Primary Open Angle Glaucoma Surgery in Sub-Saharan African Setting — Benefits and Challenges

Background: Primary open angle glaucoma is one of the leading causes of avoidable blindness in Sub-Saharan Africa Medical therapy: Anti-glaucoma medication pose a special challenge due to high cost, non availability, and presence of substandard/ adulterated drugs in the region. With wide spread poverty compliance to medication for life is poor. Trabeculectomy: Although there are various types of glaucoma surgeries, trabecu‐ lectomy with use of anti-fibrotic agent is found to offer good intra ocular pressure control among patients in the region. The use of anti-fibrotic agents like mitomycinC and 5 Flourouracil becomes necessary due to the tendency of pigmented African eye to form scar that results in bleb failure. Conclusion: Trabeculectomy with intra operative use of anti metabolite is an acceptable choice in treatment of primary open angle glaucoma in sub-Saharan Africa. The key to success is adequate pre operative patient education on the goal of treatment.