沙眼诊断和治疗的研究进展

沙眼是一种世界范围内流行的慢性、传染性的致盲性眼病。1997年,世界卫生组织建立全球消除致盲性沙眼联盟,力争到2020年消灭沙眼。本文就近年来沙眼的诊断、治疗方面的相关研究进展情况做一综述。     

我国沙眼防治的启迪与思考

沙眼曾是我国首位的致盲性眼病,经过几代人的不懈努力,终于在今年宣布消灭致盲性沙眼。沙眼衣原体的发现相关研究为防控沙眼提供了科学依据。消灭致盲性沙眼这项成就与政府的高度重视及创新性的在中国成功推广“SAFE战略”密不可分。今后仍应强化公共卫生领域疾病的诊断标准和知识培训,流行病学调查应采用国际标准。虽然中国已消灭了致盲性沙眼,但仍应重视沙眼的全面防控,防止再次流行。（中华眼科杂志,2015,51：484-486）     

防盲的过去,现在和将来

防盲是眼科最重要的目标,许多因素与防盲相关,包括科学和技术、经济和社会行为.世界卫生组织(WHO)、非官方组织及其它的功能组织在推动防盲活动方面遍及全球.90%以上的盲人生活在发展中国家.白内障是盲的最主要原因且是可治性的.盘尾丝虫病是西部非洲和中美洲的一种地方病.盘尾丝虫控制规划(OCP)是在发达国家资助下由WHO在1974年建立的,旨在控制盘尾丝虫病.传播媒介(钠苍蝇属)的控制以及新的药物使该计划在根除此疾病以达到防盲的目的方面有着成功的前景.还将讨论由沙眼、儿童盲、青光眼及糖尿病致盲的状况.眼部疾病的分子遗传学的进展为将来这些疾病所致盲的预防开辟了途径.     

重视我国沙眼的防治工作

在我国,要达到世界卫生组织提出的2020年前消除可致盲性沙眼的目标,首先需要得到地方各级政府的支持,同时有必要迅速开展全国性沙眼流行病学调查,了解患病情况和相关因素,制定和实施符合我国国情的防治措施;通过加强沙眼的卫生知识宣传,提高受众者的参与度.我国眼科工作者应当为在人口最多的国家中消除可致盲性沙眼做出应有的努力.     

沙眼衣原体研究历程及进展

沙眼是历史悠久、世界范围流行、严重肆虐人类健康的古老眼病,既往曾被列为人类三大疾病之一。公元前1533￣1500年埃及草纸书已有沙眼并发症和治疗的记载。我国公元前246￣207年秦代“外台密要”书中也有相关记述。世界卫生组织(WHO)估计目前仍有1亿4600万人患沙眼,600万人因沙眼而盲或严重视力减退,在55个国家,主要是非洲、亚洲发展中国家流行[1]。沙眼仍是全球第二位致盲性眼病,也是感染性可预防盲的首位眼病。有关沙眼病原学研究,我国微生物学家汤飞凡和眼科学家张晓楼合作,于1956年首次成功分离出沙眼“病毒”,解决了医学、微生物学史…     

沙眼防治的研究进展

沙眼是一种由沙眼衣原体感染所致的传染性角结膜炎,是世界上导致传染性盲目的主要原因.沙眼在发展中国家,如在亚非贫穷偏僻的地区、中东、拉丁美洲和澳洲的一些地区仍有很高的发病率.世界卫生组织估计全球大约有8 400万人感染沙眼,有800万人因为沙眼而致视觉损害,约590万人因此失明或者有严重的视力下降.WHO已经建立了辨认和命名沙眼的简化分级系统(TF、TI、TS、TT、CO),并针对沙眼的临床特征,提出了有效的控制沙眼的4个要素即"SAFE"战略.包括:S(Surgery),即手术矫正沙眼性倒睫;A(Antibiotics),即抗生素治疗活动性沙眼感染人群;F(Facial Cleanliness),即面部清洁眼部;E(Environmental improvements),改善环境,通过改进水的供应、卫生和居住环境以预防沙眼.近来证实,单剂口服阿奇霉素可有效地治疗沙眼,特别是群体发放阿奇霉素,对于社区水平特别是儿童沙眼的防治具有重要意义.WHO还推荐新的双板层睑板翻转术,以有效地矫正沙眼性倒睫,国家卫生部"十一五"防盲规划已将其列入推广计划.     

中国泸州市纳溪区和江阳区农村十年间儿童活动性沙眼的快速评估

背景 沙眼是一种严重的致盲眼病,经过世界卫生组织(WHO)和中国政府的不懈努力,目前中国沙眼的发病率已经大大下降,但在少数经济不发达地区仍有活动性沙眼的流行. 目的 调查四川省泸州市纳溪区和江阳区学龄儿童活动性沙眼的患病情况,评估2000年与2013年该地区儿童活动性沙眼的防治情况. 方法 采用横断面研究方法,按照WHO沙眼简化分级系统及活动性沙眼快速评估调查(TRA)的标准和要求,于2000年对泸州市纳溪区和江阳区农村地区214名6～7岁儿童进行活动性沙眼现场快速评估调查,其中男113人,女101人,将活动性沙眼分为沙眼性滤泡(TF)、沙眼性炎症(TI)、沙眼性瘢痕(TS)、沙眼性倒睫(TT)和沙眼性角膜混浊(CO),依据上述体征确定活动性沙眼的诊断.2013年本研究组再次对该地区100名学龄儿童进行活动性沙眼评估,其中男58人,女42人,了解10年间该地区学龄儿童活动性沙眼患病率的变化.结果 2000年纳溪区和江阳区共4个农村小学214名6～7岁儿童接受了调查,共发现TF 105人,患病率为49.07％;其中纳溪区儿童TF患病率为49.05％ (52/106),江阳区患病率为49.07％(53/108),差异无统计学意义(x2=0.01,P=0.99).2013年分别对纳溪区和江阳区的2所小学100名6～7岁的儿童进行了活动性沙眼流行病学调查,均未发现TF、TI、TS、TT、CO,即未发现活动性沙眼患者.结论 十年来随着中国沙眼防治工作的开展及泸州市纳溪区和江阳区经济的发展,该地区儿童活动性沙眼的流行已得到控制.     

全国防盲治盲规划(2012—2015年)(一)

一、现状和问题盲和视力损伤严重影响人民群众的身体健康和生活质量,加重了家庭和社会负担,是重大的公共卫生问题。1999年,世界卫生组织和国际防盲协会提出"2020年前消除可避免盲"的防盲治盲全球性战略目标,到2020年要在全球消除包括白内障、沙眼、河盲、儿童盲、屈光不正和低视力导致的可避免     

我国防盲治盲工作的回顾与展望

防盲治盲工作是我国公共卫生事业和眼科事业的重要组成部分。当我们跨入世纪之交新千年的时候,在中华眼科杂志创刊50年之际,回顾我国50年来,尤其近10余年来,防盲治盲工作的历程,展望21世纪防盲治盲的发展前景,使我们更增加了防盲治盲的使命感及责任感,对未来充满了希望和信心。一、我国防盲治盲工作的历程解放前和建国初,我国的眼病及盲目情况十分严重。当时致盲的主要原因是以沙眼为主的传染性眼病、维生素Ａ缺乏所致的角膜软化症、外伤及青光眼等眼病。沙眼的患病率为500%,偏远农村的患病率为800%～900%。新中国建立初期,各级政府大力组织…     

北京市密云县沙眼流行病学调查

北京市密云县沙眼流行病学调查北京市眼科研究所苏小铎，郑远远，孙葆忱，陈建东北京市密云县医院眼科朱润祥沙眼是一种常见的致盲眼病。据世界卫生组织（ＷＨＯ）估计［１］，世界上近１／４的盲人与沙眼有关。１８８７年全国残疾人抽样调查的结果表明，沙眼是我国第三位...     

Trachoma: new assault on an ancient disease

Trachoma is the leading infectious cause of blindness worldwide. The World Health Organization (WHO) estimated that approximately 5.9 million persons are blind or have severe vision-loss as a result of trachoma, and another 10 million are at high risk. Trachoma preferentially affects the most deprived communities, and within these communities, women and children bear the brunt of the burden. In recent years, there has been a renewed focus on research and heightened enthusiasm for strengthening trachoma control programs in afflicted countries. WHO has convened an alliance of member countries, non-governmental organizations, and other partners for the Global Elimination of Blinding Trachoma by the year 2020, and endorsed the multi-faceted SAFE strategy for trachoma control. SAFE-Surgery, Antibiotics, Face-washing, and Environmental improvement-has incorporated sound research on elements likely to reduce trachoma, and trachomatis blindness, in endemic communities. This review summarizes current knowledge about trachoma and its causative agent, Chlamydia trachomatis, the epidemiology and risk factors for trachoma as a prelude to reviewing the SAFE strategy. While ongoing research to support the knowledge base for SAFE must continue to be a priority, the full implementation of SAFE is the best hope for countries to reduce the global burden of blindness from this preventable cause.     

Barriers to the Implementation of the SAFE Strategy to Combat Hyperendemic Trachoma in Australia

Objective: Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia.

Methods: Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework.

Results: Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia.

Conclusions: A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in “closing the gap” between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.     

Trachomatous trichiasis and its management in endemic countries

Trichiasis is the sight-threatening consequence of conjunctival scarring in trachoma, the most common infectious cause of blindness worldwide. Trachomatous trichiasis is the result of multiple infections from childhood with Chlamydia trachomatis, which causes recurrent chronic inflammation in the tarsal conjunctiva. This produces conjunctival scarring, entropion, trichiasis, and ultimately blinding corneal opacification. The disease causes painful, usually irreversible sight loss. Over eight million people have trachomatous trichiasis, mostly those living in poor rural communities in 57 endemic countries. The global cost is estimated at US$ 5.3 billion. The WHO recommends surgery as part of the SAFE strategy for controlling the disease.We examine the principles of clinical management, treatment options, and the challenging issues of providing the quantity and quality of surgery that is needed in resource-poor settings.     

我国防盲与眼科流行病学研究的现状及发展

2005年以来的时期是我国防盲与眼科流行病学研究进展最显著的一个时期.全国眼病和视力残疾人抽样调查发现白内障(56.7%)、视网膜葡萄膜病(14.1%)和角膜病(10.3%)是目前我国盲和视力损伤的主要原因."视觉第一中国行动"二期、"百万贫困白内障患者复明工程"等重大防盲项目已取得巨大成就.2005年至2009年我国共施行了387.1万白内障复明手术,2009年百万人口白内障手术率达到796.2.全国已建成白内障无障碍县673个、无障碍市70个、无障碍省(自治区)2个.近5年已为175 501例低视力患者验配了助视器,为47 009例盲人提供了定向行走训练.初级眼保健和沙眼、糖尿病视网膜病变的防治也取得了一定成果.5年来,虽然基本完成了国家防盲任务,但远未达到"视觉2020"行动的目标要求,特别是还存在白内障手术率仍然偏低、主要致盲性眼病并未根治;流行病学研究缺少创新性、深度和广度不够等问题.今后,应切实把握好眼科流行病学的良好发展趋势,开展原创造性和分子流行病学研究;还应整合包括初级眼保健在内的各级眼保健力量,"高质量、低价格"地开展白内障、视网膜病、角膜病、沙眼、屈光不正、低视力、青光眼等防盲工作,争取早日达到"视觉2020"根治我国可避免盲的宏伟目标.     

Cost-effectiveness of trachoma control in seven world regions

BACKGROUND/AIMS: The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions. METHODS: A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review. RESULTS: Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective. CONCLUSIONS: As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.     

Internationale Initiativen zur Prävention von Blindheit

Since 1974, when the International Agency for the Prevention of Blindness (IAPB) was founded, international campaigns for blindness prevention have gained tremendous momentum in collaboration with the WHO's blindness prevention programme. In 1999 WHO and IAPB launched the campaign Vision 2020, The Right to Sight, in which WHO, IAPB, member countries of WHO and nongovernmental organizations (NGOs) that are active in this field are all working together. The major emphasis of the programme is on control of the major disorders leading to blindness and the development of infrastructures, of eye care programmes and of training and continuing education for ophthalmic staff. This campaign is unique in medicine and has the potential for reducing the prevalence of blindness in the world significantly by 2020. Even now, we can assume that 75-80% of cases of blindness can be prevented. The WHO has developed strategies for dealing with individual diseases, such as trachoma, onchocerciasis, childhood blindness and refractive errors. Programmes for glaucoma and diabetic retinopathy will follow. Early successes can already be recognized, especially in the rising numbers of cataract operations.     

Prevention of blindness as sequelae of corneal pathology

Interregional WHO meeting on prevention of corneal blindness was held in Tunis in November 14-17. The participants came to a conclusion that corneal blindness ranks second after cataract in the majority of countries of the world. It is more incident in developing countries and is the leading cause of blindness in children. The principal etiologic factors of corneal blindness are analyzed: trachoma, mycotic, parasitic, traumatic, conjunctivitis of the newborns. Recommendations on prevention of corneal blindness were developed, as were suggestions on approaches to primary and secondary prevention in the framework of primary medical care.     

Trachoma control: the SAFE strategy

As a contagious bacterial infection that affects the conjunctival covering of the eye, the cornea and the eyelids, trachoma is controlled by an endorsed integrated strategy consisting of surgery for trichiasis, antibiotic therapy, facial cleanliness and environmental improvement, namely, the SAFE strategy developed by World Health Organization. Developed based on evidence from previous field trials and constantly modified in practice, SAFE strategy has greatly boosted the progress in trachoma control. Regardless of the fact that there are still many pending questions, national program coordinators are convinced that trachoma control initiative based on SAFE strategy would be effective.