¡¡¡¡MATERIALS AND METHODS

¡¡¡¡Enugu State University of Science and Technology (ESUT) Teaching Hospital is located in Enugu, Nigeria. It serves the people of the state and her environs.

¡¡¡¡The computerised cataract surgery record form[6] was used to collect data on adult cataract surgery performed at ESUT Teaching Hospital Parklane, Enugu, Nigeria over a 12ª²month period (January to December 2006) prospectively. Cataract in children aged 15 years or less were excluded from the study. Traumatic cataracts were also excluded. Data were entered and frequency distribution generated using SSPS version 11.0.

¡¡¡¡Preª²operative examination included assessment of visual acuity(VA), dilation of pupils and slit lamp examination. Biometry was not performed as Aª²scan ultrasonography and functional keratometer were not available.

¡¡¡¡The patients were offered abª²externo extracapsular cataract extraction with posterior chamber intraocular lens implant (ECCE+PCª²IOL). Those who had posterior capsule rent received anterior chamber intraocular lens (ACª²IOL) implant or no IOL implant as deemed appropriate by the surgeon.

¡¡¡¡RESULTS

¡¡¡¡Sixtyª²seven patients had cataract surgery in our centre during the study period. There were 34 males (50.7%) and 33 females (49.3%). The mean age was 59.99¡À12.79SD, while the range was 26ª²87 years.

¡¡¡¡The preª²operative VA was as follows: 60 eyes (89.6%) had VA of <3/60, 6(8.9%) had 3/60 and 1(1.5%) had 6/60. The coª²existing ocular morbidity noted preª²operatively were glaucoma 3(4.5%) and maculopathy 2(3.0%). Others were old iritis, advanced pterygium crossing the visual axis, divergent squint, leprosy and diabetic retinopathy 1(1.5%) each.

¡¡¡¡There were 26 operations (38.8%) on the right eye and 41(61.2%) on the left eye. Sixtyª²four eyes (95.5%) had ECCE/PCª²IOL, 2 eyes (3.0%) had ECCE/ACª²IOL and 1 eye (1.5%) had ECCE only.

¡¡¡¡Three ophthalmologists did the operations. The complications included posterior capsule rent/vitreous loss 3(4.5%) and corneal decompensation 3(4.5%).

¡¡¡¡The visual acuities at 1ª²3 weeks, 4ª²11 weeks and 12 weeks post operatively are shown in Tables 1ª²3.

¡¡¡¡DISCUSSION

¡¡¡¡The total number of cataract surgeries performed in this study in one year was low (although traumatic cataract and paediatric cataract were excluded). This is in keeping with low cataract surgery rate documented in literature in Africa[1,2]. In contrast, one hundred cataract operations were performed by 2 ophthalmologists in a Nigerian mission hospital in less than 2 months[7]. The teaching hospital which serves as a centre for manpower development for different cadres of ophthalmic staff has lower productivity. The staff work at below capacity. In east Africa[8], it was noted that cataract surgeons based at Ministry of Health Hospitals had lower productivity than those based at mission or private hospitals, although they received similar training and sponsorship.

¡¡¡¡One of the emphases of the Vision 2020 programme on human resource development in Africa is the training of more ophthalmologists. While this objective should be pursued, there is equally a great need to utilise the services of the current ophthalmologist maximally. Most ophthalmologists in Nigeria due to remuneration and better job stability work in government hospitals (mainly teaching hospitals). The mission hospitals where high volume cataract surgery is practised lack the capability to employ many ophthalmologists. The government can employ ophthalmologists and deploy them to work in mission hospitals.

¡¡¡¡Cost has been documented as a barrier to uptake of cataract surgery both in Africa[2] and Asia[9]. Cataract surgery in teaching hospitals in Africa should be made free or offered at cost. When the teaching hospitals achieve high volume of cataract surgery, better utilization of available human resources would have been achieved and the overall cataract surgical rate in the country will increase. Increasing efficiency and productivity of the teaching hospitals should be the long term goal. High volume surgery would translate to better training and better outcome. It is only then that the teaching hospitals would have been playing their proper role in the Vision 2020 initiative.

ÉÏÒ»Ò³  [1] [2] [3] ÏÂÒ»Ò³