Transcript Title of article - JAMA Ophthalmology

Three-Year Outcomes of the Surgery for
Trichiasis, Antibiotics to Prevent
Recurrence Trial
Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-year
outcomes of the Surgery for Trichiasis, Antibiotics to Prevent
Recurrence trial. Arch Ophthalmol. Published online December 12,
2011. doi:10.1001/archophthalmol.2011.374.
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Introduction
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Trachoma is the leading infectious cause of blindness worldwide.
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Trachoma is caused by repeated infection with the bacterium Chlamydia
trachomatis.
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Bilamellar tarsal rotation is the recommended technique for surgical
correction of trichiasis.
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Trichiasis recurrence rates following surgery are high.
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Introduction
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A single dose of oral azithromycin reduces trichiasis recurrence by 33%
compared with topical tetracycline up to 1 year following trichiasis surgery.1
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Objective: To determine whether treatment with oral azithromycin reduces
recurrence of trichiasis up to 3 years following trichiasis surgery.
1West
SK, West ES, Alemayehu W, et al. Single-dose azithromycin prevents trichiasis recurrence
following surgery: randomized trial in Ethiopia. Arch Ophthalmol. 2006;124(3):309-314.
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Methods
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Study Design
– Randomized controlled clinical trial.
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Study Participants
– 1452 patients with trichiasis in southern Ethiopia.
– All patients underwent bilamellar tarsal rotation.
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Randomized 2:1:
– Single 1-g dose of oral azithromycin.
– Topical tetracycline twice daily for 6 weeks.
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Methods
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Data Analysis
– Survival analysis.
– Cumulative recurrence of trichiasis up to 3 years following surgery.
– Cox proportional hazards model:
• Describe risk factors for recurrence.
• Adjust for confounders in predicting recurrence.
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Limitation
– Low power, given the low rate of recurrence and loss to follow-up.
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Results
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At 3 years, the protective effect of azithromycin was still evident, with a 22%
reduction in the recurrence rate from 13% to 10% when compared with
topical tetracycline.
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Results
Cumulative incidence of
recurrence of trichiasis by
treatment group (P = .11,
determined by use of the
log-rank test).
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Results
Multivariate Analysis Predicting Cumulative Trichiasis Recurrence to 3 Years
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Comment
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Severity of entropion at baseline was the most significant risk factor for
recurrence of trichiasis by 3 years, emphasizing the importance of
performing surgery at an early stage.
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Treatment with a single dose of azithromycin after surgery remains an
integral component of the World Health Organization’s strategy for the
elimination of trichiasis.
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Contact Information
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If you have questions, please contact the corresponding author:
– Sheila K. West, PhD, Dana Center for Preventive Ophthalmology,
Wilmer Eye Institute, Room 129, Johns Hopkins University, 600 N Wolfe
St, Baltimore, MD 21287 ([email protected]).
Funding/Support
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This work was supported by grant EY13878 from the National Eye Institute.
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