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Anterior Lamellar Recession versus Posterior Lamellar Tarsal Rotation for Lower Lid Trachomatous Trichiasis: A Randomized Controlled Trial

Authors Abdelaziz FM, Kamal MA, Said MM, Diab MM

Received 13 May 2020

Accepted for publication 1 July 2020

Published 22 July 2020 Volume 2020:14 Pages 2043—2050


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Fatma M Abdelaziz, Mahmoud Ahmed Kamal, Mohamed M Said, Mostafa M Diab

Department of Ophthalmology, Faculty of Medicine, Fayoum University, Al Fayoum, Egypt

Correspondence: Mostafa M Diab
Department of Ophthalmology, Faculty of Medicine, Fayoum University, 12 George Nirose St, Al Mesalla, Fayoum, Al Fayoum 63514, Egypt
Tel +20 842152290

Purpose: To compare the outcomes of anterior lamellar recession (ALR) versus posterior lamellar tarsal rotation (PLTR) procedure for the repair of lower eyelid trachomatous trichiasis (TT).
Design: Prospective randomized comparative trial.
Methods: Study Population and Interventions: Patients with lower eyelid TT were enrolled. Patients with a history of lower lid surgery, marked horizontal lid laxity, another evident cause for the trichiasis, and those under 18 years were excluded. Participants were randomized to either PLTR or ALR. The sequence was computer-generated by an independent statistician, and the allocation sequence was concealed in sealed opaque envelops. Patients were evaluated at 1 week and 1, 3, 6, and 12 months. Main Outcome Measures: postoperative trachomatous trichiasis (PTT) and cosmetic satisfaction.
Results: A total of 60 patients were randomly assigned with 30 patients in each group. Two (3.3%) participants in PLTR group did not follow up and were excluded from the analysis. At 1, 3, and 6 months, PTT was significantly more frequent in the PLTR group than the ALR group (14.3% vs 0%; p= 0.048, 25% vs 0%; p= 0.004, 35.7% vs 10%; p= 0.019, respectively). In the ALR group, 6 patients (20%) had PTT at their 12-month follow-up visit compared with 15 patients (53.6%) in the PLTR group (P = 0.008) with absolute risk reduction of 33.6% (95% (CI= 9% − 58%)). Cosmetic dissatisfaction was significantly more frequent in the ALR group at the initial follow-up visits compared to the PLTR group. However, this difference was no longer significant at 6 and 12 months follow-up.
Conclusion: These data provide strong evidence that ALR is more effective in correction of lower eyelid trachomatous trichiasis with acceptable cosmesis compared with PLTR.

Keywords: lower lid, trichiasis, anterior lamellar recession, posterior lamellar tarsal rotation

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