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Shannath Merbs, Kathleen Oktavec, Sandra Cassard, Beatriz Munoz, Sheila West, Emily Gower; Incision height and trichiasis recurrence in bilamellar tarsal rotation surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):868.
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The bilamellar tarsal rotation (BLTR) procedure is commonly used for correction of trichiasis secondary to trachoma. It consists of making a full-thickness incision and rotating the distal eyelid fragment by suture placement. The WHO manual instructs the BLTR surgeon to make the incision 3 mm above the eyelid margin, although to our knowledge, the ideal incision height has never been investigated. The goal of this study is to investigate the impact that incision height has on recurrence.
Data from the Partnership for the Rapid Elimination of Trachoma (PRET) Surgery trial in southern Tanzania were used in this study. This study compared the new TT clamp with standard instrumentation. At their 1 yr visit, 145 sequential participants (245 eyelids) from the Tandahimba district were examined in September 2010 over 4 consecutive days. One observer everted each study eyelid and, using a Castroviejo caliper, measured the incision height from the incision scar on the tarsal surface to the edge of the upper eyelid margin. Incision height measurements for the nasal, central and temporal sections of the upper eyelid were recorded and were compared to recurrence location at 1 yr. Adjusting for randomization of instrument assignment, the odds of location-specific recurrence comparing incision heights of < 4.5 mm with those ≥ 4.5 mm was determined.
77 eyelids had recurrence. The most common location for recurrence was central. In bivariate analyses, the odds of central recurrence was significantly higher when the incision height was <4.5 nasally (OR: 3.1 95% CI: 1.4-6.6), centrally (OR: 2.2; 1.1-4.3), or temporally (OR: 2.1; 1.1-4.0). Furthermore, central recurrence was more common when the nasal height was less than the temporal incision height. In multivariate analyses, central height < 4.5 mm and severe baseline severity were independently associated with central recurrence.
Several studies have suggested that in addition to concurrent infection and inflammation, surgical technique may contribute to trichiasis recurrence and other adverse outcomes. Here we demonstrate that an incision height < 4.5 mm measured at 1 year after surgery is more likely to result in trichiasis recurrence than an incision height ≥ 4.5 mm. Given these findings and the current recommendation for an incision height of 3 mm, further study into the optimum incision height to minimize trichiasis recurrence is warranted.
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