Long term outcome of trichiasis surgery in the Gambia

Abstract

Background: Trichiasis surgery is believed to reduce the risk of losing vision from trachoma. There are limited data on the long term outcome of surgery and its effect on vision and corneal opacification. Similarly, the determinants of failure are not well understood. Methods: A cohort of people in the Gambia who had undergone surgery for trachomatous trichiasis 3-4 years earlier was re-assessed. They were examined clinically and the conjunctiva was sampled for Chlamydia trachomatis polymerase chain reaction (PCR) and general bacterial culture. Results: In total, 141/162 people were re-examined. Recurrent trichiasis was found in 89/214 (41.6%) operated eyes and 52 (24.3%) eyes had five or more lashes touching the globe. Corneal opacification improved in 36 of 78 previously affected eyes. There was a general deterioration in visual acuity between surgery and follow up, which was greater if new corneal opacification developed or trichiasis returned. Recurrent trichiasis was associated with severe conjunctival inflammation and bacterial infection. C trachomatis was detected in only one individual. Conclusions: Recurrent trichiasis following surgery is a common potentially sight threatening problem. Some improvement in the cornea can occur following surgery and the rate of visual loss tended to be less in those without recurrent trichiasis. The role of conjunctival inflammation and bacterial infection needs to be investigated further. Follow up of patients is advised to identify individuals needing additional surgical treatment.

Trichiasis Recurrence—Why the Surgery Part of Trachoma Control is Still Uncontrolled

“…16 Similarly, age alone does not appear to affect the recurrence rate of trichiasis following surgery. 12,13,15,17 An increase in risk for recurrence with age of the patient disappears when adjusted for the confounding effects of severity of trichiasis prior to surgery.…”

“…In a longitudinal study of trichiasis cases in The Gambia, bacterial infection at follow-up was associated with three-fold higher risk for recurrence. 17 Of the operated eyes, 72% had samples taken, and 27% grew pathologic isolates, largely Streptococcus pneumonia and Staphylococcus aureus. The authors note that trichiatic eyes, with scarring replacing the normal conjunctiva, may be prone to bacterial conjunctivitis, which can lead to chronic inflammation and progressive cicatricial changes.…”

Trachoma as cause of blindness: literature review

“…The trichiasis surgery slightly improves vision, reduces pain, and in some cases reduces the severity of corneal opacity [47][48][49][50]. The success of many surgical programs is hampered by the recurrence rates of infection which can be as high as 60% in three years [48,[51][52][53][54][55][56].…”

Chlamydia: Possible Mechanisms of the Long Term Complications

“…Convincingly, in a study conducted in the endemic region for trachoma after mass treatment with azithromycin or doxicyclin for C. trachomatis, there was no resistance to the antimicrobial treatment (Hong, et al 2009). Surgical treatment for trichiasis, a late complication of trachoma shows promising results, but requires to be continued with scheduled programs (Burton et al, 2005a). The severity of the ocular pathology in general, influences the duration of the disease that remedy for early intervention in the rural areas such as observed in Ethiopia (Melese et al, 2005).…”