WGGA Eye Center, Pediatric Ophthalmology and Strabismus Unit, Addis Ababa, Ethiopia.
Department of Ophthalmology, Jimma University Hospital, Jimma, Ethiopia.
BMC Ophthalmol. 2021 Dec 19;21(1):437. doi: 10.1186/s12886-021-02190-0.
Bilateral cataract is a significant cause of blindness in children in Ethiopia. This study aimed to identify the resources available for cataract surgery in children, and to assess current surgical practices, surgical output and factors affecting the outcome of surgery in Ethiopia.
A Google Forms mobile phone questionnaire was emailed to nine ophthalmologists known to perform cataract surgery in young children (0-5 years).
All nine responded. All but one had received either 12- or 3-5-month's training in pediatric ophthalmology with hands-on surgical training. The other surgeon had received informal training from an experienced colleague and visiting ophthalmologists. The surgeons were based in seven health facilities: five in the capital (Addis Ababa) and eight in six public referral hospitals and one private center. Over 12 months (2017-2018) 508 children (592 eyes) aged 0-18 years (most < 15 years) were operated by these surgeons. 84 (17%) had bilateral cataract, and 424 (83%) had unilateral cataract mainly following trauma. A mean of 66 (range 18-145) eyes were operated per surgeon. Seventy-one additional children aged > 5 years were operated by other surgeons. There were substantially fewer surgeons per million population (nine for 115 million population) than recommended by the World Health Organization and they were unevenly distributed across the country. Methylcellulose and rigid intraocular lenses were generally available but less than 50% of facilities had a sharp vitrectomy cutter and cohesive viscoelastic. Mean travel time outside Addis Ababa to a facility offering pediatric cataract surgery was 10 h.
Despite the high number of cases per surgeon, the output for bilateral cataracts was far lower than required. More well-equipped pediatric ophthalmology teams are urgently required, with deployment to under-served areas.
白内障是埃塞俄比亚儿童失明的一个重要原因。本研究旨在确定儿童白内障手术的可用资源，并评估当前的手术实践、手术产出以及影响手术结果的因素。
通过电子邮件向 9 位已知为幼儿（0-5 岁）进行白内障手术的眼科医生发送了 Google 表单手机问卷。
9 位医生均回复。除 1 位外，其他医生均接受过 12 个月或 3-5 个月的小儿眼科培训，包括实践手术培训。另一位外科医生则从经验丰富的同事和来访的眼科医生那里接受了非正式培训。这些外科医生分布在 7 个卫生机构：5 个在首都（亚的斯亚贝巴），8 个在 6 家公立转诊医院和 1 家私立中心。在 12 个月（2017-2018 年）期间，这些外科医生共为 508 名（592 只眼）0-18 岁（大多数<15 岁）的儿童进行了手术。84 名（17%）患有双眼白内障，424 名（83%）患有单侧白内障，主要是外伤所致。每位外科医生平均手术 66 只眼（18-145 只眼）。另有 71 名年龄大于 5 岁的儿童由其他外科医生进行手术。每百万人口的外科医生人数（1150 万人口中有 9 名）远低于世界卫生组织的建议，且分布不均。甲基纤维素和硬性眼内透镜通常都有，但不到 50%的机构配备有锋利的玻璃体切割刀和粘性黏弹剂。前往提供小儿白内障手术的机构的平均旅行时间为 10 小时，超出亚的斯亚贝巴以外。
尽管每位外科医生的手术数量都很高，但双侧白内障的手术数量远远低于所需数量。迫切需要更多配备齐全的小儿眼科团队，并部署到服务不足的地区。
