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

<h4>Background</h4>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...

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Autores principales:	Saul N Rajak, Esmael Habtamu, Helen A Weiss, Amir Bedri Kello, Teshome Gebre, Asrat Genet, Robin L Bailey, David C W Mabey, Peng T Khaw, Clare E Gilbert, Paul M Emerson, Matthew J Burton
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/3a463517df124d5eb270767337147684
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spelling	oai:doaj.org-article:3a463517df124d5eb2707673371476842021-11-18T05:42:25ZSurgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.1549-12771549-167610.1371/journal.pmed.1001136https://doaj.org/article/3a463517df124d5eb2707673371476842011-12-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22180731/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>ClinicalTrials.gov NCT00522912.Saul N RajakEsmael HabtamuHelen A WeissAmir Bedri KelloTeshome GebreAsrat GenetRobin L BaileyDavid C W MabeyPeng T KhawClare E GilbertPaul M EmersonMatthew J BurtonPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 12, p e1001136 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Saul N Rajak Esmael Habtamu Helen A Weiss Amir Bedri Kello Teshome Gebre Asrat Genet Robin L Bailey David C W Mabey Peng T Khaw Clare E Gilbert Paul M Emerson Matthew J Burton Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions</h4>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.<h4>Trial registration</h4>ClinicalTrials.gov NCT00522912.
format	article
author	Saul N Rajak Esmael Habtamu Helen A Weiss Amir Bedri Kello Teshome Gebre Asrat Genet Robin L Bailey David C W Mabey Peng T Khaw Clare E Gilbert Paul M Emerson Matthew J Burton
author_facet	Saul N Rajak Esmael Habtamu Helen A Weiss Amir Bedri Kello Teshome Gebre Asrat Genet Robin L Bailey David C W Mabey Peng T Khaw Clare E Gilbert Paul M Emerson Matthew J Burton
author_sort	Saul N Rajak
title	Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
title_short	Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
title_full	Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
title_fullStr	Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
title_full_unstemmed	Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.
title_sort	surgery versus epilation for the treatment of minor trichiasis in ethiopia: a randomised controlled noninferiority trial.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/3a463517df124d5eb270767337147684
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Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.

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