Azithromycin Prevents Recurrence of Severe Trichiasis Following Trichiasis Surgery: STAR Trial

Abstract

Purpose: Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threatening recurrence is unknown. This randomized, clinical trial determined if treating trichiasis surgical patients with oral azithromycin compared to usual care (topical tetracycline) resulted in a reduction in severe recurrence of trichiasis to one year. Methods: In a rural, trachoma hyperendemic district in Ethiopia, 1452 trichiasis patients age 18 or older presenting for surgery were randomly allocated to azithromycin, single 1 gram dose, versus topical tetracycline twice per day for six weeks. The outcome was recurrent severe trichiasis, defined as lashes touching the cornea, or more than 5 lashes touching the globe, to one year. Results: Patients randomized to receive azithromycin had significantly fewer severe recurrences, 4.2/100 person years overall, compared to those randomized to topical tetracycline, 7.9/100 person years (p < 0.01). Conclusions: A single dose of azithromycin has been shown to reduce severe post-surgical trichiasis recurrence rates to one year and should become standard post surgical treatment.

Keywords:

• Azithromycin
• Trichiasis
• Surgery
• Ethiopia
• Clinical trial