Challenges with trabeculectomy at University of Nigeria Teaching Hospital Ituku‑Ozalla Enugu, Nigeria: Ophthalmologists’ perspectives

Abstract

Background: Black Africans are more vulnerable to primary open angle glaucoma, which runs a catastrophic course. Primary trabeculectomy with anti-metabolites has been recommended as the suitable therapeutic option. Yet, a low glaucoma surgical rate (GSR) has been documented in Nigeria. Aim: To evaluate the challenges with performing trabeculectomy at the University of Nigeria Teaching Hospital (UNTH) Ituku-Ozalla, Enugu from the Ophthalmologists' perspectives with a view to improving the GSR in Nigeria. Methods: A cross-sectional study design with a qualitative method was adopted for this study in July 2023. It involved 18 participants (ophthalmologists) from UNTH, comprising the (12) senior registrars for the focus group discussion, and a purposive sample of 6 consultants for the in-depth interviews. Discussions and interviews were recorded and transcribed. The transcripts were analysed using the Braun and Clarke guide to thematic content analysis. Results: Poor surgical skill acquisition, with the consequent inadequate transfer of skills to trainees was the major challenge. Availability of better alternatives, the inherent lack of vision improvement following trabeculectomy and inability to pay for surgery, which translated to low uptake of trabeculectomy by patients were also important findings. Improved glaucoma surgical training, health insurance, hospital subsidy, public health education and individual patient’s counselling were the recommendations to improve the GSR. Conclusion: In UNTH Enugu, providers, patients, and glaucoma disease factors were identified as challenges with trabeculectomy. Strategies to address them especially, simulation-based glaucoma surgical training for trainers and trainees are advised to improve the situation.