Rezumat
To find out the challenges of management of glaucoma, an assessment of glaucoma services at the Federal Medical Centre, Azare was carried out through oral interviews of ophthalmic staff, enquiring about available personnel and diagnostic equipment from relevant sectors of the Hospital and local authorities. A retrospective analysis of records of glaucoma patients (aged > 20 years) who presented at the centre between February 2002 and July 2007 was carried out. The ophthalmology unit has 6 ophthalmic nurses 1ophthalmologist and 1 optometrist. Instruments available were: A Schiotz tonometer, a slit lamp biomicroscope, a Volk +90 Diopter lens, a Goldman applanation tonometer, a 1-mirror gonioscopy lens, a non contact applantation tonometer and a visual field analyzer. All the patients treated conservatively had guttae timolol 0.5% either solely (64 eyes, 50.8%) or in combination with other intraocular pressure lowering eye drops. Only one patient was treated with guttae latanoprost 0.005% (Xalatan). The only type of surgery carried out was Trabeculectomy in 22 eyes (14.0%). No intra or post operative antifibrotic agent was used. There is a dire need of human and infrastructural facilities for adequate management of glaucoma in the centre.
Keywords: Glaucoma, management, challenges, facilities.
Résumé
Pour idenfier les défis des soins du glaucome, une évaluation des services du glaucome au centre médical féderal,Azare était faite á l’aide d’interviews oraux des personnels ophthalmologique et les equipements de diagnostic dans cette unité et les autorités locaux. L’analyse retrospective des registres de glaucome agés de moins de 20 ans récu au centre entre février 2002 et juillet 2007. L’unité ophthalmologique a six infirmiers ophthalmologique, un ophthalmologue, un optometricien. Les instruments disponibles incluc, le tonometre, lampe bromicrocopique,dioptre 90, tonometre de Goldman, un mirrior gonioscopique, un tonométre á non contact et un analysateur du champ visuel. Tous les patients traités avaient avec le timolol gouttes (64 yeux,50.8%) ou en combinaison avec un réducteur de pression intraocculaire en goutte. Seulement un patient était traité á l aide de la latanoprost goutte 0.005% (xalatan). L’unique type de chirurgie effectuee était la trabeculectomie chez 22 yeux(14%). Aucun agent antifibritique intra or post chirurgical n’etait deployé. Il y a un besion aigue des facilite infrastructurels et du personnel adéquate pour les soins du glaucome dans ce centre.
Correspondence: Dr. F.O. Olatunji, P.O. Box 1003, General Post Office, Ilorin. Nigeria. Email: drfolatunji@yahoo.com
Referințe
Schwartz M and Yoles E. Neuroprotection: a new treatment modality for glaucoma? Curr Opin Ophthalmol. 2000; 11: 107-111.
Douglas GR. Pathogenetic mechanisms of glaucoma not related to intraocular pressure. Curr Opin Ophthalmol.1998; 9: 34-38.
Stewart W C, Kolker A E, Sharpe E D et al. Factors associated with long-term progression or stability in primary open-angle glaucoma. Am J Ophthalmol. 2000; 130: 274-279.
Sommer A. Glaucoma risk factors observed in the Baltimore Eye Survey Curr Opin Ophthalmol. 1996; 7: 93-98.
Bamashmus M A, Matlhaga B and Dutton G N. Causes of blindness and visual impairment in the West of Scotland. Eye. 2004;18(3): 257-261.
Sharon K. Glaucoma is second leading cause of blindness globally. Bull World Health Organ.2004; 82: 11 Geneva .
Tsai IL, Woung LC, Tsai CY, Kuo LL, Liu SW, Lin S and Wang IJ. Trends in blind and low vision registrations in Taipei City. Eur J Ophthalmol. 2008 ;18(1):118-124.
Morley A M S and Murdoch I. The future of glaucoma clinics. Br J Ophthalmol 2006; 90: 640–645
Wormald R. Treatment of raised intraocular pressure and prevention of glaucoma. Evidence at last that treatment works. BMJ 2003; 326: 723- 724.
Chuka-Okosa CM and Faal HB. Glaucoma services in the Gambia. Nig J Ophthalmol 2003; 11(1): 19-23.
Egbert P R. Glaucoma in West Africa: a neglected problem. British Journal of Ophthalmology 2002; 86: 131-132.
Omoti AE, Osahon AI, Waziri-Erameh MJM. Pattern of presentation of primary open-angle glaucoma in Benin City, Nigeria. Tropical Doctor,. 36; 2: 2006, 97-100.
Jerald A B, Robert J N. Glaucoma Open Angle. http://www.emedicine.com/oph/topic139.htm.
Celso T, Hoai VT, Jeffrey L and Robert R. Angle closure: classification, concepts, and the role of ultrasound biomicroscopy in diagnosis and treatment. Seminars in Ophthalmology. 2002; 17(2): 69–78.
Ashaye AO. Clinical features of Primary glaucoma in Ibadan. Nig J Ophthalmol 2003; 11 (2): 70-75.
Fourman S: Diagnosing acute angle-closure glaucoma: a flowchart. Surv Ophthalmol 1989; 33(6): 491-494 [Medline].
James E S. The Glaucomas. J Comm Eye Health 2002;15(41): 14
WHO, Vision 2020 global initiative for the elimination of Avoidable blindness. Action plan 2006–2011: Glaucoma 37 -39.
Richard JCB. How to manage a patient with glaucoma in Africa. Community Eye Health J 2006;19(59): 38-39.
Olurin O. Primary Glaucoma in Nigeria. East African Med J 1972; 49: 725-734.
Jay JL and Murray SB. Early trabeculectomy versus conventional management in primary open angle glaucoma. British Journal of Ophthalmology. 1988; 72: 881-889.
Qureshi M, Khan M, Shah M and Ahmad K. Glaucoma Admissions and Surgery in Public Sector Tertiary Care Hospitals in Pakistan:Results of a National Study. Ophthalmic Epidemiology. 2006;13 (2): 115-119.
Hennis A, Wu SY, Nemesure B, Honkanen R and Leske MC. Awareness of incident openangle glaucoma in a population study: the Barbados Eye Studies. Ophthalmology. 2007; 114 (10):1816-1821.
Dandona R, Dandona L, John RK, et al. Awareness of eye diseases in an urban population in southern India. Bull World Health Organ 2001; 79: 96–102.