Limits...
The determinants of trichiasis recurrence differ at one and two years following lid surgery in Vietnam: A community-based intervention study.

Khandekar R, Thanh TT, Luong VQ - Oman J Ophthalmol (2009)

Bottom Line: Early recurrence could be reduced by proper case selection.However, late recurrence seems to be dependent on interaction of risk factors.Only age of the patient was the reliable predictor of recurrence.

View Article: PubMed Central - PubMed

Affiliation: British Columbia Center for Epidemiologic and International Ophthalmology, University of British Columbia, Canada.

ABSTRACT

Aim: To compare determinants for recurrence of trichiasis at one and two years following lid surgery in Vietnam.

Study design: Community-based intervention study.

Methods: This study was carried out between 2000 and 2003 in four trachoma-endemic districts of Vietnam. Trained trichiasis surgeons performed modified Cuenod Nataf lid surgery on 648 eyes of 472 patients with Trachomatous trichiasis (TT). Trained investigators collected information on ocular and lid status before surgery and at one and two years following surgery. Trichiasis recurrence was calculated after adjusting for one or both eyes of each operated individual.

Results: Fifty-six eyes developed recurrence at one year with adjusted prevalence of 8.8% (95% CI 6.60-11.01). One hundred and one eyes [15.9% (95% CI 13.04-18.72)] had recurrence two years following surgery. Female gender, older age group, study area, severe grade of trachomatous scarring (TS), past history of lid surgery, postoperative suture adjustment and surgeon were risk factors for recurrence at the end of one year. Study area and previous lid surgery were risk factors for recurrence in the second year. Recurrence at one year could be predicted if study area and severity of Trachomatous Scarring (TS) are known.

Conclusions: One and two year recurrence rates with modified Cuenod Nataf lid surgeries for TT in Vietnam were acceptably low. Early recurrence could be reduced by proper case selection. However, late recurrence seems to be dependent on interaction of risk factors. Only age of the patient was the reliable predictor of recurrence.

No MeSH data available.


Related in: MedlinePlus

Modified Cuenod Nataf lid surgery procedure for trachomatous trichiasis in Vietnam (Schematic)
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Figure 0001: Modified Cuenod Nataf lid surgery procedure for trachomatous trichiasis in Vietnam (Schematic)

Mentions: Eight experienced trichiasis surgeons (ophthalmologists) performed the modified Cuenod Nataf surgery to correct trichiasis in 648 eyes. The steps of lid surgery adopted in our study are simple [Figure 1]. An incision is made at the grey line of the lid margin of the upper lid. Muscle and fibrous tissue are separated from the front surface of the tarsus plate by blunt dissection in the upper and lateral edges of the plate. The tarsal plate is then fractured horizontally leaving a 3 mm wide distal portion. In the conventional procedure, a triangular piece of tarsal plate is removed at both ends of the plate. In the modification adopted in Vietnam, this procedure is not carried out. Three equidistant mattress sutures are placed along the width of the lid. These sutures are then passed from the lid margin, through the cut edge of the distal piece into the anterior surface of the proximal piece of the tarsal plate near the cut edge, then back through the anterior surface of the proximal piece emerging at the cut edge and finally through the cut edge of the distal piece, emerging at the lid margin. During the entire procedure, hemostasis is maintained. Ends of the sutures are tied with one overhand throw, left long and taped to the brow. Antibiotic ointment is applied to the upper lid, the wound and then eye is lightly patched. After 24 h, the correction is noted. If TT correction is excessive, knots are loosened and if correction is less than desired, the knots are pulled tighter. Sutures are removed on the seventh postoperative day. In the absence of infection or severe inflammatory response, no systemic antibiotic or antiinflammatory medications are given.


The determinants of trichiasis recurrence differ at one and two years following lid surgery in Vietnam: A community-based intervention study.

Khandekar R, Thanh TT, Luong VQ - Oman J Ophthalmol (2009)

Modified Cuenod Nataf lid surgery procedure for trachomatous trichiasis in Vietnam (Schematic)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2903916&req=5

Figure 0001: Modified Cuenod Nataf lid surgery procedure for trachomatous trichiasis in Vietnam (Schematic)
Mentions: Eight experienced trichiasis surgeons (ophthalmologists) performed the modified Cuenod Nataf surgery to correct trichiasis in 648 eyes. The steps of lid surgery adopted in our study are simple [Figure 1]. An incision is made at the grey line of the lid margin of the upper lid. Muscle and fibrous tissue are separated from the front surface of the tarsus plate by blunt dissection in the upper and lateral edges of the plate. The tarsal plate is then fractured horizontally leaving a 3 mm wide distal portion. In the conventional procedure, a triangular piece of tarsal plate is removed at both ends of the plate. In the modification adopted in Vietnam, this procedure is not carried out. Three equidistant mattress sutures are placed along the width of the lid. These sutures are then passed from the lid margin, through the cut edge of the distal piece into the anterior surface of the proximal piece of the tarsal plate near the cut edge, then back through the anterior surface of the proximal piece emerging at the cut edge and finally through the cut edge of the distal piece, emerging at the lid margin. During the entire procedure, hemostasis is maintained. Ends of the sutures are tied with one overhand throw, left long and taped to the brow. Antibiotic ointment is applied to the upper lid, the wound and then eye is lightly patched. After 24 h, the correction is noted. If TT correction is excessive, knots are loosened and if correction is less than desired, the knots are pulled tighter. Sutures are removed on the seventh postoperative day. In the absence of infection or severe inflammatory response, no systemic antibiotic or antiinflammatory medications are given.

Bottom Line: Early recurrence could be reduced by proper case selection.However, late recurrence seems to be dependent on interaction of risk factors.Only age of the patient was the reliable predictor of recurrence.

View Article: PubMed Central - PubMed

Affiliation: British Columbia Center for Epidemiologic and International Ophthalmology, University of British Columbia, Canada.

ABSTRACT

Aim: To compare determinants for recurrence of trichiasis at one and two years following lid surgery in Vietnam.

Study design: Community-based intervention study.

Methods: This study was carried out between 2000 and 2003 in four trachoma-endemic districts of Vietnam. Trained trichiasis surgeons performed modified Cuenod Nataf lid surgery on 648 eyes of 472 patients with Trachomatous trichiasis (TT). Trained investigators collected information on ocular and lid status before surgery and at one and two years following surgery. Trichiasis recurrence was calculated after adjusting for one or both eyes of each operated individual.

Results: Fifty-six eyes developed recurrence at one year with adjusted prevalence of 8.8% (95% CI 6.60-11.01). One hundred and one eyes [15.9% (95% CI 13.04-18.72)] had recurrence two years following surgery. Female gender, older age group, study area, severe grade of trachomatous scarring (TS), past history of lid surgery, postoperative suture adjustment and surgeon were risk factors for recurrence at the end of one year. Study area and previous lid surgery were risk factors for recurrence in the second year. Recurrence at one year could be predicted if study area and severity of Trachomatous Scarring (TS) are known.

Conclusions: One and two year recurrence rates with modified Cuenod Nataf lid surgeries for TT in Vietnam were acceptably low. Early recurrence could be reduced by proper case selection. However, late recurrence seems to be dependent on interaction of risk factors. Only age of the patient was the reliable predictor of recurrence.

No MeSH data available.


Related in: MedlinePlus