Abstracts Category : Other

Trachomatous Trichiasis: Surgical Management and Impact

by EH Ali

Background:Trachomatous trichiasis (TT), is the in-turning of eyelashes from long-term, progressiveconjunctival scarring initiated by chlamydia trachomatis. It is the painful blinding stage oftrachoma. We aimed to measure impact of TT on Quality of Life (QoL) and household poverty;identify the most effective of two commonly used surgical TT procedures; and measure impactof TT surgery on QoL and daily living.Methods:A randomized, controlled, single-masked clinical trial was conducted in Ethiopia comparing thebilamellar tarsal rotation (BLTR) and posterior lamellar tarsal rotation (PLTR) procedures(1000-participants). A case-control study was nested within the trial to measure QoL usingstandard quantitative tools, and household poverty using three economic measures (assetbasedanalysis, self-rated and peer-rated wealth) among TT cases and compared to healthyneighborhood controls (200-participants). These participants were followed-up after one yearto measure impact of TT surgery on QoL and daily living using the same tools.Results:PLTR was the superior surgical procedure, with only 13% recurrent TT by 12-months comparedto 22% in the BLTR (OR=1.96; 95%CI:1.402.75; p=0.0001). At baseline, TT cases were morelikely to belong to poorer households with substantially lower QoL, less likely to participate in,more likely to report difficulty and assistance in performing productive and leisure activitiesregardless of visual impairment than controls. Twelve months after surgery, QoL scores of TTcases and their ability to perform daily activities without difficulty and assistance improvedsubstantially, independent of the presence of visual acuity improvement.Conclusions:PLTR surgery appears to be superior in terms of reduced recurrence and complications for theprogrammatic management of TT. TT is associated with household poverty and is disabling andsubstantially reduces QOL. Corrective surgery improves QoL and functional capabilities ofaffected individuals even without vision gains and may contribute to improved householdincome and wealth.