A New Surgical Technique for Postoperative Trachomatous Trichiasis

Area of Science:

• Ophthalmology
• Surgical Innovation
• Public Health

Background:

• Postoperative trichiasis (PTT) management is crucial for eliminating blinding trachoma.
• Repeat trichiasis surgery is challenging due to scar tissue and altered eyelid anatomy.
• Existing surgical methods may not adequately address complex PTT cases.

Purpose of the Study:

• To introduce and evaluate the Bevel-Rotation Advancement Procedure (B-RAP) for treating individuals requiring repeat trichiasis surgery.
• To address the difficulties associated with repeat surgeries for PTT and eyelid contour abnormalities (ECAs).

Main Methods:

• The Bevel-Rotation Advancement Procedure (B-RAP) involves a beveled tarsal incision for marginal rotation and posterior lamellar advancement.
• Scar tissue removal and dissection between eyelid lamellae are key components of the B-RAP technique.
• Two surgeons performed B-RAP on 44 eyelids in 30 patients with a history of multiple prior trichiasis surgeries.

Main Results:

• B-RAP was performed on 44 eyelids in 30 patients with PTT, many having undergone 2 or more prior surgeries.
• At 3-6 months postoperatively, 84% of eyelids (37/44) showed no recurrence of PTT.
• While 34% of eyelids had ECAs, only one case was severe, indicating good eyelid contour restoration.

Conclusions:

• The Bevel-Rotation Advancement Procedure (B-RAP) is a novel surgical technique developed for repeat trichiasis surgery.
• B-RAP accounts for altered eyelid anatomy in postsurgical PTT, improving eyelash fragment manipulation and stabilization.
• The procedure shows significant promise for enhancing outcomes in repeat trichiasis surgery, addressing a critical gap in trachoma elimination efforts.