The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.
<h4>Background</h4>Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR...
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0002392&type=printable |
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| author | Saul N Rajak Esmael Habtamu Helen A Weiss Amir B Kello Bayeh Abera Mulat Zerihun Teshome Gebre Clare E Gilbert Peng T Khaw Paul M Emerson Matthew J Burton |
| author_facet | Saul N Rajak Esmael Habtamu Helen A Weiss Amir B Kello Bayeh Abera Mulat Zerihun Teshome Gebre Clare E Gilbert Peng T Khaw Paul M Emerson Matthew J Burton |
| author_sort | Saul N Rajak |
| collection | DOAJ |
| description | <h4>Background</h4>Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings.<h4>Methodology/principal findings</h4>We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (<5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had >5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%).<h4>Conclusions/significance</h4>Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation. |
| format | Article |
| id | doaj-art-deaea422e0044b6c82d6dce9079a5759 |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-deaea422e0044b6c82d6dce9079a57592025-01-17T05:32:33ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352013-01-0178e239210.1371/journal.pntd.0002392The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.Saul N RajakEsmael HabtamuHelen A WeissAmir B KelloBayeh AberaMulat ZerihunTeshome GebreClare E GilbertPeng T KhawPaul M EmersonMatthew J Burton<h4>Background</h4>Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings.<h4>Methodology/principal findings</h4>We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (<5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had >5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%).<h4>Conclusions/significance</h4>Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation.https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0002392&type=printable |
| spellingShingle | Saul N Rajak Esmael Habtamu Helen A Weiss Amir B Kello Bayeh Abera Mulat Zerihun Teshome Gebre Clare E Gilbert Peng T Khaw Paul M Emerson Matthew J Burton The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. PLoS Neglected Tropical Diseases |
| title | The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. |
| title_full | The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. |
| title_fullStr | The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. |
| title_full_unstemmed | The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. |
| title_short | The outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence. |
| title_sort | outcome of trachomatous trichiasis surgery in ethiopia risk factors for recurrence |
| url | https://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0002392&type=printable |
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