Abstract Listings 2024

Purpose

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 post-operative 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 PTT that occurs.

Methods

A search of PubMed was undertaken by two reviewers using the terms ((“recurrent” OR “postoperative” OR “post-operative” OR “post-surgical” OR “postsurgical” OR “secondary”) AND “trichiasis”) with no date or language restrictions. The titles (and where available, abstracts) of each of the returned records were screened; full-text papers of records identified as potentially being relevant were obtained. Reference lists of full-text papers were hand-searched. We extracted relevant material from all relevant papers. We adhered to PRISMA guidelines. The review was prospectively registered on PROSPERO.

Results

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.

Conclusion

Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavourable outcomes for PTT patients is likely to require enhanced surgical 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 for improvement.

Additional Authors

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