Isawumi M A, Kolawole O U, Hassan M B
Department of Ophthalmology, College of Health Sciences, Ladoke Akintola University of Technology and Teaching Hospital, Osogbo, Nigeria.
Ghana Med J. 2013 Jun;47(2):64-9.
Couching is still being practised in developing countries including Nigeria despite its adverse effects on vision.
To find out the different techniques of couching, highlight the unacceptable poor visual sequelae and assess knowledge, attitudes, and practices of subjects.
Clinic based and prospective observational study.
Structured interview and clinical examination of consecutive patients was used to obtain information.
Fifteen subjects and 20 eyes of 9(60%) males and 6(40%) females were studied. Age range 60 -90 years and mean 72.4±8.0. Commonest presenting complaints were "I cannot see properly/clearly" 4(26.7%) and "I want to do my second eye so I can see better" 3(20%). Presenting Versus (vs.) Corrected visual acuity (VA) was75% vs 60% blind, 55% vs 45% low vision, and 0% vs 10% normal vision, p= 0.032. Friends and neighbours mostly introduced subjects to couching (26.7% each). Commonest methods involved using sharp objects/needling 45% and blunt/grooving/rocking methods (30%). Subjects assumed "supine" position 75% of time. Eighty five percent of eyes were done at the coucher's. Procedure was painful in 73.3%. Only 5 eyes (25%) maintained vision for >10years. Thirteen (86.7%) said "no" to a repeat procedure and 93.4% would advice against couching.
Couching methods used were very crude and archaic with attendant poor quality of vision and dissatisfaction. Public education, affordable and accessible cataract surgical services taken to the rural communities could gradually phase out couching.
尽管对视力有不良影响，但包括尼日利亚在内的发展中国家仍在实施针拨术。
了解针拨术的不同技术，强调不可接受的不良视觉后遗症，并评估受试者的知识、态度和行为。
基于诊所的前瞻性观察研究。
采用对连续患者进行结构化访谈和临床检查的方式获取信息。
对15名受试者共20只眼睛进行了研究，其中男性9名（60%），女性6名（40%）。年龄范围为60 - 90岁，平均年龄72.4±8.0岁。最常见的主诉是“我看不清楚/模糊”（4例，占26.7%）和“我想做另一只眼睛，这样就能看得更清楚”（3例，占20%）。就诊时视力（VA）与矫正视力相比，失明者分别为75%和60%，低视力者分别为55%和45%，正常视力者分别为0%和10%，p = 0.032。朋友和邻居大多向受试者介绍针拨术（各占26.7%）。最常见的方法是使用尖锐物体/针刺（45%）和钝性/开槽/摇动方法（30%）。75%的时间里受试者采取“仰卧”姿势。85%的眼睛是在施术者处进行手术的。73.3%的手术过程很痛苦。只有5只眼睛（25%）的视力维持超过10年。13名（86.7%）受试者表示不会重复该手术，93.4%的人会建议不要采用针拨术。
所采用的针拨术方法非常粗糙和陈旧，随之而来的是视力不佳和不满意。对农村社区开展公众教育，提供负担得起且可及的白内障手术服务，可逐步淘汰针拨术。
