Rates and risk factors for unfavorable outcomes 6 weeks after trichiasis surgery.
OBJECTIVE
Several studies of trichiasis recurrence suggest an association between surgical factors and long-term recurrence, yet data on short-term risk factors are limited. This study was conducted to evaluate risk factors for early trichiasis recurrence and other unfavorable short-term outcomes.


METHODS
Trichiasis patients presenting for surgery were evaluated for presence of active trachoma and signs of cicatricial outcomes of trachoma, including number of trichiatic lashes, epilation, and entropion. Surgical factors recorded included incision length, surgery duration, and the surgeon performing the operation. Participants were followed up for 6 weeks after surgery and evaluated for eyelid closure defect and trichiasis recurrence; in addition, in two thirds of the patients, eyelid contour abnormality and granuloma formation were evaluated.


RESULTS
First-time trichiasis surgery was performed on 2615 eyelids. Of these, 2601 eyelids without surgical failure were followed up 6 weeks after surgery. Of the eyelids treated, 2.3% had recurrent trichiasis and 1.3% had an eyelid closure defect. Data on eyelid contour abnormalities and granuloma formation were recorded for 1881 eyes, with rates of 1.2% and 10.5%, respectively. Associated risk factors differed by outcome. Surgeon was predictive of eyelid closure defect and granuloma formation. Eyelids with short incisions were nearly four times more likely to have recurrent trichiasis (95% confidence interval, 1.7-9.3). Baseline trichiasis severity was predictive of eyelid contour abnormalities and recurrent trichiasis. Epilation was associated with granuloma formation, but was protective against eyelid closure defect.


CONCLUSIONS
Surgical factors are important predictors of unfavorable outcomes in the weeks immediately after surgery. Although the overall rate of serious uncorrectable unfavorable outcomes was very low, the high rate of granuloma formation, which can be treated by removal, highlights the need for follow-up of patients after trichiasis surgery. (ClinicalTrials.gov number, NCT00347776.).
Johns Hopkins University School of Medicine, Wilmer Eye Institute, Baltimore, Maryland 21287, USA. egower1@jhmi.edu
Emily W
EW
Gower
Shannath L
SL
Merbs
Beatriz E
BE
Munoz
Amir Bedri
AB
Kello
Wondu
W
Alemayehu
Alemush
A
Imeru
Sheila K
SK
West
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017963:Azithromycin / Q000627:therapeutic use; D002921:Cicatrix / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005002:Ethiopia / Q000453:epidemiology; D005141:Eyelid Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D017789:Granuloma, Pyogenic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013752:Tetracycline / Q000627:therapeutic use; D013997:Time Factors; D014141:Trachoma / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D058457:Trichiasis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D013752:Tetracycline