Positive and Negative Associations of Myopia with Ocular Diseases in Population-Based Studies.

OBJECTIVE: Prevalence of myopia and vision impairment due to myopic macular degeneration and myopia-related optic neuropathies have markedly increased worldwide. We evaluated whether myopia is associated with the prevalence of other ocular disorders in a positive or negative sense. DESIGN: Population-based studies conducted in Russia, China and India. PARTICIPANTS: The Russian Ural Eye and Medical Study (UEMS) and the Beijing Eye Study (BES) included 5899 individuals and 4439 individuals (all aged 40+ years), respectively, and the Central India Eye and Medical Study (CIEMS) consisted of 4711 individuals, aged 30+ years. The studies were conducted in rural and urban regions in Bashkortostan/Russia, Nagpur/India, and Beijing/China. METHODS: The participants underwent a series of ophthalmological and general medical examinations. MAIN OUTCOME MEASURES: Axial length as surrogate for myopia, and prevalence of diabetic retinopathy (DR), age-related macular degeneration (AMD), angle-closure glaucoma (ACG), and open-angle glaucoma (OAG). RESULTS: In the UEMS, DR prevalence (OR:0.73;95%CI:0.56,0.96), AMD prevalence (OR:0.85;95%CI:0.74,0.98) and ACG prevalence (OR:0.72;95%CI:0.55,0.95) decreased, and OAG prevalence (OR:1.65;95%CI:1.45,1.88) increased with longer axial length in multivariable analyses. In the CIEMS, lower AMD prevalence (OR:0.81;95%CI:0.69,0.95) and lower ACG prevalence (OR:0.55;95%CI:0.36,0.83), and higher OAG prevalence (OR:1.45;95%CI:1.15,1.83) were associated with longer axial length. DR prevalence (0.33%;95%CI:0.16,0.50) was too low for statistical analysis in the CIEMS. In the BES, prevalence (OR:0.64;95%CI:0.50,0.81) and 10-year incidence of DR (OR:0.48;95%CI:0.33,0.71) and prevalence (OR:0.83;95%CI:0.77,0.89) and 5-year incidence of AMD (OR:0.996;95%CI:0.993,0.999) decreased, and prevalence (OR:1.35;95% CI:1.17,1.56) and 10-year incidence of OAG (OR:1.40;95%CI:1.22,1.61) increased with longer axial length. In all three studies, the association between higher OAG prevalence and longer axial length was nonlinear with a slight increase for the moderate myopia range, and a steep increase in the highly myopic range. CONCLUSIONS AND RELEVANCE: Myopia is associated with a lower prevalence of DR, AMD and ACG and lower incidence of DR and AMD, while high myopia more than moderate myopia is associated with a higher prevalence and incidence of OAG. Future studies may assess whether in myopia, in particular in moderate myopia, the myopia-related advantages, i.e., lower prevalence of DR, AMD and ACG, may outweigh the increased risks for OAG and other myopia-related disorders.

Surgical exposure for vitrectomy in retinopathy of prematurity.

Our purpose was to evaluate the efficacy of lateral canthotomy, sub-tenon anesthesia injection, and the use of modified speculum for gaining adequate surgical exposure during surgery for retinopathy of prematurity (ROP). Fourteen eyes of 10 consecutive patients undergoing microincisional vitrectomy surgery (MIVS) for stage 4 and stage 5 ROP were included. There was a significant widening of the palpebral fissure height and length using this technique. No patient developed a lens injury during the surgery. All the canthotomy incisions completely healed at a four-week follow-up visit. This is a safe and effective technique for increasing surgical exposure in cases of ROP requiring vitrectomy.

Krill's Disease: A Newer Management Option.

Purpose: To report a case of a young female who presented with scotoma in the right eye for few days. Case Report: Krill's disease or acute retinal pigment epithelitis (ARPE) is a self-limiting retinal disease with no specific treatment. Typical clinical and imaging features helped us to diagnose her with ARPE. Intravenous methylprednisolone (IVMP), which gives a rapid anti-inflammatory response, was advised. An SD-OCT scan post-injection showed a reduction in hyperreflectivity and height of lesion at day 3 and near total resolution by day 5. Conclusion: This case suggests rapid resolution of ARPE with the use of IVMP.

Topical glycerine for corneal clouding during retinal laser photocoagulation for retinopathy of prematurity.

AIM: To document the use of topical glycerine to reduce corneal edema in cases of retinopathy of prematurity (ROP) undergoing laser photocoagulation (PHC). METHODS: Thirty-two eyes of 16 babies (9 males) with a mean gestational age of 30 weeks, mean gestational weight of 1242 grams underwent PHC for Type 1 (zone 1 disease) retinopathy of prematurity. All babies received a single PHC session. Twenty eyes of 10 babies received intravitreal anti-VEGF injection, 1-3 weeks before PHC session. All patients received a single drop of glycerine during the PHC session to clear the corneal clouding. All patients underwent PHC to the avascular area right up to the ora serrata. Patients were seen at one week and one month to assess the adequacy of laser PHC. RESULTS: We were able to complete the PHC for all babies in a single session without any ocular or systemic adverse events. We did not find any skip lesions at follow-up, and the second session of laser PHC was not required in any eyes. CONCLUSION: Topical glycerine is safe and effective to clear corneal clouding in eyes undergoing laser PHC for retinopathy of prematurity.

BEVACIZUMAB FOR POST VITRECTOMY CYSTOID MACULAR EDEMA IN A SILICONE OIL-FILLED EYE.

PURPOSE: To report the safety and efficacy of intravitreal bevacizumab (IVB) in a case of cystoid macular edema (CME) in a silicone oil-filled eye. METHODS: A man, aged 51 years, reported with poor visual improvement in the right eye (RE) after pars plana vitrectomy with oil injection performed 2 months back for a pseudophakic, macula-off rhegmatogenous retinal detachment. His best-corrected visual acuity in the RE was counting fingers 2 m. Fundus examination of the RE showed a silicone oil-filled eye with attached retina, and CME was confirmed on spectral-domain optical coherence tomography. He was advised to undergo IVB injection, which was given a few days later. RESULTS: One week after IVB, the central macular thickness had decreased to 437 µ m. Seven weeks later, the macular edema subsided completely with a final central macular thickness of 219 µ m. His vision improved by seven lines to 6/24 and was stable for another 2 months. He underwent removal of silicone oil after 3 months, wherein his visual acuity improved further by one line to 6/18. DISCUSSION: This case demonstrates the use IVB for CME in a silicone oil-filled eye. It was found that IVB was safe and effective in CME associated with a silicone oil-filled eye.

Posttraumatic deep anterior lamellar keratoplasty dehiscence: Descemet's resistance.

An 18-year-old girl who had undergone deep anterior lamellar keratoplasty in her left eye for keratoconus a year back presented with inferonasal graft dehiscence with intact host Descemet's membrane and intact anterior chamber after sustaining blunt injury a week prior. The graft was sutured to the host bed, and complete resolution of graft edema was seen in 4 weeks. One year later, she underwent cataract surgery with foldable intraocular lens implantation. At her final follow-up, the best-corrected visual acuity in her left eye was 20/40 with a clear corneal graft and a stable posterior chamber intraocular lens implantation.

Prevalence of myopic retinopathy in rural Central India.

PURPOSE: The aim of this study was to determine the prevalence of myopic retinopathy (MR) in rural Central India. METHODS: The population-based Central India Eye and Medical Study included 4711 subjects (aged 30+ years). The participants underwent a detailed eye examination, including fundus photography. Myopic retinopathy was defined according to the Pathologic Myopia Study Group. RESULTS: Readable fundus photographs were available on 4561 (96.8%) subjects (8846 eyes). Myopic retinopathy was present in 15 (0.17 ± 0.04%; 95% confidence interval (CI):0.08%, 0.26%) eyes of 11 (0.24 ± 0.07%; 95%CI: 0.01, 0.04) individuals. Myopic retinopathy occurred only in eyes with an axial length of >26 mm. Eyes with MR had significantly larger optic discs than eyes without MR (3.69 ± 1.22 mm2 versus 2.52 ± 0.77 mm2 ; p < 0.001). In binary regression analysis, higher prevalence of MR was associated with longer axial length (p < 0.001; odds ratio (OR): 19.6; 95%CI: 4.6, 82.9), higher prevalence of open-angle glaucoma (p = 0.02; OR: 16.1; 95%CI: 1.51, 170), lower best-corrected visual acuity (expressed in logMAR) (=0.03; OR: 0.06; 95%CI: 0.004, 0.75) and female gender (p = 0.002). If level of education was added to the model, educational level was not significantly associated with MR (p = 0.17; OR: 0.53; 95%CI: 0.22, 1.31). If gender was dropped from the model, higher prevalence of MR was associated with lower educational level (p = 0.04; OR: 0.44; 95%CI: 0.20, 0.97). CONCLUSIONS: Prevalence of MR in rural Central India was low (11/4561 or 0.2%), and correlated with a 16 times higher risk of open-angle glaucoma, after adjusting for axial length and gender. If gender was excluded from the analysis, higher prevalence of MR was associated with lower educational level. This latter finding distinguishes adult MR from today's school children myopia which is strongly associated with higher educational level.

Trans-lamina cribrosa pressure difference and open-angle glaucoma. The central India eye and medical study.

PURPOSE: To assess associations of the trans-lamina cribrosa pressure difference (TLCPD) with glaucomatous optic neuropathy. METHODS: The population-based Central India Eye and Medical Study included 4711 subjects. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44 Body Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]-0.18×Age[Years] -1.91. TLCPD was IOP-CSFP. RESULTS: Mean TLCPD was 3.64±4.25 mm Hg in the non-glaucomatous population and 9.65±8.17 mmHg in the glaucomatous group. In multivariate analysis, TLCPD was associated with older age (P<0.001; standardized coefficient beta:0.53; regression coefficient B:0.18; 95% confidence interval (CI):0.17, 0.18), lower body mass index (P<0.001; beta: -0.28; B: -0.36; 95%CI: -0.38, -0.31), lower diastolic blood pressure (P<0.001; beta: -0.31; B: -0.12; 95%CI: -0.13, -0.11), higher pulse (P<0.001; beta:0.05; B:0.02; 95%CI:0.01,0.2), lower body height (P = 0.02; beta: -0.02; B: -0.01; 95%CI: -0.02,0.00), higher educational level (P<0.001; beta:0.04; B:0.15; 95%CI:0.09,0.22), higher cholesterol blood concentrations (P<0.001; beta:0.04; B:0.01; 95%CI:0.01,0.01), longer axial length (P = 0.006; beta:0.03; B:0.14; 95%CI:0.04,0.24), thicker central cornea (P<0.001; beta:0.15; B:0.02; 95%CI:0.02,0.02), higher corneal refractive power (P<0.001; beta:0.07; B:0.18; 95%CI:0.13,0.23) and presence of glaucomatous optic neuropathy (P<0.001; beta:0.11; B:3.43; 95%CI:2.96,3.99). Differences between glaucomatous subjects and non-glaucomatous subjects in CSFP were more pronounced for open-angle glaucoma (OAG) than for angle-closure glaucoma (ACG) (3.0 mmHg versus 1.8 mmHg), while differences between glaucomatous subjects and non-glaucomatous subjects in IOP were higher for ACG than for OAG (8.5 mmHg versus 3.0 mmHg). Presence of OAG was significantly associated with TLCPD (P<0.001; OR:1.24; 95%CI:1.19,1.29) but not with IOP (P = 0.08; OR:0.96; 95%CI:0.91,1.00). Prevalence of ACG was significantly associated with IOP (P = 0.04; OR:1.19; 95%CI:1.01,1.40) but not with TLCPD (P = 0.92). CONCLUSIONS: In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of open-angle glaucoma.

Prevalence and associated factors for pterygium in rural agrarian central India. The central India eye and medical study.

PURPOSE: To evaluate the prevalence of pterygia and associated factors in a rural population in a mostly undeveloped agrarian region. METHODS: The Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study comprised 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. A pterygium was diagnosed during the slit lamp examination and confirmed on corneal photographs. It was defined as a fleshy fibrovascular growth, crossing the limbus and typically seen on the nasal, and sometimes temporal, conjunctiva. RESULTS: A pterygium was detected in 798 eyes (prevalence rate: 8.47 ± 0.29%) of 608 (12.91 ± 0.49%) subjects. Bilateral pterygia were present in 190 subjects (4.0% of study population). Pterygia prevalence increased from 6.7 ± 0.8% in the age group 30-39 years, to 13.5 ± 1.2% in the age group 50-59 years, to 25.3 ± 2.1% in the age group 70-79 years. Prevalence of pterygia was associated with older age (P<0.001; regression coefficient B: 0.02; odds ratio (OR): 1.02; 95%CI: 1.01, 1.03), male gender (P<0.001;B:-0.73;OR: .48;95%CI:0.39,0.61), lower level of education (P<0.001;B:-0.30;OR:0.74;95%CI:0.69,0.80), lower body height (P=0.001;B:-0.02;OR:0.98;95%CI:0.97,0.99), and higher cylindrical refractive error (P<0.001;B:0.23;OR:1.26;95%CI:1.18,1.34). If the education level was dropped, the number of hours spent with vigorous activity outdoors (P=0.001;B:0.001;OR:1.001;95%CI:1.000,1.0001) was significantly associated with the prevalence of pterygia, in addition to older age (P<0.001;B:0.03;OR:1.03;95%CI:1.03,1.04), male gender (P<0.001;B:-0.49;OR:0.62;95%CI:0.49,0.77), lower body height (P=0.005;B:-0.02;OR:0.98;95%CI:0.97,0.99), and higher cylindrical refractive error (P<0.001;B:0.23;OR:1.25;95%CI:1.18,1.34). CONCLUSIONS: Pterygium prevalence in rural Central India is about 13% among adult Indians aged 30+ years. Older age, male gender, lower educational level, lower body height and more time spent outdoors with vigorous work were associated factors. Since the living conditions in the study location were mostly untouched by modern developments, the results may show the prevalence and associations of pterygia without major medical or technologic influences.

Prevalence of optic disc hemorrhages in rural central India. The Central Indian Eye and Medical Study.

PURPOSE: To determine the frequency of optic disc hemorrhages in a rural Indian population. METHODS: The population-based Central Indian Eye and Medical Study included 4711 subjects. Mean age was 48.5±12.9 years (range: 30-100 years). Color optic disc photographs were examined. RESULTS: Optic disc photographs were available for 4570 (97.0%) subjects. Prevalence of disc hemorrhages was 17/8869 (0.19%; 95%CI:0.10,0.28) per eye and 16/4570 (0.35±0.09%; 95%CI:0.18,0.52) per subject. Prevalence of disc hemorrhages increased from 0.05% (95%CI:0.00,0.13) in the age group of 30-39 years to 0.25% (95CI:0.00,0.49) in the age group of 60-69 years and to 0.91% (95%CI:0.24,1.58) in the age group of 70+ years. After adjusting for older age, higher systolic blood pressure, diabetes mellitus, myopic refractive error, smaller neuroretinal rim area and thinner retinal nerve fiber layer, occurrence of disc hemorrhages was associated only with glaucomatous optic nerve damage (P<0.001; Odds ratio: 87; 95%CI:32,239). Eleven of the 17 (65%; 95%CI:39,90) disc hemorrhages were found in glaucomatous eyes. Out of 193 glaucomatous eyes, 11 eyes (5.7%; 95%CI:2.4,9.0) showed a disc hemorrhage. Out of the 8676 non-glaucomatous eyes, 6 eyes (0.07%; 95%CI:0.01,0.12) had an optic disc hemorrhage. CONCLUSIONS: Prevalence of disc hemorrhages (0.2% per eye; 0.4% per subject) in Indians aged 30+ years was strongly associated with glaucoma after adjustment for age, blood pressure and diabetes mellitus. A disc hemorrhage suggested glaucomatous optic nerve damage with a positive predictive value of 65%. About 6% of glaucomatous eyes showed a disc hemorrhage at the time of clinical examination highlighting the importance of optic disc hemorrhages for the diagnosis of glaucoma.

Prevalence and associated factors of glaucoma in rural central India. The Central India Eye and Medical Study.

PURPOSE: To assess the prevalence of glaucoma in rural Central India. METHODS: The population-based Central India Eye and Medical Study is a population-based study performed in a rural region of Central India. The study included 4711 subjects (aged 30+ years). A detailed ophthalmic and medical examination was performed. Glaucoma was defined by glaucomatous optic disc morphology, and in a second step, by the criteria of the International Society of Geographical and Epidemiological Ophthalmology (ISGEO). RESULTS: Optic disc photographs were available for 4570 (97.0%) subjects. Glaucoma was detected in 122 subjects (51 unilateral) (2.67% (95%CI: 2.20, 3.14). Glaucoma prevalence for the age groups of 30-39yrs, 40-49yrs, 50-59yrs, 60-69yrs, 70-79yrs, and 80+ years was 0.54% (95%CI: 0.11, 0.98), 1.03% (95%CI: 0.49, 1.57), 1.40% (95%CI: 0.58, 2.23), 6.62% (95%CI: 4.92, 8.31), 8.71% (95%CI: 5.55, 11.75), and 14.3% (95%CI: 4.13, 24.4), respectively. In multivariable analysis, glaucoma was associated with higher age (P<0.001), lower body mass index (P = 0.025), lower blood hemoglobin concentration (P = 0.03), higher intraocular pressure (P<0.001), disc hemorrhages (P<0.001), higher prevalence of myopic retinopathy (P<0.001), lower level of education (P = 0.03), longer axial length (P<0.001), thinner retinal nerve fiber layer (P<0.001), higher vertical cup/disc diameter ratio (P<0.001), and narrow anterior chamber angle (P = 0.02). Ratio of open-angle glaucoma to angle-closure glaucoma was 7.7:1 (1.93% (95%CI: 1.64, 2.22) to 0.24% (95%CI: 0.14, 0.34)). Using the ISGEO criteria, glaucoma prevalence was 2.8% (95%CI: 2.3, 3.3) with a less clear association with older age. CONCLUSIONS: Glaucoma prevalence in remote rural Central India is comparable to other regions. Associated factors were older age, lower body mass index, lower blood concentration of hemoglobin, lower level of education, higher intraocular pressure, disc hemorrhage, myopic retinopathy, and longer axial length. The ratio of open-angle glaucoma to angle-closure glaucoma was about 8:1.