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Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis
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 locatio...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797216/ https://www.ncbi.nlm.nih.gov/pubmed/31589610 http://dx.doi.org/10.1371/journal.pntd.0007637 |
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author | Gower, Emily W. Munoz, Beatriz Rajak, Saul Habtamu, Esmael West, Sheila K. Merbs, Shannath L. Harding, Jennifer C. Alemayehu, Wondu Callahan, E. Kelly Emerson, Paul M. Gebre, Teshome Burton, Matthew J. |
author_facet | Gower, Emily W. Munoz, Beatriz Rajak, Saul Habtamu, Esmael West, Sheila K. Merbs, Shannath L. Harding, Jennifer C. Alemayehu, Wondu Callahan, E. Kelly Emerson, Paul M. Gebre, Teshome Burton, Matthew J. |
author_sort | Gower, Emily W. |
collection | PubMed |
description | 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 pre-operatively is associated with higher rates of PTT. Making an incision that extends the length of the eyelid and adequately rotating the nasal and temporal aspects of the eyelid when suturing may help to minimize the chance of developing peripheral PTT. TRIAL REGISTRATION: ClinicalTrials.gov PRET: NCT00886015; Suture: NCT005228560; Epilation: NCT00522912. |
format | Online Article Text |
id | pubmed-6797216 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-67972162019-10-25 Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis Gower, Emily W. Munoz, Beatriz Rajak, Saul Habtamu, Esmael West, Sheila K. Merbs, Shannath L. Harding, Jennifer C. Alemayehu, Wondu Callahan, E. Kelly Emerson, Paul M. Gebre, Teshome Burton, Matthew J. PLoS Negl Trop Dis Research Article 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 pre-operatively is associated with higher rates of PTT. Making an incision that extends the length of the eyelid and adequately rotating the nasal and temporal aspects of the eyelid when suturing may help to minimize the chance of developing peripheral PTT. TRIAL REGISTRATION: ClinicalTrials.gov PRET: NCT00886015; Suture: NCT005228560; Epilation: NCT00522912. Public Library of Science 2019-10-07 /pmc/articles/PMC6797216/ /pubmed/31589610 http://dx.doi.org/10.1371/journal.pntd.0007637 Text en © 2019 Gower et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Gower, Emily W. Munoz, Beatriz Rajak, Saul Habtamu, Esmael West, Sheila K. Merbs, Shannath L. Harding, Jennifer C. Alemayehu, Wondu Callahan, E. Kelly Emerson, Paul M. Gebre, Teshome Burton, Matthew J. Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title | Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title_full | Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title_fullStr | Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title_full_unstemmed | Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title_short | Pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
title_sort | pre-operative trichiatic eyelash pattern predicts post-operative trachomatous trichiasis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6797216/ https://www.ncbi.nlm.nih.gov/pubmed/31589610 http://dx.doi.org/10.1371/journal.pntd.0007637 |
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