Long-term follow-up of lid surgery for trichiasis in the Gambia: surgical success and patient perceptions

Background Surgery is an important component of the SAFE strategy which has been shown to improve visual acuity. There are limited data on long-term surgical success and patient perceptions and satisfaction. A sample of patients from the Gambia who had undergone previous lid surgery for trichiasis were therefore examined for recurrence of trichiasis and interviewed for patient satisfaction. Methods Health centre surgical records and community screening were used to identify patients who had undergone previous lid surgery. Consenting patients were examined and a questionnaire administered. Kaplan-Meier survival plots were constructed for recurrence of trichiasis. Results Sixty-five subjects were recruited. Median age at surgery was 50 years. Median time since surgery was 7 years. Fifty-two of 115 (45%) operated eyes were free of trichiasis at follow-up and 23 of 65 (35%) patients had not suffered recurrent trichiasis in an operated eye. Median time from surgery to recurrence of trichiasis was estimated as 10.0 years (95% CI 3.7-16.3). Recurrent trichiasis was not significantly associated with visual impairment or blindness at follow-up. The following patient perceptions were reported: satisfaction with surgery (88%), less discomfort than before surgery (93%), improved vision (83%), work easier (38%), worth the expenditure (94%), would recommend it to others (93%), had recommended it to others (38%), experienced intra-operative pain (26%) and experienced post-operative pain (26%). Conclusion Factors affecting surgical success, including surgical technique and re-exposure to infection, are discussed. This study provides important preliminary data for programme planners but larger prospective studies are required.