Definitions and Standardization of a New Grading Scheme for Eyelid Contour Abnormalities after Trichiasis Surgery

Abstract

BackgroundClear definitions of outcomes following trichiasis surgery are critical for planning program evaluations and for identifying ways to improve trichiasis surgery. Eyelid contour abnormality is an important adverse outcome of surgery; however, no standard method has been described to categorize eyelid contour abnormalities.Methodology/Principal FindingsA classification system for eyelid contour abnormalities following surgery for trachomatous trichiasis was developed. To determine whether the grading was reproducible using the classification system, six-week postoperative photographs were reviewed by two senior graders to characterize severity of contour abnormalities. Sample photographs defining each contour abnormality category were compiled and used to train four new graders. All six graders independently graded a Standardization Set of 75 eyelids, which included a roughly equal distribution across the severity scale, and weighted kappa scores were calculated. Two hundred forty six-week postoperative photographs from an ongoing clinical trial were randomly selected for evaluating agreement across graders. Two months after initial grading, one grader regraded a subset of the 240 photographs to measure longer-term intra-observer agreement. The weighted kappa for agreement between the two senior graders was 0.80 (95% CI: 0.71–0.89). Among the Standardization Set, agreement between the senior graders and the 4 new graders showed weighted kappa scores ranging from 0.60–0.80. Among 240 eyes comprising the clinical trial dataset, agreement ranged from weighted kappa 0.70–0.71. Longer-term intra-observer agreement was weighted kappa 0.86 (95% CI: 0.80–0.92).Conclusions/SignificanceThe standard eyelid contour grading system we developed reproducibly delineates differing levels of contour abnormality. This grading system could be useful both for helping to evaluate trichiasis surgery outcomes in clinical trials and for evaluating trichiasis surgery programs.

Patients’ Perceptions of Trichiasis Surgery: Results from the Partnership for Rapid Elimination of Trachoma (PRET) Surgery Clinical Trial

“…Contour abnormalities also may affect the distribution and replenishment of the tear film, since consistent contact between the upper eyelid and globe during blinking may be impaired 17. ECAs also can cause lagophthalmos due to misalignment of the eyelids upon closure or due to severe defects in the upper eyelid 8. Proper eyelid closure is necessary to maintain the tear film and prevent dryness.…”

“…TT was defined as at least one lash touching the globe, and severity was classified as mild, moderate, or severe based on the number of lashes touching and evidence of epilation 9. ECAs were characterized as none, mild, moderate, or severe using a grading system developed and validated for this study 8. A trained examiner assessed visual acuity at 4m monocularly (adjusted to 2 m or 1 m as needed) under ambient light using the tumbling E version of the Early Treatment Diabetic Retinopathy Study (ETDRS) chart 14.…”

The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence

“…Notching was defined as central overcorrection of the lid such as to cause a clear deviation in contour of the lid margin. This would correspond to either moderate or severe lid contour abnormalities in a recently published grading system [34].…”

A novel technique for the measurement of eyelid contour to compare outcomes following Muller’s muscle-conjunctival resection and external levator resection surgery

“…Classically, the assessment of surgical change in eyelid contour has been qualitative, typically including descriptors such as "acceptable", "good", or "excellent", although some more formal grading systems have been proposed [7,8]. Such systems typically lack standardization across raters or centers and are therefore subjective.…”