Baseline Predictors for the Postoperative Trachomatous Trichiasis Following Lid Rotation Surgery in the FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial

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Purpose To evaluate predictive factors for postoperative trachomatoustrichiasis (PTT) following trachomatous trichiasis (TT) surgery in an atrachoma-endemic setting.Methods Secondary analysis of the FLuorometholone as Adjunctive MEdicaltherapy for TT surgery (FLAME) trial for comparing fluorometholone 0.1% vs placebo as adjunctive therapy for TT surgery. A total of 3,218 upper eyelids from 2398 participants underwent posteriorlamellar (PLTR) or bilamellar (BLTR) tarsal rotation surgery and were assessed for PTT at week 4 and at months 6 and 12 post-surgery. PTT wasdefined as ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Baseline demographic and ocular characteristics were assessed for predicting 12-month PTT incidenceusing logistic regression, accounting for inter-eye correlation with generalized estimating equations.Results By 12 months, 431 upper eyelids (13.4%) developed PTT. Increasing age (adjusted odds ratio (aOR) = 1.93 for 60+ vs ≤29 years, p < 0.001), severe pre-operative TT (aOR = 2.01 for epilation >2/3 eyelid vs 1–5 lashes touching globe, p < 0.001), higher Ocular Surface Disease Indexocular symptoms score (aOR = 2.05 for 75–100 vs 0–12, p = 0.003), presence of TT at the lower eyelid (aOR = 1.96, p = 0.003), corneal opacity (aOR = 2.15 for off-center faint opacity vs none, p = 0.047), and surgery type (aOR = 3.85 for BLTR vs PLTR, p = 0.008) was independentlyassociated with a higher risk of PTT. These predictors and surgeons predicted PTT with an area under the curve of 0.74 (95% confidence interval: 0.72 to 0.77).Conclusions Several baseline demographic and ocular characteristics indicating TT severity are predictive of PTT. Using these findings to identify high-risk individuals can inform clinical decision-making/patientcounselling.

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