This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Burton, M J Articles by Bailey, R L Search for Related Content PubMed PubMed Citation Articles by Burton, M J Articles by Bailey, R L Topic Collections Relevant Article

A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia

¹ London School of Hygiene and Tropical Medicine, London, UK
² Medical Research Council Laboratories, Fajara, Gambia
³ National Eye Care Programme, Gambia
⁴ Programme National de Lutte Contre La Cecite de la Republique du Senegal
⁵ Division of Epidemiology and International Eye Health, Institute of Ophthalmology, London, UK

Correspondence to:
Correspondence to:
Dr Matthew Burton
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; matthew.burton{at}lshtm.ac.uk

Background/aim: Trachomatous trichiasis frequently returns following surgery. Several factors may promote recurrence: preoperative disease severity, surgeon ability, surgical procedure, healing responses, and infection. This study investigates whether enhanced control of infection, both of Chlamydia trachomatis and other bacteria, with azithromycin can improve surgical outcome in a trachoma control programme.

Methods: Individuals with trachomatous trichiasis were examined and operated. After surgery patients were randomised to the azithromycin or control group. The azithromycin group and children in their household were given a dose of azithromycin. Antibiotic treatment was repeated at 6 months. All patients were reassessed at 6 months and 12 months. Samples were collected for C trachomatis polymerase chain reaction and general microbiology at each examination.

Results: 451 patients were enrolled. 426 (94%) were reassessed at 1 year, of whom 176 (41.3%) had one or more lashes touching the eye and 84 (19.7%) had five or more lashes. There was no difference in trichiasis recurrence between the azithromycin and control group. Recurrent trichiasis was significantly associated with more severe preoperative trichiasis, bacterial infection, and severe conjunctival inflammation at 12 months. Significant variability in outcome was found between surgeons. Visual acuity and symptoms significantly improved following surgery.

Conclusion: In this setting, with a low prevalence of active trachoma, azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme. Audit of trichiasis surgery should be routine.

Abbreviations: BLTR, bilamellar tarsal rotation; CON, community ophthalmic nurses; MMP, matrix metalloproteinases; NECP, National Eye Care Programme; PCR, polymerase chain reaction; PLTR, posterior lamellar tarsal rotation; RCT, randomised controlled trial; STGG, skimmed milk, tryptone, glycerol and glucose broth

Keywords: trachoma; trichiasis surgery; azithromycin; bacteria; Gambia

Relevant Article

Trachoma

J D Chidambaram and T M Lietman
Br. J. Ophthalmol. 2005 89: 1232-1233. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				M. J. Burton Trachoma: an overview Br. Med. Bull., January 5, 2008; (2008) ldm034v1. [Abstract] [Full Text] [PDF]

				M. J. Burton, R. A. Adegbola, F. Kinteh, U. N. Ikumapayi, A. Foster, D. C. W. Mabey, and R. L. Bailey Bacterial Infection and Trachoma in The Gambia: A Case Control Study Invest. Ophthalmol. Vis. Sci., October 1, 2007; 48(10): 4440 - 4444. [Abstract] [Full Text] [PDF]

				C. Lin and T. Lietman Trachoma Control: Is Azithromycin the Answer for Trichiasis Too? Arch Ophthalmol, June 1, 2007; 125(6): 819 - 820. [Full Text] [PDF]

				S. K. West, E. S. West, W. Alemayehu, M. Melese, B. Munoz, A. Imeru, A. Worku, C. Gaydos, C. L. Meinert, and T. Quinn Single-Dose Azithromycin Prevents Trichiasis Recurrence Following Surgery: Randomized Trial in Ethiopia. Arch Ophthalmol, March 1, 2006; 124(3): 309 - 314. [Abstract] [Full Text] [PDF]