Traditional operative couching of the lens is not a safe alternative procedure for cataract surgery in Northern Nigeria

Abstract

Direct observation of the procedure of couching of the lens as performed b y two traditional eye couchers in Northern Nigeria was made in February 1998. Following a short prayer, an un-sterilized crude couchi ng needle was introduced through the superior pars-plana into the eye to dislodge the lens downwards and backwards into the vitreous. All patients achieved a visual acuity of counting fingers at 3 meters in the immediate post-operative period, an improvement from perception of light pre-operatively. The sterility of the surgeon, the operated eye, the operating environment and the couching needle was not ensured. The couching needle was also crude· and blunt and the couchers' manipulations were rather rough. The procedure is therefore ad judged to be an unsafe alternative to modern cataract surgery. The provision of easily accessible, affordable, and quality modern cataract surgery would eliminate couching from Northern Nigeria.