Standard surgical approaches have better outcomes in trachomatous trichiasis

Key takeaways:

• A study explored bilamellar tarsal rotation with 3 mm or 5 mm incision height and posterior lamellar tarsal rotation.
• Postoperative trichiasis was more likely with the 5 mm approach.

Two standard surgical procedures helped treat patients with trachomatous trichiasis, according to a study published in PLoS Neglected Tropical Diseases.

Emily W. Gower, PhD, of University of North Carolina at Chapel Hill, and colleagues said surgical outcomes are still an issue in countries where trachoma is endemic, so they explored which procedure worked best and if a different approach improved results.

“Some studies have reported postoperative trichiasis rates of 30% or higher for patients with trachomatous trichiasis following surgery, and repeat surgeries are more difficult,” Gower said in a press release issued by the NIH. “This trial sought to determine if we could decrease the risk of postoperative trichiasis by modifying the surgical procedure. We found that existing approaches result in better outcomes.”

Gower and colleagues randomly assigned 6,940 eyes of 4,914 patients from southern Ethiopia with trachomatous trichiasis to undergo one of three surgeries: standard bilamellar tarsal rotation (BLTR) with 3 mm incision height, BLTR with 5 mm incision height or posterior lamellar tarsal rotation (PLTR).

The primary outcome was cumulative incidence of postoperative trichiasis (PTT).

At 12 to 18 months after surgery, 1,149 eyelids had developed PTT. The difference in PTT incidence between BLTR 3 mm and PLTR was not significant. However, BLTR 5 mm had the greatest risk for PTT compared with the other two procedures. The study authors did not recommend increasing the BLTR incision height from 3 mm to 5 mm.

“In our setting, where four of the six surgeons trained on both procedures simultaneously, we do not see meaningful differences in PTT rates between BLTR-3 and PLTR overall,” the authors wrote. “The small number of surgeons in this study limits our ability to adequately address the impact of training order on study outcomes. More evidence is needed to assess the impact of training order on surgical performance.”

Reference:

• Two common surgeries equally effective for treating blinding condition of the eyelid. https://www.nih.gov/news-events/news-releases/two-common-surgeries-equally-effective-treating-blinding-condition-eyelid. Published Sept. 17, 2024. Accessed Dec. 4, 2024.

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