Community-based transconjunctival marginal rotation for cicatricial trachoma in Indians from the Upper Rio Negro basin

Abstract

The objective of the present study was to describe, for the first time in Brazil, the use by a non-ophthalmologist of a community-based marginal rotation procedure by a posterior approach in the indigenous population from the Upper Rio Negro basin. Seventy-three upper eyelids of 46 Indians (11 males and 35 females) with cicatricial upper eyelid entropion and trichiasis were operated in the Indian communities using a marginal rotational procedure by a posterior approach by a non-ophthalmologist physician who had general surgery experience but only an extremely short period (one week) of ophthalmic training. Subjects were reevaluated 6 months after surgery. Results were classified according to the presence and location of residual trichiasis and symptoms were assessed according to a three-level subjective scale (better, worse or no change). Fifty-six eyelids (76.7%) were free from trichiasis, whereas residual trichiasis was observed in 17 eyelids (23.3%) of 10 subjects. In these cases, trichiasis was either lateral or medial to the central portion of the lid. Of these 10 patients, only 4 reported that the surgery did not improve the irritative symptoms. We conclude that marginal rotation by a posterior approach is an effective and simple procedure with few complications, even when performed by non-specialists. Due to its simplicity the posterior approach is an excellent option for community-based upper eyelid entropion surgery.

Prevalence of Trachoma in a Population of the Upper Rio Negro Basin and Risk Factors for Active Disease

“…He returned to the Indian areas of São Gabriel and became the first nonophthalmologist doctor in Brazil to perform surgery on Indians in their communities. 11 The distribution of the disease did not support the common finding elsewhere of a difference between the sexes, being more common in women. 8 Other studies in Brazil have also failed to demonstrate a significantly higher prevalence of trachoma in women.…”

Análise cienciométrica da pesquisa sobre tracoma no Brasil, 2000–2020

“…Há significativa concentração de produção científica em tracoma nas regiões Norte e Sudeste do Brasil, de modo que os estados de São Paulo e Amazonas são as unidades federativas mais destacadas. Essa distribuição, no que tange à região Norte do país, pode estar vinculada à produção de pesquisas com populações indígenas, em contextos endêmicos para tracoma 17 .…”

“…A limitação de estudos no Brasil, especialmente sobre a disseminação de C. trachomatis, justifica a variação de detecção de casos com presença de sorotipo associado a tracoma em diferentes áreas de ocorrência da doença 23 . As estimativas de prevalência revelada em décadas passadas a partir de inquéritos escolares 10 e de estudo de base populacional 14 sugerem a importância do tracoma no país 10 , inclusive como importante causa de cegueira evitável 2 , além da evidência de sequelas oftalmológicas por lesões corneanas secundárias à doença em populações indígenas 17 .…”

Saúde ocular dos povos indígenas do Brasil

“…25,27 Most of the publications surveyed deal with the detection and repercussions of trachoma in indigenous communities, mainly in ethnic groups located in the Upper Rio Negro region (Makus, Aruaks and Tukanos), some of them located along the Middle Rio Negro, and others among Indians living in the Xingu Park. [28][29][30][31][32][33][34][35][36][37] These studies have reported trachoma prevalence ranging from 28,02% to 56.4%, 29,31,33,34,37 with these findings showing different epidemiological behaviors. 28 The prevalence of mild cases is higher, 31 although the inflammatory and cicatricial forms have been detected.…”

“…35 Cicatricial trachoma was studied in an investigation referring to a surgical technique for the correction of entropion and trichiasis. 36 Available information about morbidity and mortality reveals a high incidence of respiratory 6 and acute gastrointestinal infections, 7,8 malaria, 4,8,9 tuberculosis, 4,9,10,11 sexually transmitted diseases 12 , malnutrition 4,13,14 and diseases that can be prevented by vaccination. 4,7 Arterial hypertension, diabetes, alcoholism, depression and suicide are increasingly more frequent problems in various communities.…”