A New Surgical Technique for Postoperative Trachomatous Trichiasis.

Published on Sep 24, 2021in Ophthalmic Plastic and Reconstructive Surgery1.746
路 DOI :10.1097/IOP.0000000000002055
Shannath L. Merbs28
Estimated H-index: 28
(UMB: University of Maryland, Baltimore),
Sandra L. Talero + 4 AuthorsEmily W. Gower26
Estimated H-index: 26
(UNC: University of North Carolina at Chapel Hill)
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Abstract
INTRODUCTION The World Health Organization has identified management of postoperative trichiasis (PTT) as one of the key remaining areas of focus needed to eliminate blinding trachoma as a public health problem. We developed the Bevel-Rotation Advancement Procedure (B-RAP) to treat individuals who need repeat trichiasis surgery. METHODS Scarring caused by trichiasis surgery can cause the eyelid to become thick and distorted, making repeat surgery more difficult. To minimize eyelid thickness following B-RAP, a beveled incision of the tarsus is made allowing a marginal rotation of the eyelash fragment. Dissection between the anterior and posterior lamellae above the beveled incision and removal of scar tissue allows the marginal rotation to be combined with a posterior lamellar advancement to treat severely scarred eyelids with PTT and eyelid contour abnormalities (ECAs). RESULTS Two surgeons performed B-RAP on 44 eyelids of 30 patients with PTT. The number of prior trachomatous trichiasis (TT) surgeries ranged from 2 to more than 4. At the 3-6 months postoperative visit, 37 eyelids (84%) had no recurrence of PTT. Three eyelids had central lashes touching; the remaining eyelids with recurrent PTT had nasal and temporal lashes touching. Fifteen eyelids (34%) had ECAs, but only 1 was severe. CONCLUSIONS B-RAP was developed considering the altered eyelid anatomy found in the postsurgical eyelid with TT. Thinning of the eyelash fragment and removal of postoperative scar tissue improves the ability to advance and stabilize the eyelash fragment after external rotation. B-RAP shows promise as a procedure for improving outcomes of repeat trichiasis surgery.
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#1Esmael Habtamu (Lond: University of London)H-Index: 13
#2Tariku Wondie (Carter Center)H-Index: 7
Last. Matthew J. Burton (Lond: University of London)H-Index: 45
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Purpose Unfavorable outcomes after trachomatous trichiasis (TT) surgery are undermining the global trachoma elimination effort. This analysis investigates predictors of postoperative TT (PTT), eyelid contour abnormalities (ECAs), and granuloma in the 2 most common TT surgery procedures: posterior lamellar tarsal rotation (PLTR) and bilamellar tarsal rotation (BLTR). Design Secondary data analysis from a randomized, controlled, single-masked clinical trial. Participants A total of 1000 patients w...
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#1Emily W. Gower (Wake Forest University)H-Index: 26
#2Sheila K. West (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 100
Last. Shannath L. Merbs (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 28
view all 6 authors...
Background Clear definitions of outcomes following trichiasis surgery are critical for planning program evaluations and for identifying ways to improve trichiasis surgery. Eyelid contour abnormality is an important adverse outcome of surgery; however, no standard method has been described to categorize eyelid contour abnormalities. Methodology/Principal Findings A classification system for eyelid contour abnormalities following surgery for trachomatous trichiasis was developed. To determine whet...
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#1Sheila K. West (Johns Hopkins University)H-Index: 100
#2Wondu Alemayehu (Orbis International)H-Index: 23
Last. Emily W. Gower (Johns Hopkins University)H-Index: 26
view all 4 authors...
Purpose: Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threat...
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#1Stuart R. Seiff (UCSF: University of California, San Francisco)H-Index: 28
#2Susan R. Carter (UCSF: University of California, San Francisco)H-Index: 16
Last. Phillip H. Choo (UCSF: University of California, San Francisco)H-Index: 4
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Abstract PURPOSE: To report the efficacy of tarsal margin rotation with posterior lamella superadvancement in the management of cicatricial entropion of the upper eyelid. METHODS: In 15 consecutive patients, 22 eyelids with cicatricial entropion were managed with tarsal margin rotation and posterior lamella superadvancement. In a retrospective study, the technique and results were evaluated. RESULTS: In all 22 upper eyelids, the normal eyelashes rotated away from the surface of the eye. Mean fol...
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#1Mark H. Reacher (Johns Hopkins University)H-Index: 5
#2Beatriz MunozH-Index: 79
Last. Hugh R. Taylor (University of Melbourne)H-Index: 124
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鈥 The effectiveness of commonly used procedures to correct trachomatous trichiasis of the upper lid was examined in a clinical trial in Oman. Lids were graded as having minor trichiasis (five or fewer lashes), major trichiasis (more than five lashes), and defective lid closure. Randomly allocated surgery specific for lid grade was completed in 384 lids, of which 369 (96%) were followed up once or twice approximately 9 and 21 months after surgery. The definition of operative success included no e...
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#1M. H. ReacherH-Index: 1
#2M. J. E. HuberH-Index: 1
Last. A. AlghassanyH-Index: 1
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Three surgeons operated on upper eye lids of northern Omani villagers for trichiasis due to trachoma using a standardised protocol. The lids were graded as minor trichiasis, five or fewer lashes; major trichiasis, six or more lashes; and lid closure defect. Operative success was defined as no lash/eyeball contact and complete gentle lid closure. One hundred and sixty five lids with major trichiasis were allocated by random number tables to one of five operations: bilamellar tarsal rotation (Ball...
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