New DVD supports trachoma surgery training

Trachomatous trichiasis (TT) is the blinding consequence of infective trachoma. It occurs when in-turned eyelashes scrape the cornea, and it affects over eight million people worldwide. It is painful and has been likened to thorns scraping your eyes every time you blink. Lid rotation surgery, which restores the in-turned eyelashes to the proper position, is the mainstay of treatment for TT. Unfortunately, the results of surgery can be poor with many patients developing recurrent trichiasis. There is evidence to suggest that poor surgical technique is responsible for a significant proportion of the recurrent cases. There is a pressing need to strengthen surgical training. To help strengthen trichiasis surgery programmes, the International Centre for Eye Health (ICEH) has produced a comprehensive TT surgery training DVD, which was fi lmed in Ethiopia. Currently, trainee trichiasis surgeons undertake a course of about two weeks, containing both theoretical and practical components. Training programmes usually teach one of the WHO approved lid rotation procedures: bilamellar tarsal rotation (BLTR) or posterior lamellar tarsal rotation (PLTR). These are described in the WHO trichiasis surgery training and certifi cation manuals. A frequent limitation of training is the lack of exposure to surgical cases. Moreover, many trained surgeons do not operate frequently and most do not receive regular supervision. The ICEH DVD contains step-by-step teaching videos of both BLTR and PLTR procedures. In addition, there is extensive supporting material, such as the assessment and counselling of patients, setting up an operating theatre, sterilising instruments and post-operative care. The DVD will be distributed free of charge, in bulk, to National Trachoma Control programmes and non-governmental organisations for free distribution in training programmes. In addition, it can be obtained free of charge from TALC (Email [email protected] or see page 30). It is available in English and French, and was made possible thanks to the support of Band Aid via Fight For Sight, the Carter Center, the International Trachoma Initiative, and Stanton Media. For this issue on instruments and consumables, we have specially adapted the following extract from the DVD. It covers using a steam autoclave to sterilise the instruments used in trachoma surgery. Using a steam autoclave The kerosene-burning steam-pressure autoclave (Figure 1) is widely available in trachoma endemic regions. If you use a different model of autoclave you must read and carefully follow the instructions.