***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In this r and omized trial , Saul Rajak et al. compare silk sutures ( removed at 7–10 days ) or absorbable sutures ( left in place ) during surgery for the management of trachomatous trichiasis PURPOSE Trachoma is the leading infectious cause of blindness . Conjunctival Chlamydia trachomatis infection causes scarring , entropion , trichiasis , and blinding corneal opacification . Worldwide , there are 8 million people with trichiasis . Although trichiasis surgery can reduce the risk of blindness , retrospective data suggest that long-term recurrence rates may be high . A 4-year prospect i ve investigation of recurrent trichiasis was conducted in The Gambia . METHODS Patients with trichiasis were examined at baseline , 6 months , 1 year , and 4 years after  posterior lamellar tarsal rotation surgery . Conjunctival swabs for bacteriology and PCR for C. trachomatis were collected at baseline , 6 months , and 1 year . RESULTS Three hundred fifty-six Gambian patients were enrolled at baseline and 266 were reassessed at 4 years ( 94 % of surviving patients ) . The recurrence rates were 32 % , 40 % , and 41 % at 6 months , 1 year , and 4 years , respectively . At 4 years , 30 % of patients had bilateral trichiasis and 21 % had bilateral corneal opacity . Recurrence was associated with severe conjunctival inflammation and severe trichiasis ( > 10 lashes ) at baseline . CONCLUSIONS Trichiasis recurrence rates were high , and most cases recurred within 6 months of surgery . The results suggest that there are important aspects of surgical technique and quality that should to be addressed . Persistent inflammation is strongly associated with recurrence at 4 years The effectiveness of commonly used procedures to correct trachomatous trichiasis of the upper lid was examined in a clinical trial in Oman . Lids were grade d as having minor trichiasis ( five or fewer lashes ) , major trichiasis ( more than five lashes ) , and defective lid closure . R and omly allocated surgery specific for lid grade was completed in 384 lids , of which 369 ( 96 % ) were followed up once or twice approximately 9 and 21 months after surgery . The definition of operative success included no evidence of trichiasis and complete lid closure .  Tarsal rotation  was the most effective operation and was successful in 80 % of cases of minor trichiasis , compared with success rates of 29 % for electrolysis and 18 % for cryoablation .  Tarsal rotation  was successful in 77 % of cases of major trichiasis , compared with a 41 % success rate for  tarsal advance and rotation .  Surgery for major trichiasis produced a significant improvement in visual acuity in operated vs nonoperated fellow eyes in a regression model incorporating the between-eyes correlation of visual acuity Background / aim : Trachomatous trichiasis frequently returns following surgery . Several factors may promote recurrence : preoperative disease severity , surgeon ability , surgical procedure , healing responses , and infection . This study investigates whether enhanced control of infection , both of Chlamydia trachomatis and other bacteria , with azithromycin can improve surgical outcome in a trachoma control programme . Methods : Individuals with trachomatous trichiasis were examined and operated . After surgery patients were r and omised to the azithromycin or control group . The azithromycin group and children in their household were given a dose of azithromycin . Antibiotic treatment was repeated at 6 months . All patients were reassessed at 6 months and 12 months . Sample s were collected for C trachomatis polymerase chain reaction and general microbiology at each examination . Results : 451 patients were enrolled . 426 ( 94 % ) were reassessed at 1 year , of whom 176 ( 41.3 % ) had one or more lashes touching the eye and 84 ( 19.7 % ) had five or more lashes . There was no difference in trichiasis recurrence between the azithromycin and control group . Recurrent trichiasis was significantly associated with more severe preoperative trichiasis , bacterial infection , and severe conjunctival inflammation at 12 months . Significant variability in outcome was found between surgeons . Visual acuity and symptoms significantly improved following surgery . Conclusion : In this setting , with a low prevalence of active trachoma , azithromycin did not improve the outcome of trichiasis surgery conducted by a trachoma control programme . Audit of trichiasis surgery should be routine Background Surgery for trachomatous trichiasis ( TT ) is a key component of the SAFE Strategy for trachoma control . Unfortunately , recurrent TT following surgery is common , probably due to various surgical and disease factors . To develop strategies to reduce recurrence rates it is necessary to underst and its pathological basis . In this study we investigated the relationship between recurrent trichiasis and the expression of various cytokines and fibrogenic genes during a two-year follow-up period . Methodology /Principal Findings Individuals undergoing surgery for TT were examined at baseline ( pre-operative ) , 6 , 12 , 18 and 24 months . Conjunctival swab sample s were collected from the tarsal conjunctiva for RNA isolation on each occasion . Individuals who developed recurrent TT with at least 3  lashes  touching the eye on one or more occasion were design ated “ cases ” and an equal number of “ controls ” were r and omly selected from those without recurrent TT , frequency matched for age and baseline TT severity . The expression of the following genes was measured by quantitative RT-PCR : S100A7 , IL1B , CXCL5 , TNFA , NOS2A , CTGF , MMP7 , MMP9 and MMP12 . Thirteen hundred individuals were enrolled and underwent surgery . By two years 122 had developed recurrent TT with at least 3 lashes touching the eye . Recurrent TT was consistently associated across multiple time points with about a 2-fold increase in S100A7 expression ( p = 0.008 ) . Clinical ly visible conjunctival inflammation was associated with increased S100A7 , IL1B , CXCL5 , MMP9 and MMP12 expression . Conclusions / Significance Increased S100A7 expression was associated with trachomatous conjunctival scarring and may be linked to the pathophysiology of recurrent TT . S100A7 expression could be a potential biomarker for this disease process . As part of the epithelial innate immune response S100A7 has multiple actions , potentially contributing to a chronic pro-inflammatory response , which may lead to ongoing tissue damage and increased scarring OBJECTIVE To determine whether treatment with oral azithromycin compared with topical tetracycline reduces the recurrence of trichiasis for up to 3 years following surgery for trichiasis . METHODS The Surgery for Trichiasis , Antibiotics to Prevent Recurrence ( STAR ) trial is a r and omized , single-masked , clinical trial conducted in southern Ethiopia , a region where trachoma is hyperendemic . A total of 1452 patients who underwent trichiasis surgery were r and omly assigned at a 2:1 ratio to either a single dose of oral azithromycin ( 1 g ) or topical tetracycline ( twice per day for 6 weeks ) following surgery . MAIN OUTCOME MEASURES Recurrence of trichiasis within 3 years following surgery . RESULTS The rate of recurrence was 10 % in the azithromycin group and 13 % in the tetracycline group . The azithromycin group had a 22 % reduction in recurrence of trichiasis 3 years after surgery compared with the tetracycline group ( P = .13 ) . Severity of entropion at baseline was the most significant predictor of recurrence of trichiasis at 3 years . CONCLUSION Trichiasis recurrence rates in the STAR trial remained low for up to 3 years following surgery . The protective effect of a single dose of azithromycin was less than at 1 year and , although not statistically significant , was still suggestive up to 3 years following trichiasis surgery . APPLICATION TO CLINICAL PRACTICE A single dose of azithromycin after surgery remains an integral component of the World Health Organization 's strategy for the elimination of trachoma by the year 2020 In this r and omized , non-inferiority trial , Saul Rajak et al compare epilation and surgery for the management of minor trichiasis in Ethiopia , the country with the most cases of trachomatous trichiasis BACKGROUND  Trichiasis recurrence following surgery is a serious problem for trachoma programs . OBJECTIVE To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year , and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient . DESIGN A r and omized , single-masked , clinical trial was conducted in Ethiopia . A total of 1452 patients with trichiasis were r and omized 1:1:1 to the following 3 arms : single-dose ( 1 g ) oral azithromycin alone , single-dose azithromycin for household members ( 20 mg/kg up to 1 g ) plus the patient , or topical tetracycline ( twice per day for 6 weeks ) . MAIN OUTCOME MEASURES Trichiasis recurrence within 1 year following surgery . RESULTS The combined azithromycin groups had significantly fewer recurrences , 6.9 of 100 person-years overall , compared with topical tetracycline , 10.3 of 100 person-years ( P = .047 ) . There was no additional reduction in the arm that also treated household members , 8.1 of 100 person-years , compared with treating the surgical patients alone , 5.8 of 100 person-years ( P = .19 ) . CONCLUSIONS In trachoma-endemic areas , a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline . Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program , patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence BACKGROUND Blindness from trachoma is a significant problem for many underdeveloped countries . While active trachoma is common in children , trichiasis , the potentially blinding sequella , develops in adulthood and affects mainly women . Little is known about factors associated with the development of trichiasis . METHODS The 7-year incidence of trichiasis and its association with ocular chlamydia infection was examined in a cohort of women from a hyperendemic area . A total of 4,932 women 18 years and older , living in 11 villages in Central Tanzania , were examined in 1989 . A follow-up examination in 1996 was performed on all women with scars living in six of the 11 villages and on a r and om sample of women without scars from the same villages . Trachoma was grade d clinical ly , chlamydia infection was ascertained at follow-up using polymerase chain reaction-enzyme immunoassay ( PCR-EIA ) . RESULTS A total 523 of the women with scars and 503 of the women without scars were re-examined . Forty-eight of the women with scars ( incidence , 9.2 % ) and three of the women without scars ( 0.6 % ) developed trichiasis in the 7-year period . Prevalence of chlamydia infection was significantly higher in the group with scars ( 11.7 % versus 7.1 % ) . Trichiasis cases were more likely to be older , and to have chlamydia infection at follow-up odds ratio ( 95 % confidence interval ) 2.5 ( 1.1 - 5.7 ) . CONCLUSION The 7-year incidence rate in the population with scars was high , over 1 % per year . Ocular chlamydia infection was more common in the group with scars at baseline and was also associated with being a trichiasis case , suggesting the importance of potentially long-term chlamydia infection in the progression to trichiasis . Antibiotic distribution programmes for trachoma control should include women with scars BACKGROUND Trachoma is the leading worldwide cause of preventable blindness . Surgery can alleviate trachomatous trichiasis ( TT ) , the blinding sequelae of trachoma , but recurrence rates are high . OBJECTIVE To investigate risk factors for TT recurrence . METHODS We conducted a prospect i ve case-control cohort study in Nepal that included patients with TT who were undergoing bilamellar tarsal-rotation surgery and control subjects who have scarring but no TT .  Conjunctivae were grade d for trachoma and swabbed to detect Chlamydia trachomatis by in-house and commercial ( Roche Amplicor ; Roche Diagnostics Corp , Indianapolis , Ind)-polymerase chain reaction . Univariate and multivariate analyses were performed for associations with chlamydiae and other risk factors . RESULTS Postoperative TT recurrence rates were 11.1 % ( 4 cases ) at 6 months and 25.0 % ( 11 cases ) at 12 months while no controls developed TT . Significantly , 5 ( 45.5 % ) of 11 patients with TT 
    Output:
    
These trials suggest the most effective surgery is full‐thickness incision of the tarsal plate and rotation of the terminal tarsal strip .
Epilation was less effective at preventing eyelashes from touching the globe than surgery for mild trichiasis , but had comparable results for vision and corneal change .
Community‐based surgery when compared to health centres increased uptake with comparable outcomes .
Adverse events were typically infrequent or mild and included rare postoperative infections , eyelid contour abnormalities and conjunctival granulomas .
Authors ' conclusions No trials were design ed to evaluate whether the interventions for trichiasis prevent blindness as an outcome ; however , several found modest improvement in vision following intervention .
Certain interventions have been shown to be more effective at eliminating trichiasis .
Full‐thickness incision of the tarsal plate and rotation of the lash‐bearing lid margin was found to be the best technique and is preferably delivered in the community .
Surgery performed with silk or absorbable sutures gave comparable results .
Post‐operative azithromycin was found to improve outcomes where overall recurrence was low