1. Three-Year Outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence Trial Woreta F, Munoz B, Gower E, Alemayehu W, West SK. Three-year outcomes of the Surgery for Trichiasis, Antibiotics to Prevent Recurrence trial. Arch Ophthalmol. Published online December 12, 2011. doi:10.1001/archophthalmol.2011.374. Copyright restrictions may apply

2. Introduction Trachoma is the leading infectious cause of blindness worldwide. Trachoma is caused by repeated infection with the bacterium Chlamydia trachomatis. Bilamellar tarsal rotation is the recommended technique for surgical correction of trichiasis. Trichiasis recurrence rates following surgery are high. Copyright restrictions may apply

3. Introduction A single dose of oral azithromycin reduces trichiasis recurrence by 33% compared with topical tetracycline up to 1 year following trichiasis surgery. 1 Objective: To determine whether treatment with oral azithromycin reduces recurrence of trichiasis up to 3 years following trichiasis surgery. 1 West SK, West ES, Alemayehu W, et al. Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia. Arch Ophthalmol. 2006;124(3):309-314. Copyright restrictions may apply

4. Methods Study Design –Randomized controlled clinical trial. Study Participants –1452 patients with trichiasis in southern Ethiopia. –All patients underwent bilamellar tarsal rotation. Randomized 2:1: –Single 1-g dose of oral azithromycin. –Topical tetracycline twice daily for 6 weeks. Copyright restrictions may apply

5. Data Analysis –Survival analysis. –Cumulative recurrence of trichiasis up to 3 years following surgery. –Cox proportional hazards model: Describe risk factors for recurrence. Adjust for confounders in predicting recurrence. Limitation –Low power, given the low rate of recurrence and loss to follow-up. Copyright restrictions may apply Methods

6. At 3 years, the protective effect of azithromycin was still evident, with a 22% reduction in the recurrence rate from 13% to 10% when compared with topical tetracycline. Copyright restrictions may apply Results

7. Copyright restrictions may apply Cumulative incidence of recurrence of trichiasis by treatment group (P =.11, determined by use of the log-rank test). Results

8. Multivariate Analysis Predicting Cumulative Trichiasis Recurrence to 3 Years Copyright restrictions may apply Results

9. Severity of entropion at baseline was the most significant risk factor for recurrence of trichiasis by 3 years, emphasizing the importance of performing surgery at an early stage. Treatment with a single dose of azithromycin after surgery remains an integral component of the World Health Organization’s strategy for the elimination of trichiasis. Copyright restrictions may apply Comment

10. If you have questions, please contact the corresponding author: –Sheila K. West, PhD, Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Room 129, Johns Hopkins University, 600 N Wolfe St, Baltimore, MD 21287 (shwest@jhmi.edu). Funding/Support This work was supported by grant EY13878 from the National Eye Institute. Copyright restrictions may apply Contact Information