title: Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial.
abstract: BACKGROUND
  Trachomatous trichiasis (TT) needs to be managed to reduce the risk of vision loss. The long-term impact of epilation (a common traditional practice of repeated plucking of lashes touching the eye) in preventing visual impairment and corneal opacity from TT is unknown. We conducted a randomized controlled trial of epilation versus surgery for the management of minor TT (fewer than six lashes touching the eye) in Ethiopia. Here we report the four-year outcome and the effect on vision and corneal opacity.
  
  
  RESULTS
  1300 individuals with minor TT were recruited and randomly assigned to quality trichiasis surgery or repeated epilation using high quality epilation forceps by a trained person with good near vision. Participants were examined six-monthly for two-years, and then at four-years after randomisation. At two-years all epilation arm participants were offered free surgery. At four-years 1151 (88.5%) were re-examined: 572 (88%) and 579 (89%) from epilation and surgery arms, respectively. At that time, 21.1% of the surgery arm participants had recurrent TT; 189/572 (33%) of the epilation arm had received surgery, while 383 (67%) declined surgery and had continued epilating ("epilation-only"). Among the epilation-only group, 207 (54.1%) fully controlled their TT, 166 (43.3%) had minor TT and 10 (2.6%) had major TT (&gt;5 lashes). There were no differences between participants in the epilation-only, epilation-to-surgery and surgery arm participants in changes in visual acuity and corneal opacity between baseline and four-years.
  
  
  CONCLUSIONS
  Most minor TT participants randomised to the epilation arm continued epilating and controlled their TT. Change in vision and corneal opacity was comparable between surgery and epilation-only participants. This suggests that good quality epilation with regular follow-up is a reasonable second-line alternative to surgery for minor TT for individuals who either decline surgery or do not have immediate access to surgical treatment.
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom; The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Esmael
authors.initials: E
authors.lastname: Habtamu
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Saul N
authors.initials: SN
authors.lastname: Rajak
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Tadesse
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Tariku
authors.initials: T
authors.lastname: Wondie
authors.affiliation: The Carter Center, Addis Ababa, Ethiopia.
authors.forename: Mulat
authors.initials: M
authors.lastname: Zerihun
authors.affiliation: Amhara Regional Health Bureau, Bahirdar, Ethiopia.
authors.forename: Birhan
authors.initials: B
authors.lastname: Guadie
authors.affiliation: International Trachoma Initiative, Addis Ababa, Ethiopia.
authors.forename: Teshome
authors.initials: T
authors.lastname: Gebre
authors.affiliation: Light for the World, Addis Ababa, Ethiopia.
authors.forename: Amir Bedri
authors.initials: AB
authors.lastname: Kello
authors.affiliation: The Carter Center, Atlanta, Georgia, United States of America.
authors.forename: Kelly
authors.initials: K
authors.lastname: Callahan
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: David C W
authors.initials: DC
authors.lastname: Mabey
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Peng T
authors.initials: PT
authors.lastname: Khaw
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Gilbert
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.affiliation: International Trachoma Initiative, Atlanta, Georgia, United States of America.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Emerson
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom; NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Burton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003318:Corneal Opacity / Q000628:therapy; D005260:Female; D006204:Hair Removal; D006801:Humans; D008297:Male; D008875:Middle Aged; D014141:Trachoma / Q000628:therapy*; D058457:Trichiasis / Q000628:therapy*; D014792:Visual Acuity