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Kreis AJ, Gower EW, Kropp M, Kello AB, Nouhoum G, Resnikoff S, Talero SL, Solomon AW. The prevention and management of postoperative trachomatous trichiasis: A systematic review. Surv Ophthalmol 2024; 69:93-102. [PMID: 36878359 DOI: 10.1016/j.survophthal.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/07/2023]
Abstract
Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.
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Affiliation(s)
- Andreas J Kreis
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Emily W Gower
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martina Kropp
- Experimental Ophthalmology, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University Hospitals of Geneva, Geneva, Switzerland
| | - Amir B Kello
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Guirou Nouhoum
- Techniques and Technologies of Bamako, Institut d'Ophtalmologie Tropicale d'Afrique, University of the Sciences, Bamako, Mali
| | - Serge Resnikoff
- Organisation pour la Prévention de la Cécité, Paris, France; School of Optometry & Vision Science (SOVS), University of New South Wales, Sydney, Australia
| | - Sandra L Talero
- Research Department of Development and Innovation, Superior School of Ophthalmology, Barraquer Institute of America, Bogotá, Colombia
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Mwangi G, Courtright P, Solomon AW. National approaches to trichiasis surgical follow-up, outcome assessment and surgeon audit in trachoma-endemic countries in Africa. Br J Ophthalmol 2020; 105:904-908. [PMID: 32713838 PMCID: PMC7611077 DOI: 10.1136/bjophthalmol-2019-315777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/02/2020] [Accepted: 06/25/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Poor outcomes of trichiasis surgery, including postoperative trichiasis, are common in many trachoma-endemic countries in Africa. To improve outcomes, WHO recommends regular follow-up and outcome assessment of surgical cases plus audit of trichiasis surgeons. AIMS To assess national approaches to trichiasis surgical follow-up, outcome assessment and audit, and identify national targets for good surgical outcome (defined as the percentage of patients undergoing surgery for trichiasis remaining free of post-operative trichiasis for a defined interval after surgery). METHODS A cross-sectional survey was carried out between May and July 2018, involving all 29 known-trachoma-endemic countries in Africa. An emailed questionnaire was used to collect information on national targets for surgical outcomes, policies, monitoring and strategies to address underperformance by surgeons. RESULTS All national programmes provided information; 2 of the 29 had not yet implemented trichiasis surgery as part of their trachoma elimination programme. Findings from 27 countries are therefore reported. Only four countries reported having a national policy for trichiasis surgery follow-up and outcome assessment and only two had a national policy for conducting audits of trichiasis surgeons. Only 9 of the 27 countries had a cut-off point at which poorly performing surgeons would be instructed to discontinue surgery until retraining or other interventions had been undertaken. DISCUSSION To address the challenge of post-operative trichiasis and other poor outcomes, national trachoma programmes should create and implement policies and systems to follow up patients, assess surgical outcomes and monitor the performance of individual surgeons through post-surgical audits.
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Affiliation(s)
- Grace Mwangi
- Department of Surgery, Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Paul Courtright
- Kilimanjaro Centre for Community Ophthalmology, Division of Ophthalmology, University of Cape Town, Observatory, South Africa
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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Djore D, Djibrine D, Ali AB, Tyau-Tyau H, Hiron D, Kali B, Biao JE, Bernasconi J, Bengraïne K, Resnikoff S. Pilot Audit of Trichiasis Surgery Outcomes Using a Mobile App in the Republic of Chad. Middle East Afr J Ophthalmol 2020; 27:14-21. [PMID: 32549719 PMCID: PMC7276166 DOI: 10.4103/meajo.meajo_75_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 10/06/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE: The purpose of the study was to assess the feasibility of a mobile data collection app for use in trichiasis surgical audits in the Melfi and Mangalme districts of the Guera region of the Republic of Chad and to perform a cost analysis to determine if the auditing mechanism could be implemented nationally. MATERIALS AND METHODS: Patients who underwent trichiasis surgery 6 months prior and who had follow-up 7–14 days after surgery were included in the study. Each surgeon had a sample of 20% of operated eyelids; nine surgeons with data for ≥20 eyelids were included. A trichiasis recurrence rate of ≥25% suggested that the surgeon needed retraining. Smartphones captured data using the data collection app, which transmitted data to an online server. Direct costs and supervision costs were collated and summed. RESULTS: There were 916 eyelids operated on; 170 patients (269 eyelids, 29% follow-up rate) participated in the audit. Twenty participants (11.8%) had recurrence. The mean recurrence rate among surgeons was 8.3% (standard deviation: 0.07%; range: 0%–17.9%). None had a recurrence rate of ≥25%; thus, no retraining was necessary. The total cost of the audit was US$15,111.25 ($12,882.28 in direct costs and $2,228.97 in supervision costs). CONCLUSIONS: The simple, easy-to-use, and low-cost mobile auditing mechanism is a practical solution for conducting surgical audits in remote and resource-limited settings and is undergoing national scale-up by the Chadian trachoma elimination program.
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Affiliation(s)
| | - Djada Djibrine
- Faculty of Medicine of N'Djamena, N'Djamena, Chad.,Department of Ophtalmology, National Referral Hospital, N'Djamena, Chad
| | | | | | - Doniphan Hiron
- Organization for the Prevention of Blindness, Paris, France
| | - Barka Kali
- Organization for the Prevention of Blindness, N'Djamena, Chad
| | - Jean-Eudes Biao
- Organization for the Prevention of Blindness, N'Djamena, Chad
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Ramyil A, Bascaran C, Bunce C, Alada J, Wade P, Mpyet C. Outcome of trachoma lid surgeries in Jigawa state, Nigeria. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1233683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Alice Ramyil
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catey Bunce
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
- University College London (UCL), London, UK
| | - Joel Alada
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Patricia Wade
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
| | - Caleb Mpyet
- Department of Ophthalmology, University of Jos and Jos University Teaching Hospital, Jos, Nigeria
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Ramyil A, Bascaran C, Bunce C, Wade P, Oyediji F, Mpyet C. An assessment of trichiasis surgery workforce in Jigawa State, Nigeria. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1259145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- A.V. Ramyil
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - C. Bascaran
- Clinical Research Department, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Catey Bunce
- Department of Medical statistics, King's college London,, London, UK
| | - P. Wade
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - F. Oyediji
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
| | - C. Mpyet
- Depatment of Ophthalmology, Jos UniversityTeaching Hospital, Jos, Nigeria
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Lavett DK, Lansingh VC, Carter MJ, Eckert KA, Silva JC. Will the SAFE strategy be sufficient to eliminate trachoma by 2020? Puzzlements and possible solutions. ScientificWorldJournal 2013; 2013:648106. [PMID: 23766701 PMCID: PMC3671555 DOI: 10.1155/2013/648106] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Since the inception of (the Global Elimination of Blinding Trachoma) GET 2020 in 1997 and the implementation of the SAFE strategy a year later, much progress has been made toward lowering the prevalence of trachoma worldwide with elimination of the disease in some countries. However, high recurrence of trichiasis after surgery, difficulty in controlling the reemergence of infection after mass distribution of azithromycin in some communities, the incomplete understanding of environment in relation to the disease, and the difficulty in establishing the prevalence of the disease in low endemic areas are some of the issues still facing completion of the GET 2020 goals. In this narrative review, literature was searched from 1998 to January 2013 in PubMed for original studies and reviews. Reasons for these ongoing problems are discussed, and several suggestions are made as avenues for exploration in relation to improving the SAFE strategy with emphasis on improving surgical quality and management of the mass treatment with antibiotics. In addition, more research needs to be done to better understand the approach to improve sanitation, hygiene, and environment. The main conclusion of this review is that scale-up is needed for all SAFE components, and more research should be generated from communities outside of Africa and Asia.
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Affiliation(s)
- Diane K. Lavett
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Van C. Lansingh
- International Agency for the Prevention of Blindness/VISION 2020 Latin America, 3720 San Simeon Circle, Weston, FL 33331, USA
- Hamilton Eye Institute, University of Memphis, Memphis, TN 38152, USA
| | - Marissa J. Carter
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
| | - Kristen A. Eckert
- Strategic Solutions, Inc., 1143 Salsbury Avenue, Cody, WY 82414, USA
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Current world literature. Curr Opin Ophthalmol 2012; 23:330-5. [PMID: 22673820 DOI: 10.1097/icu.0b013e32835584e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-year outcomes of the surgery for trichiasis, antibiotics to prevent recurrence trial. ACTA ACUST UNITED AC 2011; 130:427-31. [PMID: 22159169 DOI: 10.1001/archophthalmol.2011.374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine whether treatment with oral azithromycin compared with topical tetracycline reduces the recurrence of trichiasis for up to 3 years following surgery for trichiasis. METHODS The Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) trial is a randomized, single-masked, clinical trial conducted in southern Ethiopia, a region where trachoma is hyperendemic. A total of 1452 patients who underwent trichiasis surgery were randomly assigned at a 2:1 ratio to either a single dose of oral azithromycin (1 g) or topical tetracycline (twice per day for 6 weeks) following surgery. MAIN OUTCOME MEASURES Recurrence of trichiasis within 3 years following surgery. RESULTS The rate of recurrence was 10% in the azithromycin group and 13% in the tetracycline group. The azithromycin group had a 22% reduction in recurrence of trichiasis 3 years after surgery compared with the tetracycline group (P = .13). Severity of entropion at baseline was the most significant predictor of recurrence of trichiasis at 3 years. CONCLUSION Trichiasis recurrence rates in the STAR trial remained low for up to 3 years following surgery. The protective effect of a single dose of azithromycin was less than at 1 year and, although not statistically significant, was still suggestive up to 3 years following trichiasis surgery. APPLICATION TO CLINICAL PRACTICE A single dose of azithromycin after surgery remains an integral component of the World Health Organization's strategy for the elimination of trachoma by the year 2020.
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Affiliation(s)
- Fasika Woreta
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287, USA
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