Clinical Trial Finds Two common surgical approaches Equally Effective for Managing Trachomatous Trichiasis

Trachomatous trichiasis, a potentially blinding condition where inward-turned eyelashes scratch the front of the eye, can successfully be treated by either of the two most common types of eyelid surgery, according to findings from a large comparison trial funded by the National Institutes of Health.

“Some studies have reported post-operative trichiasis rates of 30% or higher for patients with trachomatous trichiasis following surgery, and repeat surgeries are more difficult,” said Emily Gower, Ph.D., University of North Carolina at Chapel Hill. “This trial sought to determine if we could decrease the risk of post-operative trichiasis by modifying the surgical procedure. We found that existing approaches result in better outcomes.”

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. 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.

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 at 3 mm incision height, bilamellar tarsal rotation at 5 mm incision height, or posterior lamellar tarsal rotation. 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 bilamellar tarsal rotation were significantly more likely to have post-operative trichiasis. The results indicate that the current standard surgeries – either method at 3 mm – are better options for trichiasis treatment than the 5 mm method.

Reference: Emily W. Gower, Alemayehu Sisay, Belay Bayissasse, Dawit Seyum, Jerusha Weaver, Beatriz Munoz, Alexander P. Keil, Andrea Bankoski, Kristin M. Sullivan, Hashiya Kana, Fisseha Admassu, Demissie Tadesse, Shannath L. Merbs. The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the maximizing trichiasis surgery success (MTSS) randomized trial. PLOS Neglected Tropical Diseases, 2024; 18 (9): e0012034 DOI: 10.1371/journal.pntd.0012034