The London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS Negl Trop Dis. 2013 Aug 22;7(8):e2392. doi: 10.1371/journal.pntd.0002392. eCollection 2013.
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.
METHODOLOGY/PRINCIPAL FINDINGS: 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 (>5 trichiatic lashes) and minor (<5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had >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%).
CONCLUSIONS/SIGNIFICANCE: 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.
超过 120 万人因沙眼性倒睫（TT）而失明。眼睑旋转手术是治疗的主要手段，但复发率可能很高。我们研究了在流行地区最广泛实施的两种 TT 手术之一的后板层睑板旋转术（PLTR）的结果（复发率和其他并发症）。
方法/主要发现：我们对 1300 名接受 PLTR 手术的参与者进行了为期两年的随访研究，这些参与者由五名 TT 护士外科医生之一进行手术。所有参与者在基线和术后 6、12、18 和 24 个月都接受了详细的沙眼眼部检查。该研究调查了复发率、其他并发症以及与复发相关的因素。术前有 635 名参与者中有 207 名（32.6%）和 641 名参与者中有 108 名（16.9%）患有主要（>5 根倒睫）和次要（<5 根倒睫）TT，分别发生了复发。在 315 例复发中，42/315（总体 3.3%）有>5 根睫毛（主要复发）。术后前六个月复发最多：在此期间发生了 172 例（55%）。复发与术前主要 TT 相关（OR 2.39，95%CI 1.83-3.11），与定向/变形睫毛相比，术前不规则睫毛（OR 1.99，95%CI 1.23-3.20），年龄>40 岁（OR 1.59，95%CI 1.14-2.20）和特定外科医生（外科医生复发风险范围：18%-53%）。69 例（5.7%）发生肉芽肿，156 例（13.0%）发生切迹。
结论/意义：尽管外科医生数量多、训练有素，但复发风险仍然很高。然而，绝大多数是轻微复发，可能不会对角膜或视力产生重大影响。外科医生之间的复发差异令人担忧；手术技术、培训和术后即刻眼睑位置需要进一步研究。
