PURPOSE: 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.
RCT Entities:
PURPOSE: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.
Authors: Emily W Gower; Shannath L Merbs; Beatriz E Munoz; Amir Bedri Kello; Wondu Alemayehu; Alemush Imeru; Sheila K West Journal: Invest Ophthalmol Vis Sci Date: 2011-04-25 Impact factor: 4.799
Authors: Saul N Rajak; Esmael Habtamu; Helen A Weiss; Amir Bedri; Teshome Gebre; Robin L Bailey; David C W Mabey; Peng T Khaw; Clare E Gilbert; Paul M Emerson; Matthew J Burton Journal: Invest Ophthalmol Vis Sci Date: 2011-10-10 Impact factor: 4.799
Authors: E Quicke; A Sillah; E M Harding-Esch; A Last; H Joof; P Makalo; R L Bailey; S E Burr Journal: Trop Med Int Health Date: 2013-09-06 Impact factor: 2.622
Authors: Emily W Gower; Sheila K West; Sandra D Cassard; Beatriz E Munoz; Jennifer C Harding; Shannath L Merbs Journal: PLoS Negl Trop Dis Date: 2012-06-26
Authors: Saul N Rajak; Esmael Habtamu; Helen A Weiss; Amir B Kello; Bayeh Abera; Mulat Zerihun; Teshome Gebre; Clare E Gilbert; Peng T Khaw; Paul M Emerson; Matthew J Burton Journal: PLoS Negl Trop Dis Date: 2013-08-22
Authors: Saul N Rajak; Esmael Habtamu; Helen A Weiss; Amir Bedri Kello; Teshome Gebre; Asrat Genet; Robin L Bailey; David C W Mabey; Peng T Khaw; Clare E Gilbert; Paul M Emerson; Matthew J Burton Journal: PLoS Med Date: 2011-12-13 Impact factor: 11.069
Authors: Matthew J Burton; Saul N Rajak; Athumani Ramadhani; Helen A Weiss; Esmael Habtamu; Bayeh Abera; Baye Abera; Paul M Emerson; Peng T Khaw; David C W Mabey; Martin J Holland; Robin L Bailey Journal: PLoS Negl Trop Dis Date: 2012-12-20