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E. W. Gower, B. E. Munoz, W. Alemayehu, S. K. West; Surgical Factors Play a Significant Role in Rates of Trichiasis Recurrence. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2514.
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Trachoma is the leading infectious cause of blindness worldwide. Rates of trichiasis recurrence following surgery are high in many settings. Early studies of recurrence suggested that surgical factors may play a role. However, what factors in particular are important have not been well elucidated. The goal of this analysis was to examine surgical factors collected in a standardized fashion in the context of a clinical trial in order to examine what factors may play a role.
This analysis is based on data from the STAR trial, a randomized clinical trial to evaluate the use of antibiotics at the time of surgery in preventing trichiasis recurrence. Eligible individuals were evaluated for baseline trichiasis severity. Eyes with previously unoperated trichiasis were operated using the bilamellar tarsal rotation procedure. During surgery, data were collected on the duration of surgery, length of incision, operated eye (right or left) and name of surgeon. Patients were followed for two years to evaluate trichiasis recurrence. Length of incision was measured by cutting a piece of suture material that extended from one end of the incision to the other following the eyelid contour. Cox proportional hazard models were used to examine risk factor associations.
1452 individuals enrolled in the STAR trial. Operated eyes were distributed equally between left and right eyelids. By two years post-surgery, 136 eyelids (9.4%) had developed recurrence. 8% of right eyes and 11% of left eyes developed recurrence. 58% of the recurrences were in left eyes. 38 (2.6%) eyelids had short incisions; 18% of eyelids with short incisions developed trichiasis recurrence compared to 9% of eyelids with longer incisions (p=0.05). Rates of recurrence by surgeon varied from 8-12%. In multivariate analyses adjusting for antibiotic treatment at time of surgery, age, gender and baseline trichiasis severity, left eyes were 45% more likely to develop recurrence than right eyes (HR 1.45; 95% CI: 1.03-2.05). In addition, a borderline statistically significant association was seen by surgeon. Surgeon 3 was 50% more likely to have patients with trichiasis recurrence than surgeon 1 (95% CI: 0.95-2.39).
Surgical factors play an integral role in long-term trichiasis recurrence. Methods to help standardize procedures may prove useful in improving trichiasis recurrence rates.
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