West Sheila, Alemayehu Wondu, Munoz Beatriz, Gower Emily West
Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland 21287, USA.
Ophthalmic Epidemiol. 2007 Sep-Oct;14(5):273-7. doi: 10.1080/09286580701410323.
Trichiasis, the potentially visually disabling result of chronic trachoma, is a leading cause of blindness world wide. Surgery can repair trichiasis, but recurrence of severe trichiasis (lashes touching the cornea) following surgery is likely to have immediate vision threatening consequences. Azithromycin use post-surgery appeared to be beneficial against recurrences but there were a mix of severe, moderate, and mild trichiasis; the specific effect on prevention of severe, vision-threatening recurrence is unknown. This randomized, clinical trial determined if treating trichiasis surgical patients with oral azithromycin compared to usual care (topical tetracycline) resulted in a reduction in severe recurrence of trichiasis to one year.
In a rural, trachoma hyperendemic district in Ethiopia, 1452 trichiasis patients age 18 or older presenting for surgery were randomly allocated to azithromycin, single 1 gram dose, versus topical tetracycline twice per day for six weeks. The outcome was recurrent severe trichiasis, defined as lashes touching the cornea, or more than 5 lashes touching the globe, to one year.
Patients randomized to receive azithromycin had significantly fewer severe recurrences, 4.2/100 person years overall, compared to those randomized to topical tetracycline, 7.9/100 person years (p < 0.01).
A single dose of azithromycin has been shown to reduce severe post-surgical trichiasis recurrence rates to one year and should become standard post surgical treatment.
睑内翻是慢性沙眼可能导致视力丧失的结果，是全球失明的主要原因。手术可以修复睑内翻，但手术后严重睑内翻（睫毛接触角膜）的复发可能会立即产生威胁视力的后果。手术后使用阿奇霉素似乎对预防复发有益，但存在重度、中度和轻度睑内翻的混合情况；其对预防严重的、威胁视力的复发的具体效果尚不清楚。这项随机临床试验确定，与常规治疗（局部用四环素）相比，用口服阿奇霉素治疗睑内翻手术患者是否能在一年内降低严重睑内翻的复发率。
在埃塞俄比亚一个沙眼高度流行的农村地区，1452名18岁及以上前来接受手术的睑内翻患者被随机分配接受单剂量1克阿奇霉素治疗，或每天两次局部用四环素，持续六周。观察的结果是至一年时复发性严重睑内翻，定义为睫毛接触角膜，或超过5根睫毛接触眼球。
随机接受阿奇霉素治疗的患者严重复发明显较少，总体上为4.2/100人年，而随机接受局部用四环素治疗的患者为7.9/100人年（p<0.01）。
已证明单剂量阿奇霉素可将手术后严重睑内翻的复发率降低至一年，应成为标准的术后治疗方法。
