Surgery versus epilation for the treatment of minor trichiasis in ethiopia: a randomised controlled noninferiority trial.


Rajak, SN; Habtamu, E; Weiss, HA; Kello, AB; Gebre, T; Genet, A; Bailey, RL; Mabey, DC; Khaw, PT; Gilbert, CE; Emerson, PM; Burton, MJ; (2011) Surgery versus epilation for the treatment of minor trichiasis in ethiopia: a randomised controlled noninferiority trial. PLoS medicine, 8 (12). e1001136. ISSN 1549-1277 DOI: https://doi.org/10.1371/journal.pmed.1001136

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Abstract

BACKGROUND Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (<six lashes touching eye). This trial investigated whether epilation is noninferior to surgery for managing minor trichiasis. METHODS AND FINDINGS 1,300 individuals with minor trichiasis from Amhara Regional State, Ethiopia were recruited and randomly assigned (1?1) to receive trichiasis surgery or epilation. The epilation group were given new forceps and epilation training. The surgical group received trichiasis surgery. Participants were examined every 6 months for 2 years by clinicians masked to allocation, with 93.5% follow-up at 24 months. The primary outcome measure ("failure") was ?five lashes touching the eye or receiving trichiasis surgery during 24 months of follow-up, and was assessed for noninferiority with a 10% prespecified noninferiority margin. Secondary outcomes included number of lashes touching, time to failure, and changes in visual acuity and corneal opacity. Cumulative risk of failure over 24 months was 13.2% in the epilation group and 2.2% in the surgical group (risk difference?=?11%). The 95% confidence interval (8.1%-13.9%) includes the 10% noninferiority margin. Mean number of lashes touching the eye was greater in the epilation group than the surgery group (at 24 months 0.95 versus 0.09, respectively; p<0.001); there was no difference in change in visual acuity or corneal opacity between the two groups. CONCLUSIONS This trial was inconclusive regarding inferiority of epilation to surgery for the treatment of minor trichiasis, relative to the prespecified margin. Epilation had a comparable effect to surgery on visual acuity and corneal outcomes. We suggest that surgery be performed whenever possible but epilation be used for treatment of minor trichiasis patients without access to or declining surgery. TRIAL REGISTRATION ClinicalTrials.govNCT00522912 Please see later in the article for the Editors' Summary.

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Neglected Tropical Diseases Network
Tropical Epidemiology Group
The International Centre for Evidence in Disability
International Centre for Eye Health
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 22180731
Web of Science ID: 298668100001
URI: http://researchonline.lshtm.ac.uk/id/eprint/20542

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