{"doi":"10.1371/journal.pntd.0012034","title":"The impact of modified incision height and surgical procedure on trichiasis surgery outcomes: Results of the maximizing trichiasis surgery success (MTSS) randomized trial","abstract":"BACKGROUND: Poor surgical outcomes remain a problem in trachoma-endemic countries working to reach elimination thresholds. Methods to improve outcomes could positively impact programmatic success. METHODS: This parallel, three-armed clinical trial conducted in Ethiopia randomized individuals with previously unoperated trachomatous trichiasis (TT) to receive surgery utilizing one of three approaches: bilamellar tarsal rotation with a 3 mm incision height (BLTR-3), BLTR with 5 mm incision height (BLTR-5) and posterior lamellar tarsal rotation (PLTR). We followed participants for one year. The primary outcome was post-operative trichiasis (PTT). Secondary outcomes were eyelid contour abnormalities (ECA) and pyogenic granulomata. FINDINGS: We randomized and operated on 4,914 individuals with previously unoperated TT (6,940 eyes). Primary analyses include 6,815 eyes with follow-up. Overall, 1,149 (16.9%) eyes developed PTT. The risk difference for PTT was minimal comparing BLTR-3 and PLTR (adjusted risk difference [aRD] 1.8% (98.3%CI: -0.5-4.2%)), but significantly higher for BLTR-5 surgeries compared to BLTR-3 (aRD: 6.7% (3.9-9.4%)) and PLTR (aRD: 8.6% (5.9-11.3%)). BLTR-5 had the lowest ECA (6.1% versus 9.6% BLTR-3, 11.2% PLTR) and granuloma rates (5.2% versus 6.5% BLTR-3 and 7.5% PLTR). One eyelid operated with PLTR experienced an eyelid margin division; four BLTR-3 and eight BLTR-5 eyelids experienced excessive bleeding. INTERPRETATION: We do not recommend modifying the BLTR incision height of 3 mm. Overall, we did not find a significant difference in PTT between BLTR-3 and PLTR in terms of PTT or ECA. TRIAL REGISTRATION: Registration number: NCT03100747; ClinicalTrials.gov Full study protocol available at (https://doi.org/10.15139/S3/QHZXWD).","journal":"PLoS neglected tropical diseases","year":2024,"id":450595,"datarank":0.30033319721271046,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.05891751034759535,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.05891751034759535,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":3,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9573,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03100747"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":979728,"name":"Alemayehu Sisay","orcid":"0000-0002-1952-3341","position":1,"is_corresponding":false},{"id":980125,"name":"Belay Bayissasse","orcid":null,"position":2,"is_corresponding":false},{"id":1271092,"name":"Dawit Seyum","orcid":"0000-0003-3565-8462","position":3,"is_corresponding":false},{"id":1271093,"name":"Jerusha Weaver","orcid":"0000-0001-5960-5475","position":4,"is_corresponding":false},{"id":326848,"name":"Beatriz Muñoz","orcid":"0000-0001-7013-0992","position":5,"is_corresponding":false},{"id":105707,"name":"Alexander P. Keil","orcid":"0000-0002-0955-6107","position":6,"is_corresponding":false},{"id":1271094,"name":"Andrea Bankoski","orcid":"0000-0001-6093-4399","position":7,"is_corresponding":false},{"id":798938,"name":"Kristin M. Sullivan","orcid":"0000-0001-6810-4998","position":8,"is_corresponding":false},{"id":1271542,"name":"Hashiya M. Kana","orcid":null,"position":9,"is_corresponding":false},{"id":1271543,"name":"Fisseha Admassu","orcid":null,"position":10,"is_corresponding":false},{"id":1271544,"name":"Demissie Tadesse","orcid":null,"position":11,"is_corresponding":false},{"id":979727,"name":"Shannath L. Merbs","orcid":"0000-0002-7492-990X","position":12,"is_corresponding":false},{"id":420429,"name":"Emily W. Gower","orcid":"0000-0003-1016-9910","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-19T02:02:28.969209Z","pmid":"39226693","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}