Practice of trabeculectomy by ophthalmologists in Nigeria

Aim: To assess the practice of trabeculectomy among ophthalmologists in Nigeria. Materials and Methods: This was a cross-sectional study in which structured, self- administered questionnaires were distributed to 80 consenting ophthalmologists present during the 2010 annual scientific session of the Ophthalmological Society of Nigeria. All consenting ophthalmologists treat glaucoma patients. Information obtained were demographic characteristics, glaucoma outpatient load, number of trabeculectomies performed in the preceding 1 year and during residency training, and factors influencing trabeculectomy practice. Data were analyzed with Statistical Package for Social Science version 16.0. Relationships between variables were tested using the Χ2 test for statistical significance. Results: Sixty-five of the 80 consenting ophthalmologists responded to the questionnaires (81.3% response rate); 32 (53.3%) were females and 28 (46.7%) were males (5 non-responders). Ages ranged from 30 to 60 years with a mean of 44 years ± SD 7.7. Only 36 (57.1%) performed trabeculectomy in the 1 year preceding the study. There was an overall trabeculectomy rate of 0.9/ophthalmologist/month. Of the 15 respondents who performed more than 15 trabeculectomies during residency, 14 (93.3%) also performed the surgery in the year preceding this study (P = 0.001). The main limitation to the practice of the procedure was patients' unwillingness to accept surgery, as identified by 50 (89.3%) respondents. Conclusions: A low trabeculectomy rate of 0.9/ophthalmologist/month was found in this study. It was significantly associated with insufficient exposure to the surgery during residency training and patients' poor acceptance of the surgery

A Review of trabeculectomies at a Nigerian teaching hospital

Background: Trabeculectomy is the commonest surgical procedure for glaucoma. The outcome of trabeculectomy in the treatment of all types of glaucoma over a 4-year period in a Nigerian population was reviewed. Objective: To determine the surgical rate and effectiveness of trabeculectomy in lowering of intra ocular pressure (IOP) and preservation of visual acuity. Methods: Retrospective review of all trabeculectomies (TEs) done at the Obafemi Awolowo University Teaching Hospital; Ile-Ife between January 1999 and December 2002. The outcome of trabeculectomy was correlated with the biomicroscopic appearance of the filtering bleb; visual acuity and IOP levels. Descriptive statistics were applied to the data. Results: Of the 647 glaucoma patients only fifty-three (8.2); 34 males and 19 females; had trabeculectomy done during the study period. Seventy-two consecutive eyes of these 53 Nigerian patients were operated upon. Majority; 63 (87.5) were in the primary glaucoma group of which 46 63.9) were open angle glaucoma type. Nine eyes (12.5) belonged to the secondary glaucoma group (neovascular; uveitic and traumatic angle recession). Successful control of intra-ocular pressure with medical therapy was recorded only in 13.9f the patients. The mean pre-operative and first post-operative day IOP were 32.5+/- 6.2mmHg and 10.6+/- 2.3mmHg respectively. Mean post-op IOP at 3 months and one year were 14.6+/- 4.2mmHg; and 13.5+/- 5.8mmHg respectively. One year after surgery 34 eyes (61.8) had intraocular pressure (IOP) of 20mm Hg or less without glaucoma medication. Hyphema 11 (15.3) was the commonest post-operative complication documented. Conclusions: Surgical intervention in the management of glaucoma; especially trabeculectomy is not commonly done in this Teaching Hospital. IOP control with medication alone is not adequate in the long term. A significant proportion of the eyes (61.8) had complete success in IOP control following trabeculectomy

Autologous whole Blood Patch in Repair of Leaking Filtering Bleds : Case Report on Initial Experience

Aim: To show the value of autologous whole blood patch in the management of leaking filtering blebs in Nigerian eyes.Methods: Two male patients who had trabeculectomy and adjunctive application of mitomycin C subsequently developed leaking blebs at the University of Benin Teaching Hospital; Benin City; Nigeria. A 27-gauge needle was used to inject 0.75- 1.0ml of whole blood under the conjunctival buttonhole.Result: The procedure succeeded in arresting the bleb leak but the trabeculectomy failed after 7 and 10 months respectively. Repeat trabeculectomy using another site remained successful after 2 years and 18 months respectively.Conclusion: Autologous whole blood patch is successful in sealing leaking blebs complications following trabeculectomy