Surgery Versus Epilation for the Treatment of Minor Trichiasis in Ethiopia: A Randomised Controlled Noninferiority Trial

Rajak, Saul; Habtamu, Esmael; Weiss, Helen A.; Kello, Amir Bedri; Gebre, Teshome; Genet, Asrat; Bailey, Robin L.; Mabey, David; Khaw, PT; Gilbert, Clare; Emerson, Paul M.; Burton, Matthew J.

doi:10.1371/journal.pmed.1001136

Cited by 32 publications

(60 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During the course of two recently reported randomised controlled trials conducted in Ethiopia we recruited 1300 individuals with the full spectrum of TT type and severity, who received PLTR surgery with silk sutures, and were followed up for two year [30], [31]. This represents the largest data set to date on the results of PLTR surgery (recurrence risks, vision and other outcomes), and provides an opportunity to investigate outcomes in relation to the type and position of the trichiatic lashes.…”

Section: Introductionmentioning

confidence: 99%

The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence

et al. 2013

Self Cite

View full text Add to dashboard Cite

BackgroundOver 1.2 million people are blind from trachomatous trichiasis (TT). Lid rotation surgery is the mainstay of treatment, but recurrence rates can be high. We investigated the outcomes (recurrence rates and other complications) of posterior lamellar tarsal rotation (PLTR) surgery, one of the two most widely practised TT procedures in endemic settings.Methodology/Principal FindingsWe conducted a two-year follow-up study of 1300 participants who had PLTR surgery, conducted by one of five TT nurse surgeons. None had previously undergone TT surgery. All participants received a detailed trachoma eye examination at baseline and 6, 12, 18 and 24 months post-operatively. The study investigated the recurrence rates, other complications and factors associated with recurrence. Recurrence occurred in 207/635 (32.6%) and 108/641 (16.9%) of participants with pre-operative major (>5 trichiatic lashes) and minor (<5 lashes) TT respectively. Of the 315 recurrences, 42/315 (3.3% overall) had >5 lashes (major recurrence). Recurrence was greatest in the first six months after surgery: 172 cases (55%) occurring in this period. Recurrence was associated with major TT pre-operatively (OR 2.39, 95% CI 1.83–3.11), pre-operative entropic lashes compared to misdirected/metaplastic lashes (OR 1.99, 95% CI 1.23–3.20), age over 40 years (OR 1.59, 95% CI 1.14–2.20) and specific surgeons (surgeon recurrence risk range: 18%–53%). Granuloma occurred in 69 (5.7%) and notching in 156 (13.0%).Conclusions/SignificanceRisk of recurrence is high despite high volume, highly trained surgeons. However, the vast majority are minor recurrences, which may not have significant corneal or visual consequences. Inter-surgeon variation in recurrence is concerning; surgical technique, training and immediate post-operative lid position require further investigation.

show abstract

Section: Introductionmentioning

confidence: 99%

The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence

et al. 2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is because the risk of recurrence is heavily influenced by pre-operative disease severity; all the participants in our study had minor trichiasis at baseline; other studies have enrolled patients with more severe disease [5,22,25,26]. …”

Section: Discussionmentioning

confidence: 99%

Epilation for Minor Trachomatous Trichiasis: Four-Year Results of a Randomised Controlled Trial

et al. 2015

Self Cite

View full text Add to dashboard Cite

BackgroundTrachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity.Methodology/ Principal Findings1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating (“epilation-only”). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (>5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years.Conclusions/ SignificanceMost minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment.

show abstract

“…En uno de los pocos estudios controlados y con asignación aleatoria (48), la tasa de fracaso del tratamiento quirúrgico fue 2,2 % frente a 14 % con la depilación, y hubo 17 % de recurrencias a los 2 años después del tratamiento quirúrgico y 49,7 % con la depilación. El fracaso se define como cinco o más pestañas que tocan el globo ocular, y la recurrencia, como una o más pestañas que tocan el globo ocular (48). En los pacientes sometidos a cirugía, la incidencia de progresión de la opacificación corneal fue de 4,1 % a los 2 años.…”

Section: Tratamientounclassified

“…En los pacientes sometidos a cirugía, la incidencia de progresión de la opacificación corneal fue de 4,1 % a los 2 años. Las complicaciones quirúrgicas más comunes son: infección (0,5 %), sangrado (0,5 %), hipocorrección (0,8 %), granulomas (0 a 14 %) y anormalidades o muescas en el borde palpebral (0 a 30 %), que se asocian a lagoftalmos y problemas con la película lagrimal (46,48).…”

Section: Tratamientounclassified

Tracoma: de lo básico a lo clínico

Carvajal-Fernández

Villegas-Mesa

Quintero-Gutiérrez

et al. 2017

iatreia

View full text Add to dashboard Cite

RESUMENEl tracoma es una de las Enfermedades Tropicales Desatendidas; lo producen los serotipos A, B, Ba y C de la bacteria intracelular Chlamydia trachomatis, adquirida a partir de la diseminación directa por contacto ocular, propagación indirecta por fómites, transmisión por moscas que buscan los ojos y contacto con los dedos contaminados con secreciones oculares y nasales. En la actualidad es la principal causa de ceguera prevenible en el mundo, representa el 1,4 % de los casos totales y genera el deterioro visual de 1,8 millones de personas, de las cuales 500 000 tienen ceguera. Se calcula que hay 51 países endémicos distribuidos en África, Asia, Latinoamérica y Oceanía. En América hay focos activos en Brasil, México, Guatemala y Colombia. Las manifestaciones oculares iniciales son epífora, inyección conjuntival y secreción mucopurulenta; con el curso crónico se producen queratitis, entropión, triquiasis y opacidades corneales. El diagnóstico es básicamente clínico. Para eliminar esta enfermedad, la Organización Mundial de la Salud formuló el Programa Global para la Eliminación del Tracoma para 2020, basado en la implementación de la estrategia SAFE, consistente en cirugía para evitar complicaciones, tratamiento antibiótico, higiene facial y corporal y mejoramiento de las condiciones ambientales.

show abstract

Surgery Versus Epilation for the Treatment of Minor Trichiasis in Ethiopia: A Randomised Controlled Noninferiority Trial

Abstract: In this randomized, non-inferiority trial, Saul Rajak et al compare epilation and surgery for the management of minor trichiasis in Ethiopia, the country with the most cases of trachomatous trichiasis.

Cited by 32 publications

References 20 publications

The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence

The Outcome of Trachomatous Trichiasis Surgery in Ethiopia: Risk Factors for Recurrence

Epilation for Minor Trachomatous Trichiasis: Four-Year Results of a Randomised Controlled Trial

Tracoma: de lo básico a lo clínico

Contact Info

Product

Resources

About