Impact of Refresher Training on Outcomes of Trachomatous Trichiasis Surgery

Abstract

Purpose : Trachomatous trichiasis (TT) is a severe, blinding consequence of chronic inflammation and scarring in the conjunctiva resulting from trachoma, which is the leading infectious cause of blindness worldwide. Our study evaluated the effectiveness of refresher training (RT), including the “Head Start” approach and live surgery following the WHO recommended procedure for the certification of TT surgeons on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.

Methods : A total of N=283 eyes contributed by 173 patients were included in analysis. Patients were included in the study if they were undergoing UL TT surgery in at least one eye by one of the participating surgeons. Patients were split into two cohorts: Cohort 1 (C1) was comprised of patients enrolled prior to the RT, and Cohort 2 (C2) included those enrolled after the RT. Data were collected at 3 time points: baseline, 6-month, and 12-month follow-up. Surgical outcomes were recorded throughout follow-up using multiple response forms. The main outcome of interest was development of post-operation TT (POTT), which was defined as: presence of at least one UL lash touching the eye; and/or epilation; and/or repeat surgery. A series of multivariate generalized estimating equations (GEEs) were fit to model POTT against all potential covariates of interest, including demographic factors and clinical measurements. Odds ratios (ORs) and 95% CIs were calculated.

Results : Within C1, 37/128 eyes (28.91%) developed POTT while within C2, 22/133 eyes (16.54%) developed POTT (p=0.03). In the fully saturated GEE model, only the cohort covariate was significant at the alpha=0.05 significance level (p=0.03) after adjusting for all other covariates. After performing stepwise model selection using the quasilikelihood under the independence model criterion (QIC), our final model included cohort as the singular chosen covariate. The corresponding OR for an eye being in C2 relative to C1 was 0.41 (95% CI:0.19, 0.86).

Conclusions : Our results indicate a substantial reduction in the odds of developing POTT for eyes receiving treatment after initiating RT including the “Head Start” approach followed by live surgery training as compared to eyes receiving treatment prior to the RT. This observation implies a significant potential benefit of the program’s effectiveness, even with experienced surgeons, and suggests comprehensive RT may be a valuable strategy to improve surgical outcomes.

This is a 2021 ARVO Annual Meeting abstract.