Patients’ Perceptions of Trichiasis Surgery: Results from the Partnership for Rapid Elimination of Trachoma (PRET) Surgery Clinical Trial

Abstract

Purpose: While quality of life surveys have been conducted in trachomatous trichiasis (TT) surgery populations, little is known about patients’ perceptions of the surgical experience and outcomes.

Methods: We interviewed a subset of Partnership for the Rapid Elimination of Trachoma (PRET) surgery trial participants 24 months after surgery. Questions focused on current ocular symptoms, perceived daily functioning, physical appearance, and overall perception of surgery. We stratified participants based on surgical outcomes: normal upper eyelid, postoperative TT, or eyelid contour abnormality (ECA) in one or both eyelids. We compared responses between sexes and surgical outcome groups using contingency tables and Fisher’s exact tests.

Results: A total of 483 individuals participated and 86% were very satisfied with surgery results; 96% reported ocular symptom improvement. Participants with moderate to severe ECA or postoperative TT were more likely to report current ocular problems than those with normal eyelids (46% and 58% vs 34%, respectively; p = 0.01 for each comparison). The most common symptom among participants with moderate to severe postoperative TT was feeling lashes touching (blurred vision was the most common among participants with moderate to severe ECA). Overall, 83% stated surgery improved daily life; participants with ECA were less likely to report improvement than others (p = 0.002). Participants who had moderate or severe postoperative TT were least likely to state that they would undergo repeat surgery (80%), followed by participants with ECA (86%).

Conclusions: Postoperative TT and ECA both reduced satisfaction with surgery, but appeared to influence different aspects of life. Improving surgical outcomes both by reducing recurrence rates and limiting ECAs are essential.

• Eyelid contour abnormality
• patient satisfaction
• surgery
• trachoma
• trichiasis

ACKNOWLEDGMENTS

We gratefully acknowledge the PRET team and the trichiasis surgery patients in Tanzania, without whom this research would not be possible.

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was made possible by a generous grant from the Bill and Melinda Gates Foundation to the Johns Hopkins School of Medicine (SKW) and research funds from an Ernest and Elizabeth Althouse Special Scholars Award from Research to Prevent Blindness (EWG). The funders had no role in the study design, analysis, or interpretation of results. Helen Keller International provided manpower and funding to assist in screening and surgery.