June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Outcomes of Repeat Trichiasis Surgery
Author Affiliations & Notes
  • Emily Gower
    Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC
  • Sandra Cassard
    Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD
  • Shannath Merbs
    Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD
  • Jennifer Harding
    Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD
  • Beatriz Munoz
    Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD
  • Sheila West
    Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, MD
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 870. doi:
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      Emily Gower, Sandra Cassard, Shannath Merbs, Jennifer Harding, Beatriz Munoz, Sheila West; Outcomes of Repeat Trichiasis Surgery. Invest. Ophthalmol. Vis. Sci. 2013;54(15):870.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: Recurrence following initial trachomatous trichiasis surgery is common. Many surgical programs highly recommend repeat surgery for individuals with recurrence. However, data are limited on the outcomes of repeat surgery. The goal of this study was to evaluate these outcomes.

Methods: The Partnership for Rapid Elimination of Trachoma Surgery Trial enrolled individuals in southern Tanzania undergoing first-time surgery in at least one eye. Participants were randomized to standard BLTR surgery or BLTR surgery using the TT clamp and followed for two years. Those who developed trichiasis recurrence during the trial were offered repeat surgery using standard instrumentation at the end of the 2-year trial. All individuals living in the Mtwara district of Tanzania who had repeat surgery were followed 6 months later and evaluated for second trichiasis recurrence and eyelid contour abnormality.

Results: 140 eyes underwent repeat surgery and were evaluated 6 months after second operation. 42% (n=59) had recurrence at 6 months. The severity of second recurrence was the same as or worse than the first recurrence in 45% of those with second recurrence. After controlling for operating surgeon, the only significant predictor of second recurrence, was severity of first recurrence. Baseline trichiasis severity did not predict second recurrence. 63 (45%) second surgeries resulted in an eyelid contour abnormality, with half being moderate or severe abnormalities. 1/3 of those with an eyelid contour abnormality after repeat surgery also had trichiasis recurrence again. 33 of the 63 eyes with eyelid contour abnormalities did not have a contour abnormality prior to second surgery.

Conclusions: Repeat trichiasis surgery often leads to poor outcomes, and in some the post-surgical eyelid status is worse than it was immediately prior to second surgery. Methods for improving repeat trichiasis surgery outcomes need to be developed. In addition, surgical programs need to examine whether repeat surgeries are an effective use of limited resources. Repeat trichiasis surgery often leads to poor outcomes.

Keywords: 736 trachoma • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  
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