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Trichiasis surgery in The Gambia: a 4-year prospective study.

Author(s): Rajak SN, Makalo P, Sillah A, Holland MJ, Mabey DC, Bailey RL, Burton MJ

Affiliation(s): London School of Hygiene and Tropical Medicine, London, UK. saul.rajak@lshtm.ac.uk

Publication date & source: 2010-10, Invest Ophthalmol Vis Sci., 51(10):4996-5001. Epub 2010 May 26.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

PURPOSE: Trachoma is the leading infectious cause of blindness. Conjunctival Chlamydia trachomatis infection causes scarring, entropion, trichiasis, and blinding corneal opacification. Worldwide, there are 8 million people with trichiasis. Although trichiasis surgery can reduce the risk of blindness, retrospective data suggest that long-term recurrence rates may be high. A 4-year prospective investigation of recurrent trichiasis was conducted in The Gambia. METHODS: Patients with trichiasis were examined at baseline, 6 months, 1 year, and 4 years after posterior lamellar tarsal rotation surgery. Conjunctival swabs for bacteriology and PCR for C. trachomatis were collected at baseline, 6 months, and 1 year. RESULTS: Three hundred fifty-six Gambian patients were enrolled at baseline and 266 were reassessed at 4 years (94% of surviving patients). The recurrence rates were 32%, 40%, and 41% at 6 months, 1 year, and 4 years, respectively. At 4 years, 30% of patients had bilateral trichiasis and 21% had bilateral corneal opacity. Recurrence was associated with severe conjunctival inflammation and severe trichiasis (>10 lashes) at baseline. CONCLUSIONS: Trichiasis recurrence rates were high, and most cases recurred within 6 months of surgery. The results suggest that there are important aspects of surgical technique and quality that should to be addressed. Persistent inflammation is strongly associated with recurrence at 4 years.

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