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Shannath L. Merbs, Sandra D. Cassard, Jennifer L. Harding, Beatriz E. Munoz, Sheila K. West, Emily W. Gower; Relationship between Immediate Post-operative Appearance and 6-week Operative Success in Trichiasis Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):67.
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Trichiasis is a potentially blinding complication of trachoma. The bilamellar tarsal rotation (BLTR) procedure is commonly used for trichiasis correction. It consists of making a full-thickness incision and rotating the distal eyelid fragment by suture placement. The goal of this study was to investigate whether the immediate post-operative appearance of the eyelid predicted the surgical outcome at 6 weeks.
Immediate post-operative images of the eyelid and 6-week outcome data from the ongoing Partnership for the Rapid Elimination of Trachoma (PRET) Surgery trial in Tanzania were used in this study. Using the 6-week surgical results, 200 eyelids were randomly selected within strata to ensure an equal distribution of normal, recurrence, or eyelid contour abnormality (ECA). Eyelids with multiple unfavorable outcomes were excluded. The immediate post-operative photographs were evaluated in a masked fashion by an oculoplastic surgeon (SLM), who recorded a predicted single 6-week outcome based on the appearance of the eyelid right after surgery: normal, recurrence (with location noted as nasal, central, and/or temporal), or ECA (with severity noted as moderate or severe). Predicted grades were compared to the 6-week study outcome. Sensitivity and specificity of predictions were calculated for each outcome. Since each eye could only have one outcome, analyses of trichiasis recurrence excluded eyes with ECA and analyses of ECA excluded eyelids with trichiasis recurrence.
85 eyelids of 100 eyelids with ECA were accurately predicted from the immediate post-operative photos (sensitivity 85%, 95% confidence interval (CI): (78%, 92%), specificity 88%, 95% CI: (79%, 97%)), and predicted severity of the ECA was accurate 58% of the time. Likewise, trichiasis recurrence at any location was correctly predicted in 35 of 50 eyelids (sensitivity 70%, 95% CI: (57%, 83%), specificity 90%, 95% CI: (82%, 98%)). Sensitivity and specificity for predicting location of recurrence were also reasonably good, 62-65% and 83-92%, respectively. Recurrence and ECA were rarely predicted when they were absent (10% and 12%, respectively).
We have demonstrated that post-operative success of BLTR can be accurately predicted from the immediate post-surgical eyelid appearance. Therefore, trichiasis surgeons should be educated to recognize the ideal and sub-optimal immediate post-surgical appearance and understand how to improve the appearance by adjusting the suture placement or tension.
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