Absorbable Versus Silk Sutures for Surgical Treatment of Trachomatous Trichiasis in Ethiopia: A Randomised Controlled Trial
Background:
Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye). Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial.
Methods and Findings:
1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1∶1) by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910) or silk sutures (removed at 7–10 days) in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye) at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68–1.20). The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications.
Conclusions:
There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3–6 months, which might allow us to better determine whether a patient needs additional surgery.
Trial registration:
ClinicalTrials.gov NCT00522860
: Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Absorbable Versus Silk Sutures for Surgical Treatment of Trachomatous Trichiasis in Ethiopia: A Randomised Controlled Trial. PLoS Med 8(12): e32767. doi:10.1371/journal.pmed.1001137
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001137
Souhrn
Background:
Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye). Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial.
Methods and Findings:
1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1∶1) by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910) or silk sutures (removed at 7–10 days) in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye) at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68–1.20). The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications.
Conclusions:
There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3–6 months, which might allow us to better determine whether a patient needs additional surgery.
Trial registration:
ClinicalTrials.gov NCT00522860
: Please see later in the article for the Editors' Summary
Zdroje
1. MariottiSPPascoliniDRose-NussbaumerJ 2009 Trachoma: global magnitude of a preventable cause of blindness. Br J Ophthalmol 93 563 568
2. ResnikoffSPascoliniDEtya'aleDKocurIPararajasegaramR 2004 Global data on visual impairment in the year 2002. Bull World Health Organ 82 844 851
3. World Health Organization 2006 Trachoma control - a guide for programme managers Geneva World Health Organization
4. YorstonDMabeyDHattSBurtonM 2006 Interventions for trachoma trichiasis. Cochrane Database Syst Rev CD004008
5. BogHYorstonDFosterA 1993 Results of community-based eyelid surgery for trichiasis due to trachoma. Br J Ophthalmol 77 81 83
6. KhandekarRMohammedAJCourtrightP 2001 Recurrence of trichiasis: a long-term follow-up study in the Sultanate of Oman. Ophthalmic Epidemiol 8 155 161
7. BurtonMJBowmanRJFaalHAryeeEAIkumapayiUN 2005 Long term outcome of trichiasis surgery in the Gambia. Br J Ophthalmol 89 575 579
8. BurtonMJKintehFJallowOSillahABahM 2005 A randomised controlled trial of azithromycin following surgery for trachomatous trichiasis in the Gambia. Br J Ophthalmol 89 1282 1288
9. RajakSNMakaloPSillahAHollandMJMabeyDC 2010 Trichiasis surgery in The Gambia: a 4-year prospective study. Invest Ophthalmol Vis Sci 51 4996 5001
10. WestESMkochaHMunozBMabeyDFosterA 2005 Risk factors for postsurgical trichiasis recurrence in a trachoma-endemic area. Invest Ophthalmol Vis Sci 46 447 453
11. ElTELewallenSCourtrightP 2006 Routine bilamellar tarsal rotation surgery for trachomatous trichiasis: short-term outcome and factors associated with surgical failure. Ophthal Plast Reconstr Surg 22 109 112
12. ReacherMHMunozBAlghassanyADaarASElbualyM 1992 A controlled trial of surgery for trachomatous trichiasis of the upper lid. Arch Ophthalmol 110 667 674
13. WestSKWestESAlemayehuWMeleseMMunozB 2006 Single-dose azithromycin prevents trichiasis recurrence following surgery: randomized trial in Ethiopia. Arch Ophthalmol 124 309 314
14. ZhangHKandelRPAtakariHKDeanD 2006 Impact of oral azithromycin on recurrence of trachomatous trichiasis in Nepal over 1 year. Br J Ophthalmol 90 943 948
15. ReacherMHHuberMJCanagaratnamRAlghassanyA 1990 A trial of surgery for trichiasis of the upper lid from trachoma. Br J Ophthalmol 74 109 113
16. ReacherMFosterAHuberJ 1993 Trichiasis surgery for trachoma: the bilamellar tarsal rotation procedure Geneva World Health Organization
17. YeungYMHonCYHoCK 1997 A simple surgical treatment for upper lid trichiasis. Ophthalmic Surg Lasers 28 74 76
18. BowmanRJJattaBFaalHBaileyRFosterA 2000 Long-term follow-up of lid surgery for trichiasis in the Gambia: surgical success and patient perceptions. Eye 14 864 868
19. BowmanRJFaalHMyattMAdegbolaRFosterA 2002 Longitudinal study of trachomatous trichiasis in the Gambia. Br J Ophthalmol 86 339 343
20. CraigPHWilliamsJADavisKWMagounADLevyAJ 1975 A biologic comparison of polyglactin 910 and polyglycolic acid synthetic absorbable sutures. Surg Gynecol Obstet 141 1 10
21. DawsonCRJonesBRTarizzoML 1981 Guide to trachoma control Geneva World Health Organization
22. World Health O 2005 Final assessment of trichiasis surgeons Geneva World Health Organisation
23. AdamuYAlemayehuW 2002 A randomized clinical trial of the success rates of bilamellar tarsal rotation and tarsotomy for upper eyelid trachomatous trichiasis. Ethiop Med J 40 107 114
24. GowerEWMerbsSLMunozBKelloABAlemayehuW 2010 Rates and risk factors for unfavorable outcomes 6 weeks after trichiasis surgery. Invest Ophthalmol Vis Sci 52 2704 2711
25. BurtonMJBaileyRLJeffriesDRajakSNAdegbolaRA 2010 Conjunctival expression of matrix metalloproteinase and proinflammatory cytokine genes after trichiasis surgery. Invest Ophthalmol Vis Sci 51 3583 3590
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2011 Číslo 12
- Jak rozpoznat pacienty s familiární hypercholesterolémií ve své praxi
- Myasthenia gravis: kombinace chirurgie a farmakoterapie jako nejefektivnější modalita?
- Statinová intolerance
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
- Mutace v genu PCSK9 zodpovědné za rozvoj familiární hypercholesterolémie
Najčítanejšie v tomto čísle
- Violent Crime, Epilepsy, and Traumatic Brain Injury
- Rotating Night Shift Work and Risk of Type 2 Diabetes: Two Prospective Cohort Studies in Women
- Shift Work as a Risk Factor for Future Type 2 Diabetes: Evidence, Mechanisms, Implications, and Future Research Directions
- Disclosure of Investigators' Recruitment Performance in Multicenter Clinical Trials: A Further Step for Research Transparency