Bilamellar Tarsal Rotation (BLTR) vs Posterior Lamellar Tarsal Rotation (PLTR) for Trachomatous Trichiasis (TT)

Abstract

Purpose : TT surgery is a key strategy for avoiding blindness and visual impairment from trachoma. A prior field trial comparing alternative WHO-endorsed TT surgery techniques found ~50% lower incidence of postoperative TT (PTT) with PLTR than BLTR. However, some have raised concerns of performance bias in that study. We hypothesized that in a “real world” study PLTR also would have less PTT than BLTR.

Methods : Observational data were taken from a field trial nested within a TT control program in Jimma Zone, Ethiopia, wherein TT surgeons used the procedure they preferred (BLTR or PLTR) for each eye with TT to be operated. Perioperative management followed standard programmatic operating procedures. Because randomization of treatment assignment (fluorometholone 0.1% or placebo) was stratified by surgeon, no adjustment for the still-masked treatment variable was needed. Uni- and multivariable logistic regression, adjusting for inter-eye correlation and relevant baseline factors (age, number of lashes touching globe, extent of epilation, entropion severity, and extent of upper palpebral conjunctival scarring), compared the cumulative incidence at ≤1 year after TT surgery of postoperative TT (PTT), defined as any upper eyelid lash touching the globe, evidence of epilation and/or undergoing PTT surgery.

Results : At baseline, most TT severity markers were statistically significantly more favorable in the BLTR (678 eyes) than the PLTR (855 eyes) group. Cumulative PTT incidence during 12 months’ follow-up was 21.4% and 8.2% for BLTR and PLTR eyes respectively—adjusted odds ratio (aOR)=0.32, 95% confidence interval (CI), 0.23-0.45. Crude association and a multivariate sensitivity analysis showed similar results. Prospectively defined postoperative adverse outcomes of TT surgery were more frequent with BLTR than PLTR (p=0.002) at 4 weeks post-surgery, but were cross-sectionally similar between groups by 12 months (p=0.81).

Conclusions : When surgeons applied their preferred surgical technique, postoperative TT occurred less than half as often with PLTR than BLTR. These real-world data confirm the prior trial’s primary result and suggests that using PLTR instead of BLTR reduces PTT incidence≥50%.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Cumulative incidence of postoperative TT through 12 months in eyes with TT that underwent BLTR or PLTR.