Management of primary childhood glaucoma: Evaluation of practice, practice gaps, and needs in a low-resource country

Abstract

Abstract Purpose: To evaluate the current practice, equipment availability, and training needs for managing childhood glaucoma in Nigeria. Materials and Methods: An online questionnaire (Google Forms) was distributed through E-mails and social media platforms of pediatric ophthalmologists and glaucoma specialists who practice in Nigeria and manage glaucoma in children aged 0–16 years. Information concerning sociodemographic characteristics, type of practice, location of practice, years of practice, status, and preferred practices in the management of childhood glaucoma cataracts were obtained and analyzed with SPSS. Results: Thirty (23.3%) out of 129 eligible participants indicated they perform glaucoma surgeries in children. The majority (66.6%) had practiced as specialists for 10 years or less, and 70% were pediatric ophthalmologists. A third of the respondents practiced in the country’s southwest region, with none in the Northeast region. The most common surgery performed for primary congenital glaucoma was combined trabeculotomy trabeculectomy, while trabeculectomy was the most common surgery performed for juvenile open-angle glaucoma. Two respondents reported performing glaucoma drainage device surgery and seven reported possessions of skills for goniotomy. All centers had trabeculectomy instrument sets, while three centers had facilities for endolaser cyclophotocoagulation, and only two centers had knives for goniotomy. Antimetabolites were routinely used for childhood glaucoma surgeries by 26 (86.7%) respondents, and the most common antimetabolite used was mitomycin (21; 80.8%). Conclusion: There is a need for the development of in-country training programs and the exchange of skills through collaboration among those providing glaucoma services within Nigeria to improve the care of children with glaucoma.