Original article
Impact of Trichiasis Surgery on Physical Functioning in Ethiopian Patients: STAR Trial

https://doi.org/10.1016/j.ajo.2010.10.039Get rights and content

Purpose

To evaluate the physical functioning of Ethiopian trichiasis surgery patients before and 6 months after surgery.

Design

Nested cohort study.

Methods

This study was nested within the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) clinical trial conducted in Ethiopia. Demographic information, ocular examinations, and physical functioning assessments were collected before and 6 months after surgery. A single score for patients' physical functioning was constructed using Rasch analysis. A multivariate linear regression model was used to determine if change in physical functioning was associated with change in visual acuity.

Results

Of the 438 participants, 411 (93.8%) had both baseline and follow-up questionnaires. Physical functioning scores at baseline ranged from −6.32 (great difficulty) to +6.01 (no difficulty). The percentage of participants reporting no difficulty in physical functioning increased by 32.6%; the proportion of participants in the mild/no visual impairment category increased by 8.6%. A multivariate linear regression model showed that for every line of vision gained, physical functioning improves significantly (0.09 units; 95% CI: 0.02–0.16).

Conclusions

Surgery to correct trichiasis appears to improve patients' physical functioning as measured at 6 months. More effort in promoting trichiasis surgery is essential, not only to prevent corneal blindness, but also to enable improved functioning in daily life.

Section snippets

Methods

This study was nested within the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) clinical trial. The STAR trial is a randomized, single-masked clinical trial of antibiotic use in 1452 patients who received trichiasis surgery in the Wolayta Soddo zone of the Southern Nations, Nationalities, and Peoples Region (SNNPR) of Ethiopia. The primary aim was to determine whether postoperative treatment with azithromycin reduces trichiasis recurrence as compared to topical tetracycline

Results

Of the 438 participants, 18 (4.1%) did not have baseline questionnaires, and 9 (2.1%) were not present at follow-up; 5 of 9 had developed recurrent trichiasis before the 6-month follow-up. Thus, 411 participants had both baseline and follow-up questionnaires. Most of these 411 participants were female (74.5%). At baseline, 131 of the 411 participants (31.9%) had severe entropion, and 330 (80.3%) had surgery on both eyelids (Table 1). When comparing these 411 participants to the 27 participants

Discussion

Data from this study suggest that in addition to improving vision, trichiasis surgery can result in improvement in physical functioning at 6 months following surgery. Individuals with the most severe impairment at baseline showed the largest gains in physical functioning at 6 months after surgery. These individuals included those with severe entropion, worse baseline vision in the better eye, and worse baseline physical functioning score. These cases clearly had the most to gain from surgical

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