PLoS neglected tropical diseases · 2025
Outcomes of posterior lamellar tarsal rotation vs bilamellar tarsal rotation for trachomatous trichiasis.
Клиническое исследование III фазыСравнительное исследованиеСтатьяРандомизированное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод в очереди
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Kempen John H, Chen Yineng, Abashawl Aida, Mohammed Ahlam Awad, Dodson Sarity, Alemayehu Wondu, Gemechu Alemu, Mengesha Aemero Abateneh, Kumsa Dereje Adugna, Succar Tony, McWilliams Kathleen, Jin Fangming, Bunya Vatinee Y, Maguire Maureen G, Burton Matthew J, Ying Gui-Shuang, FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial Research Group
Аннотация
BACKGROUND: Trachomatous trichiasis (TT) surgery is a key strategy for avoiding blindness and visual impairment from trachoma. We compared alternative WHO-endorsed TT surgery techniques, hypothesizing that in a "real world" study posterior lamellar tarsal rotation (PLTR) would be associated with less postoperative TT (PTT) than bilamellar tarsal rotation (BLTR).
METHODS: In an ongoing TT control program in Jimma Zone, Ethiopia, TT surgeons used their preferred procedure (PLTR or BLTR) for upper eyelids with TT. Logistic regression-crude or adjusting for inter-eye correlation and relevant baseline factors (age, number of trichiatic lashes, epilation, entropion severity, and upper palpebral conjunctival scarring severity)-was used to compare the one-year cumulative incidence of PTT (any upper eyelid lash touching the globe, evidence of epilation and/or repeat TT surgery).
FINDINGS: Most baseline TT severity markers were worse in the PLTR (855 eyes) than the BLTR (678 eyes) group and PLTR surgeons were less experienced than BLTR surgeons. Nevertheless, one-year cumulative PTT incidences were 8.2% (PLTR) and 21.4% (BLTR; adjusted odds ratio = 0.27, 95% confidence interval: 0.19-0.39). Prospectively ascertained postoperative adverse TT surgery outcomes were similar between groups by six months and 12 months postoperatively.
INTERPRETATION: When surgeons applied their preferred surgical technique, PTT occurred less than half as often with PLTR than BLTR. These real-world data confirm a prior trial's primary result, suggesting that using PLTR instead of BLTR reduces PTT incidence to a clinically important degree without increasing adverse outcomes. Another recent trial suggests continued BLTR is appropriate for surgeons already trained in that technique.
TRIAL REGISTRATION: www.clinicaltrials.gov, NCT04149210.
METHODS: In an ongoing TT control program in Jimma Zone, Ethiopia, TT surgeons used their preferred procedure (PLTR or BLTR) for upper eyelids with TT. Logistic regression-crude or adjusting for inter-eye correlation and relevant baseline factors (age, number of trichiatic lashes, epilation, entropion severity, and upper palpebral conjunctival scarring severity)-was used to compare the one-year cumulative incidence of PTT (any upper eyelid lash touching the globe, evidence of epilation and/or repeat TT surgery).
FINDINGS: Most baseline TT severity markers were worse in the PLTR (855 eyes) than the BLTR (678 eyes) group and PLTR surgeons were less experienced than BLTR surgeons. Nevertheless, one-year cumulative PTT incidences were 8.2% (PLTR) and 21.4% (BLTR; adjusted odds ratio = 0.27, 95% confidence interval: 0.19-0.39). Prospectively ascertained postoperative adverse TT surgery outcomes were similar between groups by six months and 12 months postoperatively.
INTERPRETATION: When surgeons applied their preferred surgical technique, PTT occurred less than half as often with PLTR than BLTR. These real-world data confirm a prior trial's primary result, suggesting that using PLTR instead of BLTR reduces PTT incidence to a clinically important degree without increasing adverse outcomes. Another recent trial suggests continued BLTR is appropriate for surgeons already trained in that technique.
TRIAL REGISTRATION: www.clinicaltrials.gov, NCT04149210.