Treatment of blindness caused by upper eyelid disease is equally effective with two common procedures

Press release

Tuesday September 17, 2020

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The NIH-funded study does not support any changes in the surgical technique used to treat trichiasis.

Trachomatous trichiasis can be successfully treated with one of two common eyelid surgeries, according to the results of a large trial funded by the National Institutes of Health. This study confirms that both techniques can be used to treat the condition. Previous smaller studies have suggested that one type of surgery is more effective than the other. The study was published in PLOS Neglected Tropical DiseasesThe National Eye Institute, part of the NIH, funded the project.

Emily Gower, PhD, of the University of North Carolina at Chapel Hill, said some studies have reported postoperative trichiasis rates of 30 % or higher in patients who had trachomatous trichiasis after surgery. Repeat surgeries are also more difficult. This trial was designed to see if changing surgical procedures could reduce the risk of postoperative trichiasis. “We found that existing methods worked better.”

About 1.7 million people suffer from trachomatous trichiasis, mainly in rural and poor areas of Africa. The condition is caused by repeated eye infections. Chlamydia trachomatisTrachoma is spread by direct human-to-human contact. In hot, dry regions of the world, trachoma is common. Repeated infections can lead to eyelid deformities and scarring. The edge of the eyelid is pushed inward by this deformity, causing the eyelashes to scratch the eye. Untreated trichiasis can lead to corneal disorders and blindness.

Surgery to correct internal rotation of the eyelid is the most effective and common treatment for trichiasis. It is typically performed in one of two ways. Some programs in Africa have begun retraining their surgeons on the posterior lamellar rotation (PLTR) method after a few small studies showed it to be more effective. Additionally, analyses of patients treated with bilamellar rotation surgery (BLTR) have suggested that a slight shift in the position of the incision (5 millimeters higher than the eyelid margin instead of 3 mm) may result in fewer recurrences. However, this had not been evaluated. This study directly compared the three surgical approaches and assessed the postoperative risk of trichiasis.

In the study conducted in southern Ethiopia, 4,914 patients with trichiasis (6,940 eligible eyes) were enrolled. Participants were randomly assigned to receive either BLTR with a 3-mm incision or BLTR with a 5-mm incision. Researchers reexamined patients at 6 weeks and again at 12 to 18 months for trichiasis. On average, 17 % eyelids were affected by postoperative trichiasis. The risk of trichiasis after surgery was the same for both methods using a 3-mm incision, but those receiving a 5-mm incision height were more likely to develop trichiasis. The results show that either of the two standard surgical methods at a 3-mm incision height is more effective in treating trichiasis than the 5-mm method.

This study is funded by NEI grant UG1EY025992 and has a clinical trial registration number. NCT03100747.

NEI leads federal efforts to end vision loss and improve quality of life through vision research…by stimulating innovation, fostering collaborative relationships, expanding the supply of vision workers, and educating key stakeholders and the public. NEI funds basic and clinical research programs that aim to improve the quality of life for people with low vision and develop sight-saving treatments. Visit the site for more information. https://www.nei.nih.gov.

The National Institutes of Health: The NIH is the medical research agency of the U.S. Department of Health and Human Services. It includes 27 institutes and centers. The NIH, the national medical research agency, is a component of the U.S. Department of Health and Human Services. It is responsible for conducting basic, translational, and clinical medical research and investigating causes, treatments, and cures. Visit the NIH website for more information about its programs and services. www.nih.gov.

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