Recurrence of trichiasis: A long-term follow-up study in the Sultanate of Oman

Khandekar, Rajiv; Mohammed, Ali Jaffer; Courtright, Paul

doi:10.1076/opep.8.2.155.4165

Cited by 79 publications

(53 citation statements)

References 5 publications

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“…Recurrence undermines the confidence of patients in the surgery, and is frustrating for the surgical team. Data from different settings suggest trichiasis recurs following surgery at a rate of approximately 17% per year, 14,16,27,28 although this can vary greatly and has been reported as high as 43% at two years (West E, unpublished data). Recurrence is higher in those for whom repeat surgery is attempted because these are more difficult cases to correct.…”

Section: Review Of the Safe Strategymentioning

confidence: 99%

“…A study of risk factors in Oman found that surgical patients residing in areas with high trachoma rates were more likely to have recurrence, providing some support to the hypothesis that ongoing exposure to infection is a factor in both the development of trichiasis and recurrence following surgery. 27 Some of the recurrence is surgery related, which is apparent within a short time following surgery. 23 Several steps can be undertaken to keep surgical failure as low as possible.…”

Section: Review Of the Safe Strategymentioning

confidence: 99%

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Blinding Trachoma: Prevention With the Safe Strategy

West

2003

The American Journal of Tropical Medicine and Hygiene

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Abstract. Trachoma, the second leading cause of blindness worldwide, differentially affects the poorest communities, which may have the least access to resources. With the establishment of the Global Elimination of Blinding Trachoma by 2020 (GET 2020) goal, the World Health Organization has set an ambitious target for country programs. The currently recommended surgery for trichiasis/entropion, antibiotics for active disease, facial cleanliness, and environmental change to reduce transmission (SAFE) strategy targets all key elements believed to be necessary for a short-and long-term intervention program. This report reviews the need for a multi-faceted strategy, and the evidence supporting the elements of SAFE. Concerns about the implementation are discussed. Additional research is suggested that will enhance the implementation of the SAFE strategy. In the current climate of significant political and social momentum for trachoma control, the SAFE strategy is a safe bet to accomplish the elimination of blinding trachoma.

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Section: Review Of the Safe Strategymentioning

confidence: 99%

Section: Review Of the Safe Strategymentioning

confidence: 99%

Blinding Trachoma: Prevention With the Safe Strategy

West

2003

The American Journal of Tropical Medicine and Hygiene

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“…21 Follow-up studies of surgical cases have found that post-surgical recurrence was highest in areas with the greatest trachoma prevalence. 11,15 One study reported a higher rate of recurrence in surgical eyes with ocular C. trachomatis infection compared with eyes with no infection. 22 However, the clinical trial in Ethiopia that found benefit in postoperative use of azithromycin could not attribute the protective effect to lower post-surgical rates of ocular C. trachomatis, 12 with the caution that missed episodes of infection could have occurred between the data collection periods.…”

Section: Post-operative Environmentmentioning

confidence: 99%

“…11 However, in controlled clinical trials under strict surgical conditions, adverse outcomes following surgery are low. In a clinical trial of BTRP, the adverse outcome rate (including recurrent trichiasis) at 18 months was 18%.…”

mentioning

confidence: 99%

Trichiasis Recurrence—Why the Surgery Part of Trachoma Control is Still Uncontrolled

West¹

2011

US Ophthalmic Review

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Trachoma is the leading infectious cause of blindness worldwide. 2 The burden of trichiasis is likely even greater than would be measured by visual loss alone; one study found persons with trichiasis but no visual loss reported disruption of daily activities equivalent to that reported by persons with visual loss from other causes.3 Trichiasis SurgeryAs part of a multifaceted approach to trachoma control, the WHO recommends surgery to correct trichiasis. Many techniques have been used to correct trichiasis, including epilation, cryoablation, tarsal advance and rotation, the Trabut method, Cuenod Nataf, and the bilamellar tarsal rotation procedure (BTRP). BTRP has been shown in a clinical trial to provide good long-term results compared with other techniques. 4 In addition to improvement in ocular symptoms, trichiasis surgery appears to improve visual acuity, likely due to decrease in photophobia and resolution of corneal swelling. 5 A handbook illustrating the correct techniques for BTRP has been published by the WHO. 6 As trachoma is most endemic in resource-poor areas, it became immediately clear that there were insufficient ophthalmologists to reduce the backlog of trichiasis surgery, or handle new cases. Trichiasis surgeons were trained from the ranks of eye care nurses, medical assistants, and integrated eye care workers. A study of outcomes of trichiasis surgery, comparing ophthalmologists with these trained non-physicians, showed equivalent results, thus paving the way for surgery to be carried out at health posts, district centers, and even in the villages using this new cadre of manpower. 7,8 The WHO has now published a manual for certification of trichiasis surgeons, which can be used by country programs to be certain that standards for undertaking trichiasis surgery are met.9 Adverse Outcomes of SurgeryHowever, some reports from trachoma programs based on outcomes after follow-up of trichiasis surgery patients paint a dismal picture. One study of trichiasis surgery cases with follow-up of at least two years, carried out in several districts of Tanzania, found a recurrence rate of trichiasis of 28%, varying by district from 16 to 38%. 10 In The Gambia, trichiasis recurrence rates at one year were 41%, and varied among surgeons from 0% to >80%. AbstractTrichiasis surgery is a pillar of the World Health Organization (WHO) strategy for trachoma control. Visual acuity improvement and symptomatic relief follow surgery for trichiasis, and non-ophthalmologists have been trained to carry out the surgery in trachoma-endemic communities. However, recurrence of trichiasis following surgery is unfortunately common, which can undermine public confidence in national trachoma programs.Recurrence of trichiasis following surgery is more likely in high-risk patients (those with previous surgery or who have severe entropion). The most common cause appears to be surgeon skill, with large variations in recurrence reported by surgeon. Proper training, standardization, certification, and supervision would reduce adverse out...

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“…4 Therefore, covering of the bare tarsus (different grafts) and excess skin removal have been recommended to prevent downward migration of anterior lamella and provide a less bulky eyelid. [4][5][6][7][8][9][10][11][12][13] Furthermore, a firm attachment of the anterior lamella at the supratarsal area, to our view, would prevent downward migration and consequently recurrence of the upper eyelid entropion. Therefore, the aim of this study was to assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation without any graft on the bare tarsus.…”

Section: Introductionmentioning

confidence: 99%

Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos

Aghai

Gordiz

Falavarjani

et al. 2016

Eye

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Purpose To assess the results of anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure in patients with upper eyelid cicatricial entropion without lagophthalmos. Methods In a prospective interventional case series, 52 eyelids (32 patients) were included (April 2009-December 2010. Excluded were patients with previous eyelid surgeries, lagophthalmos, and o12 months of follow-up. Using a microscope, after recessing anterior lamella 3-4 mm above the eyelid margin, it was fixed with 4-5 interrupted 6-0 vicryl sutures. Excess anterior lamella was then excised (blepharoplasty), supratarsal fixation sutures (6-0 vicryl) were put and the skin was closed with 6-0 nylon sutures. Success and failure defined based upon eyelash-globe touch on the last followup visit (at least 12 months), respectively. Results There were 21 females (65.6%) and 11 males (34.4%) with a mean age of 69.7 years (SD = 6.9) and mean follow-up of 21.06 months (SD = 8.26). Success was observed in 39 (75%) and failure in 13 (25%). Mean time of failure was 4.5 months (SD = 3). Although re-treatment with radio-frequency electrolysis (eight eyelids) and re-anterior lamellar recession (two eyelids) resulted in success in 12 eyelids with failure, two patients (three eyelids) declined further procedure. Except for thickened eyelid margin, no complications were observed. Conclusion Anterior lamellar recession, blepharoplasty, and supratarsal fixation procedure is an effective and safe technique for the treatment of the upper eyelid cicatricial entropion without lagophthalmos.

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Recurrence of trichiasis: A long-term follow-up study in the Sultanate of Oman

Abstract: The risk of recurrence after electro-epilation and bilamellar tarsal rotation surgery is high; strategies that account for recurrence need to be introduced.

Cited by 79 publications

References 5 publications

Blinding Trachoma: Prevention With the Safe Strategy

Blinding Trachoma: Prevention With the Safe Strategy

Trichiasis Recurrence—Why the Surgery Part of Trachoma Control is Still Uncontrolled

Anterior lamellar recession, blepharoplasty, and supratarsal fixation for cicatricial upper eyelid entropion without lagophthalmos

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