Generation of cytotoxic molecules and oxidative stress in haemolymph of pebrinised tasar silkworm Antheraea mylitta Drury.

The present study was carried out to investigate the effects of microsporidial infection on redox regulation mechanism and oxidative stress in tasar silkworm Antheraea mylitta. High level of superoxide radical (p < 0.05), nitric oxide (p < 0.001) and lipid peroxidation (p < 0.001) was observed in haemolymph of pebrinised larvae, which indicated the resultant generation of cytotoxic molecules and oxidative damage. Increased phenol oxidase (PO) activity in haemolymph of pebrinised larvae indicated the activation of immune defences during pathological conditions. In addition, higher level of glutathione-S-tranferase (GST) activity and reduced glutathione (GSH) level observed in pebrinised larvae indicated adaptive behaviour of tissue against toxic oxyradicals (p < 0.05). Conversely, low level of ascorbic acid (ASA) content suggested that the larvae might have used these compounds to counteract stress in tissues or low uptake under microspridial infection (p < 0.05). Present findings provide new insights into the cellular and biochemical bases of host-pathogen interactions in tasar silkworm A. mylitta.

Myofibrosarcoma of Maxilla - Case Report and Review of Literature.

Myofibrosarcoma is a distinct mesenchymal malignancy which commonly occurs in head and neck region. It has a high tendency for local recurrence and distant metastasis. 39-year-old male presented with epistaxis, nasal obstruction and left sided complete loss of vision. He underwent functional endoscopic sinus surgery and guided biopsy. MRI scan showed a lesion epicentred in the left maxillary sinus, superiorly extending into the orbit. He underwent Class 4b maxillectomy with neck dissection, tracheostomy and free flap reconstruction. Histopathological examination yielded final diagnosis as myofibrosarcoma of maxilla. The patient was planned for adjuvant radiotherapy and has been disease free for 3 years.

Occult Thyroid Carcinoma with Cervical Lymph Node Metastasis: A Rare Case Report.

Cervical lymph node metastasis is one of the most common clinical presentations of papillary thyroid carcinoma (PTC). Occult thyroid carcinoma is described as absence of primary tumour or with presence of microcarcinoma in thyroid with cervical lymph node metastasis. Frequency of occult thyroid cancer has decreased due to developments in imaging and improved accuracy of histological examinations. 38 year old male presented to us with complaints of swelling over the left side of neck for the past 2 months. Ultrasonography was suggestive of multiple suspicious enlarged nodes in left level II, III, IV and V and fine needle aspiration cytology showed features of metastatic PTC. He was planned for total thyroidectomy with central compartment clearance and bilateral functional neck dissection. Final histopathology staging was pT0N1b. Radioactive iodine (RAI) screening showed residual functioning thyroid and later therapeutic RAI was administered. He has been on regular follow up and disease free for 1 year post treatment. Occult thyroid carcinoma is a rare diagnosis with multiple treatment plans. Few hypothesis for this entity includes tumor regression, ectopic thyroid carcinoma or missed pathological findings.

A Rare Case Report of Osteosarcoma of Maxilla with Double Free-Flap Reconstruction.

Osteosarcomas are rare and highly malignant bone tumours which are composed of malignant mesenchymal cells producing osteoid or immature bone. Maxillary osteosarcomas are rare tumours accounting for less than 1% of head and neck malignancies. Aggressive surgical resection is the main modality of treatment with good reconstruction. Due to the complex anatomy and location of maxilla as well as its proximity to the skull, resection with negative margins is always a challenge and so is the reconstruction so as to reduce the morbidity of the patient and to also give a good functional and cosmetic outcome. Clinical outcomes can be improved with administration of neoadjuvant or adjuvant chemotherapy in selected cases and radiotherapy in case of positive margins. A 41-year-old male patient presented to the outpatient department with complaints of a bulge over the hard palate for the past 1 year. CT scan showed a 6 × 5 × 4 cm osseous expansile lesion arising from the maxillary bone. Biopsy of the tumour showed features of conventional high-grade osteosarcoma. Plate-preserving maxillectomy with tracheostomy was done followed by reconstruction with a double free flap. On post-operative day 1, the flap showed signs of venous congestion and a new free anterolateral thigh flap was done. Patient was discharged on day 7 with a Ryles tube and a tracheostomy tube in situ. Final histopathological examination showed that the tumour was a high-grade chondroblastic osteosarcoma. After regular post-operative visits in the outpatient department and evaluation with flexible laryngoscopy, patient was started on oral feed by day 10 and decannulated by day 15. He has been on regular follow-up for the past 1 year and shows no signs of recurrence or residual disease on clinical examination as well as imaging. Maxillary osteosarcoma is a rare bone tumour which requires accurate imaging and biopsy for accurate surgical planning. The ideal treatment modality is radical resection with negative margins and appropriate reconstruction. With the advent of microvascular surgery, free flaps form the backbone for reconstruction of such large defects.

Transoral Robotic Surgery for a Rare Case of Venolymphatic Malformation in Parapharyngeal Space.

Venous malformations are low flow endothelial malformations with aberrant and ectatic venous channels. They are defects in vascular growth which causes functional and cosmetic impairment. Gradual growth in size of the lesion occurs due to venous congestion or thrombosis. Venous malformations in parapharyngeal space are a rare entity and are difficult to diagnose. Case Report. 13 year old boy presented with a history of hyposmia and progressive difficulty in breathing for a duration of 2.5 years. MRI face and neck with contrast showed a 4.5 × 4.3x3.6 cm lesion in the left parapharyngeal space. CT angiogram of brain and neck demonstrated a heterogeneously enhancing mass in the left parapharyngeal region. PET scan illustrated an ill-defined mass in the left pre styloid parapharyngeal space. Biopsy from the lesion showed features consistent with venolymphatic malformation. Flexible laryngoscopy showed a bulge over the left soft palate region with narrowing of nasopharyngeal lumen. Patient underwent transoral robotic surgery for complete excision of the mass. Post-operative period was uneventful. He has been on follow up for the past 1 year with no evidence of any residual or recurrent disease. Venolymphatic malformation is a rare lesion in the parapharyngeal space which is difficult to diagnose pre operatively. Surgical excision is the preferred modality of treatment for deep seated lesions in the parapharyngeal space. The advent of transoral robotic surgery have reduced the morbidity and improved clearance for such cases.

Extraskeletal Myxoid Chondrosarcoma of Floor of Mouth-A Rare Case Report and Review of Literature.

Introduction: Chondrosarcomas are rare malignancies of the cartilage and myxoid chondrosarcoma is its variant which commonly occurs in soft tissue of extremities. Extraskeletal chondrosarcoma is a rare malignant neoplasm of bone or soft tissue origin and is characterized by the presence of spindle cells admixed with well differentiated cartilage or chondroid stroma. They are mostly radioresistant tumours and surgical resections with adequate margins is considered as the ideal treatment modality with adjuvant radiotherapy in high grade tumours and add on chemotherapy, in case of presence of poor prognostic factors. Case Report: A 51-year-old diabetic, hypertensive female patient presented to our outpatient department with difficulty in chewing food for a duration of 6 months. On clinical examination, she had an ulceroproliferative growth involving right lower alveolus and floor of mouth. MRI face and neck with contrast showed a 4.1 × 2.9 × 4.5 cm lesion involving right lower alveolus extending to floor of mouth. Biopsy showed features of extraskeletal myxoid chondrosarcoma. She was planned for upfront surgery (Right composite resection with modified radical neck dissection with free fibula flap). Patient was stable post-surgery and was discharged in stable condition. Final histopathology report was high grade myxoid chondrosarcoma. The case was presented in tumour board and the patient was planned for adjuvant radiotherapy. She has been on regular follow up for the past 2 years and shows no signs of recurrence. Conclusion: Extraskeletal myxoid chondrosarcoma of oral cavity is a rare entity and very few cases are reported. It is a malignant neoplasm which is diagnosed with the help of immunohistochemistry. Surgery is the ideal modality of treatment accompanied by adjuvant radiotherapy in cases of high-grade tumours.

Prevalence and associations of retinal vein occlusions: the Central India Eye and Medical Study.

PURPOSE: To determine the prevalence of retinal vein occlusions (RVOs) in rural central India. METHODS: The population-based Central India Eye and Medical Study was performed in rural central India and included 4,711 subjects (30 years and older). Using fundus photographs, we assessed the prevalence of branch retinal vein occlusions and central retinal vein occlusions. RESULTS: An RVO was detected in 38 eyes (0.42 ± 0.07%; 95% confidence interval: 0.29-0.56) of 35 subjects (0.76 ± 0.13%; 95% confidence interval: 0.50-1.01). Prevalence of branch retinal vein occlusions was 0.66% ± 0.12% per subject (95% confidence interval: 0.42%-0.90%) and of central retinal vein occlusions was 0.11% ± 0.05% per subject (95% confidence interval: 0.01%-0.21%). In binary logistic analysis, presence of RVOs was associated with higher age (P = 0.007), systolic blood pressure (P < 0.001), blood concentration of urea (P = 0.02), and narrower anterior chamber angle (P < 0.03). The RVO prevalence was not significantly (all Ps > 0.10) associated with body mass index; blood concentrations of glucose, cholesterol, high-density lipoproteins, and creatinine; presence of diabetes mellitus, tuberculosis and malaria; nutritional parameters; alcohol consumption; refractive error; and optic disk size. The age-specific prevalence rates of RVOs were 0.18% ± 0.13%, 0.29% ± 0.15%, 0.89% ± 0.34%, 1.07% ± 0.36%, 2.72% ± 0.85%, and 3.64% ± 2.55%, respectively, for decadal age groups. In two (5%) eyes, RVO had caused low vision (visual acuity <20/60 and ≥20/400). CONCLUSION: In the rural agrarian low-income population of Central India, RVOs were detected in 0.8% of adults, with branch retinal vein occlusions being approximately seven times more common than central retinal vein occlusions. Main associated factors were higher age, blood pressure, urea blood concentration, and narrow chamber angle. RVOs were no major reason for visual impairment.

Trigeminal Schwannoma - Case Report of a Rare Tumour.

Schwannomas are benign nerve tumours arising from the Schwann cells. Approximately 25-45% of schwannomas occurs in the head and neck region. Majority of schwannomas in the head and neck region arise from the vagus nerve. Trigeminal schwannomas account for about 0.2% of all intracranial tumours. Trigeminal schwannomas can originate from any section of the fifth cranial nerve, from the root to the distal extracranial branches, but majority develops from the Gasserian ganglion, usually growing in the middle cranium. Most common presenting symptom is facial pain. MRI is the imaging modality of choice and CT scan usually serves as a supplementary imaging especially for skull base tumours. 47 year old male patient presented to the outpatient department with complains of swelling over the left side of palate. Contrast enhanced CT scan demonstrated a large bilobed heterogeneously enhancing soft tissue lesion in the left infratemporal fossa with widened foramen ovale and extension of lesion into the Meckel's cave, larger contiguous component extending into ramus of mandible. MRI scan showed a large lobulated mass in the left masticator space with intracranial extension. Biopsy of the lesion was suggestive of schwannoma. The patient underwent left composite resection with dural repair and free flap reconstruction. Post operatively, on day 5 he developed features of meningitis for which he was treated conservatively and later discharged in stable condition. Trigeminal schwannomas are rare tumours with very low chance of malignant transformation which commonly presents with facial pain. MRI is the imaging modality of choice. Complete surgical excision is the treatment of choice.

Parotid Metastasis in a Case of Papillary Thyroid Carcinoma: Case Report and Review of Literature.

Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid neoplasm. Common sites of regional and distant metastasis includes lymph nodes, lungs and bone. 51 year old female patient who was a known case of PTC with a history of multiple surgeries, radioactive iodine therapy (RAI) and oral chemotherapy presented with a painful right parotid mass. PET scan demonstrated FDG avid lesions in the right parotid gland, cervical lymph nodes and other distant sites. Cytology report showed features of metastatic PTC. Patient underwent extended total parotidectomy with facial nerve resection, skin and masseter muscle resection and extended radical neck dissection. Final histopathology (HPE) report showed metastatic papillary carcinoma thyroid. Patient is currently on oral chemotherapy and on regular follow up. PTC rarely metastasizes to parotid gland and such cases have to be treated with surgery alone or with a combination of surgery and RAI based on tumour burden.

A Rare Case of Extraosseous Osteosarcoma (EOS) of Parotid Gland.

Extraosseous osteosarcoma is a rare malignant soft tissue neoplasm, and extraosseous osteosarcoma of the parotid gland is very rare. It has a very aggressive course, and there are no standardized treatment guidelines. We report the case of a 20 year old male patient who presented with history of right neck swelling since 6 years for which he had undergone right parotid surgery 5 years ago. The final histopathological report indicated that the mass was a pleomorphic adenoma. One year after the first surgery, the patient experienced recurrence of swelling over the operated site, and the size of the swelling has been increasing gradually since then. He was evaluated clinically, and a large mass was noted over the upper aspect of the right upper neck, extending to the occipital and parotid regions. An MRI scan was done which showed a 12 × 10 × 8 cm lesion centred in the right parotid gland, involving paraspinal muscles, C1-C2 vertebrae and extending into the parapharyngeal space. FNAC of the lesion showed features of pleomorphic adenoma. The patient underwent a complete excision of the tumour. The patient's post-operative period was uneventful. The final histopathological report of the patient was extraosseous osteosarcoma of the parotid gland. The patient was referred for adjuvant radiotherapy. He has been on regular follow-up for the past 6 months and has shown no sign of recurrence. EOS is an extremely rare tumour of the head and neck region which often requires extensive surgical resection with or without adjuvant radiotherapy. It has a high rate of local recurrence and a very low disease free survival. Such patients should be kept on a close follow-up.

Lens thickness and associated factors.

BACKGROUND: To determine the normative data for lens thickness and its associated factors in a population-based study. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study included 4711 subjects (aged 30+ years). METHODS: The subjects underwent a detailed ophthalmological examination including measurement of the lens thickness by sonography. MAIN OUTCOME MEASURE: Sonographic lens thickness measurement. RESULTS: After excluding pseudophakic or aphakic eyes, lens thickness measurements were available for 9046 eyes of 4610 (97.9%) subjects with a mean age of 49.1 ± 13.2 years (range: 30-100 years) and a mean refractive error of -0.11 ± 1.77 dioptres (median, 0 dioptres; range, -21.75 to +7.75 dioptres). Mean lens thickness was 3.95 ± 0.49 mm. In multivariate analysis, a thick lens was significantly associated with higher age (P < 0.001), male gender (P < 0.001), higher body stature (P = 0.02), higher body mass index (P = 0.003), thicker central cornea (P = 0.008), shallower anterior chamber depth (P < 0.001) and hyperopic refractive error (P < 0.001). After adjustment for ocular and systemic parameters, lens thickness decreased with higher degree of nuclear cataract. CONCLUSIONS: In the rural Central Indian population, a thick lens was associated with higher age, male gender, high body stature, high body mass index, hyperopia, thick central cornea, shallow anterior chamber depth and nuclear cataract. The data may be helpful to explain anatomic relationships of the anterior segment of the eye and to elucidate risk factors of diseases associated with ocular dimensions.

Anterior chamber depth and its associations with ocular and general parameters in adults.

BACKGROUND: To investigate the normative data of anterior chamber depth and its associations in adults in rural Central India. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study included 4711 subjects aged 30+ years (response rate 80.1%). METHODS: The subjects underwent an ophthalmological examination including measurement of the anterior chamber depth by sonography. MAIN OUTCOME MEASURE: Anterior chamber depth. RESULTS: Mean anterior chamber depth was 3.22 ± 0.34 mm. In multivariate analysis, a shallow chamber depth was significantly associated with higher age (P < 0.001), female gender (P < 0.001), shorter body stature (P = 0.003), hyperopic refractive error (P < 0.001), higher lens thickness (P < 0.001) and shorter axial length (P < 0.001). CONCLUSIONS: In the rural Central Indian population, a shallow anterior chamber was associated with higher age, female gender, short body stature, hyperopia, thick lens and shorter axial length. Compared with population-based data from East Asia (China), the anterior chamber was markedly deeper in India. The data may be helpful to explain anatomic relationships of the anterior segment of the eye, to elucidate risk factors of angle-closure glaucoma and to explain ethnic differences in the prevalence of angle-closure glaucoma.

Unique Case of Spontaneous Basilar Artery Stroke in an Operated Child with Craniopharyngioma.

Craniopharyngiomas are the most commonly presented nonglial tumors in child patients. They cause significant morbidity and mortality, both before and after surgery. The most common immediate postsurgery complications are attributable to pituitary insufficiency. Neurovascular complications account for only 2.7 to 2.9% surgical cases, and usually involve the vessels of the Circle of Willis. Thrombosis or vasospasm of the vessels of posterior circulation is unheard of. Here, we are reporting a unique case of a child with craniopharyngioma who developed acute spontaneous basilar artery thrombosis and posterior circulation stroke 6 days after surgery.

"PTFE Sleeve Graft" Technique to Remove Neurovascular Conflict in Micro Vascular Decompression for Trigeminal Neuralgia.

Background: Microvascular decompression (MVD) of the trigeminal nerve is a well-accepted nondestructive procedure for trigeminal neuralgia. Usually, Teflon (PTFE) puff or felt graft techniques, which are most commonly used, are associated with arachnoiditis and recurrence among other complications. We use the "sleeve graft" technique using PTFE to separate the neurovascular conflict and here we describe our experience with the same in 376 cases. Objectives: To study the outcomes in 376 patients treated with sleeve graft technique for trigeminal neuralgia. Materials and Methods: For a period of 18 years, from 2002 to 2020, all cases of medically refractory trigeminal neuralgia were subjected to the "sleeve graft" technique for MVD. Pre- and post-operatively, pain score was given according to Barrow Neurological Institute pain intensity score. Cases were observed for any complications and pain relief in short and long-term follow-up. Results: In total, 376 cases of refractory primary trigeminal neuralgia cases, among which 198 patients underwent MVD with no prior intervention, 158 underwent MVD following percutaneous ablative procedure, 13 were "Revision MVD" previously done at other centers, and four were post gamma knife failure. There was no incidence of arachnoiditis or recurrence of symptoms. Further, 368 (97.8%) patients had complete recovery from symptoms while eight (2.2%) had partial recovery after 5 years of follow-up. Complications included hearing loss (n = 1), temporary hypoesthesia (n = 45), and permanent hypoesthesia (n = 7). Conclusion: "PTFE Sleeve Graft" technique to remove the neurovascular conflict in micro vascular decompression (MVD) for trigeminal neuralgia is a safe and effective technique that yields better results.

Corneal refractive power and its associations with ocular and general parameters: the Central India Eye and Medical Study.

PURPOSE: To investigate the normal distribution of corneal refractive power (CRP) and its associations with other ocular and systemic parameters in the Central Indian population. DESIGN: Population-based study. PARTICIPANTS: 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. METHODS: A detailed ophthalmic and medical examination was performed. Horizontal and vertical CRP were measured using a non-automatic keratometer. MAIN OUTCOME MEASURES: Corneal refractive power. RESULTS: After excluding pseudophakic or aphakic eyes, keratometric measurements were available on 9024 eyes of 4617 study participants (98.0%) with a mean age of 49.1±13.2 years (range, 30-100 years) and a mean refractive error of -0.20±1.52 diopters (D). Mean horizontal CRP was 44.60±1.68 D (mean ± standard deviation; range, 36.5-52.0 D), and vertical CRP was 44.62±1.74 D (range, 37.75-52.0 D) with no significant difference between both parameters (P=0.27). In multivariate analysis, CRP was significantly (P < 0.001) associated with the systemic parameters of increasing age (P < 0.001), lower level of education (P=0.02), and lower body height (P < 0.001), and with the ocular parameters of thinner central corneal thickness (P < 0.001), deeper anterior chamber (P < 0.001), shorter axial length (P < 0.001), and myopic refractive error (P < 0.001). The results remained unchanged if eyes with CRP ≥48 D were excluded. CONCLUSIONS: Horizontal CRP increased with higher age, lower level of education, lower body height, thinner central cornea, deeper anterior chamber, shorter axial length, and myopic refractive error. The association with age may be of importance for refractive surgery. The association of a steeper cornea with a shorter body stature and a shorter axial length parallels an association between shorter body length and shorter axial length without association with refractive error. The association among steeper cornea, shorter body length, and lower educational level complements the association between shorter body length and lower educational level. The correlation between steeper cornea and deeper anterior chamber may be explained geometrically.

Comparative Evaluation of Clinical and Radiological Outcomes of Retromandibular Transparotid and Transoral Endoscopic-Assisted Approach for Surgical Management of Mandibular Subcondylar Fractures.

STUDY DESIGN: A prospective randomized comparative study was conducted to evaluate the clinical and radiological outcomes of the retromandibular transparotid (RMT) approach with endoscopic-assisted transoral (ENDO) approach used for open reduction and internal fixation (ORIF) of adult mandibular subcondylar fractures. OBJECTIVES: To evaluate and compare the primary functional outcome using the Helkimo's dysfunction index, the surgical ease, the incidence of facial nerve weakness, the cosmetic outcomes and the number of complications following ORIF of mandibular subcodylar fractures using the RMT and ENDO approaches. METHODS: In this prospective study, 20 patients with unilateral/bilateral subcondylay fractures requiring ORIF were recruited between 2017 and 2018. Patients were randomly divided into RMT and ENDO group, 10 patients in each. Clinical and radiological assessment was done preoperatively and in postoperative period it was done at different intervals over the period of 6 months. The intraoperative parameter time taken during surgery was correlated for association with the time elasped since day of trauma and with the fracture severity. Similarly, the presence of multiple fractures of the mandible and postoperative occlusion were evaluated for the association. RESULTS: Comparable functional results were noted in both groups without any statistical significance. ORIF in ENDO group proved to be more time-consuming. For the RMT group, visible scars were rated best or close to best at the end of 6 months but a greater number of facial nerve injuries were reported in the RMT group. CONCLUSIONS: Superiority of one approach over others cannot be established since the outcomes were not statistically different. However, the ENDO approach appears to be safer. Therefore, there is a need for the development of innovative armamentarium which would improve the dexterity and ease of the surgeon and hence the total time taken for this minimally invasive approach for the management of subcondylar fracture.

Central corneal thickness and its association with ocular and general parameters in Indians: the Central India Eye and Medical Study.

PURPOSE: To evaluate the distribution of central corneal thickness (CCT) and its associations in an adult Indian population. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a rural region close to Nagpur in Central India; it included 4711 subjects (ages 30+ years) of 5885 eligible subjects (response rate, 80.1%). METHODS: The participants underwent a detailed ophthalmic and medical examination, including 200 standardized questions on socioeconomic background, lifestyle, social relations, and psychiatric depression. This study was focused on CCT as measured by sonography and its associations. Intraocular pressure was measured by applanation tonometry. MAIN OUTCOME MEASURES: Central corneal thickness and intraocular pressure. RESULTS: Central corneal thickness measurement data were available on 9370 (99.4%) eyes. Mean CCT was 514+/-33 microm (median, 517 microm; range, 290-696 microm). By multiple regression analysis, CCT was associated significantly with younger age (P<0.001), male gender (P<0.001), higher body mass index (P = 0.006), lower corneal refractive power (P<0.001), deeper anterior chamber (P = 0.02), thicker lens (P = 0.02), and shorter axial length (P = 0.006). Central corneal thickness was not associated significantly with refractive error (P = 0.54) or cylindrical refractive error (P = 0.20). If eyes with a corneal refractive power of 45 or more diopters were excluded, the relationship between CCT and axial length was no longer statistically significant (P>0.05), whereas all other relationships remained significant. Intraocular pressure readings increased significantly (P<0.001) with both higher CCT and higher corneal refractive power. CONCLUSIONS: Indians from rural Central India have markedly thinner corneas than do Caucasians or Chinese, and, as in other populations, CCT is greater in men. CCT was associated with younger age, higher body mass index, lower corneal refractive power, deeper anterior chamber, thicker lens, and shorter axial length. Intraocular pressure readings were associated with CCT, with high readings in those eyes that had thick corneas or steep corneas. Central corneal thickness and steepness of the anterior corneal surface may thus both have to be taken into account when applanation tonometry is performed. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Refractive error in central India: the Central India Eye and Medical Study.

OBJECTIVE: To evaluate the refractive error and its associations in the adult population of rural Central India. DESIGN: Population-based study. PARTICIPANTS: The Central India Eye and Medical Study is a population-based study performed in a markedly rural region in Central India. It included 4711 subjects (aged 30 years or older) of 5885 eligible subjects (response rate, 80.1%). METHODS: The participants underwent a detailed ophthalmic and medical examination, including standardized questions on the socioeconomic background, lifestyle, and social relations. This study was focused on the refractive error, the prevalence of hyperopia and myopia, and its factors. MAIN OUTCOME MEASURES: Refractive error. RESULTS: After exclusion of pseudophakic or aphakic eyes, 9076 (96.3%) eyes of 4619 (98.0%) subjects (2472 females) were included into the study. The mean refractive error was -0.20+/-1.51 diopters (D). Myopia of more than -0.50 D, -1.0 D, more than -6.0 D, and more than -8 D occurred in 17.0+/-0.6%, 13.0+/-0.5%, 0.9+/-1.4%, and 0.4+/-0.1% of the subjects, respectively. Hyperopia of more than 0.50 D was detected in 18.0+/-0.6% of the subjects. Refractive error was associated significantly (i.e., became more hyperopic) with lower age (P<0.001), lower best-corrected visual acuity (P<0.001), lower corneal refractive power (P<0.001), and shorter axial length (P<0.001). In multivariate analysis, refractive error was not significantly associated with the level of education (P = 0.56). High myopia (>-8 D) was associated significantly with male gender (P = 0.03) and lower best-corrected visual acuity (P<0.001). Mean anisometropia was 0.41+/-1.02 D. It was associated significantly with age (P<0.001), myopic refractive error (P<0.001), and lower best-corrected visual acuity (P<0.001). The mean astigmatic error was 0.29+/-0.60 D and was associated significantly with higher age (P<0.001), level of education (P = 0.01), lower best-corrected visual acuity (P<0.001), and higher corneal refractive power (P<0.001). CONCLUSIONS: The rural population of Central India has not experienced a myopic shift as described for many urban populations at the Pacific Rim. Correspondingly, the relatively low level of education was not associated with myopia. Urbanization may be a major factor for myopization. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Ocular axial length and its associations in an adult population of central rural India: the Central India Eye and Medical Study.

PURPOSE: To investigate the normal distribution of axial length of the globe, which is a major measurement of the eye, and its associations with other ocular and systemic parameters. DESIGN: Population-based study. PARTICIPANTS: 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) of 5885 eligible individuals (response rate, 80.1%). METHODS: A detailed ophthalmic and medical examination was performed. The axial length was measured sonographically. MAIN OUTCOME MEASURES: Axial length. RESULTS: Axial length measurements were available on 4698 study participants (99.7%). Their mean age was 49.4+/-13.4 years (range, 30-100 years), and the mean refractive error was -0.18+/-1.48 diopters (range, -20.0 to +7.25 diopters). Mean axial length was 22.6+/-0.91 mm (range, 18.22-34.20 mm). In multivariate analysis, axial length was significantly (P<0.001) associated with the systemic parameters of increased age, taller body height, greater body mass index, and higher level of education, and with the ocular parameters of lower best-corrected visual acuity, lower corneal refractive power, deeper anterior chamber, thicker lens, and more myopic spherical power and cylindrical refractive power. Within the highly myopic group, as defined by an axial length that exceeded 26.5 mm, none of these associations (except for the association between axial length and spherical refractive power) were statistically significant (P>0.15) in univariate or multivariate analysis. CONCLUSIONS: In a rural population of central India, the mean ocular axial length was 22.6+/-0.91 mm, which was shorter than that of other populations. Axial length was associated with the systemic parameters of increased age, taller body height, greater body mass index, and a higher level of education, and with the ocular parameters of lower best-corrected visual acuity, lower corneal refractive power, deeper anterior chamber, thicker lens, and more myopic spherical and cylindrical refractive power. These associations were valid only for those eyes that were not highly myopic, whereas axial length was associated with refractive error only in highly myopic eyes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Body height and ocular dimensions in the adult population in rural Central India. The Central India Eye and Medical Study.

BACKGROUND: To investigate associations between anthropomorphic parameters and ocular dimensions in a typical rural society untouched by the effects of urbanization. METHODS: The Central India Eye and Medical Study performed in rural Central India included 4,711 participants aged 30 or more years. The participants underwent a detailed ophthalmic and medical examination. RESULTS: After controlling for age, gender, level of education, and body mass index (BMI), taller subjects were more likely to have larger eyes with a longer axial length (+0.23 mm for each 10 cm increase in height), lower corneal refractive power (-0.50 diopters for each 10 cm increase in height), deeper anterior chambers (+0.03 mm for each 10 cm increase in height), and longer vitreous cavity (+0.20 mm for each 10 cm increase in height). Central corneal thickness (P = 0.97) and lens thickness (P = 0.08) were not significantly associated with body height. After controlling for age, gender, level of education and height, subjects with a higher BMI had shorter globes (-0.02 mm for each unit increase in BMI), flatter corneas (-0.03 diopters for each unit increase in BMI) and thicker corneas (+0.49 µm for each unit increase in BMI), thicker lenses and longer vitreous cavities. Body height as compared with the BMI had a stronger influence on the ocular biometric data. After correcting for age, gender, level of education and axial length, for each increase in body height by 10 cm or for each increase in BMI by one unit, the refractive error significantly increased by 0.23 diopters (P < 0.001) and by 0.40 diopters (P < 0.001) respectively. CONCLUSIONS: In the rural population of Central India without urbanization-associated myopization, body height and size of the eye were associated with each other: taller subjects had larger eyes with a flatter cornea. An increase in body height per 10 cm was associated with an increase in anterior chamber depth by 1% and an increase in vitreous cavity length by 1%. Subjects with a higher body mass index had shorter eyes, flatter and thicker corneas, and thicker lenses. Taller subjects and subjects with a higher BMI were more hyperopic. Since the occurrence of some ocular diseases depends on eye size and refractive error, the results may be helpful for screening examinations and for elucidating pathogenic associations.