Baerveldt glaucoma implant with Supramid© ripcord stent in neovascular glaucoma: a case series

AIM: To report the outcome of Baerveldt glaucoma implant (BGI) with Supramid© ripcord use in neovascular glaucoma (NVG). METHODS: We retrospectively evaluated the surgical outcome of the BGI with Supramid© 3/0 ripcord stent in patients with NVG. No tube ligation or venting slits were performed. Supramid was removed after 3mo if the target intraocular pressure (IOP) was not achieved. Surgical success was defined as IOP≤21 mm Hg with (qualified success) or without IOP-lowering medications (complete success). RESULTS: Twenty-six eyes from 24 patients were included in the study. The median duration of follow-up was 4 [interquartile range (IQR)=1-5]y, ranging from 0.5 to 5y. IOP decreased by a mean of 24.2 mm Hg (59.7%); from a mean of 40.5±12.6 mm Hg at baseline to 16.3±11.9 mm Hg, P≤0.001. The number of glaucoma medications reduced from a median of 5 (IQR=5-6) to 1 (IQR=0-2, P≤0.001) at the final follow-up. Overall success rates were 88.0% at 1y, 34.8% at 3y, 66.7% at 4y, and 50% at 5y. Hypertensive phase (HP) in the first 3mo occurred in 15/26 eyes (57.7%) with a mean IOP of 31.1 mm Hg. CONCLUSION: BGI with Supramid© ripcord stent gives close to 90% of the overall survival rate at the final follow-up without significant early hypotony. However, early HP is still a challenge.     

Negative correlation between age of subjects and length of the appendix in Bangladeshi males

Introduction

The anatomy of the vermiform appendix shows variations in its macroscopic dimensions some of which have potential to influence the clinical aspects of the appendix. Anatomical studies on the appendix using people in Bangladesh as a sample are limited and fall short of producing any standardized anthropometric data. This study is predominantly a cross-sectional observational study which also uses some statistical analysis to understand the relationships amongst variables.

Material and methods

Fifty-six adult male postmortem appendices and adnexa were examined for macroscopic features. Possible interrelationships among the variables were assessed through statistical analysis. The age of the samples ranged from 18 to 67 years. The most common position of the appendix was retrocolic (53.57%) followed by pelvic (30.35%), postileal (12.5%), and subcaecal (3.5%).

Results

In most cases (62.5%) the mesoappendix did not reach the tip of the appendix. The appendicular length varied from 6.00 cm to 16.30 cm with mean (± SD) and median value of 10.21 ±2.50 cm and 10.00 cm respectively. The base of the appendix was 1.90 to 3.80 cm away from the ileocaecal junction. The other macroscopic measurements of the appendix were taken at the base, at the midzone and at the tip of the appendix and the mean of the three measurements was considered as the overall value. Thus, the overall external diameter varied between 0.32 cm and 0.83 cm. Assessment of possible correlations amongst different variables revealed a significant negative correlation between the age of the subjects and the length of the appendix.

Conclusions

The data of the present study may provide a baseline along with some previous data in the standardization of the anthropometric information regarding the vermiform appendix of Bangladeshi males.     

Atypical presentation of leprosy in HIV

Atypical presentations can be expected when leprosy, a mycobacterial disease is associated with HIV. We report a case of a 28 year old male driver with a high risk behavior, who came for evaluation of hypoaesthetic, scaly erythematous plaques over face, trunk, upper extremity; verrucous lesions over elbows and necrotic lesions over the neck and lower extremities since 6 months. No other systemic complaints were present. Nerve examination showed grossly thickened left greater auricular nerve and cord like thickening of bilateral ulnar and lateral popliteal nerves. His investigations revealed anemia, a reactive ELISA for HIV-1 and CD4 of 400 cell/cmm. Ultrasonography of the thickened nerves revealed an abscess in the left ulnar nerve whereas the left greater auricular nerve showed neuritis. Histopathology from an erythematous plaque was suggestive of borderline tuberculoid leprosy in reaction. Final diagnosis was borderline tuberculoid leprosy in type 1 reaction with atypical and varied morphology in an immunocompromised male with neuritis of the left greater auricular nerve, a silent left ulnar nerve abscess with early left ulnar nerve palsy. Our case highlights the atypical morphology of leprosy lesions and the unexpected protective cellular response as suggested by formation of nerve abscess in a HIV positive patient.