Trachoma is the leading worldwide cause of preventable blindness. Surgerycan alleviate trachomatous trichiasis (TT), the blinding sequelae of trachoma,but recurrence rates are high.
To investigate risk factors for TT recurrence.
We conducted a prospective case-control cohort study in Nepal that includedpatients with TT who were undergoing bilamellar tarsal-rotation surgery andcontrol subjects who have scarring but no TT. Conjunctivae were graded fortrachoma and swabbed to detect Chlamydia trachomatis byin-house and commercial (Roche Amplicor; Roche Diagnostics Corp, Indianapolis,Ind)–polymerase chain reaction. Univariate and multivariate analyseswere performed for associations with chlamydiae and other risk factors.
Postoperative TT recurrence rates were 11.1% (4 cases) at 6 months and25.0% (11 cases) at 12 months while no controls developed TT. Significantly,5 (45.5%) of 11 patients with TT recurrences at 12 months had chlamydial infectionat baseline (odds ratio, 6.0; 95% confidence interval, 1.5-24.3; P = .01), 8 (72.7%) at 6 months (odds ratio, 28; 95% confidence interval,4.3-181.0; P <.001), and 9 (81.8%) at 12 months(odds ratio, 48; 95% confidence interval, 7.5-302.6; P =.00). No controls were infected during this time. Active trachoma and thebaseline number of eyelashes touching the globe were also risk factors forTT recurrence.
Main Outcome Measures
The outcome variable was TT recurrence at 6 and 12 months.
To our knowledge, this is the first study to demonstrate that chlamydialinfection at the time of surgery and at follow-up is a significant risk factorfor postoperative TT recurrence.