Brief Title
Modified Instrumentation for Surgery to Correct Trichiasis
Official Title
Partnership for the Rapid Elimination of Trachoma (PRET) Clinical Trial of Evaluation of Modified Instrumentation for Surgery to Correct Trichiasis
Brief Summary
Trachoma, an ocular infection caused by C. trachomatis, is the second leading infectious cause of blindness worldwide. Years of repeated infection with C. trachomatis cause the eyelid to scar and contract and ultimately to rotate inward such that the eyelashes rub against the eyeball and abrade the cornea (trichiasis). The World Health Organization (WHO) has endorsed a multi-faceted strategy to combat trachoma which includes surgery to repair lids distorted by trachoma (trichiasis) in imminent danger of vision loss. Current evidence suggests that long-term success rates of trichiasis surgery are less than optimal due to variation in surgical technique. Previous research by this study team has demonstrated that shorter incisions have a higher rate of trichiasis recurrence. In addition, observations by this team's oculoplastic surgeon have led to the hypothesis that granuloma formation and lid contour abnormalities may result from current surgical practices. The objective of this study is to compare outcomes of trichiasis surgeries performed with the newly developed trachomatous trichiasis (TT) clamp versus surgeries following standard technique (bilamellar tarsal rotation procedure or BLTR).
Detailed Description
Field observations in 2005 by this study's PI and oculoplastic surgeon revealed some significant departures from current trichiasis surgery procedure (bilamellar tarsal rotation procedure or BTRP), as described in the WHO manual, "Trichiasis Surgery for Trachoma-the Bilamellar Tarsal Rotation Procedure". These procedural departures were felt to contribute to adverse outcomes, including trichiasis recurrence, granuloma formation and lid contour abnormalities. This study team developed a new surgical tool, the TT clamp, to help improve surgical outcomes following BLTR. A randomized, single-masked clinical trial will be implemented in the Mtwara region in Tanzania. Study participants will be randomized on a 1:1 basis to surgery with the TT clamp or to surgery with standard BLTR equipment. All surgeries will take place at surgical centers in Mtwara and Lindi over an 8-month period. Baseline assessment for severity of trichiasis and other predictors of surgical failure will be carried out prior to surgery. Follow-up is planned at 2 weeks (for suture removal), 6 weeks, 12 months, and 24 months post-surgery. At each follow-up visit participants will be assessed for evidence of unfavorable outcomes, including trichiasis recurrence, granuloma formation, and lid contour abnormalities. All outcomes will be assessed clinically by a trained observer who is masked to intervention status.
Study Type
Interventional
Primary Outcome
Number of Eyelids With Presence of Recurrent Trichiasis
Secondary Outcome
Number of Eyelids With Mild, Moderate, Severe, or no Eyelid Contour Abnormality
Condition
Trachoma
Intervention
TT Clamp
Study Arms / Comparison Groups
TT Clamp
Description: The TT clamp will be used in trichiasis surgery.
Publications
* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.
Recruitment Information
Recruitment Status
Device
Estimated Enrollment
1927
Start Date
May 2009
Completion Date
June 2012
Primary Completion Date
January 2012
Eligibility Criteria
Inclusion Criteria: - Presence of upper lid trichiasis: defined by at least one eyelash touching the globe of the eye or evidence of epilation - No previous report of trichiasis surgery in at least one eye with trichiasis: - eyes with prior surgery are already at high risk due to the prior surgery, and their inclusion may decrease our ability to clearly evaluate our primary outcome - if unilateral surgery has been performed previously, only the eye without prior history of surgery will be in the study, even if both eyes require surgery - Age 18 or older (in order to provide consent as an adult): the vast majority of trichiasis patients are aged 18 or older - At time of enrollment, subjects must state their intention to remain in the area for two years to facilitate study follow-up Exclusion Criteria: - Absence of upper lid trichiasis - Prior trichiasis surgery on both eyes - Age 18 or younger - Subjects who are transiently in the area
Gender
All
Ages
18 Years - N/A
Accepts Healthy Volunteers
No
Contacts
Emily Gower, PhD, ,
Location Countries
United States
Location Countries
United States
Administrative Informations
NCT ID
NCT00886015
Organization ID
NA_00019216
Responsible Party
Principal Investigator
Study Sponsor
Johns Hopkins University
Collaborators
Bill and Melinda Gates Foundation
Study Sponsor
Emily Gower, PhD, Principal Investigator, Johns Hopkins University
Verification Date
April 2017