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Trachomatous Trichiasis (TT)Phase 3FLAMENCT04149210

FLuorometholone as Adjunctive MEdical Therapy for TT Surgery (FLAME) Trial

A Phase 3 study testing Fluorometholone 0.1% Oph Susp and Artificial Tears in people with Trachomatous Trichiasis (TT) and Eye Diseases, run by Massachusetts Eye and Ear Infirmary at 1 site in Ethiopia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This study aims : To assess the efficacy of fluorometholone 0.1% one drop twice daily for four weeks in reducing the incidence of post-operative trachomatous trichiasis (TT) when given as adjunctive therapy with TT surgery in the programmatic setting To assess whether such treatment is sufficiently safe for wide-scale… Read more about this study

Who is it for?
Ages 15 years and older
What is being tested?
Fluorometholone 0.1% Oph Susp and Artificial Tears
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
2,410 participants
Where
1 siteEthiopia
Study dates
19 Aug 2021to 30 Nov 2024
Phase
Phase 3
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 15 years and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Age 15 years or more, corresponding to the age of patients treated in the Fred Hollows Foundation/Federal Ministry of Health Program at field sites without general anesthesia.
  • One or both eyes with upper lid trachomatous trichiasis-with one or more eyelashes touching the eye or evidence of epilation, with a plan to undergo TT surgery on at least one upper eyelid.
  • Collection of all baseline data prior to randomization
  • Signed, informed consent (and assent, when applicable)

Who cannot join

  • Contraindication(s) to the use of the test articles, including a known allergy or sensitivity to the study medication (fluorometholone) or its components, and contraindication(s) to use of azithromycin
  • IOP≥22 mmHg and/or currently taking more than two ocular anti-hypertensive medications in the study eye (prior IOP-lowering surgery is acceptable; combinations of two IOP-lowering agents such as Dorzamol are considered two medications)
  • A known severe / serious ocular pathology or medical condition which may preclude study completion or increase the risk of harm in the study (e.g., suspicion of non-trachomatous active ocular infection or suspicion of glaucoma of a degree to which where an intraocular pressure spike would be vision-threatening).
  • Any condition known to be present at baseline for which it is anticipated ocular or systemic corticosteroid therapy will be required.
  • Any significant illness or condition (e.g., hypertension with systolic blood pressure≥170 mmHg and/or diastolic blood pressure≥110 mmHg) that could, in the study team's opinion, be expected to interfere with the study parameters or study conduct; or put the subject at significant risk.
  • Previous upper lid TT surgery on all eyes with upper lid TT. (If one eye has previously undergone upper lid TT surgery but another eye with upper lid TT has not, the patient may be enrolled, and only the latter eye will be counted for the primary analyses).

Trial locations and contacts

1 site in 1 country.

Ethiopia1 site
  • Oromia Health Bureau

    Addis Ababa, Addis Ababa

Other trials in Ethiopia

About this study

This study aims :

  • To assess the efficacy of fluorometholone 0.1% one drop twice daily for four weeks in reducing the incidence of post-operative trachomatous trichiasis (TT) when given as adjunctive therapy with TT surgery in the programmatic setting
  • To assess whether such treatment is sufficiently safe for wide-scale implementation in TT programs.
  • To estimate the costs of adding fluorometholone 0.1% treatment to TT surgery per case of postoperative TT averted, and to characterize the value of such treatment under a range of plausible health economic circumstances
Read the detailed description

The investigators are pursuing an agenda to evaluate a new potentially cost-effective approach to improving trichiasis surgery outcomes: perioperative topical anti-inflammatory therapy. Inflammation-whether induced by the trachoma disease process or surgery itself-most likely contributes to progressive cicatrization leading to failure of lid rotation surgery in a clinically important proportion of TT cases. The investigators hypothesize that adjunctive topical fluorometholone therapy following trichiasis surgery will reduce the risk of recurrent trichiasis and will be acceptably safe. The rationale for the efficacy aspect of this hypothesis is that interruption of inflammation postoperatively would reduce postoperative scarring/contracture driven by ongoing disease-driven inflammation and/or surgically-induced inflammation thus reducing the incidence of TT recurrence (post-operative TT) and other inflammation-related outcomes.

Being tested
Fluorometholone 0.1% Oph Susp, Artificial Tears
Keywords
fluorometholone 0.1%, trachomatous trichiasis, Eye Diseases, Eyelid Diseases, trachomatous, trichiasis, FLAME, TT Surgery
Medical subject headings
Eye Diseases, Eyelid Diseases, Trichiasis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Fluorometholone 0.1% Oph SuspDrug

    Also called FML

    fluorometholone 0.1% one drop twice daily for four weeks, beginning with one drop just before trachomatous trichiasis surgery on the upper lid.

  • Artificial TearsDrug

    Also called Placebo

    Artificial tears (placebo) given one drop twice daily for four weeks, beginning with one drop just prior to trachomatous trichiasis surgery on the upper lid.

Study groups in NCT04149210
Study groupRoleWhat they receive
fluorometholoneExperimentalFluorometholone 0.1% eyedrops, one drop twice daily for four weeks
Receives: Drug: Fluorometholone 0.1% Oph Susp
Artificial TearsPlacebo comparatorone drop two times daily for four weeks
Receives: Drug: Artificial Tears

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Postoperative TT by One Year, as Determined by Trained Study Team Members

    The primary outcome measure is the postoperative recurrence of trachomatous trichiasis (TT), defined as one or more eyelashes in the upper eyelid touching the globe or evidence of epilation (lash stubs) in the upper eyelid on examination, or a history of repeat trichiasis surgery at any time in the upper eyelid during the one year follow-up period after the baseline surgery.

    Measured: 12 months

Secondary outcomes (18)
  1. Efficacy Measure 1 - Entropion

    Presence and extent of entropion of the upper eyelid

    Measured: 1 year

  2. Efficacy Measure 2 - Reoperation

    Number of study eyes undergoing reoperation for postoperative trichiasis

    Measured: 1 year

  3. Efficacy Measure 3 - Lashes

    Number and location of trichiatic lashes from the upper eyelid touching the globe

    Measured: 1 year

  4. Efficacy Measure 4 - Health Economic Analysis

    Marginal cost per case of postoperative trichiasis avoided (Cost-effectiveness in the use of Fluorometholone 0.1%)

    Measured: 1 year

  5. Safety/Adverse Outcomes 1 - Corneal Opacity

    Presence and grade of corneal opacity in study eyes

    Measured: 1 year

  6. Safety/Adverse Outcomes 2 - Overcorrection

    Presence of overcorrection in study eyes

    Measured: 1 year

  7. Safety/Adverse Outcomes 3 - Eyelid Abnormalities

    Presence of eyelid notching/eyelid contour abnormalities in study eyes

    Measured: 1 year

  8. Safety/Adverse Outcome 4 - Lid Closure Defect

    Presence of lid closure defect in study eyes

    Measured: 1 year

  9. Safety/Adverse Outcomes 5 - Granuloma

    Presence of granuloma in study eyes at 1 year

    Measured: 1 year

  10. Safety/Adverse Outcomes 6 - Pain Level

    Pain scale score ranges from 5 (least pain) to 20 (most pain)

    Measured: 1 year

  11. Safety/Adverse Outcomes 7 - IOP in mmHg

    Intraocular pressure (IOP) elevation ≥ 10 mmHg from baseline in study eyes at week 4

    Measured: 4 weeks

  12. Safety/Adverse Outcomes 8 - Cataract Surgery

    Occurrence of cataract surgery in study eyes

    Measured: 1 year

  13. Safety/Adverse Outcomes 9 - TT in Non-study Eye

    Cumulative incidence of TT in the fellow eye by one year

    Measured: 1 year

  14. Safety/Adverse Outcomes 10 - Adverse Events

    Adverse events attributed to study treatment by one year

    Measured: 1 year

  15. Patient-reported Outcomes 1 - Patient Satisfaction

    Patient satisfaction level in regards to the trichiasis surgery outcome measured on a likert scale for satisfaction (from very dissatisfied to very satisfied)

    Measured: 1 year

  16. Patient-reported Outcomes 2 - Cosmetic Outcome

    Patient satisfaction level in regards to the cosmetic outcome of the trichiasis surgery measured on a likert scale for satisfaction (from very dissatisfied to very satisfied)

    Measured: 1 year

  17. Patient-reported Outcomes 3 - Health Utility

    Quality of life assessed using the tool EuroQol 5 Dimensions (EQ-5D) comprising mobility, self-care, usual activities, pain/discomfort and anxiety/depression dimensions and assessed on five levels from no problems to extreme problems

    Measured: 1 year

  18. Additional Variables 1 - Visual Acuity

    Visual acuity with presenting correction in study eyes

    Measured: 1 year

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Nov 2019
  2. Study start19 Aug 2021
  3. Primary completion30 Nov 2024
  4. Study completion30 Nov 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
This is a 1:1 randomized, double-masked, placebo controlled clinical trial
Masking
Triple blind
Who is masked
Participant, Care provider, Investigator
Enrolment
2,410 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04149210
Sponsor's protocol ID
2019P002286
Acronym
FLAME
Status last verified
Mar 2026
First submitted
12 Oct 2019
Last updated
24 Mar 2026
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Kempen JH, Abashawl A, Mohammed AA, Dodson S, Alemayehu W, Jin F, Gemechu A, Mengesha AA, Kumsa DA, Chen Y, McWilliams K, Tulu B, Abdela G, Megersa A, Cheru T, Mohammad G, Succar T, Bunya VY, Frick KD, Maguire MG, Burton MJ, Ying GS; FLAME Trial Research Group. Evaluation of fluorometholone as adjunctive medical therapy for trachomatous trichiasis surgery (FLAME): a parallel, double-blind, randomised controlled field trial in the Jimma Zone, Ethiopia. Lancet Glob Health. 2026 Mar;14(3):e395-e406. doi: 10.1016/S2214-109X(25)00493-0. Epub 2026 Jan 12.

    PubMed 41539314
  • Kempen JH, Chen Y, Abashawl A, Mohammed AA, Dodson S, Alemayehu W, Gemechu A, Mengesha AA, Kumsa DA, Succar T, McWilliams K, Jin F, Bunya VY, Maguire MG, Burton MJ, Ying GS; FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial Research Group. Outcomes of posterior lamellar tarsal rotation vs bilamellar tarsal rotation for trachomatous trichiasis. PLoS Negl Trop Dis. 2025 Jul 30;19(7):e0013152. doi: 10.1371/journal.pntd.0013152. eCollection 2025 Jul.

    PubMed 40737343
  • Mohammed AA, Abashawl A, Dodson S, Alemayehu W, Gemechu A, Abateneh A, Kumsa D, Succar T, Chen Y, McWilliams K, Bunya VY, Maguire MG, Burton MJ, Ying GS, Kempen JH; FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial Research Group. The FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial: Study Design. Ophthalmic Epidemiol. 2024 Dec;31(6):611-619. doi: 10.1080/09286586.2024.2415052. Epub 2024 Dec 10.

    PubMed 39656933
  • Mohammed AA, Abashawl A, Dodson S, Alemayehu W, Gemechu A, Mengesha AA, Kumsa D, Succar T, Chen Y, McWilliams K, Bunya VY, Maguire MG, Burton MJ, Ying GS, Kempen JH; FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial Research Group. The FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial: Study Design. medRxiv [Preprint]. 2024 Jul 7:2024.06.26.24308549. doi: 10.1101/2024.06.26.24308549.

    PubMed 39006430

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Fluorometholone 0.1% Oph Susp and Artificial Tears in people with Trachomatous Trichiasis (TT) and Eye Diseases, run by Massachusetts Eye and Ear Infirmary at 1 site in Ethiopia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 24 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Ethiopia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 24 Mar 2026). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Postoperative TT by One Year, as Determined by Trained Study Team Members (time frame: 12 months). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04149210, which also lists 4 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 24 Mar 2026.

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