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Background: The posterior ethmoid sinuses have a complex anatomy and a highly variable normal structure. The posterior ethmoid Onodi cell needs careful assessment because of its proximity to the optic nerve and the internal carotid artery canal. Recognising the distinctions is essential for optimal pre-op preparation. Sphenoid sinus surgery can now be performed without worrying about compromising vital structures like the internal carotid artery or optic nerve. Preoperative radiological assessment is a quick and easy way to check for ethmoid cell pneumatisation differences. Aim and objectives: To determine the pneumatisation patterns of Onodi cells among the North-East Indian population using 16-slice multidetector computed tomography (MDCT). Results: Nine-hundred MDCT paranasal sinuses were analysed over a period of 0–2 years, out of which 220 cases showed the presence of Onodi cell. Type I were 89 cases (40.45%, CI 32.00–48.90), Type II were 128 cases (58.18%, CI 49.72–66.63), and 3 cases with Type III cell (1.36%, CI 0.18–2.54). Conclusion: The most prevalent pneumatisation pattern is Type II. The pneumatisation patterns of Onodi cells can be best detected and evaluated by multiplanar MDCT imaging. Sinus surgeons need a firm grasp of pneumatisation patterns to avoid damaging the optic nerve and internal carotid artery canal during operations. [ABSTRACT FROM AUTHOR]

Background: Optic nerve sheath diameter (ONSD) is an emerging non-invasive, easily accessible, and possibly useful measurement for evaluating changes in intracranial pressure (ICP). The utilization of bedside ultrasonography (USG) to measure ONSD has garnered increased attention due to its portability, real-time capability, and lack of ionizing radiation. The primary aim of the study was to assess whether bedside USG-guided ONSD measurement can reliably predict increased ICP in traumatic brain injury (TBI) patients. Methods: A total of 95 patients admitted to the trauma intensive care unit was included in this cross sectional study. Patient brain computed tomography (CT) scans and Glasgow Coma Scale (GCS) scores were assessed at the time of admission. Bedside USG-guided binocular ONSD was measured and the mean ONSD was noted. Microsoft Excel was used for statistical analysis. Results: Patients with low GCS had higher mean ONSD values (6.4±1.0 mm). A highly significant association was found among the GCS, CT results, and ONSD measurements (P<0.001). Compared to CT scans, the bedside USG ONSD had 86.42% sensitivity and 64.29% specificity for detecting elevated ICP. The positive predictive value of ONSD to identify elevated ICP was 93.33%, and its negative predictive value was 45.00%. ONSD measurement accuracy was 83.16%. Conclusions: Increased ICP can be accurately predicted by bedside USG measurement of ONSD and can be a valuable adjunctive tool in the management of TBI patients. [ABSTRACT FROM AUTHOR]

Background: Retinal vein occlusion (RVO) is one of the most common causes of retinal vascular disease, second to diabetic retinopathy. We aimed to compare the lamina cribrosa thickness(LCT) of patients with unilateral branch RVO(BRVO) versus healthy individuals. Materials and Methods: This was a hospital‑based, prospective, cross‑sectional, and comparative study. Participants were newly diagnosed RVO cases (n = 25) and apparently normal age‑matched healthy controls (n = 25). All the participants underwent systemic and comprehensive ophthalmic examination, including refraction and enhanced depth imaging optical coherence tomography. Relevant parameters were compared between the groups using the independent t‑test. Statistical significance thresholds were set at a P < 0.05. Results: The mean age of cases (66.7% female) and controls (52% female) was 55.9 ± 7.4 and 59.4 ± 7.0 years, respectively, (P = 0.089). The mean LCT of the affected eyes in cases (176.6 ± 28.3 µm) was significantly lower compared to the unaffected eyes of cases(200.6 ± 33.1 µm, P= 0.008) and control eye (230.9 ± 36.9 µm, P= 0.001). Conclusions: A thinner lamina cribrosa (LC) was observed in both eyes of unilateral RVO patients compared with healthy, nonglaucomatous subjects’ eyes. The role of LCT as a local mechanical factor in the pathogenesis of BRVO and their relationship to systemic factors merits further investigation. [ABSTRACT FROM AUTHOR]

Background: In India and other developing nations, traumatic brain injuries (TBIs) are main cause of disability, socioeconomic loss, morbidity, and mortality. In patients with TBI, Rotterdam CT score (RCTS) and diameter of optic nerve sheath (ONSD) have both been reliable independent predictors of prognosis. ONSD measurement has become a substitute non-invasive technique for keeping track of intracranial pressure (ICP). Aims and Objectives: The aims of this study were to study correlation between ONSD and RCTS in predicting outcome and prognosis in patients with traumatic brain injury. Materials and Methods: Total 90 patients with TBI were included in study. All patients meeting inclusion criteria were included and CT scan was performed. RTCS was done based, on which patients were divided into two groups (mild and severe head injury). According to standard protocol, ONSD was measured. Results: Among 90 cases included that most common cause of injury was motor vehicle accident (72.2%). Mean ONSD in the present study was 4.37±0.84 mm. About 57 (63.3%) patients had RCTS score of 1, 2, and 3 (mild head injury) and 33 (36.7%) had RCTS score of 4, 5, and 6 (severe head injury). Cutoff value of ONSD for predicting severity of TBI derived from receiver operating characteristic curve was >4.4 mm. There is a positive correlation between ONSD and RCTS. Conclusion: CT ONSD is a useful radiological tool to identify elevated ICP and it should be noted in every CT report in TBI cases. [ABSTRACT FROM AUTHOR]

Background: Cavernous sinus syndrome (CSS) consists of a variable combination of involvement of the 3rd-to-6th cranial nerves. The etiologies vary across studies, and it has a significant impact on the outcome. This study was done to delineate the etiology, clinico-radiological profile and outcome of CSS. In this prospective study, patients were recruited consecutively over 2 years, and were followed up for at least 6 months. MRI of the brain and orbit with contrast was done, and other relevant investigations were performed to arrive at a specific etiology. Tolosa-Hunt Syndrome (THS) was defined in accordance with the second edition of the International Classification of Headache Disorders (ICHD-II). Results: Of the 92 patients studied, THS was the predominant diagnosis, followed by Tuberculosis, fungal infection, aneurysm, neoplastic and Sjögren's syndrome. Cranial nerves commonly involved were 3rd, 4th, 6th and 5th. The optic nerve was affected in 54.3% of patients. The non-THS patients showed the greater occurrence of proptosis, complete ophthalmoplegia, involvement of optic nerve and cranial nerves 7th–10th. Nasal blockage was present in fungal infection. MRI revealed more frequent involvement of orbit in non-THS cases. Bony erosions, ICA narrowing, intracranial extension and involvement of paranasal sinus were seen in fungal infection and neoplasm. THS patients improved with corticosteroid therapy, although, there was recurrence in 8 patients. Conclusions: THS and tuberculosis were the most common cause of CSS. Clinical and radiological features were useful in distinguishing among the etiologies. Most of the patients responded to treatment, although, recurrence was seen in THS. [ABSTRACT FROM AUTHOR]

Purpose: The present study aimed to assess the changes in optic disc and peripapillary retinal nerve fiber layer (RNFL) parameters in myopic patients and its correlation with axial length (AL) and spherical equivalent (SE) using optical coherence tomography (OCT).Methods: This was a cross-sectional study carried out from August 2019 to September 2021 in the ophthalmology department of a tertiary care hospital in eastern India. Myopic patients in the age group of 20-40 years and SE between - 0.5 to - 10 Diopters (D) were included in the study. Patients were divided into two groups on the basis of degree of myopia and AL. Appropriate statistical analysis was done at the end of the study period.Results: The study included 307 eyes of 307 myopic patients. There were 181 females (58.96%) and 126 males (41.04%). The mean age of the patients enrolled for the study was 28.78 ± 5.76 years. Statistically significant difference (P < 0.001) was found between SE and AL in between the subgroups of A and B. With every 1 D increase in SE, the average peripapillary RNFL thickness decreased by 0.61 μ while with every 1 mm increase in AL, the average peripapillary RNFL thickness was found to reduce by 1.03 μ.Conclusion: Analysis of optic nerve head parameters and RNFL thickness by OCT for the diagnosis should be compared with a normative control group that has been matched for refractive error and AL instead of comparison with a normative database that has only been age matched. [ABSTRACT FROM AUTHOR]

Introduction: Adverse neurologic outcomes following cardiac surgery can be catastrophic to the patient, next of kin, healthcare facility and community at large. Ultrasonographic measurement of Optic Nerve Sheath Diameter (ONSD) has emerged as a promising modality to reflect Intracranial Pressure (ICP) and neurological status in various neurological settings. Aim: To explore ONSD as a tool to reflect ICP changes and predict neurologic outcomes in a cardiac surgical perioperative setting during Cardiopulmonary Bypass (CPB). Materials and Methods: This was an open-label, prospective and observational study conducted in Department of Anaesthesia, Command Hospital, Karnataka, India, from June 2016 to July 2018. All patients aged between 15 and 80 years who underwent open heart surgeries irrespective of gender, primary diagnosis and preoperative American society of Anaesthesiologist's Physical Status (ASA PS) grade were enrolled in the study. Serial ultasonographic ONSD of both eyes in two planes (viz. sagittal and transverse) were acquired by a single observer at the following time intervals: baseline (prior to general anaesthesia induction, immediately postintubation, and every 15 minutes interval during CPB (until 150 minutes or end of the CPB whichever was earlier). Postoperative neurologic reassessment was done at 6 hours/postextubation (whichever earlier), at 24 hours and after 7 days, postoperatively. Continuous variables were compared using the student t-tests, while Chi-square or Fisher'sexact test was used to compare categorical variables. To assess inter-rater reliability for categorical variables, the Cohen's Kappa statistic was used. Results: The mean age of the study cohort was 56.30±11.42 years. A slight male preponderance (56%) was observed. With regards to mean of total CPB time, it was insignificantly higher in patients with adverse neurologic outcomes as compared to those without adverse neurological outcomes (165.83±53.61 minutes vs. 121.36±21.41 minutes; p-value=0.098). Patients with adverse neurologic outcomes had significantly higher ONSD (average of both planes) on CPB from 60 minutes through 150 minutes/end of CPB timeline for right eye (p-value < 0.001), left eye (p-value <0.001), and both eyes (p-value <0.001). For patients with ONSD value (average of both eyes in both planes of each eye) ≥5.5 mm had more likelihood to develop adverse neurologic outcomes, postoperatively. With respect to maximum ONSD anytime during CPB (average of both eyes in both planes of each eye), an arbitrary cut-off of ≥5.5 mm showed a sensitivity of 100%, specificity of 95%, diagnostic accuracy of 100%, and predictive value of 100% with significant p-value of <0.001. Conclusion: Serial ultrasonographic ONSD measurement is assuredly a promising tool to monitor elevated level of ICP as well as a good predictor for the assessment of major adverse neurologic outcomes secondary to open heart cardiac surgeries. [ABSTRACT FROM AUTHOR]

Introduction: As glaucoma is one of the leading causes of blindness, its early diagnosis is crucial. Standard Visual Fields (VF) examinations are used in the diagnosis and follow-up of glaucoma, but the major drawback is that the abnormalities do not appear until 20-40% of ganglion cells are lost. Defects in the Retinal Nerve Fiber Layer (RNFL), measured by Optical Coherence Tomography (OCT), is an excellent objective and quantitative method in the diagnosis and management of glaucoma at earlier stages. Aim: To assess the ability of OCT in diagnosing early glaucomatous changes using RNFL, Optic Nerve Head (ONH) and macular thickness parameters. Materials and Methods: A hospital-based case control study was done for 18 months at Department of Ophthalmology, Sawai Man Singh (SMS) Hospital and Medical College, Jaipur, Rajasthan, India. Fifty patients meeting the inclusion criteria were evaluated in the study as case group. To compare the results with those of a normal population 50 age and sex matched subjects were included. Each subject underwent detailed ocular examination and RNFL, ONH and macular thickness parameters were measured using Spectral Domain (SD) OCT. The unpaired t-test was used to compare continuous variables and Chi-square test was used to compare categorical variables. The Area Under the Curve (AUC) with its 95% Confidence Interval (CI) was calculated. The p-value <0.05 was considered significant. Results: Fifty glaucoma or glaucoma suspect cases and 50 controls partcipated in the present study, i.e., 100 eyes in each group were studied. Mean RNFL thickness, superior thickness, inferior thickness and temporal thickness were significantly (p<0.05) lower among cases than controls. Cup area, cup/disc (C/D) area ratio, horizontal and vertical cup to disc ratio (CDR) were significantly (p=0.0001) higher among cases than controls. Vertically Integrated Rim Area (VIRA) was significantly (p<0.05) lower among cases (0.19±0.13) than controls (0.28±0.05). There was no significant (p>0.05) difference in disc area between cases and controls. All the macular thickness parameters were significantly (p<0.05) lower among cases than controls except fovea. Overall, ONH and macular thickness parameters had high sensitivity and specificity than RNFL parameters in glaucoma patients. Conclusion: The present study found that a combination of RNFL, ONH and macular thickness parameters improved the diagnostic accuracy of OCT in early detection of Primary Open Angle Glaucoma (POAG). [ABSTRACT FROM AUTHOR]

Background: India accounts for 20% of the global retinoblastoma (RB) burden. However, the existing data on RB1 gene germline mutations and its influence on clinical decisions is minimally explored. Methods: Fifty children with RB underwent complete clinical examination and appropriate multidisciplinary management. Screening of germline RB1 gene mutations was performed through next-generation sequencing and Multiplex Ligation-dependent Probe Amplification (MLPA) analysis. The mutation and non-mutation groups were compared for clinical parameters especially severity, progression and recurrence. Results: Twenty-nine patients had bilateral RB (BLRB) and 21 had unilateral RB (ULRB). The genetic analysis revealed 20 RB1 variations in 29 probands, inclusive of 3 novel mutations, known 16 mutations and heterozygous whole gene deletions. The mutation detection rate (MDR) was 86.2% in BLRB and 19% in ULRB. Associations of disease recurrence (p = 0.021), progression (p = 0.000) and higher percentage of optic nerve invasion, subretinal seeds and high-risk pathological factors were observed in the mutation group. Clinical management was influenced by the presence of germline mutations, particularly while deciding on enucleation, frequency of periodic follow up and radiotherapy. Conclusions: We identified novel RB1 mutations, and our mutation detection rate was on par with the previous global studies. In our study, genetic results influenced clinical management and we suggest that it should be an essential and integral component of RB-care in India and elsewhere. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to investigate the optic disc morphology in primary angle-closure glaucoma (PACG) versus primary open-angle glaucoma (POAG) in South Indians.Methods: A total of 60 patients (60 eyes) with PACG and 52 patients (52 eyes) with POAG were included in a cross-sectional observational study. The glaucoma diagnosis was based on a glaucomatous appearance of the optic disc correlating with visual field defects. The glaucoma was graded as early, moderate, or severe, depending upon perimetric loss. All patients underwent an ophthalmic evaluation, including visual field examination and planimetric analysis of 30° stereoscopic color optic disc photographs.Results: The POAG and PACG groups did not differ significantly in a disc or rim area, rim width, and frequencies of disc hemorrhages or rim notches. However, early POAG group (n = 15) had a significantly deeper cup depth (P = 0.01), larger beta zone (P = 0.01), and a higher frequency of localized retinal nerve fiber layer (RNFL) defects (P = 0.02) than early PACG (n = 20).Conclusion: In the early stage of the disease, POAG compared to PACG may be characterized by deeper disc cupping, a larger beta zone of peripapillary atrophy, and a higher frequency of localized RNFL defects. Such differences in early glaucoma may suggest differences in pathophysiology in POAG and PACG. [ABSTRACT FROM AUTHOR]

Introduction: Glaucoma is the group of acute and chronic multifactorial condition where lowering IOP is the mainstay of the treatment in the patients, but despite of all effort progression of disease is inevitable. The prevalence of primary open angle glaucoma (POAG) in India is 1.62% and increasing with age, where 98.5% were not even aware of the disease. In our study, we assessed the outcome of trabeculectomy using retinal nerve fiber layer (RNFL) thickness measurements and clinical parameters. Material and Method: Twenty seven patients of primary open angle glaucoma undergoing trabeculectomy were included. Ophthalmological examinations including best corrected visual acuity, pupils and anterior segment evaluation, intraocular pressure, fundus and optic disc examination, perimetry and optic coherence tomography were performed preoperatively and 1 week, 1 month and 3 months postoperatively in each and every subject. Results: With mean age of 57.9 years, total of 18 male and 9 female patients were recruited. IOP was decreased by 43.85% from baseline but best corrected visual acuity was increased marginally after 3 months postoperatively. Optic nerve head parameters were improved significantly. Visual Field analysis showed that mean sensitivity and mean deviation were improved from 8.73±4.5493 and 19.044±4.6111 preoperatively to 9.859±5.5606 and 17.926±5.4928 dB postoperatively, respectively. Conclusion: Our data suggested that in early POAG, trabeculectomy provides good IOP control and clinical outcome with little complication rate under experienced hands. [ABSTRACT FROM AUTHOR]

This study reports findings from a 56-year-old patient, who had received bilateral intravitreal injection of putative adipose tissue-derived stem cells at a private clinic in India with the promise of treatment of NAION. During an observation period of 8, respectively, 18 months, the intravitreally injected cells remained silent in the vitreous bodies without either therapeutic effects or complications. The cells cleared with vitrectomy without evidence of integration in the optic nerve or retina. Contrary to recent reports on patients receiving intravitreal injections of similar putative stem cells with the aim of treating AMD, our patient suffered no devastating ocular consequences. Summary. Contrary to recent reports, this case demonstrated no devastating consequences of intravitreal injection of adipose tissue-derived stem cells during an observation period of up to 18 months. After vitrectomy, the cells cleared without evidence of either harm or integration. [ABSTRACT FROM AUTHOR]

Purpose: To analyze applications for blindness certificates to find causes of visual impairment (VI), handicap, and blindness in a tertiary hospital of Bihar.Methods: Applications for blindness certificates were analyzed over a two-year period. The main cause of blindness, visual handicap, and VI in these applications was ascertained by age group and etiology. VI disability percentages and definitions proposed by Governmen of India (category 0-4; 20-100%) were used to categorize and give percentage to all applicants. Results were compared with data from studies on blindness certificates and population based studies.Results: In total, 203 applicants were reviewed. Mean age was 23.5 ± 7.9 years. Overall, most common cause of visual handicap (40-100% impairment) and blindness (75-100% impairment) was macular pathology (P <.05), while most common cause of overall VI (20-100% impairment) was amblyopia. In age group 0-15 years, most common causes of blindness/visual handicap were congenital globe and hereditary retinal or optic nerve disorders (P = 0.016). In age group 16-30 years, macular pathology was the most common cause of visual handicap [P = 0.007], while amblyopia was the most common cause of VI [P = 0.00]. Between 31 and 45 years of age group, corneal scar in one eye was the most common cause of VI, while macular scar in both eyes was the most common cause of visual handicap. Glaucoma and diabetic retinopathy were the most common causes of blindness/visual handicap between 46 and 65 years and above 65 years of age, respectively. Data about causes of VI such as amblyopia, complicated cataract surgery, and one eyed blindness could not be ascertained by analyzing blindness certificate alone.Conclusion: Data from applications for blindness certificates provide valuable information regarding different causes of VI that might otherwise not be eligible for blindness certification and provide an insight into the overall trends in disease profile and service delivery. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is one of the most common neurodegenerative movement disorders and its incidence is increasing worldwide along with population aging. Previous clinical and histologic studies suggest that the neurodegenerative process, which affects the brain, may also affect the retina of PD patients. Objective: The objective of this study was to determine the thickness changes of retina nerve fibers and macular volume with optical coherence tomography (OCT) in PD patients. Materials and Methods: The spectral domain OCT was used to assess the thickness of retinal nerve fiber layer (RNFL) and macular volume from 34 PD patients and 50 healthy age-matched controls. Results: Compared with healthy age-matched controls, the RNFL thickness of PD patients was much thinner (P < 0.05) in all retinal quadrants, with temporal thinning being more than nasal thinning. Macular volumes were diminished in both perifoveal and outer macular regions in all sectors (P < 0.05) with preserved foveal volume. The degree of tissue loss corroborated with the severity of disease as objectively assessed by standardized rating scales (UPDRS). Conclusion: There is generalized retinal nerve degeneration in patients of PD and the degree of loss correlated with the severity and duration of disease. [ABSTRACT FROM AUTHOR]

Background: The peak incidence of traumatic brain injury (TBI) has been reported in children and young adults. Intracranial pressure (ICP) as an important component can be measured with invasive technique, whereas noninvasive measurement of optic nerve sheath diameter (ONSD) is increasingly becoming popular. Positive end-expiratory pressure (PEEP) has been found to affect ICP. We aimed to compare the effect of different values of PEEP on ONSD and to obtain the correlation with ICP measurement. Setting and Design: Neurointensive Care Unit, Trauma Center, AIIMS, New Delhi. Materials and Methods: Pediatric patients with TBI, of either gender, between 1 and 18 years of age in whom ICP was measured using intraparenchymal Codman catheter admitted in neurointensive care unit were enrolled. For this crossover study, the sequence of PEEP (0 or 3 or 5 cm H2O) was randomized and ONSD was measured. The mean of three ONSD values was taken as final value. Statistical Method: The ONSD, ICP, peak airway pressure, and hemodynamic parameters at various stages were compared using two-way repeated measures analysis of variance with Bonferroni correction. A P value of <0.05 was considered to be significant. Results: Ten patients (seven males, three females) participated in the study. There was no significant increase in ONSD values when PEEP was increased from 0 to 3 cm H2O. However, increase in PEEP values from 3 to 5 cm H2O showed significantly increased ONSD values. Conclusion: PEEP up to 3 cm H2O can be safely applied in pediatric patients following TBI. Further increment of PEEP might accentuate the ICP values. [ABSTRACT FROM AUTHOR]

Context: Optic nerve sheath diameter (ONSD) has long been accepted as a reliable proxy of intracranial pressure especially in critical care and bedside settings. The present consensus is to measure ONSD in both eyes and take average value, which is cumbersome and a potential cause of discomfort to the patient. Aim: We aim to compare the values of ONSD of the right and left eye in a random sample as measured by bedside ocular ultrasonography (USG) in Indian adults. Settings and Design: This was a prospective study conducted from September 2012 to March 2013 in the Department of Internal Medicine of a tertiary care hospital situated at moderate high altitude (11,500 ft) in India. Materials and Methods: Patients admitted with high altitude pulmonary edema (HAPE) were recruited by convenience sampling. The ONSD of both eyes were measured 3 mm behind the globe using a 7.5 MHz linear probe on the closed eyelids of supine subjects. Statistical Analysis: Analysis was done using SPSS 17.0. Results: A total of 47 patients of HAPE were recruited to the study with daily ONSD recording of both eyes during the admission period. The mean ONSD of the left eye was 4.60 (standard deviation [SD] = 0.71) whereas the mean ONSD of right eye 4.59 (SD = 0.72). The ONSD of the right eye and left eye was strongly correlated (correlation coefficient = 0.98 with P < 0.0001). The mean difference in the ONSD of both eyes (right-left) was -0.0044 (SD = 0.11) which was not statistically significant (P = 0.533). Conclusion: Our results suggest that the difference in ONSD of both eyes is not statistically significant in disease or health. This study also suggests that the ONSD of either eye can be predicted by the other eye recordings. Based on these findings, it can be suggested that during ocular USG for routine bedside/research purposes it is sufficient to measure ONSD of any of the one eye to save time and avoid discomfort to the patient. [ABSTRACT FROM AUTHOR]

The article describes the case of a female patient with bilateral symmetrical choroidal vitiligo. Topics discussed include symptoms experienced by the patient, results of the patient's medical examinations, characterization of choroidal vitiligo, the patient's medical history, and findings on the pattern and extent of choroidal hypopigmentation in the patient.

Purpose Of the Study: The purpose of this study was to report clinical features, neuroimaging, and visual outcome in pediatric optic neuritis (ON) in Indian population.Materials and Methods: This is a retrospective study of children up to the age of 16 years, diagnosed with ON, that presented at pediatric and neuroophthalmology clinic of a tertiary eye care center, in South India, within the period of 2010-2015.Results: We identified 62 eyes of 40 children diagnosed as ON within the study period. The mean age was 11.15 ± 3.24 years (1-15 years) with mean follow-up of 13 months. In this series, there was female preponderance (67%). Mean logarithm of the minimum angle of resolution visual acuity at presentation was 1.14 ± 0.93, which after treatment recovered to 0.10 ± 0.26 at final visit (P < 0.001). Involvement was bilateral in 22 children (55%) and recurrent in 3 eyes of 3 children. Preceding febrile illness was reported in seven cases (18%). Four (10%) cases were diagnosed as multiple sclerosis (MS), one with neuromyelitis optica , and one with acute disseminated encephalomyelitis. One case was associated with tuberculous meningitis, 1 with septicemia, and 1 with bilateral maxillary sinusitis. Neuroimaging studies of optic nerve in 14 children demonstrated isolated optic nerve enhancement. Magnetic resonance imaging brain revealed white matter T2 hyperintense lesions separate from optic nerve in ten cases, of which four cases were diagnosed as MS.Conclusions: Bilateral presentation was common, association with MS was low. Papillitis was more frequent than retrobulbar neuritis and prognosis was good in pediatric ON in Indian population. [ABSTRACT FROM AUTHOR]

Introduction: Intra Ocular Pressure (IOP) is fluid pressure within the eye, which ranges normally from 10-21 mmHg. Elevated IOP is the most important risk factor for the optic nerve damage. Leg press test is an exercise which lowers IOP. Aim: To evaluate the effect of IOP after leg press test in young males in Melmaruvathur, Tamil Nadu, India. Materials and Methods: The present cross-sectional study was conducted on 102 young male volunteers from Melmaruvathur Adhiparasakthi Institute of Medical Sciences (MAPIMS) in the age group of 18-27 years. The systolic blood pressure of subjects ranged from 110-124 mmHg and diastolic blood pressure ranging from 70-82 mmHg without having the habit of smoking, taking alcohol and without any eye infection were included in this study. We measured the height, weight and IOP before and after leg press test for the participants by using Schiotz tonometer. IOP measurements was analysed by mean and standard deviation, paired t-test was used to compare the two measurements. Results: Mean IOP of Right eye before leg press test was 16.17±3.08, after leg press test was 11.84±3.11 showing highly significant p<0.001. Mean IOP of Left eye before leg press test was 16.92±2.64, after leg press test was 12.65±3.45 showing highly significant p<0.001. Conclusion: Hence our study suggests that IOP of both eyes was decreased after leg press test. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including multiple sclerosis, neuromyelitis optica, and optic neuritis.

Purpose: The purpose of this study is to develop methods to identify glaucoma by examining the optic nerve head (ONH) of donor's eyes when information on the preexisting ocular disease is unavailable.Materials and Methods: The ONH of the donor's eyes was evaluated under a stereomicroscope for the cup-disc ratio (CDR) and focal retinal rim thinning. The vertical diameter of the cup and disc was also measured using a precalibrated eyepiece micrometer. The suspect eyes were subjected to histological analysis to confirm the presence of specific glaucomatous changes.Results: A total of 202 eyes from 119 donors (68 males and 51 females, aged 42-96) were evaluated for glaucoma. Among them, 190 (94%) eyes showing vertical CDR in the of 0.0-0.6 range were considered nonglaucomatous and the remaining eyes with >0.6 as glaucoma suspect. The calculated mean CDR of the two groups (0.3 ± 0.16, 0.62 ± 0.27) was highly significant (P = 0.0003). Of 12 eyes suspected of glaucoma, 7 eyes from 5 donors showed specific glaucomatous changes by histology. The prevalence of glaucoma was 4.2% among the donors studied.Conclusions: A simple method of screening fresh donor eyes for selecting those with glaucoma features using CDR and histological analysis was reported. This method helps to obtain biologically active human ocular tissue for glaucoma research on gene expression, ultrastructural/proteome changes, and outflow mechanism. [ABSTRACT FROM AUTHOR]

Background and Aims: The aim was to evaluate efficacy of optic nerve sheath diameter (ONSD) by ultrasound as a noninvasive method for detecting raised intracranial pressure (ICP) in intensive care unit, to compare with computed tomography/magnetic resonance imaging (MRI) findings of raised ICP and to prognosticate ONSD value with treatment. Materials and Methods: We conducted a prospective, observational study on 101 adults by including 41 healthy individuals in group A as control and 60 patients in group B admitted with fever, headache, vomiting, and altered sensorium. We examined them in supine position using 10 MHz linear array probe on closed eyelid. ONSD was measured 3 mm behind the globe in each eye. A mean binocular ONSD > 4.6 mm in female and 4.8 mm in male was considered abnormal. Midline shift, edema, effacement or ONSD > 5.0 mm on T2 MRI suggestive of elevated ICP was used to evaluate ONSD accuracy. Results: Group A mean ONSD was 4.6 mm in females and 4.8 mm in males. Group B mean ONSD for 17 females was 5.103 ± 0.6221 mm (P = 0.002) and for 43 males 5.081 ± 0.5799 mm (P = 0.032). Radiological sign of raised ICP was confirmed in 35 patients (females = 11 and males = 24) with high ONSD value. Sensitivity of detecting raised ICP by ONSD was 84.6% in females and 75% in males while specificity was 100% in both genders. Out of 25 patients without radiological signs of raised ICP 10 patients showed high ONSD (females = 4.735 mm and males = 4.907 mm). ONSD was well prognosticated with treatment modalities. Conclusion: Bedside ocular ultrasonography for measuring ONSD can be used an early test for diagnosing raised ICP as it is a noninvasive, cost effective bedside test, which can be repeated for re-evaluation. [ABSTRACT FROM AUTHOR]

Introduction: Sphenoid sinus has got importance due to transsphenoid approach to the pituitary gland. This study is an attempt to know the variations in North Karnataka population, through cadaveric dissection and CT scan study. Objective: We want to study variations in sphenoid sinus and its percentage in North Karnataka population. Material and Methods: Endoscopic examination and dissection of sphenoid sinus was carried out in 30 cadavers (three female and 27 male) using 0°, 30°, 70° rigid nasal endoscopes. Sections were then made in the sagittal plane to confirm the anatomical findings and to take the necessary measurements with millimeter strips. Results: In six of cadavers pre-sellar, in four it was sellar and in 20 it was post-sellar while conchal type of sphenoid sinus was absent. The septa terminated on bone covering internal carotid artery (ICA) in seven cadavers while in two cadavers they terminated on the bone covering Optic nerve (ON). Findings of CT scan study were pre-sellar-8, sellar-14 and post-sellar-37 and in case of one subject left side sinus was conchal. Pneumatization of greater wing of sphenoid was observed in two sinuses, of pterygoid process in four sinuses and of anterior clinoid process in two sinuses. We also found onodi cell in one sinus. Conclusion: Sphenoid sinus shows various types of pneumatisation, and this place the sinus in close proximity to important neurovascular structures that are present around the sinus. Newer techniques are used to confirm surgical landmarks making these techniques very safe. [ABSTRACT FROM AUTHOR]

Aim: To provide the normative data of macular and retinal nerve fiber layer (RNFL) thickness in Indians using spectral domain OCT (Spectralis OCT, Heidelberg Engineering, Germany) and to evaluate the effects of age, gender, and refraction on these parameters. Design: Observational, cross-sectional study. Materials and Methods: The eyes of 105 healthy patients aged between 20-75 years, with no ocular disease and best corrected visual acuity of 20/20, were scanned using standard scanning protocols by a single examiner. Exclusion criteria included glaucoma, retinal diseases, diabetes, history of prior intraocular surgery or laser treatment. The mean macular and RNFL thickness were recorded, and the effects of age, gender, and refraction on these parameters were evaluated. This data was compared with published literature on Caucasians to assess the ethnic variations of these parameters. Results: The normal central foveal thickness in healthy Indian eyes measured using Spectralis OCT was 260.1 ± 18.19 µm. The nasal inner quadrant showed maximum retinal thickness (338.88 ± 18.17 µm).The mean RNFL thickness was 101.43 ± 8.63 µm with maximum thickness in the inferior quadrant. The central foveal thickness showed a gender-based difference (P = 0.005) but did not correlate significantly with age (P = 0.134), whereas the parafoveal, perifoveal thickness, macular volume, and RNFL thickness showed significant negative correlation with age. Conclusions: Our study provides the normative database for Indians on Spectralis OCT. It also suggests that age should be considered while interpreting the macular thickness and RNFL, whereas gender should also be given consideration in central foveal thickness. [ABSTRACT FROM AUTHOR]

The bony orbits are skeletal cavities located on either side of the nose. Racial differences in orbital measurements are known. The aim of the present study was to determine the distances of various fissures and foramen in the orbit with reference to certain bony / surgical landmarks on the orbital margins in Indian population which can be useful during various surgical procedures. The distance of optic canal (OC), superior orbital fissure (SOF), inferior orbital fissure (IOF), lacrimal foramen (LF) were measured from landmarks like anterior lacrimal crest (ALC) for medial wall, supraorbital foramen/ notch (SON) for superior wall, fronto-zygomatic suture (FZ) for lateral wall and a point on inferior margin (IOM) just above the infraorbital foramen. Distance of anterior and posterior ethmoidal foramen (AEF and PEF) from ALC was measured. The incidence of middle ethmoidal foramen (MEF) and lacrimal foramen (LF) was noted. The mean distance of OC was 39.71 ± 2.67 mm (from ALC), 45.11 ± 3.4 mm (from SN), 45.97 ± 3.9 mm (from FZ) and 48.32 ± 2.8 mm (from IOM). The safe distance for optic nerve for each orbital wall was derived by subtracting 5 mm from the shortest measured distance [ABSTRACT FROM AUTHOR]

Abstract: Arsenic (As), lead (Pb) and cadmium (Cd) are the major metal contaminants of ground water in India. We have reported the toxic effect of their mixture (metal mixture, MM), at human relevant doses, on developing rat astrocytes. Astrocyte damage has been shown to be associated with myelin disintegration in CNS. We, therefore, hypothesized that the MM would perturb myelinating white matter in cerebral cortex, optic nerve (O.N.) and retina. We observed modulation in the levels of myelin and axon proteins, such as myelin basic protein (MBP), proteolipid protein, 2′-, 3′-cyclic-nucleotide-3′-phosphodiesterase, myelin-associated glycoprotein and neurofilament (NF) in the brain of developing rats. Dose and time-dependent synergistic toxic effect was noted. The MBP- and NF-immunolabeling, as well as luxol-fast blue (LFB) staining demonstrated a reduction in the area of intact myelin-fiber, and an increase in vacuolated axons, especially in the corpus-callosum. Transmission electron microscopy (TEM) of O.N. revealed a reduction in myelin thickness and axon-density. The immunolabeling with MBP, NF, and LFB staining in O.N. supported the TEM data. The hematoxylin and eosin staining of retina displayed a decrease in the thickness of nerve-fiber, plexiform-layer, and retinal ganglion cell (RGC) count. Investigating the mechanism revealed a loss in glutamine synthetase activity in the cerebral cortex and O.N., and a fall in the brain derived neurotrophic factor in retina. An enhanced apoptosis in MBP, NF and Brn3b-containing cells justified the diminution in myelinating axons in CNS. Our findings for the first time indicate white matter damage by MM, which may have significance in neurodevelopmental-pediatrics, neurotoxicology and retinal-cell biology. [Copyright &y& Elsevier]

Purpose: To study the clinical profile of serpiginous choroiditis in eastern India. Materials and Methods: Ninety-one eyes of 54 patients with serpiginous choroiditis presenting to a tertiary care centre in eastern India between January 2006 and December 2010 were included in the study. Clinical presentation, treatment given, and visual outcome of the eyes were studied. Results: Thirty-five (64.8%) patients were male and 19 (35.2%) were female in the age group of 13-62 years (mean age: 34.1 ± 18.7 years). Blurring of vision (71; 78%) and floaters (36; 39.5%) were commonest symptoms. In 75 (82.4%) eyes, choroiditis started from optic nerve head and spreading centrifugally. Overall, 38 (41.75%) eyes had macular involvement at first visit. Mantoux test reading was 10 mm or more (Group A) in 12 (22.22%) patients and less than 10 mm (Group B) in 42 (77.77%) patients. Difference between Groups A and B in macular involvement at first visit (10; 50% vs. 28; 39.4%) and rate of recurrence (3; 15% vs. 14; 19.7%) was not statistically significant (P = 0.37 and 0.68). Oral steroid (51; 94.4%) was the commonest mode of treatment. Fifty-one (56%) eyes had two lines or more improvement in vision. Conclusions: The present study details the clinical presentation, treatment, and visual outcome of serpiginous choroiditis. Mantoux test reading does not affect the clinical presentation or the treatment outcome in these eyes. [ABSTRACT FROM AUTHOR]

Background & Aims: Complications of preeclampsia include cerebral and pulmonary oedema which strongly correlate with optic nerve sheath diameter (ONSD) and lung ultrasound score (LUSS) respectively. This study was conducted to compare ONSD and LUSS in healthy and preeclamptic parturients. Methods: In this prospective observational analytical study, healthy pregnant women and preeclamptic women, 35 each, age >18 years and gestational age >34 weeks up to 24 hours of delivery, were included. Approval from institutional ethical committee was obtained and trial registered with clinical trial registry of India. Ultrasound assessment for ONSD and LUSS (12 region lung technique) was performed. Severity of preeclampsia was noted. Data was analysed using appropriate statistical tests. ROC analysis was performed to obtain a cutoff value for both ONSD and LUSS to predict complications of preeclampsia. A p-value of <0.05 was considered significant. Results: Of the 35 preeclamptic women, 19 had severe preeclampsia. Severe preeclamptics had higher ONSD and LUSS than mild preeclamptics and healthy parturients (p-value < 0.001). No difference was observed in LUSS between mild preeclamptics and healthy parturients. Mean ONSD of >4.65mm and LUSS of >2 predicted preeclampsia complications with a sensitivity of 77.14% and 68.57%, specificity of 91.43% and 85.71% and AUC of 0.907 and 0.806 respectively. Conclusion: ONSD and LUSS assessment is an easy, bedside, noninvasive technique to assess complications, guide fluid therapy and monitor response to treatment in preeclamptic parturients. Thus, early intervention can help in reducing maternal/fetal morbidity and mortality [ABSTRACT FROM AUTHOR]

Summary: Background: CT has evolved as the gold standard for evaluation of head injury, but early CT is not always possible. Bedside ultrasonography is available in most trauma units and optic nerve ultrasound (ONUS) examination should be feasible. Objective: To evaluate the role of ONUS for people with head injury. Setting: Tertiary care trauma service in a teaching hospital in a large metropolitan city in India. Design: Prospective, blinded, observational study. Methods: From April 2006 to January 2007, all adult patients with head injury but without obvious ocular trauma, for whom it was possible to perform CT, were enrolled. Using a 7.5-MHz ultrasonographic probe on the closed eyelids, optic nerve sheath diameter (ONSD) was measured on either side. A mean binocular ONSD less than 5.00mm was considered normal. Cranial CT findings were used as a reference standard to evaluate ONUS. Results: The study included 100 participants (72 men, 28 women, median age 28 years, median Glasgow Coma Scale score 11). Clinical features did not correlate with CT for signs of raised intracranial pressure (ICP). The mean binocular ONSD (5.8±0.57mm) was significantly increased among individuals with signs of raised ICP on CT compared with the mean ONSD (3.5±0.75mm) among those without such signs. ONUS revealed evidence of raised ICP in 74 cases (confirmed by CT in 72 cases), 59 of whom had significant intracranial haematoma needing surgical evacuation. Of the 26 cases with negative ONUS, confirmed by CT in 25 cases, only 1 needed surgical intervention for drainage of intracranial haematoma. ONUS was false positive for two and false negative for one person. The sensitivity of ONUS in detecting elevated ICP was 98.6%, specificity 92.8%, positive predictive value 97.26% and negative predictive value 96.3%. Conclusion: ONUS has potential as a sensitive bedside screening test for detecting raised ICP and the presence of intracranial haematoma needing surgical intervention in adult head injury. This can be of immense help for unstable patients, in mass casualty situations and in remote locations. [Copyright &y& Elsevier]

Purpose: To compare the confocal laser tomographic scanning evaluation with photographic measurements of the optic nerve head in a South Indian population.Methods: The prospective comparative clinical non-interventional epidemiologic study included 62 subjects (62 eyes) forming a population-based sample, selected randomly. Mean age was 47.2 +/- 8.9 years, mean refractive error measured was -0.17 +/- 1.10 diopter (range, - 4.50 to + 2.50 diopter). Confocal laser scanning tomographic images on Heidelberg Retina Tomograph (HRT) and colour optic disc photographs were morphometrically analysed and compared. Main outcome measures were morphologic optic disc parameters.Results: The optic disc area measurements were significantly smaller (p < 0.001) in the HRT technique than in the photographic method. In contrast, the HRT as compared to the photographic measurements showed significantly (p < 0.001) larger values for the relative width and relative area of the neuroretinal rim. The differences in measurements between both methods were maximum in the nasal part (p < 0.001) of the optic disc and minimum in the temporal disc region.Conclusion: In normal eyes of South Indians, neuroretinal rim measurements by the HRT and expressed as percentage of disc size measurements are significantly larger than rim measurements on disc photographs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the morphology of the optic nerve head in an unselected population group in south India. Methods: The study included 70 subjects forming a population based sample, selected in a random manner. Mean age was 47.5 (SD 8.7) years, mean refractive error measured -0.07 (1.11) dioptres (range -4.50 to +2.50 dioptres). Optic disc slides were morphometrically analysed. Results: Mean optic disc area measured 2.58 (0.65) mm². It was statistically independent of age and refractive error. Optic disc shape was slightly vertically oval. Mean neuroretinol rim area was 1.60 (0.37) mm². It was significantly and positively correlated with optic disc size and optic cup size. It was independent of age, sex, refractive error, and axial length. In all subjects included in the study, the rim was smallest in the temporal horizontal optic disc sector. Mean horizontal cup/disc diameter ratio (0.66 (0.07)) was significantly (p<0.001) higher than the mean vertical cup/disc diameter ratio (0.56 (0.08)). Both ratios were highly significantly (p <0.001) and positively correlated with optic disc size. The α zone of parapapillary atrophy (0.84 (0.29) mm²), and β zone (0.13 (0.38) mm²), respectively, occurred in 69 (98.6%) subjects and in eight (11.4%) subjects, respectively. They were significantly larger in the temporal horizontal sector. The α zone was significantly (p<0.001) larger and occurred significantly more often than β zone. Retinal arterioles and venules were wider, and in spatial correlation, the visibility of the retinal nerve fibre layer was significantly better, in the temporal inferior disc arcade and the temporal superior arcade than in the nasal superior arcade and the nasal inferior vessel arcade. Except for the absolute size measurements these optic nerve head parameters did not differ markedly (p >0.05) from the values found in white people. Conclusions: South Indians and white people do not show marked differences... [ABSTRACT FROM AUTHOR]

The article describes the case of a 10-year-old boy who showed progressive painless dimness of vision which was preceded by difficulty in reading and handwriting, difficulty in using the left side of the body, and continual falling over, and was later diagnosed with neurofibromatosis type 1 (NF1).

Purpose: The people of Northeast India comprise mostly of Mongoloid descent with characteristic craniofacial features. The purpose of this study was to evaluate the normal orbital structures with MRI and determine normative data in the Northeast Indian pediatric population., Methods: MRI images of the 302 orbits of 151 pediatric patients below 16 years of age were retrospectively evaluated to measure the various orbital structures. Both axial and coronal MRI images were utilized for various orbital measurements. An independent sample t-test was done to compare various orbital data according to the sex and side. Linear regression was also done., Results: The mean age of the pediatric population was 9.64 ± 1.47 years with a male: Female ratio of 1.13:1. The mean interzygomatic line was 88.4 ± 9.09 mm and the interorbital line was 22.18 ± 3.62 mm. The mean thicknesses of medial, lateral, superior, and inferior recti muscles were 2.58 ± 0.46, 2.34 ± 0.42, 2.16 ± 0.40, and 2.53 ± 0.49 mm in males and 2.41 ± 0.41, 2.08 ± 0.34, 2.08 ± 0.46, and 2.46 ± 0.49 mm in females. The mean horizontal orbital, vertical orbital diameters, orbital index, mean volume of eyeball, and orbital cavity were 30.27 ± 2.97,3 7.06 ± 3.57, 122.58 ± 7.39, 4.63 ± 0.84, and 15.29 ± 3.52 in males, while 29.16 ± 3.23, 34.96 ± 3.99,119.96 ± 7.31, 4.49 ± 0.87, and 14.65 ± 3.47 in females, respectively. With an increase in age, the interzygomatic line (r = 0.883, r 2 = 0.780; P < 0.0005), anterior medial interorbital line (r = 0.808, r 2 = 0.652; P < 0.0005), mean volume of eyeball (r = 0.915, r 2 = 0.838; P < 0.0005), orbital cavity (r = 0.924, r 2 = 0.854; P < 0.0005), and distance between the optic nerve entry site (r = 0.829, r 2 = 0.687; P < 0.0005) were increased., Conclusion: This study provides normative data of various orbital structures in a pediatric population and these data likely to be useful for diagnosing various pediatric orbital disorders and helps in the planning of various surgical procedures of orbits.

The article presents information on glaucoma which is defined as an optic neuropathy. According to estimates, there are more than 60 million cases of glaucoma worldwide. The ocular disorder can be classified as open-angle or closed-angle glaucoma. Therapeutic options include the use of drugs such as alpha-agonists and oral glycerol or intravenous mannitol.

Purpose: To report 15-year incidence rate and associated risk factors of pterygium among people aged 30 years and above at baseline in the rural clusters of longitudinal Andhra Pradesh Eye Disease Study (APEDS III)., Methods: The baseline APEDS I included 7771 participants of which 6447 (83%) were traced and 5395 (83.7%) were re-examined in APEDS III. To estimate the incidence of pterygium, we selected participants who were 30 years and above at baseline (4188), of which 2976 were traced and 2627 (88.3%) were examined, and based on inclusion criteria, 2290 participants were included in the study. The incidence rate of pterygium was defined as the proportion of people free of pterygium at baseline who had developed the condition at 15-year follow-up (range 13-17 years). Univariate and multivariable analyses for risk factors were undertaken., Results: The sex-adjusted incidence rate of pterygium was 25.2 per 100 person-years (95% CI 24.8 to 25.7) which was significantly higher for men than women (26.3 per 100 person-years (95% CI 25.6 to 27.0) and 24.7 (95% CI 24.1 to 25.3) respectively). At the multivariable analysis, male gender (RR: 1.35, 95% CI 1.0 to 1.83), no formal education (RR: 2.46, 95% CI 1.22 to 4.93), outdoor occupation (RR: 1.47, 95% CI 1.14 to 1.9) and lower body mass index (BMI) (<18.5) (RR: 1.25, 95% CI 1.02 to 1.55) were associated with increased risk of pterygium., Conclusions: The overall incidence rate of pterygium was high in this rural population, especially in men and those engaged in outdoor activities, lack of formal education and with lower BMI. It is likely that greater exposure to ultraviolet light is a major contributing factor, thus warranting preventive strategies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: This study aims to evaluate normal orbital structures with nonenhanced computed tomography (NCCT) and determine normative data for the Indian population., Methods: CT images of the orbits of 100 patients were retrospectively reviewed on a work station to record the normative data of the orbits. Clinical details of all patients were reviewed to ensure that they did not have ocular/orbital diseases. Both axial and coronal images were utilized to record the data., Results: The mean age of the population evaluated was 34.07 years, with male to female ratio of 1.77. The average orbital index for the left orbit was 97 and for the right side was 103. The mean thickness of left inferior rectus, lateral rectus, medial rectus, and the superior rectus was 3.36 mm, 3.14 mm, 3.80 mm, and 3.75 mm, respectively. The right inferior rectus, lateral rectus, medial rectus, and the superior rectus measured 3.46 mm, 3.14 mm, 3.83 mm, and 3.78 mm, respectively. The optic nerve sheath complex diameter varied between 3.05 mm and 7.17 mm for the left eye and 3.05 mm and 7.0 mm for the right eye., Conclusion: The study provides normative data on various orbital structures in an Indian population. This data is likely to be useful for diagnosing various orbital pathologies and in planning surgical orbital procedures., Competing Interests: None

Purpose: To determine the prevalence of congenitally abnormal disc (all anomalies) in an adult population in southern India., Methods: Subjects aged ≥40 years (n=6013) underwent a complete ophthalmic examination. Optic disc anomalies were diagnosed according to the definitions given in the article., Results: Optic disc anomalies were found in 81 eyes of 66 (1.1%, 95% CIs 0.00834 to 0.01361) patients. The prevalence of each anomaly in the descending order was peripapillary myelinated nerve fibre (0.28%), epipapillary glial tissue on the optic disc (0.28%), peripapillary vascular loops (0.16%), tilted disc (0.09%), optic disc coloboma (0.08%), optic nerve hypoplasia (0.04%), optic disc pit (0.04%), optic disc pigmentation (0.03%), optic nerve head drusen (0.03%), Bergmeister's papilla (0.03%), optic disc pit and coloboma (0.01%)., Conclusions: The prevalence of optic disc anomalies is 1.1% in the adult South Indian population., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

. Purpose: To determine the prevalence of myelinated retinal nerve fibers in the adult Indian population. Methods: The Central India Eye and Medical Study performed in rural Central India included 4711 participants aged 30+ years. The participants underwent a detailed ophthalmic and medical examination. Results: Readable fundus photographs were available for 8645 eyes of 4485 (95.2%) subjects. Myelinated retinal nerve fibers were detected in 52 eyes (46 subjects) with a prevalence rate of 0.58 ± 0.08 per 100 eyes [95% confidence interval (CI): 0.42, 0.74] and 1.03 ± 0.15 per 100 subjects (95%CI: 0.73, 1.32). Prevalence of myelinated retinal nerve fibers was significantly associated hyperopic refractive error (p = 0.008; OR: 1.31; 95%CI: 1.07, 1.59). It was not significantly associated with age (p = 0.11), best corrected visual acuity (logMAR; p = 0.33), intraocular pressure (p = 0.09), amount of nuclear cataract (p = 0.93), optic disc area (p = 0.60), presence of glaucomatous optic nerve atrophy (p = 0.62), and early age-related macular degeneration (p = 0.53). Conclusions: Myelinated retinal nerve fibers are present in about 10 out of 1000 adult Indians in rural Central India, with a higher prevalence in hyperopic eyes. Prevalence of myelinated retinal nerve fibers was not associated with age, visual acuity, glaucoma and macular degeneration. [ABSTRACT FROM AUTHOR]

Purpose: To determine optic disc size and its associations in an adult population in central India. Methods: The Central India Eye and Medical Study (CIEMS), Part 1 is a population-based, cross-sectional cohort study and included 1000 subjects out of 1314 (76.1%) subjects from a rural area of Maharasthra/India, aged 30+ years, invited to participate. Confocal laser scanning tomographic optic disc images were morphometrically examined. Results: Mean optic disc area (2.25 ± 0.51 mm2, range 1.12–4.61 mm2) was significantly correlated with myopic refractive error (p < 0.001) and axial length (p < 0.001), whereas gender (p = 0.14), body height (p = 0.44) and best corrected visual acuity (p = 0.59) were not significantly associated in multiple regression analysis. Conclusions: Mean optic disc area is larger in the central Indian population than in White people. Axial length and myopic refractive error are independent factors that influence optic disc size. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence, risk factors and the severity of visual loss caused by steroid-induced glaucoma (SIG) among children., Methods: Five-year records of all paediatric glaucoma cases presenting to the glaucoma services of our tertiary care centre were evaluated. Data of children presenting with SIG were recorded with respect to their visual acuity, highest baseline intraocular pressure, cup:disc ratio, perimetry and need of glaucoma filtering surgery. Parents were interviewed to assess the indication of steroid use, type of steroid used, person prescribing it and the duration of use. The prevalence of visual impairment was calculated based on WHO criteria., Results: Of 1259 cases of paediatric glaucoma presenting at our centre over 5 years, 59 children (4.7%) were diagnosed with SIG. Of these, 51 (87%) had been prescribed topical steroids for vernal keratoconjunctivitis (VKC). The median duration of steroid use was 18 months (range 1 month to 8 years). Also, 82% of children with VKC had been prescribed steroids by the treating ophthalmologist and 52% had been on topical steroids for >1 year. Glaucomatous optic neuropathy was the cause of blindness in 37.3% (22/59) and low vision in 23.7% (14/59) children. And 27% (16/59) were unilaterally blind at presentation., Conclusions: A third of the children presenting with SIG to our tertiary care centre were bilaterally blind at presentation. Ophthalmologists need to consider steroid-sparing agents to treat VKC and monitor these children closely for glaucoma if they prescribe topical steroids in order to prevent unnecessary childhood blindness., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)