title: Corneal Sensitivity and Presence of Pathogenic Organisms Among Participants Who Have Undergone Trichiasis Surgery Differ by Surgical Outcome.
abstract: OBJECTIVE
  To explore the potential association between reduced corneal sensation and/or conjunctival bacterial colonization and postoperative trichiasis and eyelid contour abnormalities after corrective eyelid surgery among participants with a history of trachomatous trichiasis.
  
  
  METHODS
  As an ancillary study to the Partnership for Rapid Elimination of Trachoma (PRET) Surgery Trial in southern Tanzania, we collected data on 580 PRET participants who had undergone trichiasis surgery 1 year earlier and 200 age-group-matched individuals without trichiasis. Assessments included eyelid status evaluation (presence and severity of postoperative trichiasis and/or eyelid contour abnormality), corneal sensitivity by Cochet-Bonnet aesthesiometer, a questionnaire on symptoms of ocular irritation, and conjunctival microbiology. We divided PRET participants based on their eyelid status and compared results across PRET groups and versus normals.
  
  
  RESULTS
  PRET participants had reduced corneal sensitivity compared with age-matched normals (mean sensitivity ranged from 2.8 to 3.8 cm in PRET participants vs. 5.9 cm in normals), and increasing severity of postoperative trichiasis was associated in a stepwise fashion with reduced corneal sensitivity (mean = 3.5 cm for mild and 2.6 cm for severe postoperative trichiasis). Conjunctival colonization with pathogenic bacteria was also associated with more severe postoperative trichiasis (Cochran-Armitage trend test P = 0.001) and with reduced corneal sensitivity (trend test P < 0.0001). Symptoms of ocular irritation were not associated with previous trichiasis surgery, postoperative trichiasis, or eyelid contour abnormality.
  
  
  CONCLUSIONS
  These findings indicate that reduced corneal sensitivity accompanies trachomatous trichiasis and suggest that reduced corneal sensitivity may play an important role in the harboring of pathogenic bacteria on the ocular surface.
authors.affiliation: *Brown University, Providence, RI; †Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD; ‡Helen Keller International, Dar es Salaam, Tanzania; §Division of Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD; ¶School of Medicine, Baltimore, MD; Muhimbili Hospital, Dar es Salaam, Tanzania; ‖Kongwa Trachoma Project Satellite Office, Mtwara, Tanzania; and **Departments of Epidemiology and Ophthalmology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Yvette
authors.initials: Y
authors.lastname: Schein
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Harding
authors.forename: Shannath L
authors.initials: SL
authors.lastname: Merbs
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Cassard
authors.forename: Kasubi
authors.initials: K
authors.lastname: Mabula
authors.forename: Majid S
authors.initials: MS
authors.lastname: Othman
authors.forename: Sheila K
authors.initials: SK
authors.lastname: West
authors.forename: Emily W
authors.initials: EW
authors.lastname: Gower
mesh_terms: D001419:Bacteria / Q000302:isolation & purification*; D003228:Conjunctiva / Q000382:microbiology*; D003316:Corneal Diseases / Q000503:physiopathology*; D003941:Diagnostic Techniques, Ophthalmological; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology*; D013508:Ophthalmologic Surgical Procedures; D011183:Postoperative Complications; D011795:Surveys and Questionnaires; D014141:Trachoma / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery; D058457:Trichiasis / Q000382:microbiology* / Q000503:physiopathology / Q000601:surgery*