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S.L. Merbs, E. West, H. Mkocha, S. West; Handedness of the Surgeon as an Explanation of the Pattern of Recurrence of Trichiasis Following Surgery . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5607.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Trichiasis is a potentially blinding complication of trachoma. The World Health Organization (WHO) has endorsed the bilamellar tarsal rotation procedure (BTRP) for correction of trichiasis. Reported recurrence rates of trichiasis following this surgery range from 16–62%. To investigate the possible factors that lead to such a high recurrence rate, a study of patients living in Tanzania who had undergone BTRP trichiasis surgery was performed. Methods: Records of the operating surgeons in five districts of central Tanzania, all of whom were right handed, were used to identify individuals who had undergone trichiasis surgery at least 18 months prior to the start of this study. Participants were evaluated for trichiasis recurrence. Trichiasis recurrence was defined as either the presence of at least one eyelash touching the globe or evidence of epilation. For patients with trichiatic lashes, the number and location of lashes touching the globe overall and the number of lashes specifically touching the cornea were recorded. Location of recurrence was based upon the origin(s) of the trichiatic lashes: nasal, central or temporal. Results: A total of 601 potential participants were identified. Patients were excluded because of multiple surgeries, failure to be located, or refusal to participate. Among the 384 study participants, 630 eyes had undergone a single trichiasis correction surgery. Eyes with trichiasis surgery were divided equally between left and right: 319 right eyes and 311 left eyes. A total of 176 eyes (27.9%) had trichiasis recurrence at the time of follow up. Left eyes had a higher rate of recurrence overall than right eyes (31.5% vs 24.5% , p=0.05). In left eyes, temporal recurrence was most common (41.4%). Among right eyes, central recurrence was most common but nasal recurrence was more frequent than temporal recurrence (32.7% vs. 20.4%). Conclusions: If surgical technique and handedness of the surgeon were not important, right and left eyes should have equivalent recurrence rates. The ease of performing the surgical technique as a right–handed surgeon is not equivalent on either side of the eyelid and likely explains the preponderance of left eyelid and left side–of–the–eyelid recurrence. An explanation based upon the BTRP surgical technique as outlined by the WHO and the handedness of the surgeon suggest how the surgical technique could possibly be altered to reduce recurrence rates.
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