Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis.

• Published in: PLOS Neglected Tropical Diseases
• Main Authors: Emily W Gower, Beatriz Munoz, Saul Rajak, Esmael Habtamu, Sheila K West, Shannath L Merbs, Jennifer C Harding, Wondu Alemayehu, E Kelly Callahan, Paul M Emerson, Teshome Gebre, Matthew J Burton
• Format: Article in Journal/Newspaper
• Language: English
• Published: Public Library of Science (PLoS) 2019
• Subjects: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270; Arctic
• Online Access: https://doi.org/10.1371/journal.pntd.0007637; https://doaj.org/article/d5217fdcb40d4c6a9fc277244a7fded1

Importance Trichiasis surgery programs globally have faced high rates of poor surgical outcomes. Identifying correctable risk factors for improving long-term outcomes is essential for countries targeting elimination of trachoma as a public health problem. Objective To determine whether the location of trichiatic eyelashes prior to surgery influences development of post-operative trichiasis (PTT) within two years after surgery. Design Secondary data analysis of four randomized clinical trials evaluating methods to improve trichiasis surgery outcomes. These include the Surgery for Trichiasis, Antibiotics for Recurrence (STAR) trial, Partnership for Rapid Elimination of Trachoma (PRET-Surgery), absorbable versus silk sutures trial, and epilation versus surgery for minor trichiasis trial. Setting Primary trials were conducted in rural areas of Ethiopia and Tanzania. Interventions or exposures Trichiasis surgery performed with either the bilamellar tarsal rotation procedure or posterior lamellar rotation procedure. Main outcomes Prevalence of PTT within two years after surgery, location of trichiatic eyelashes pre-operatively and post-operatively. Results 6,747 eyelids that underwent first-time trichiasis surgery were included. PTT rates varied by study, ranging from 10-40%. PTT was less severe (based on number of trichiatic eyelashes) than initial trichiasis for 72% of those developing PTT, and only 2% of eyelids were worse at follow up than pre-operatively. Eyelids with central only-trichiasis pre-operatively had lower rates of PTT than eyelids with peripheral only trichiasis in each of the three trials that included severe TT cases. 10% of eyelids with peripheral trichiasis pre-operatively that develop PTT have central TT post-operatively. Conclusions and relevance Pre-operative central trichiasis is less likely than peripheral trichiasis to be associated with subsequent PTT. Regardless of type of surgery, surgeon skill levels, or pre-operative trichiasis severity, the presence of peripheral trichiasis ...