@article{27130,
  keywords = {Visual Acuity, Trichiasis, Trachoma, Middle Aged, Male, Humans, Hair Removal, Female, Corneal Opacity, Aged, 80 and over, Aged, Adult, Adolescent},
  author = {Habtamu E and Rajak S and Tadesse Z and Wondie T and Zerihun M and Guadie B and Gebre T and Kello AB and Callahan K and Mabey D and Khaw PT and Gilbert CE and Weiss HA and Emerson P and Burton M},
  title = {Epilation for minor trachomatous trichiasis: four-year results of a randomised controlled trial.},
  abstract = {<p><strong>BACKGROUND: </strong>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.</p>

<p><strong>METHODOLOGY/ PRINCIPAL FINDINGS: </strong>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.</p>

<p><strong>CONCLUSIONS/ SIGNIFICANCE: </strong>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.</p>
},
  year = {2015},
  journal = {PLoS neglected tropical diseases},
  volume = {9},
  pages = {e0003558},
  issn = {1935-2735},
  url = {http://www.plosntds.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pntd.0003558&representation=PDF},
  doi = {10.1371/journal.pntd.0003558},
  language = {eng},
}