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Saul N. Rajak, Esamel Habtamu, Helen Weiss, Clare Gilbert, Paul Emerson, Matthew Burton; A Prospective Study of The Outcomes and Risk Factors For Failure of Trachomatous Trichiasis Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1024.
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Over two million people worldwide are blind from trachomatous trichiasis (TT). Surgery is the mainstay of treatment for TT, usually using posterior lamellar or bilamellar tarsal rotation (PLTR/BLTR). However, trichiasis recurrence occurs frequently; rates as high as 62% at three years have been reported. We conducted a cohort study to assess recurrence rates after PLTR surgery, risk factors for recurrence and other complications of the procedure.
Individuals with trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and received PLTR surgery. One of two trachoma specialists conducted a full trachoma examination at baseline, 6, 12, 18 and 24 months.
We recruited 1300 individuals. Recurrence occurred in 316/1276 (24.8%) participants. However recurrence with greater than 5 lashes (major TT) only occurred in 42 cases (3.3%) and, unlike minor recurrence (less than 6 lashes), was associated with worse corneal opacity and visual acuity at follow-up. Recurrence had occurred within the first six months post-operatively in 58%. Individual surgeon recurrence rates ranged from 17.7% to 52.6%. Recurrence was independently associated with pre-operative disease severity, particular surgeons and older age. Minor complications included lid notching (156 participants, 13%) and granuloma (69 participants, 5.7%).
Although recurrence occurs frequently after PLTR surgery, it is frequently not severe and may not contribute to worsening corneal opacity or visual acuity. The high early recurrence rates, the intersurgeon variation and frequently observed minor complications suggest aspects of surgical practice and technique need further attention.
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