Trichiasis surgery in The Gambia: a 4-year prospective study.
OBJECTIVE
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.
Rajak
Saul N
SN
London School of Hygiene and Tropical Medicine, London, UK. saul.rajak@lshtm.ac.uk
Makalo
Pateh
P
Sillah
Ansumana
A
Holland
Martin J
MJ
Mabey
David C W
DC
Bailey
Robin L
RL
Burton
Matthew J
MJ
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002692:Chlamydia trachomatis / Q000235:genetics / Q000302:isolation & purification*; D003318:Corneal Opacity / Q000175:diagnosis / Q000382:microbiology; D005140:Eyelashes; D005141:Eyelid Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005714:Gambia; D006201:Hair Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D055502:Secondary Prevention; D014141:Trachoma / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity
D000900:Anti-Bacterial Agents; D017963:Azithromycin