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Impact of refresher training on the outcomes of trachomatous trichiasis surgery
  1. Clara Pak1,
  2. Nathan Hall2,
  3. Demissie Tadesse Bekele3,4,
  4. K H Martin Kollmann4,
  5. Tesfaye Tadele5,
  6. Redda Tekle-Haimanot5,
  7. Tarik Taye5,
  8. Babar Qureshi4,
  9. Wubante Yalew4,
  10. Emily W Gower6,
  11. John H Kempen2,3
  1. 1 University of Rochester School of Medicine and Dentistry, Rochester, Minnesota, USA
  2. 2 Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
  3. 3 MyungSung Christian Medical Center (MCM) Eye Unit of MCM Comprehensive Specialized Hospital and MyungSung Medical College, Addis Ababa, Ethiopia
  4. 4 Christian Blind Mission, Bensheim, Germany
  5. 5 Grarbet Tehadiso Mahber, Addis Ababa, Ethiopia
  6. 6 Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
  1. Correspondence to Professor John H Kempen, Ophthalmology, Massachusetts Eye and Ear, Boston, MA 02114, USA; john_kempen{at}


Background/aims Trachomatous trichiasis (TT) is a severe consequence of chronic inflammation/conjunctival scarring resulting from trachoma, the leading infectious cause of blindness worldwide. Our prospective cohort study evaluated the effectiveness of refresher training (RT) for experienced surgeons (1–22 years) on the outcomes of upper lid (UL) TT surgery in rural Ethiopia.

Methods Patients undergoing UL TT surgery in at least one eye by a participating surgeon were included. Patients were split into two cohorts: patients enrolled prior to (C1) and after (C2) RT. RT consisted of a 1-week programme with practice on a HEAD START mannequin and supportive supervision in live surgery by expert trainers. Data were collected at preoperative enrolment, and at 6-month and 12-month follow-up visits. The primary outcome was development of postoperative TT (PTT). A series of multivariate generalised estimating equations were fit to model PTT involving potential covariates of interest.

Results A total of 261 eyes contributed by 173 patients were studied between 2017 and 2019. By 1-year postoperatively, 37/128 eyes (28.9%) in C1 and 22/133 eyes (16.5%) in C2 had developed PTT (p=0.03). Other than surgeon RT participation, no factors studied were associated with differences in PTT.

Conclusion Our results indicate a significant reduction in the risk of PTT after experienced surgeons’ participation in RT as compared with eyes receiving surgery before RT. This observation suggests a significant potential benefit of the RT with HEAD START mannequin practice and supportive supervision during surgery, and suggests RT may be a valuable strategy to improve surgical outcomes.

  • Treatment Surgery
  • Public health
  • Infection
  • Epidemiology
  • Conjunctiva

Data availability statement

No data are available.

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  • X @johnkempen3

  • Contributors JHK, DTB, KHMK, RT-H. Acquisition, analysis and/or interpretation of data for the work: all authors. Drafting the work: CP and JHK. Revising the work critically for important intellectual content: all Authors. JHK is guarantor.

  • Funding Primary funding for the project was provided by Christian Blind Mission International (grant number 550083, Bensheim, Germany). Secondary funding was provided by the Massachusetts Eye and Ear Infirmary (Boston, Massachusetts, USA). There are no competing interests for any author.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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