systematic random sampling, we selected people who had been operated on (controls) and those who refused surgery (cases) from registration documents and used a pre-tested, interviewer-administered, structured questionnaire for data collection. We used SPSS version 23 to analyse the data and used multivariate logistic regression to identify the determinants.
UNASSIGNED: Having witnessed a poor surgical outcome [adjusted odds ratio (aOR): 3.51, 95% CI: 1.94-6.35] and lack of knowledge about TT (aOR: 1.77, 95% CI: 1.18-2.65) increased the refusal rate for surgery. Having trust in the surgeon (aOR: 0.26, 95% CI: 0.15-0.45), knowledge about eyelid surgery (aOR: 0.32, 95% CI: 0.16-0.64), long duration of trichiasis (aOR: 0.50, 95% CI: 0.31-0.79), decision-making via discussion with the family (aOR: 0.29, 95% CI: 0.13-0.64), frequent epilation (aOR: 0.31, 95% CI: 0.17-0.60), and receiving personal advice (aOR: 0.11, 95% CI: 0.04-0.28) reduced refusal rates.
UNASSIGNED: Refusing to have TT surgery was significantly related to knowledge about upper eyelid surgery, past surgical outcomes, decision-making capacity, and personal influences. Improved systems for upper eyelid surgery should be established in Ethiopia to better manage, and reduce unfavourable, surgical outcomes, and reduce surgery refusal.
دراسة الحالات والشواهد لُمُحدِّدات الرفض للجراحة التصحيحية للجفن العلوي بين مرضى الشعرة التراخومية في إثيوبيا.
ميليز كيتو، كيبادنيو ميهريتي، تاي أبوهاي.
UNASSIGNED: تسبب العدوى المتكررة بالُمُتَدثِّّرة الُحُثَرِية مرض الشعرة التراخومية. والجراحة هي الطريقة الرئيسية والمفضلة للعلاج. ومع ذلك، يرفض كثير من الأشخاص إجراء الجراحة، رغم توفُّر الخدمات المجانية في المرافق الصحية القريبة.
UNASSIGNED: هدفت هذه الدراسة الى تحديد المحددات الخاصة برفض إجراء الجراحة بين مرضى الشعرة التراخومية في إثيوبيا.
UNASSIGNED: أُجريت دراسة الحالات والشواهد القائمة على المجتمع هذه على 338 من الحالات و338 من الشواهد في الفترة من 5 أكتوبر/ تشرين الأول إلى 17 ديسمبر/ كانون الأول 2018. وباستخدام أخْْذ العينات العشوائية النظامية، اخترنا أشخاصًا خضعوا للجراحة (الشواهد)، وآخرين رفضوا الجراحة (لحالات) من وثائق التسجيل، واستخدمنا استبيانًا منظَّ ا مًا اختُبر من قبلُ ويُجرِجِيه القائمون بالمقابلة لجمع البيانات. واستخدمنا الإصدار 23 من برنامج SPSS لتحليل البيانات، واستخدمنا الانحدار اللوجستي المتعدد المتغيرات لتحديد المحددات.
UNASSIGNED: إن المعاناة من حصيلة جراحية سلبية [نسبة الأرجحية الُمُعدَّلة: 3.51، فاصل الثقة 6.35-1.94 :٪95]، وعدم الإلمام بمعلومات عن مرض الشعرة التراخومية (نسبة الأرجحية الُمُعدَّلة: 1.77، فاصل الثقة 2.65 -1.18 :٪95) أدى إلى زيادة معدل رفض الخضوع للجراحة. وأدت الثقة في الجرَّاح (نسبة الأرجحية الُمُعدَّلة: 0.26، فاصل الثقة 0.45-0.15 :٪95)، والإلمام بمعلومات عن جراحة الجفن (نسبة الأرجحية الُمُعدَّلة: 0.32، فاصل الثقة 0.64-0.16 :٪95)، وطول مدة الإصابة بانحراف الأهداب (نسبة الأرجحية الُمُعدَّلة: 0.50، فاصل الثقة 0.79-0.31 :٪95)، واتخاذ القرار من خلال المناقشة مع الأسرة (نسبة الأرجحية الُمُعدَّلة: 0.29، فاصل الثقة 0.64-0.13 :٪95)، والنَّتْْف المتكرر (نسبة الأرجحية الُمُعدَّلة: 0.31، فاصل الثقة 0.60-0.17 :٪95)، والحصول على المشورة الشخصية (نسبة الأرجحية الُمُعدَّلة: 0.11، فاصل الثقة 0.28-0.04 :٪95) إلى انخفاض معدلات الرفض.
UNASSIGNED: كان رفض إجراء جراحة الشعرة التراخومية مرتبطًا ارتباطًا كبيًرًا بالإلمام بمعلومات عن جراحة الجفن العلوي، والمخرجات الجراحية السابقة، والقدرة على اتخاذ القرار، والتأثيرات الشخصية. وينبغي إنشاء نُظُم محسنة لجراحة الجفن العلوي في إثيوبيا لتحسين علاج المخرجات الجراحية غير المواتية والحد منها.
Étude cas-témoins des déterminants des refus de chirurgie réparatrice de la paupière supérieure chez les patients atteints de trichiasis trachomateux en Éthiopie.
UNASSIGNED: L\'infection répétée à Chlamydia trachomatis provoque un trichiasis trachomateux. La chirurgie est la méthode de traitement principale et privilégiée. Cependant, de nombreuses personnes refusent les interventions chirurgicales malgré la disponibilité de services gratuits dans les établissements de santé situés à proximité.
UNASSIGNED: Identifier les déterminants du refus d\'intervention chirurgicale chez les patients atteints de trichiasis trachomateux en Éthiopie.
UNASSIGNED: La présente étude cas-témoins réalisée au niveau communautaire a été menée auprès de 338 cas et 338 témoins entre le 5 octobre et le 17 décembre 2018. À l\'aide d\'un échantillonnage aléatoire systématique et à partir des documents d\'inscription, nous avons sélectionné des personnes qui avaient subi une intervention chirurgicale (témoins) et des personnes qui avaient refusé l\'intervention (cas). Nous avons utilisé un questionnaire structuré, administré par un enquêteur et préalablement testé pour la collecte des données. Nous avons utilisé le logiciel SPSS version 23 pour analyser les données et avons recouru à la régression logistique multivariée pour identifier les déterminants.
UNASSIGNED: Le fait d\'avoir été témoin d\'un mauvais résultat chirurgical [odds ratio ajusté (ORa) : 3,51 ; IC à 95 % : 1,94-6,35] et le manque de connaissances sur le trichiasis trachomateux (ORa : 1,77 ; IC à 95 % : 1,18-2,65) sont des facteurs qui ont contribué à l\'augmentation du taux de refus de la chirurgie. Le fait d\'avoir confiance en son chirurgien (ORa : 0,26 ; IC à 95 % : 0,15-0,45), de posséder des connaissances sur la chirurgie de la paupière (ORa : 0,32 ; IC à 95 % : 0,16-0,64), d\'être atteint de trichiasis depuis longtemps (ORa : 0,50 ; IC à 95 % : 0,31-0,79), de baser sa décision sur la discussion avec la famille (ORa : 0,29 ; IC à 95 % : 0,13-0,64), de s\'épiler fréquemment (ORa : 0,31 ; IC à 95 % : 0,17-0,60), et de recevoir des conseils personnels (ORa : 0,11 ; IC à 95 % : 0,04-0,28) étaient des facteurs qui ont contribué à diminuer les taux de refus.
UNASSIGNED: Le refus d\'avoir recours à la chirurgie du trichiasis trachomateux était étroitement lié aux connaissances sur la chirurgie de la paupière supérieure, aux issues chirurgicales antérieures, à la capacité de prise de décision et aux influences personnelles. Des systèmes améliorés de chirurgie de la paupière supérieure devraient être mis en place en Éthiopie pour mieux prendre en charge, diminuer le nombre des issues chirurgicales défavorables et réduire le refus du recours à la chirurgie.

BACKGROUND: Trachoma is a chronic conjunctivitis caused by the bacterium Chlamydia trachomatis. Repeated infections lead to trachomatous conjunctival scarring which can progress to potentially blinding trachomatous trichiasis (TT). In trachoma hyperendemic conditions, women compared to men have an increased risk of scarring and TT, which can progress to blinding corneal opacification. This study determined if there were gender differences in scarring prevalence and severity when trachoma prevalence approaches elimination, in a formerly trachoma hyperendemic region.
RESULTS: A cross-sectional prevalence study was conducted amongst adults age 15 years and older in Kongwa district, Tanzania in 2019. 3168 persons over age 15 years agreed to be examined and had at least one eye with a gradable image. Ocular photographs were graded for scarring according to a published four-step severity scale. Overall, about half of all study participants had scarring. However, more females (52.3%) had any scarring compared to males (47.2%), OR = 1.22 (95% CI = 1.05-1.43). For every year increase in age, there was a 6.5% increase in the odds of having more severe scarring (95% CI: 5.8%, 7.2%). Women were more likely than men to have severe scarring, OR 2.36 (95% CI: 1.84-3.02). Residence in a community with TF≥10% was associated with a 1.6-fold increased odds of any scarring.
CONCLUSIONS: Overall scarring prevalence and more severe scarring prevalence was higher in females compared to males, even adjusting for age and community TF prevalence. The data suggest that processes occur that lead to women preferentially progressing towards more severe scarring compared to men.