Trichiasis | Fluorometholone as Ancillary Therapy for TT Surgery
Trichiasis research study
What is the primary objective of this study?
The investigators aim to evaluate a new potentially cost-effective approach to improving trichiasis surgery outcomes, perioperative topical anti-inflammatory therapy. The investigators hypothesize that adjunctive topical fluorometholone therapy following trichiasis surgery will reduce the risk of recurrent trichiasis. The rationale for this hypothesis is that interruption of inflammation postoperatively would reduce postoperative scarring, leading to better outcomes. As an initial step toward evaluating this modality, the investigators believe it to be necessary to evaluate topical corticosteroid therapy in a safety-oriented study, for which the investigators also hypothesize that fluorometholone will have a perioperative safety profile acceptable for large-scale programmatic use. Topical corticosteroid therapy is associated with potential risks of cataract induction and intraocular pressure (IOP) elevation in susceptible individuals. Fluorometholone has lower intraocular penetration than alternative corticosteroids, with correspondingly less IOP-raising effect while still having favorable effects on conjunctival inflammation, and is a low-cost generic drug. Its poor delivery of corticosteroid into the eye itself provides an advantage in this setting, as the major side effects of therapy are the result of intraocular effects, and therapy only is needed to the conjunctiva. However, prior to use in a large-scale trial it is sensible to make sure adverse outcomes are not observed in a substantial number of TT patients in a smaller scale trial. Secondary goals of such a trial are to evaluate alternative topical corticosteroid dosing schedules to identify an optimal dosing schedule and to identify any preliminary signals of potential efficacy.
Who is eligible to participate?
Inclusion Criteria: 1. Age 18 years or more 2. Diagnosis with trachomatous trichiasis 3. Plan for lid rotation surgery (Bilamellar Tarsal Rotation) on at least one upper eyelid 4. LOCS 3 cataract grading is level 3 or less for the nuclear cataract scale, and level 2 or less for the cortical cataract and posterior subcapsular cataract scales. 5. Intraocular pressure between 8-20 mm Hg in the study eye. Exclusion Criteria: 1. Contraindications to the use of the test articles 2. Known allergy or sensitivity to any medication used in this study, including the study medication or its components (e.g., fluorometholone) 3. Currently taking more than two ocular anti-hypertensive medications in the study eye (prior IOP-lowering surgery is acceptable; combinations of two agents such as Cosopt and Combigan are considered two medications) 4. Glaucoma sufficiently advanced that an intraocular pressure spike potentially would put the patient at substantial risk of vision loss, per study ophthalmologist's judgment. 5. Non-phakic (i.e., pseudophakic or aphakic) study eye (contralateral non-phakic eye is permitted). 6. Other than trachoma, any active ocular infections (bacterial, viral, or fungal), or any active ocular inflammation (e.g., scleritis, iritis). 7. History or diagnosis of ocular herpes or presence of a corneal lesion of suspected herpetic origin; or a diagnosis or suspected diagnosis of ophthalmic mycobacterial infection in either eye. 8. Corneal or scleral thinning in either eye. 9. A severe / serious ocular pathology or medical condition which may preclude study completion. 10. Any condition for which it is anticipated ocular or systemic corticosteroid therapy would be required. 11. Unwilling to discontinue use of contact lenses for the duration of the study (should the unusual circumstance of a trachomatous trichiasis patient who uses contact lenses be encountered) 12. Any significant illness or condition that could, in the investigator's or sub-investigator's opinion, be expected to interfere with the study parameters or study conduct; or put the subject at significant risk 13. For women of childbearing age, currently pregnant and/or breastfeeding, as obtained by self-report (because of concerns about the (programmatic) use of azithromycin in this setting). 14. Cataract in the study eye, defined as LOCS-3 cataract grading is level 3.1 or more for the nuclear cataract scale, or level 2.1 or more for the cortical cataract or posterior subcapsular cataract scales.
Which medical condition, disease, disorder, syndrome, illness, or injury is researched?
Bilamellar Tarsal Rotation
Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.
Drug:Fluorometholone 0.1% ophthalmic solution
Other:Artificial tears (Placebo)Artificial tears (Placebo)
Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.
Fluorometholone 0.1% 1 gtt bid x4weeksFluorometholone 0.1% 1 drop two times daily for four weeks
Artificial Tears 1 gtt bid x4 weeks
Fluorometholone 0.1% 1 gtt qid x 4 weeksFluorometholone 0.1% 1 drop four times daily for four weeks
Artificial Tears 1 gtt qid x4 weeks
Fluorometholone 0.1% 1 gtt qid x 8 weeksFluorometholone 0.1% 1 drop four times daily for eight weeks
Artificial Tears 1 gtt qid x8 weeks
Start Date: November 2013
Completed Date: April 2016
Primary Outcome: Safety assessments
Secondary Outcome: Recurrence of trichiasis in the study eye
Study sponsors, principal investigator, and references
Principal Investigator: John H Kempen, MD MPH PhD
Lead Sponsor: University of Pennsylvania
Collaborator: Lions Clubs International Foundation (funding)