Gilbert Clare E, Murthy G V S, Sivasubramaniam S, Kyari F, Imam A, Rabiu M M, Abdull M, Tafida A
International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, England.
Ophthalmic Epidemiol. 2010 Oct;17(5):269-75. doi: 10.3109/09286586.2010.508349.
Couching is an ancient treatment for cataract which is still practiced in some of the poorer developing countries, particularly in sub-Saharan Africa. The purpose of this study is to describe risk factors for couching and visual acuity outcomes in a nationally representative sample of adults aged 40 years and above in Nigeria.
Probability in proportion size methods were used to identify a representative sample. Of the 15,375 adults enumerated, 13,582 were interviewed and examined. Examination included logMar acuities, slit lamp examination and dilated fundoscopy with digital fundus imaging.
Almost half of the 583 eyes undergoing a procedure for cataract had been couched (249 eyes, 42.7%). Individuals living in rural areas (P = 0.033) and in the two underserved northern administrative zones (P = 0.33; P = 0.002) were more likely to have been couched. Visual outcomes were poor according to World Health Organization categories, with 55.8% of people and 73.1% of eyes having a presenting visual acuity of less than 3/60 and only 9.7% and 2.4% of people and eyes respectively having a good outcome (6/18 or better). None were wearing an aphakic correction, and with correction acuities improved but 42.6% of eyes were still blind (< 3/60).
Couching is still widely practiced in Nigeria and visual outcomes are very poor. The population needs to be made aware of the risks associated with the procedure, and services for high quality, affordable cataract surgery need to be expanded, particularly in rural areas and in the north of the country.
针拨术是一种古老的白内障治疗方法，在一些较贫困的发展中国家仍在使用，尤其是在撒哈拉以南非洲地区。本研究的目的是描述尼日利亚全国具有代表性的40岁及以上成年人样本中针拨术的危险因素和视力结果。
采用按比例概率抽样方法确定代表性样本。在普查的15375名成年人中，13582人接受了访谈和检查。检查包括logMar视力、裂隙灯检查以及散瞳眼底镜检查和数字眼底成像。
在接受白内障手术的583只眼中，近一半（249只眼，42.7%）曾接受过针拨术。居住在农村地区的人（P = 0.033）以及北部两个医疗服务不足的行政区的人（P = 0.33；P = 0.002）更有可能接受过针拨术。根据世界卫生组织的分类标准，视力结果较差，55.8%的人和73.1%的眼就诊时视力低于3/60，只有9.7%的人和2.4%的眼分别获得了良好的结果（6/18或更好）。没有人佩戴无晶状体矫正眼镜，矫正后视力有所改善，但仍有42.6%的眼失明（<3/60）。
针拨术在尼日利亚仍广泛应用，视力结果非常差。需要让民众了解该手术相关的风险，并且需要扩大高质量、可负担得起的白内障手术服务，尤其是在农村地区和该国北部。
