Maximizing Outcomes of Repeat Trichiasis Surgery Performed by Integrated Eye Care Workers

Project Summary Trachoma is the leading infectious cause of blindness globally, and it disproportionally affects the world’s most marginalized populations. Trachomatous trichiasis (TT) is a condition resulting from years of repeated ocular chlamydia trachomatous infections that cause the eyelid to turn in and the eyelashes to rub the eye, eventually leading to blindness. While surgery is available to correct trichiasis, more than 20% of patients experience post-operative trichiasis (PTT) needing further surgical management. Yet, current management procedures for post-operative trichiasis are suboptimal. A recently completed clinical trial, BESRAT, compared an existing surgery procedure (posterior lamellar tarsal rotation) against a newly developed procedure, Bevel-Rotate Advancement Procedure (B-RAP). The trial used the best surgeons available. The trial suggested that B-RAP performed better than the existing procedure, particularly for patients with severe PTT or an eyelid contour abnormality at the time of repeat surgery. The next step is to determine whether a larger group of TT surgeons can perform B-RAP well and to compare it against the other standard TT surgery procedure, bilamellar tarsal rotation (BLTR). The primary objective of this randomized clinical trial is to determine whether repeat trichiasis surgery performed with B-RAP improves surgical success compared to BLTR among a group of 8-10 district TT surgeons in Tanzania. The study aims to enroll 1,000 individuals with PTT. The primary outcome is repeat PTT within one year after surgery. Additionally, the study will assess eyelid contour abnormalities and how they change over a two-year period as well as patient reported outcomes. If this project is successful in improving surgical outcomes, it could change the approach to treating PTT globally. Individuals with trichiasis have a significantly reduced quality of life; correcting their trichiasis long-term has the potential to improve their quality of life and their family members’ quality of life considerably.