Predictors of Trachomatous Trichiasis Surgery Outcome

Abstract

PurposeUnfavorable outcomes after trachomatous trichiasis (TT) surgery are undermining the global trachoma elimination effort. This analysis investigates predictors of postoperative TT (PTT), eyelid contour abnormalities (ECAs), and granuloma in the 2 most common TT surgery procedures: posterior lamellar tarsal rotation (PLTR) and bilamellar tarsal rotation (BLTR).DesignSecondary data analysis from a randomized, controlled, single-masked clinical trial.ParticipantsA total of 1000 patients with TT, with lashes touching the eye or evidence of epilation, in association with tarsal conjunctival scarring.MethodsParticipants were randomly allocated and received BLTR (n = 501) or PLTR (n = 499) surgery. Disease severity at baseline, surgical incisions, sutures, and corrections were graded during and immediately after surgery. Participants were examined at 6 and 12 months by assessors masked to allocation.Main Outcome MeasuresPredictors of PTT, ECA, and granuloma.ResultsData were available for 992 (99.2%) trial participants (496 in each arm). There was strong evidence that performing more peripheral dissection with scissors in PLTR (odd ratio [OR], 0.70; 95% confidence interval [CI], 0.54–0.91; P = 0.008) and BLTR (OR, 0.83; 95% CI, 0.72–0.96; P = 0.01) independently protected against PTT. Baseline major trichiasis and mixed location lashes and immediate postoperative central undercorrection independently predicted PTT in both surgical procedures. Peripheral lashes in PLTR (OR, 5.91; 95% CI, 1.48–23.5; P = 0.01) and external central incision height ≥4 mm in BLTR (OR, 2.89; 95% CI, 1.55–5.41; P = 0.001) were independently associated with PTT. Suture interval asymmetry of >2 mm (OR, 3.18; 95% CI, 1.31–7.70; P = 0.01) in PLTR and baseline conjunctival scarring in BLTR (OR, 1.72; 95% CI, 1.06–2.81; P = 0.03) were independently associated with ECA. Older age was independently associated with ECA in both PLTR (P value for trend < 0.0001) and BLTR (P value for trend = 0.03). There was substantial intersurgeon variability in ECA rates for both PLTR (range, 19.0%–36.2%) and BLTR (range, 6.1%–28.7%) procedures. In PLTR surgery, irregular posterior lamellar incision at the center of the eyelid (OR, 6.72; 95% CI, 1.55–29.04; P = 0.01) and ECA (OR, 3.08; 95% CI, 1.37–6.94; P = 0.007) resulted in granuloma formation.ConclusionsPoor postoperative outcomes in TT surgery were associated with inadequate peripheral dissection, irregular incision, asymmetric suture position and tension, inadequate correction, and lash location. Addressing these will improve TT surgical outcomes.

The magnitude and associated Factors of Postoperative Trichiasis among adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia

“…As people gets older, the likely hood of having postoperative Trichiasis increases by threefold. This nding was similar to the studies conducted in West Gojjam Zone, Ethiopia (15,20), and in four districts of Vietnam (27). This might be because as the age gets older, the body's immune response may be decreased (29).…”

“…The study of Tanzania, Nepal, and Vietnam was used other than the PLTR technique. A study in the West Gojam Zone, Ethiopia shows PLTR procedure has a lower recurrence rate (20).…”

The conjunctival transcriptome in Ethiopians after trichiasis surgery: associations with the development of eyelid contour abnormalities and the effect of oral doxycycline treatment

“…The factors underlying the increased inflammation in these individuals is unclear; there was no difference in baseline clinical inflammation grade between those that did and did not develop ECA. Risk factors associated with ECA development include baseline trichiasis severity and older age 32,33 , however there was no difference in baseline age or trichiasis severity in those with and without ECA in this study. Intersurgeon variability and distance between sutures were also associated with ECA development following PLTR surgery 33 , however there was no difference between surgeon and ECA outcome in this trial.…”

Oral doxycycline for the prevention of postoperative trachomatous trichiasis in Ethiopia: a randomised, double-blind, placebo-controlled trial

“…In this study, the main determinants of postoperative trichiasis were preoperative trichiasis severity (major trachomatous trichiasis), peripheral trichiasis eyelash location, intersurgeon variability, and patient age, which have consistently been reported in previous trials. 6 , 46 …”