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Surgery for trichiasis: Author reply
Ophthalmology Volume 111, Number 11, November 2004 References 1. Alemayehu W, Melese M, Bejiga A, et al. Surgery for trichiasis by ophthalmologists versus integrated eye care workers: a randomized trial. Ophthalmology 2004;111:578 – 84. 2. Sodhi PK, Yadava U, Mehta DK. Efficacy of lamellar division for correcting cicatricial lid entropion and its associated features unrectified by tarsal fracture technique. Orbit 2002; 21:9 –17.
Author reply Dear Editor: Drs Sodhi and Verma’s comments are well taken. As described in the methodology section, we have excluded all patients with previous surgery, major eye lid closure defects (TT3 in our newly developed modified trichiasis grading scheme), and metaplastic cilias. We had only 2 cases of minor lid margin defects. Integrated eye care workers were trained to identify such patients and refer to centers with ophthalmologists. In general, it is worthwhile to inform readers that we are working in a hyperendemic area with a severe shortage of ophthalmologists and infrastructure in the face of a huge
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backlog of trichiasis. The situation of hyperendemicity is evidenced by the number of children with trichiasis being observed in the area. We are totally in agreement with the suggestion of introducing anterior lamellar repositioning in our ophthalmic practice. However, this, as Sodhi and Verma rightly mention, can be introduced to only a selected few centers in the country where ophthalmologists are practicing. Unfortunately, these centers are inaccessible to the vast majority of the rural population. We thank Sodhi and Verma for their interest and suggestions. WONDU ALEMAYEHU, MD, MPH MULUKEN MELESE, MD, MPH ABEBE BEJIGA, MD ALEMAYEHU WORKU, PHD WORKAYEHU KEBEDE, MD Addis Ababa, Ethiopia DEMEKE FANTAYE, ON Wolkitie, Ethiopia
Author reply Dear Editor: Drs Sodhi and Verma’s comments are well taken. As described in the methodology section, we have excluded all patients with previous surgery, major eye lid closure defects (TT3 in our newly developed modified trichiasis grading scheme), and metaplastic cilias. We had only 2 cases of minor lid margin defects. Integrated eye care workers were trained to identify such patients and refer to centers with ophthalmologists. In general, it is worthwhile to inform readers that we are working in a hyperendemic area with a severe shortage of ophthalmologists and infrastructure in the face of a huge
2148
backlog of trichiasis. The situation of hyperendemicity is evidenced by the number of children with trichiasis being observed in the area. We are totally in agreement with the suggestion of introducing anterior lamellar repositioning in our ophthalmic practice. However, this, as Sodhi and Verma rightly mention, can be introduced to only a selected few centers in the country where ophthalmologists are practicing. Unfortunately, these centers are inaccessible to the vast majority of the rural population. We thank Sodhi and Verma for their interest and suggestions. WONDU ALEMAYEHU, MD, MPH MULUKEN MELESE, MD, MPH ABEBE BEJIGA, MD ALEMAYEHU WORKU, PHD WORKAYEHU KEBEDE, MD Addis Ababa, Ethiopia DEMEKE FANTAYE, ON Wolkitie, Ethiopia