Purchase this article with an account.
Emily W Gower, Beatriz E Munoz, Saul Rajak, Shannath L Merbs, Esmael Ali, Matthew John Burton; Pre-operative Eyelash Location Predicts Long-term Trichiasis Surgery Success . Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6203.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Trichiasis (TT) surgery outcomes are often poor. We evaluated the association between pre- and postoperative TT lash locations to inform surgical program decisions and guide improvements in surgical techniques.
We analyzed data from 4 clinical trials aimed at improving surgery outcomes: STAR, PRET-surgery, epilation vs surgery for minor TT, and absorbable vs silk sutures for major TT. Data were available for location and number of trichiatic lashes present preoperatively and at each follow up visit. We characterized preoperative eyelashes as peripheral only, central only, or both peripheral and central (with or without epiliation). We identified all eyes that developed postoperative TT within 2 years, and characterized the location of trichiatic lashes at the first visit with postoperative TT. We compared baseline and postoperative lash locations.
We evaluated 6,547 eyes that had first-time surgery; 1,717 (26%) had postoperative TT. Postoperative TT rates varied across studies, but the distribution of postoperative TT lash patterns was remarkably similar. In all 4 studies, eyes with only central lashes at baseline were least likely to have postoperative TT (13% recurrence overall; range across studies: 2%-22%), while not surprisingly those with central+peripheral lashes were the most likely (41% recurrence overall; range: 12-48%). Among eyes with postoperative TT, most had less severe TT postoperatively. However, among 299 eyes with only peripheral TT preoperatively, 7% had central TT lashes at follow up, and among 347 eyes with baseline peripheral lashes and epilation, 13% had central lashes touching postoperatively. Transition from central to peripheral lashes was less common: 2% with central only and 9% with central+epilation at baseline had only peripheral lashes at follow up.
Typically, TT surgery reduces or eliminates TT. However, some patients are worse off after surgery, becuase their TT transitions from peripheral to central lashes, which are more likely to damage the cornea and lead to blindness than peripheral lashes. Surgical technique must be evaluated, as our finding of higher postoperative TT in eyes with peripheral lashes suggests that adequate correction is not made at the time of surgery. This could be a result of a short incision length that is placed centrally, or inherent increased tension at the peripheral aspects caused by the lateral canthal tendon.
This PDF is available to Subscribers Only