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The Trachomatous Trichiasis Clamp:  A Surgical Instrument Designed to Improve Bilamellar Tarsal Rotation Procedure Outcomes

Shannath L. Merbs, MD, PhD; Amir B. Kello, MD; Hassan Gelema, MD; Sheila K. West, PhD; Emily W. Gower, PhD
Arch Ophthalmol. 2012;130(2):220-223. doi:10.1001/archopthalmol.2011.1657.
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The World Health Organization has endorsed the bilamellar tarsal rotation procedure to correct blinding trachomatous trichiasis. Our field observations of bilamellar tarsal rotation have revealed some significant departures from this procedure as described in the World Health Organization manual. We designed the trachomatous trichiasis clamp to address the shortcomings of the standard instrumentation and to help nonphysicians perform the procedure more safely, reproducibly, and successfully. The trachomatous trichiasis clamp standardizes several aspects of the surgical technique that are not always performed consistently, providing guides for correct clamp and incision placement. A full-thickness eyelid incision can be made and sutures placed in a bloodless field. Two surgical technicians tested the trachomatous trichiasis clamp in 10 patients and found that it was easier to use, shortened surgery time, allowed straighter and more precisely placed incisions, and offered excellent protection for the eye.

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Figure 1. Hemostat placement. A, Hemostats were placed more than 5 mm onto the eyelid and closer together than described by the World Health Organization manual. B, Excessive crushing of the eyelid tissue can occur by the locked hemostat clamps. C, A 1-year postoperative examination demonstrates an incision made more than 3 mm from the eyelid margin. D, Intraoperative bleeding obscures the cut edges of the tarsus and makes suture placement difficult.

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Figure 2. The trachomatous trichiasis clamp. A, The eyelid margin is aligned with the groove in the base plate, and the locking slider adjusts the clamp tension. B, The trachomatous trichiasis clamp is placed on the upper eyelid, which can be viewed through the surgical window. The 3-mm mark on the window side frame denotes correct incision placement.

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Figure 3. Full-thickness incision and suturing with the trachomatous trichiasis clamp. A, A full-thickness incision from the eyelid margin is made with one precise incision, and in place, the trachomatous trichiasis clamp creates a bloodless field. B, Sutures can be placed with the clamp in position.




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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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