Trihijaza

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Trihijaza
Specijalnostiофталмологија

Trihijaza je dosta česta abnormalnost očnog kapka, koja se definiša kao pogrešno usmeravanje rasta trepavica prema globusu. Može biti difuzno po celom očnom kapku ili može imati malu segmentnu distribuciju.[1]

Trihijazu mogu izazvati brojni uzroci, a strategiju korekcije i ispravljanje ovog poremećaja diktira anatomska abnormalnost koja je uzrokovala pogrešno usmeravanje rasta trepavica.

Etiopatogeneza[уреди]

Trihijaza je najčešće idiopatska, ali može biti i stečena. U moguže i poznate uzroke spadaju blefaritis, posttraumatske i postoperativne promene, ožiljak ivice kapka (npr. usled cikatrizirajućeg pemfigoida, atopičnog keratokonjunktivitisa, Stevens– Johnsonova sindroma, hemijskog oštećenja), epiblefarona (suvišni nabor kože u području donjeg kapka koji usmerava trepavice u vertikalni položaj) i distrihijaze (urođeni suvišni niza trepavica).[2][3][4][5]

Klinička slika[уреди]

Simptomi su osjećaj stranog tela u oku, suzenje i crvenilo oka.[6]

Dijagnoza[уреди]

Dijagnoza se obično postavlja kliničkim pregledom. Obrada uključuje bojenje fluoresceinom kako bi se isključile abrazije ili erozije (ulceracije) rožnjače.[7]

Terapija[уреди]

Ablacione metode

Trihijaza se leči odstranjenjem trepavica forcepsom,[8] ili u slučajevima koji se često ponavljaju, elektrokauterizacijom,[9] i/ili kriohirurškim zahvatom.[10][11][12]

Hirurška terapija

Hirurgija trihijaze može bolesniku značajno poboljšati kvalitet života, bez obzira na promene vidne oštrine.[10] Opisane su mnoge hiruške procedure za lečenje trihijaze, u zavisnosti od uzroka koji je izazvao problem.

  • Radiofrekventna ablacija trepavica i folikula — je izuzetno efikasna i može se izvršiti brzo i jednostavno uz pomoć prcepne lampe ili sa hirurškim lupama i lokalnom anestezijom. Najmanja radiofrekventna sonda (npr Ellman TA1, A8 savitljivi 1 / 16th vari tip) uvedi se uz trepavicu do folikula, s najnižom lokacijom koja omogućava njeno jednostavno uvođenje. Mašinu treba podesiti na cut/coag. Nakon intervencije na margini kapka nedostajaće mali deo tkiva koći granulirati stvranjem minimalnog ožiljka. Mitomicin C koji ubrizganu folikul dlake odmah nakon radiofrekventne ablacije može smanjiti recidive trihijaze.[13]
  • Argonska laserska ablacija — može biti efikasna, ali je veoma zamorna i za pacijenta i za hirurga. Prema nekim istraživanjima tretman sa rubinskim laserima može biti održiva i dobro tolerisana opcija za ublažavanje simptoma trihijaze.[14]
  • Klinasta resekcija segmenta očnog kapka — zahteva rezoluciju kapka pune debljine; i u mnogim slučajevima to može biti preterano.
  • Operacija repozicioniranja trepavica i folikula — treba da bude usmerena ka anatomskom uzroku problema.
Simptomatska terapija

Od simptomatske terapije mogu se primeniti veštačke suze i masti,kakao bi smanjili iritantni efekti mehaničkog trljanja trepavica.

Kod nekih bolesti kao što su npr. očni cikatrikalni pemphigoid, Stevens-Johnsonov sindrom, praćenih pogrešnim usmjeravanjem trepavica, medicinska terapija bi trebala biti usmerena prema toj bolesti.

Prema nekim studijama azitromicin smanjuje učestalost recidiva nakon hirurškog zahvata do godinu dana.[15] Kao i da doksiciklin uspešno suzbija kontraktilne fibroblaste kod bolesnika sa trahomom i predlažu da bi doksiciklin mogao biti koristan kao tretman za sprečavanje ponovne pojave trihijaze nakon operacije.[16]

Izvori[уреди]

  1. ^ Rajak SN, O Collin JR, Burton MJ. Trachomatous Trichiasis and its Management in Endemic Countries. Surv Ophthalmol. 2012 Jan 27.
  2. ^ Ngondi J, Reacher MH, Matthews FE, et al. Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan. Trans R Soc Trop Med Hyg. 2009 Mar. 103(3):305-14.
  3. ^ Ngondi J, Gebre T, Shargie EB, et al. Risk factors for active trachoma in children and trichiasis in adults: a household survey in Amhara Regional State, Ethiopia. Trans R Soc Trop Med Hyg. 2008 May. 102(5):432-8.
  4. ^ West ES, Munoz B, Imeru A, Alemayehu W, Melese M, West SK. The association between epilation and corneal opacity among eyes with trachomatous trichiasis. Br J Ophthalmol. 2006 Feb. 90(2):171-4.
  5. ^ Graham H, Robert. „Trichiasis”. www.emedicine.medscape.com (2018). Приступљено 24. 1. 2019. 
  6. ^ Graham H, Robert. „Trichiasis Clinical Presentation U: Trichiasis”. www.emedicine.medscape.com (2018). Приступљено 24. 1. 2019. 
  7. ^ Graham H, Robert. „Causes U: Trichiasis”. www.emedicine.medscape.com (2018). Приступљено 24. 1. 2019. 
  8. ^ Rajak SN, Habtamu E, Weiss HA, Kello AB, Gebre T, Genet A, et al. Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial. PLoS Med. 2011 Dec. 8(12):e1001136.
  9. ^ Rajak SN, Habtamu E, Weiss HA, Bedri A, Gebre T, Genet A, et al. Epilation for trachomatous trichiasis and the risk of corneal opacification. Ophthalmology. 2012 Jan. 119(1):84-9.
  10. 10,0 10,1 Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Mohammed A, et al. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia. PLoS Negl Trop Dis. 2016 Apr. 10 (4):e0004627.
  11. ^ Chi MJ, Park MS, Nam DH, Moon HS, Baek SH. Eyelid splitting with follicular extirpation using a monopolar cautery for the treatment of trichiasis and distichiasis. Graefes Arch Clin Exp Ophthalmol. 2007 May. 245(5):637-40.
  12. ^ Collin RJO. Entropion and trichiasis. A Manual of Systemic Eyelid Surgery. New York: Churchill-Livingstone; 1989. 7-26.
  13. ^ Kim GN, Yoo WS, Kim SJ, Han YS, Chung IY, Park JM, et al. The effect of 0.02% mitomycin C injection into the hair follicle with radiofrequency ablation in trichiasis patients. Korean J Ophthalmol. 2014 Feb. 28 (1):12-8.
  14. ^ Moore J, De Silva SR, O'Hare K, Humphry RC. Ruby laser for the treatment of trichiasis. Lasers Med Sci. 2009 Mar. 24(2):137-9.
  15. ^ Burton MJ, Kinteh F, Jallow O, et al. A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia. Br J Ophthalmol. 2005 Oct. 89(10):1282-8.
  16. ^ Li H, Ezra DG, Burton MJ, Bailly M. Doxycycline prevents matrix remodeling and contraction by trichiasis-derived conjunctival fibroblasts. Invest Ophthalmol Vis Sci. 2013 Jul 12. 54(7):4675-82.

Literatura[уреди]

  • Habtamu E, Wondie T, Aweke S, Tadesse Z, Zerihun M, Zewudie Z, et al. Posterior lamellar versus bilamellar tarsal rotation surgery for trachomatous trichiasis in Ethiopia: a randomised controlled trial. Lancet Glob Health. 2016 Mar. 4 (3):e175-84.
  • Barr K, Essex RW, Liu S, Henderson T. Comparison of trichiasis recurrence after primary bilamellar tarsal rotation or anterior lamellar repositioning surgery performed for trachoma. Clin Experiment Ophthalmol. 2014 May-Jun. 42 (4):311-6.
  • Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-Year Outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence Trial. Arch Ophthalmol. 2011 Dec 12. Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-Year Outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence Trial. Arch Ophthalmol. 2012 Feb 14. [Medline].
  • Bartley GB, Bullock JD, Olsen TG, Lutz PD. An experimental study to compare methods of eyelash ablation. Ophthalmology. 1987 Oct. 94(10):1286-9.
  • Bartley GB, Lowry JC. Argon laser treatment of trichiasis. Am J Ophthalmol. 1992 Jan 15. 113(1):71-4.
  • Burton MJ, Bowman RJ, Faal H, et al. The long-term natural history of trachomatous trichiasis in the Gambia. Invest Ophthalmol Vis Sci. 2006 Mar. 47(3):847-52.
  • Dhaliwal U, Nagpal G, Bhatia MS. Health-related quality of life in patients with trachomatous trichiasis or entropion. Ophthalmic Epidemiol. 2006 Feb. 13(1):59-66.
  • Durkin SR, Casson R, Newland HS, Selva D. Prevalence of trachoma and diabetes-related eye disease among a cohort of adult Aboriginal patients screened over the period 1999-2004 in remote South Australia. Clin Experiment Ophthalmol. 2006 May-Jun. 34(4):329-34.
  • Edwards T, Cumberland P, Hailu G, Todd J. Impact of health education on active trachoma in hyperendemic rural communities in Ethiopia. Ophthalmology. 2006 Apr. 113(4):548-55.
  • El Toukhy E, Lewallen S, Courtright P. Routine bilamellar tarsal rotation surgery for trachomatous trichiasis: short-term outcome and factors associated with surgical failure. Ophthal Plast Reconstr Surg. 2006 Mar-Apr. 22(2):109-12.
  • Elder MJ, Collin R. Anterior lamellar repositioning and grey line split for upper lid entropion in ocular cicatricial pemphigoid. Eye. 1996. 10 (Pt 4):439-42.
  • Johnson RL, Collin JR. Treatment of trichiasis with a lid cryoprobe. Br J Ophthalmol. 1985 Apr. 69(4):267-70.
  • Jordan DR, Zafar A, Brownstein S, Faraji H. Cicatricial conjunctival inflammation with trichiasis as the presenting feature of Wegener granulomatosis. Ophthal Plast Reconstr Surg. 2006 Jan-Feb. 22(1):69-71.
  • Kersten RC, Kleiner FP, Kulwin DR. Tarsotomy for the treatment of cicatricial entropion with trichiasis. Arch Ophthalmol. 1992 May. 110(5):714-7. [Medline].
  • Kuckelkorn R, Schrage N, Becker J, Reim M. Tarsoconjunctival advancement: a modified surgical technique to correct cicatricial entropion and metaplasia of the marginal tarsus. Ophthalmic Surg Lasers. 1997 Feb. 28(2):156-61.
  • Nagpal G, Dhaliwal U, Bhatia MS. Barriers to acceptance of intervention among patients with trachomatous trichiasis or entropion presenting to a teaching hospital. Ophthalmic Epidemiol. 2006 Feb. 13(1):53-8.
  • Polack S, Brooker S, Kuper H, Mariotti S, Mabey D, Foster A. Mapping the global distribution of trachoma. Bull World Health Organ. 2005 Dec. 83(12):913-9.
  • Rhatigan MC, Ashworth JL, Goodall K, Leatherbarrow B. Correction of blepharoconjunctivitis-related upper eyelid entropion using the anterior lamellar reposition technique. Eye. 1997. 11 (Pt 1):118-20.
  • Shiu M, McNab AA. Cicatricial entropion and trichiasis in an urban Australian population. Clin Experiment Ophthalmol. 2005 Dec. 33(6):582-5. [Medline].
  • Tirakunwichcha S, Tinnangwattana U, Hiranwiwatkul P, Rohitopakarn S. Folliculectomy: management in segmental trichiasis and distichiasis. J Med Assoc Thai. 2006 Jan. 89(1):90-3.
  • West ES, Alemayehu W, Munoz B, Melese M, Imeru A, West SK. Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial methodology. Ophthalmic Epidemiol. 2005 Aug. 12(4):279-86.
  • West S, Alemayehu W, Munoz B, Gower EW. Azithromycin prevents recurrence of severe trichiasis following trichiasis surgery: STAR trial. Ophthalmic Epidemiol. 2007 Sep-Oct. 14(5):273-7.
  • West SK, West ES, Alemayehu W, et al. Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia. Arch Ophthalmol. 2006 Mar. 124(3):309-14.
  • Wojono TH. Lid splitting with lash resection for cicatricial entropion. Ophthalmic Plast Reconst Surg. 1992. 8:287-289.
  • Wood JR, Anderson RL. Complications of cryosurgery. Arch Ophthalmol. 1981 Mar. 99(3):460-3.
  • Yeung YM, Hon CY, Ho CK. A simple surgical treatment for upper lid trichiasis. Ophthalmic Surg Lasers. 1997 Jan. 28(1):74-6.
  • Zhang H, Kandel RP, Atakari HK, Dean D. Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year. Br J Ophthalmol. 2006 Aug. 90(8):943-8.
  • Cruz AAV, Garcez C, Duarte A, Akaishi PMS. Interlamellar Autogenous Tarsal Graft for the Correction of Lower Eyelid Trichiasis Associated With Eyelid Margin Thinning. Ophthalmic Plast Reconstr Surg. 2018 Jan 25.
  • Ferraz LC, Meneghim RL, Galindo-Ferreiro A, Wanzeler AC, Saruwatari MM, Satto LH, et al. Outcomes of two surgical techniques for major trichiasis treatment. Orbit. 2018 Feb. 37 (1):36-40.

Spoljašnje veze[уреди]

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