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Meta-Analysis
. 2015 Nov 13;2015(11):CD004008.
doi: 10.1002/14651858.CD004008.pub3.

Interventions for trachoma trichiasis

Matthew Burton  1 , Esmael Habtamu, Derek Ho, Emily W Gower
Affiliations
Meta-Analysis

Interventions for trachoma trichiasis

Matthew Burton et al. Cochrane Database Syst Rev. .

Abstract

Background: Trachoma is the leading infectious cause of blindness. The World Health Organization (WHO) recommends eliminating trachomatous blindness through the SAFE strategy: Surgery for trichiasis, Antibiotic treatment, Facial cleanliness and Environmental hygiene. This is an update of a Cochrane review first published in 2003, and previously updated in 2006.

Objectives: To assess the effects of interventions for trachomatous trichiasis for people living in endemic settings.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 4), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to May 2015), EMBASE (January 1980 to May 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 7 May 2015. We searched the reference lists of included studies to identify further potentially relevant studies. We also contacted authors for details of other relevant studies.

Selection criteria: We included randomised trials of any intervention intended to treat trachomatous trichiasis.

Data collection and analysis: Three review authors independently selected and assessed the trials, including the risk of bias. We contacted trial authors for missing data when necessary. Our primary outcome was post-operative trichiasis which was defined as any lash touching the globe at three months, one year or two years after surgery.

Main results: Thirteen studies met the inclusion criteria with 8586 participants. Most of the studies were conducted in sub-Saharan Africa. The majority of the studies were of a low or unclear risk of bias.Five studies compared different surgical interventions. Most surgical interventions were performed by non-physician technicians. These trials suggest the most effective surgery is full-thickness incision of the tarsal plate and rotation of the terminal tarsal strip. Pooled data from two studies suggested that the bilamellar rotation was more effective than unilamellar rotation (OR 0.29, 95% CI 0.16 to 0.50). Use of a lid clamp reduced lid contour abnormalities (OR 0.65, 95% CI 0.44 to 0.98) and granuloma formation (OR 0.67, 95% CI 0.46 to 0.97). Absorbable sutures gave comparable outcomes to silk sutures (OR 0.90, 95% CI 0.68 to 1.20) and were associated with less frequent granuloma formation (OR 0.63, 95% CI 0.40 to 0.99). Epilation was less effective at preventing eyelashes from touching the globe than surgery for mild trichiasis, but had comparable results for vision and corneal change. Peri-operative azithromycin reduced post-operative trichiasis; however, the estimate of effect was imprecise and compatible with no effect or increased trichiasis (OR 0.85, 95% CI 0.63 to 1.14; 1954 eyes; 3 studies). Community-based surgery when compared to health centres increased uptake with comparable outcomes. Surgery performed by ophthalmologists and integrated eye care workers was comparable. Adverse events were typically infrequent or mild and included rare postoperative infections, eyelid contour abnormalities and conjunctival granulomas.

Authors' conclusions: No trials were designed to evaluate whether the interventions for trichiasis prevent blindness as an outcome; however, several found modest improvement in vision following intervention. Certain interventions have been shown to be more effective at eliminating trichiasis. Full-thickness incision of the tarsal plate and rotation of the lash-bearing lid margin was found to be the best technique and is preferably delivered in the community. Surgery may be carried out by an ophthalmologist or a trained ophthalmic assistant. Surgery performed with silk or absorbable sutures gave comparable results. Post-operative azithromycin was found to improve outcomes where overall recurrence was low.

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Conflict of interest statement

MJB was an investigator on three of the trials: Burton 2005a; Rajak 2011a; Rajak 2011b

EH was an investigator on two of the trials: Rajak 2011a; Rajak 2011b

EWG was an investigator on two of the trials: West 2006; Gower 2013

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Bilamellar tarsal rotation versus tarsal advance and rotation, Outcome 1 One or more lashes touching globe at nine months.
1.2
1.2. Analysis
Comparison 1 Bilamellar tarsal rotation versus tarsal advance and rotation, Outcome 2 Overcorrection following surgery.
1.3
1.3. Analysis
Comparison 1 Bilamellar tarsal rotation versus tarsal advance and rotation, Outcome 3 Defective lid closure following surgery.
2.1
2.1. Analysis
Comparison 2 Peri‐operative azithromycin versus no azithromycin, Outcome 1 One or more lashes touching the globe at one year.
2.2
2.2. Analysis
Comparison 2 Peri‐operative azithromycin versus no azithromycin, Outcome 2 One or more lashes touching the globe at longer follow‐up.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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