The Ahmed Glaucoma Valve in Refractory Glaucoma: Experiences in Southwest Ethiopia

BACKGROUND: The management of refractory glaucoma is a challenging task for any glaucoma surgeon. This study is aimed to evaluate the efficacy of Ahmed Glaucoma Valve implantation in refractory glaucomas in South-West Ethiopia.METHODS: A retrospective review was conducted on the charts of consecutive patients treated with Ahmed glaucoma valve implantation at Jimma University Specialized Hospital between August 2012 and August 2014. Success was defined as Intraocular Pressure (IOP) less than 22 mm Hg and greater than 5mm Hg at 6 months, with at least 30% reduction from baseline, without medical therapy (complete success) or either with or without medication (qualified successes)..RESULTS: A total of 12 eyes of 11 patients were included. The mean age of patients was 40.7 (SD= 19.0) years; 63.6% of them were males. The main types of glaucoma were pseudoexfoliative (3 eyes), uveitic (2 eyes), chronic angle closure (2 eyes) and Juvenile Open Angle (JOAG) (2 eyes). The mean IOP was reduced from preoperative level (32.75±7.14 mmHg) to (15.75 ±4.35 mmHg) at six postoperative months, (P<0.001); 66.7% eyes had complete successes while 83.3% had qualified success. Intra- operative complications were encountered in 2(16.7%) eyes, while 5/12 (41.7%) eyes had post-operative complications-hypotony (one with choroidal effusion) and progression of cataract in 2 eyes each. Hypertensive phase was diagnosed in 2(16.7%) eyes.CONCLUSION: The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas with success rate comparable with those reported from other studies.KEYWORDS: Ahmed glaucoma valve, refractory glaucoma, complications, Ethiopi

Willingness to Pay for Cataract Surgery Among Outreach Site Patients in South West Ethiopia: A Cross-Sectional Study

Background: Cost recovery for cataract surgery will have significant input towards a sustainable eye care system; therefore it is important to assess the willingness to pay of patients with cataract blindness for cataract surgery. Methods: A cross sectional survey was conducted in two outreach sites in South West Ethiopia to determine their willingness to pay for cataract surgery. Consecutive patients who had mature senile cataract and came to two outreach program sites were included in the study. Results: A total of 134 patients were included in the study. The mean age was 62.5years (SD=9.4). The majority, 86 (64.2 %), were males making the male to female ratio 1.79:1. A total of 102 (76.1%) participants of the study said that they were willing to pay for their cataract surgery. Males were more willing to pay as compared to females (83.7% vs. 62.5%, p=0.006). Those with low socio-economic conditions were less willing to pay (p< 0.05). Willingness to pay was not associated with the age (p= 0.25), literacy (p=0.66), religion (0.3), or family size (0.43) of the participants. On multiple logistic regression analysis, however, only being a female and also having a low socioeconomic status were significantly associated with not willing to pay. Conclusions: A good proportion of the rural residents were willing to pay for their cataract surgery. Being female and having lower socioeconomic status are associated with not willingness to pay