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Clinical Trial
. 2025 Jul 30;19(7):e0013152.
doi: 10.1371/journal.pntd.0013152. eCollection 2025 Jul.

Outcomes of posterior lamellar tarsal rotation vs bilamellar tarsal rotation for trachomatous trichiasis

John H Kempen  1   2   3   4   5 , Yineng Chen  6 , Aida Abashawl  7 , Ahlam Awad Mohammed  7 , Sarity Dodson  8   9 , Wondu Alemayehu  8 , Alemu Gemechu  8 , Aemero Abateneh Mengesha  7   10 , Dereje Adugna Kumsa  11 , Tony Succar  12 , Kathleen McWilliams  6 , Fangming Jin  6 , Vatinee Y Bunya  6 , Maureen G Maguire  6 , Matthew J Burton  13   14 , Gui-Shuang Ying  6   15 ; FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial Research Group
Affiliations
Clinical Trial

Outcomes of posterior lamellar tarsal rotation vs bilamellar tarsal rotation for trachomatous trichiasis

John H Kempen et al. PLoS Negl Trop Dis. .

Abstract

Background: Trachomatous trichiasis (TT) surgery is a key strategy for avoiding blindness and visual impairment from trachoma. We compared alternative WHO-endorsed TT surgery techniques, hypothesizing that in a "real world" study posterior lamellar tarsal rotation (PLTR) would be associated with less postoperative TT (PTT) than bilamellar tarsal rotation (BLTR).

Methods: In an ongoing TT control program in Jimma Zone, Ethiopia, TT surgeons used their preferred procedure (PLTR or BLTR) for upper eyelids with TT. Logistic regression-crude or adjusting for inter-eye correlation and relevant baseline factors (age, number of trichiatic lashes, epilation, entropion severity, and upper palpebral conjunctival scarring severity)-was used to compare the one-year cumulative incidence of PTT (any upper eyelid lash touching the globe, evidence of epilation and/or repeat TT surgery).

Findings: Most baseline TT severity markers were worse in the PLTR (855 eyes) than the BLTR (678 eyes) group and PLTR surgeons were less experienced than BLTR surgeons. Nevertheless, one-year cumulative PTT incidences were 8.2% (PLTR) and 21.4% (BLTR; adjusted odds ratio = 0.27, 95% confidence interval: 0.19-0.39). Prospectively ascertained postoperative adverse TT surgery outcomes were similar between groups by six months and 12 months postoperatively.

Interpretation: When surgeons applied their preferred surgical technique, PTT occurred less than half as often with PLTR than BLTR. These real-world data confirm a prior trial's primary result, suggesting that using PLTR instead of BLTR reduces PTT incidence to a clinically important degree without increasing adverse outcomes. Another recent trial suggests continued BLTR is appropriate for surgeons already trained in that technique.

Trial registration: www.clinicaltrials.gov, NCT04149210.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: JHK owns Betaliq and Tarsier stock. Betaliq is developing an intraocular pressure-lowering eyedrop. Tarsier is developing an anti-inflammatory eyedrop. Neither is marketing their products at this point. VYB is a member of the Advisory Board for Kowa.

Figures

Fig 1
Fig 1. Cumulative incidence of postoperative trachomatous trichiasis (TT) during follow-up after bilamellar tarsal rotation (BLTR) or posterior lamellar tarsal rotation (PLTR) surgery.
See this image and copyright information in PMC

References

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