Trachomatous trichiasis, a condition in which inward-turned eyelashes scrape the eye and can lead to blindness, can be effectively treated with either of the two most popular types of eyelid surgeries.

The National Institutes of Health (NIH) supported a significant comparison trial that led to this conclusion. Earlier, smaller studies had raised concerns about the success of one of the procedures.

However, this latest research provides reassurance that both methods for treating the condition are effective. The study was published in PLOS Neglected Tropical Diseases (1^✔ ✔Trusted Source
The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the maximizing trichiasis surgery success (MTSS) randomized trial

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).

According to research, individuals with trachomatous trichiasis had post-operative trichiasis rates of 30% or greater after surgery.

Emily Gower, Ph.D. from the University of North Carolina at Chapel Hill, mentioned that repeat procedures are more challenging.

The purpose of the trial was to determine waltering the surgical technique could lower the risk of post-operative trichiasis. It has been observed that the current methods yield superior results.

What is Trachomatous Trichiasis?

Trachomatous trichiasis affects approximately 1.7 million people worldwide, mostly in poor and rural areas of Africa. The condition arises after repeated or chronic eye infections with the bacteria Chlamydia trachomatis, which is spread by person-to-person contact.

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Trachoma is very common in hot, dry areas of the world and repeat infections can eventually lead to scarring and malformation of the eyelid. This malformation causes the edge of the eyelid to draw inward, so that eyelashes scratch the eye.

If left untreated, trichiasis can result in corneal clouding and eventually blindness.

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Surgical Procedure to Treat Trachomatous Trichiasis

The most common and effective treatment for trichiasis is surgery to correct the in-turning of the eyelid, which typically is performed in one of two different ways.

The study compared three different surgical approaches for treating trachomatous trichiasis:

1. Bilamellar Tarsal Rotation (BLTR) at 3 mm incision height

   : This is the standard method where the surgical incision is made 3 millimeters above the edge of the eyelid. It is widely used and is one of the most common procedures for trichiasis.




2. Bilamellar Tarsal Rotation (BLTR) at 5 mm incision height

   : In this, the incision is made slightly higher (5 millimeters) above the edge of the eyelid, with the idea that it might reduce the recurrence of trichiasis.




3. Posterior Lamellar Tarsal Rotation (PLTR)

   : This technique involves rotating the inner layer of the eyelid to prevent the eyelashes from scratching the eye.

The study, which took place in southern Ethiopia, enrolled 4,914 patients with trichiasis in one or both eyes (6,940 eligible eyes).

The participants were randomized to receive

• Bilamellar Tarsal Rotation (BLTR) at 3 mm incision height
• Bilamellar Tarsal Rotation (BLTR) at 5 mm incision height
• Posterior Lamellar Tarsal Rotation (PLTR)

Researchers rechecked the patients for post-operative trichiasis at six weeks and again at 12-18 months. On average, approximately 17% of eyelids had post-operative trichiasis.

There was no difference in risk of post-operative trichiasis between the two methods with a 3 mm incision height, while those who received the 5 mm incision height BLTR were significantly more likely to have post-operative trichiasis.

The study concluded that both the 3 mm BLTR and the PLTR are effective for treating trichiasis, but the 5 mm BLTR was associated with a higher risk of recurrence.

Reference:

1. The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the maximizing trichiasis surgery success (MTSS) randomized trial- (https:journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0012034)

Source-Eurekalert