03002nas a2200433   4500000000100000008004100001653001600042653001500058653002200073653001300095653001700108653001500125653001600140653000900156653001100165653002200176653001100198653001300209653000900222653001000231653001500241100001200256700001400268700001300282700001300295700001200308700001400320700001200334700001500346700001200361700001400373700001300387245009300400856009000493300001000583490000600593520195500599022001402554       2013                            d10aYoung Adult10aTrichiasis10aTreatment Outcome10aTrachoma10aRisk Factors10aRecurrence10aMiddle Aged10aMale10aHumans10aFollow-Up Studies10aFemale10aEthiopia10aAged10aAdult10aAdolescent1 aRajak S1 aHabtamu E1 aWeiss HA1 aKello AB1 aAbera B1 aZerihun M1 aGebre T1 aGilbert CE1 aKhaw PT1 aEmerson P1 aBurton M00aThe outcome of trachomatous trichiasis surgery in Ethiopia: risk factors for recurrence.  uhttp://journals.plos.org/plosntds/article/asset?id=10.1371%2Fjournal.pntd.0002392.PDF  ae23920 v73 a<p><strong>BACKGROUND: </strong>Over 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings.</p>

<p><strong>METHODOLOGY/PRINCIPAL FINDINGS: </strong>We conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (&gt;5 trichiatic lashes) and minor (&lt;5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had &gt;5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83-3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23-3.20), age over 40 years (OR 1.59, 95% CI 1.14-2.20) and specific surgeons (surgeon recurrence risk range: 18%-53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%).</p>

<p><strong>CONCLUSIONS/SIGNIFICANCE: </strong>Risk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation.</p>
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