Fluorometholone as Ancillary Therapy for TT Surgery

Bilamellar Tarsal Rotation, Trachoma, Trichiasis

trachoma, trichiasis, trachomatous trichiasis, bilamellar tarsal rotation, fluorometholone, placebo controlled

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.

Protocol Title: Fluorometholone 0.1% as Perioperative Adjunct Therapy for Lid-rotation Surgery in Trachomatous Entropion and Trichiasis, Dose-varying Study Study Design: Randomized, double-masked, dose-ranging study of three dose levels of fluorometholone 0.1% or placebo in one eye of subjects with trachomatous trichiasis (TT) undergoing lid rotation surgery Primary Study Objective: Evaluate the safety and tolerability of three (3) doses of fluorometholone 0.1% in subjects with trachomatous trichiasis (TT) undergoing lid rotation surgery (Bilamellar Tarsal Rotation) Secondary Study Objective: Conduct a preliminary assessment of the efficacy of three (3) doses of fluorometholone 0.1% in subjects with trachomatous trichiasis (TT) undergoing lid rotation surgery (Bilamellar Tarsal Rotation) Number of Subjects: Up to 156 eyes of up to 156 subjects Study Population: Subjects with trachomatous trichiasis (TT) undergoing lid rotation surgery (Bilamellar Tarsal Rotation) Test Articles: 1. Fluorometholone 0.1% one drop twice daily for four weeks 2. Placebo one drop twice daily for four weeks 3. Fluorometholone 0.1% one drop four times daily for four weeks 4. Placebo one drop four times daily for four weeks 5. Fluorometholone 0.1% one drop four times daily for eight weeks 6. Placebo one drop four times daily for eight weeks Visit Schedule: Following trichiasis surgery on Day 0, subjects will return for study visits approximately on Days 14, 28, 56, 90, and 365 Tolerability Parameters: * Treatment-emergent ocular symptoms/signs * Discontinuation of drug / treatment because of side effects Safety Parameters: * Intraocular pressure elevation ≥30 mm Hg * Cataract * Adverse events * Treatment emergent abnormal ophthalmic findings * Treatment emergent external examination findings * Visual acuity Efficacy Parameters: * Trichiasis recurrence * Entropion recurrence * Trachoma activity grade (to the extent activity can be graded in eyes with severe trachomatous scarring)

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Ethiopia