Abdominal tuberculosis--a study of 25 cases.

Abdominal tuberculosis is one of the common extra pulmonary tubercular infections. Its clinical presentation is protean and it has diagnostic dilemma, as most of the investigations are non-specific and less sensitive. Therefore this study was undertaken to define the most suggestive clinical features of abdominal tuberculosis, to find out the efficacy of most commonly available investigations and also to evaluate the response of abdominal tuberculosis to conventional antitubercular therapy. Twenty five cases of either sex were studied in department of gastroenterology in BSMMU (earlier IPGMR), Dhaka from January 2001 to June 2003. All patients were clinically evaluated and were investigated by available tests. Eighteen patients were diagnosed by investigations (One by detecting AFB, 9 with caseating granuloma in biopsy specimen and 8 with suggestive radiological findings). Diagnosis of 7 patients were made from the common clinical features (fever, weight loss, altered bowel habit, abdominal pain and distension, positive non-specific findings and from response by antitubercular therapy. All patients received conventional 9 month anti-tubercular treatment with Rifampicin, Isoniazide and Pyrazinamide and were followed up clinically during and one year after completion of treatment. All patients were improved with minimum side effects of drug. Therefore, it is observed that a representative tissue biopsy (when approachable) and radiological findings are good method of diagnosis of abdominal tuberculosis. Strongly suggestive clinical features with positive non specific investigation findings are also an indication for anti tubercular treatment in all endemic countries like Nepal, Bangladesh and India. Treatment of abdominal tuberculosis is in no way different from that of other conventional anti-TB therapy.

Suprachoroidal haemorrhage. Secondary management.

We report a case of successful management of expulsive suprachoroidal haemorrhage following cataract surgery. This case study highlights the strategy of adequate management.

Triple procedure in posterior segment intraocular foreign body.

Three patients with intraocular foreign bodies and traumatic cataracts underwent single stage pars plana lensectomy with anterior capsule preservation, vitrectomy, removal of the foreign body, and intraocular lens implantation. The preserved anterior capsule permitted support for the placement of an intraocular lens in the posterior chamber in the ciliary sulcus. The procedure enabled early visual rehabilitation. This procedure seems useful in the management of posterior segment intraocular foreign body associated with cataract.

Systemic aspirin and systemic vitamin E in senile cataracts: cataract V.

We undertook a prospective study in senile cataract patients using systemic aspirin and systemic vitamin E. Vitamin E treated eyes did show less progression of PSC opacities extent and less new nuclear opacities during the follow-up, but overall vitamin E treated eyes did no better than the control group eyes. More eyes in systemic aspirin treated group maintained the initial vision and loss of vision in the aspirin group was also less marked. Aspirin also caused a significant less mean increase in cortical opacity extent, nuclear/opacity and density and PSC opacity extent and density as well as in ophthalmoscopically graded opacity extent and density. We suggest that aspirin is a potential drug which should be further evaluated in large double blind photodocumentated studies. The present data does not justify the recommendation that aspirin be prescribed for slowing down cataract progression. This must await large studies and confirmation.

A simple accurate method of cataract classification. Cataract-I.

A simple and accurate system of cataract classification using slit lamp and direct ophthalmoscope is reported. Lens opacities are classified into cortical (anterior and posterior), nuclear and posterior sub-capsular and each sub-type of opacity is graded, extent and density wise, using both slit lamp and direct ophthalmoscope. A circle representing enface view of opacity divided into 100 equal parts is used in calculating the area of each opacity. This classification takes into account both the area and depth of opacity in arriving at the total extent of sub-type of each opacity. For density determination, we do not recommend the use of a resolution target projection ophthalmoscope. Intra-observer and inter-observer variability studies using this classification system indicated that the classification system is fairly reliable.

Methodology for studies on medical therapy of cataracts: cataract-II.

The methodology for testing any possible effect of potential anti-cataract agents is described. This is based on slit lamp and ophthalmoscopic cataract classification and on visual acuity. The difficulties encountered in such studies are highlighted. The presented methodology is suggested to be fairly adequate in assessing usefulness of any possible medical therapy of cataracts.

Topical sulindac therapy in diabetic senile cataracts: cataract-IV.

Sulindac, a non-steroidal anti-inflammatory drug has been found to be a potent inhibitor of enzyme aldose reductase. We used sulindac topically in diabetic senile cataract patients to note if it effects the progression of cataracts. More of sulindac treated eyes maintained initial vision and fewer eyes had visual loss of up to two lines or more as compared to control eyes. The extent and density of different opacities showed less progression in sulindac treated eyes but it was not statistically significant except that the ophthalmoscopically observed density of opacity showed statistically very significant lesser mean increase in sulindac treated eyes. We suggest that sulindac is a potential drug which should be further evaluated in large double blind photodocumented studies in diabetic senile cataracts.

Topical glutathione therapy in senile cataracts. Cataract-III.

We undertook a prospective study in 66 cataract patients to study if topical glutathione has any effects on the progression of cataracts. The eye with more advanced cataract received topical glutathione drops q.i.d. and contralateral eye served as control. Only 32 patients completed the follow-up of three months or more. Data analysis revealed no beneficial effect of topical glutathione drops on any of the parameters studied. PSC opacity density in eyes treated with topical glutathione showed significant increase as compared to control eyes.