Abstract
BackgroundSurgical technique, including suture placement and tension, is believed to contribute to the outcome of bilamellar tarsal rotation surgery for trachomatous trichiasis. However, the immediate post-operative appearance that minimizes the chance of recurrence and other adverse outcomes has not been investigated.Methodology/Principal FindingsTo explore whether the degree of correction immediately after surgery is predictive of surgical outcome at the 6-week post-operative visit, photographs taken immediately after surgery were used to predict surgical outcomes, including the severity of eyelid contour abnormality and trichiasis recurrence. Both eyelid contour abnormalities and recurrence were accurately predicted from the immediate post-operative photographs by an experienced oculoplastic surgeon 85% and 70% of the time, respectively. Participants with a “slight over-correction” that resulted in no eyelid contour abnormality and no recurrence were used to identify immediate post-operative contours that lead to a successful surgical outcome.Conclusions/SignificanceThe immediate post-operative eyelid contour is an important indicator of post-operative success of BLTR surgery. Based upon our findings, we developed a Surgery Photocard. This card illustrates some examples of immediate post-surgical appearances, which led to a successful outcome, as well as sub-optimal appearances, which led to poor surgical outcomes. The card also provides suggestions for improving the appearance by adjusting the suture placement or tension based upon standard oculoplastic principles.
Highlights
Despite a World Health Organization (WHO) initiative in 1998 to eliminate trachoma by 2020, this disease continues to plague poor regions of many developing countries
The WHO has endorsed the Bilamelar Tarsal Rotation (BLTR) procedure for the correction of trachomatous trichaisis (TT), [2,3] and in many countries, this surgery is performed by non-physicians, hereafter referred to as surgical technicians
In this study we evaluated the relationship between immediate postoperative contour and 6-week outcomes utilizing immediate post-operative photos of 200 trichiasis surgeries
Summary
Despite a World Health Organization (WHO) initiative in 1998 to eliminate trachoma by 2020, this disease continues to plague poor regions of many developing countries. [1] For those individuals who have already developed conjunctival scarring and trichiasis, the principle option to prevent unnecessary blindness is surgery. The WHO has endorsed the Bilamelar Tarsal Rotation (BLTR) procedure for the correction of trachomatous trichaisis (TT), [2,3] and in many countries, this surgery is performed by non-physicians, hereafter referred to as surgical technicians. Several studies have suggested that in addition to concurrent infection and inflammation, [4] surgical technique may contribute significantly to trichiasis recurrence. The exact surgical factors that contribute to recurrence and other adverse outcomes have not been fully elucidated. Surgical technique, including suture placement and tension, is believed to contribute to the outcome of bilamellar tarsal rotation surgery for trachomatous trichiasis. The immediate post-operative appearance that minimizes the chance of recurrence and other adverse outcomes has not been investigated
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