Publications by authors named "Bahareh Kheiri"

40 Publications

Intraocular Pressure Changes in the Contralateral Eye After Glaucoma Surgery.

J Glaucoma 2021 Oct 11. Epub 2021 Oct 11.

Ophthalmic Research center, Research Institute for Ophthalmology and Vision Science and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Ophthalmology and Poostchi Ophthalmology Research Center, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran Department of Ophthalmology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Ophthalmic Research center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Prcis: Glaucoma surgery in one eye can result in significant IOP elevation in the fellow eye in a significant percentage of subjects. This effect is more pronounced following glaucoma drainage device implantation and in subjects developing post-operative hypotony in the first eye.

Purpose: To investigate the course and magnitude of intraocular pressure (IOP) changes in contralateral eyes following glaucoma surgery.

Patients And Methods: We studied 131 glaucoma patients undergoing surgery. IOP changes in fellow eyes and the number of glaucoma medications were recorded for 6 months. Both normal and glaucomatous fellow eyes were included. Patients on pre-operative acetazolamide were analyzed separately. IOP change ≥4▒mmHg or 20% increase from baseline values was considered significant.

Results: Baseline IOP in fellow eyes was 13.1±3.3▒mmHg which increased significantly at all time points with a peak at one week (mean increase: 3.1±3.2▒mmHg) gradually decreasing up to six months (mean increase 0.9±2.1▒mmHg). The number of fellow eyes with clinically significant IOP elevation at one day, one week, and 1, 3 and 6 months was 47, 76, 47, 31 and 37 showing mean IOP rise of 4.5±2.3 (38.5%), 5.4±1.8 (48.5%), 4.8±1.6 (44.2%), 3.7±1.3 (36.5%) and 3.2±1.3 (32.6%) mmHg, respectively. Medications were added to 18 fellow eyes (including 10 initially "normal" eyes) while 7 other fellow eyes required surgery.Significant IOP elevation in fellow eyes was associated with tube shunt surgery (P<0.008 at all time points), a diagnosis of glaucoma following cataract surgery, IOP ≤5▒mmHg on the first post-operative day (P=0.002) and use of pre-operative acetazolamide.

Conclusion: Glaucoma surgery was associated with IOP elevation in fellow eyes in a significant number of subjects and suggests that IOP in the unoperated eye should also be checked at post-operative visits.
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http://dx.doi.org/10.1097/IJG.0000000000001950DOI Listing
October 2021

Retinal Vascular Abnormalities in Different Types of Inherited Retinal Dystrophies Assessed by Optical Coherence Tomography Angiography.

J Curr Ophthalmol 2021 Apr-Jun;33(2):189-196. Epub 2021 Jul 5.

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To investigate the retinal vascular characteristics among patients with different types of inherited retinal dystrophies (IRDs).

Methods: This comparative cross-sectional study was conducted on 59 genetically confirmed cases of IRD including 37 patients with retinitis pigmentosa (RP) (74 eyes), 13 patients with Stargardt disease (STGD) (26 eyes), and 9 patients with cone-rod dystrophy (CRD) (18 eyes). Both eyes of 50 age- and sex-matched healthy individuals were investigated as controls. All participants underwent optical coherence tomography angiography to investigate the vascular densities (VDs) of superficial and deep capillary plexus (SCP and DCP) as well as foveal avascular zone area.

Results: In RP, significantly lower VD in whole image ( = 0.001 for DCP), fovea ( = 0.038 for SCP), parafovea ( < 0.001 for SCP and DCP), and perifovea ( < 0.001 for SCP and DCP) was observed compared to controls. In STGD, VD of parafovea ( = 0.012 for SCP and = 0.001 for DCP) and fovea ( = 0.016 for DCP) was significantly lower than controls. In CRD, the VD of parafovea ( = 0.025 for DCP) was significantly lower than controls. Whole image density was significantly lower in RP compared to STGD ( < 0.001 for SCP) and CRD ( = 0.037 for SCP). VD in parafovea ( = 0.005 for SCP) and perifovea ( < 0.001 for SCP and DCP) regions was significantly lower in RP compared with STGD. Also, foveal VD in STGD was significantly lower than RP ( = 0.023 for DCP).

Conclusion: Our study demonstrated lower VDs in three different IRDs including RP, STGD, and CRD compared to healthy controls. Changes were more dominant in RP patients.
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http://dx.doi.org/10.4103/joco.joco_11_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365577PMC
July 2021

Virtual Reality Game Playing in Amblyopia Therapy: A Randomized Clinical Trial.

J Pediatr Ophthalmol Strabismus 2021 May-Jun;58(3):154-160. Epub 2021 May 1.

Purpose: To compare the visual outcome of occlusion therapy with virtual reality game playing as a new therapy for children with amblyopia.

Methods: This randomized clinical trial was performed on 50 children between 4 and 10 years old who had unilateral amblyopia. They were randomly divided into virtual reality and patching groups (n = 25 in each). The virtual reality group was trained binocularly using the virtual reality games through a head set for 1 hour per day 5 days a week for 4 weeks. Patients in the patching group occluded their non-amblyopic eyes 2, 4, and 6 hours for mild (best corrected visual acuity [BCVA] 0.2 to 0.3 logarithm of the minimum angle of resolution [logMAR]), moderate (0.3 to 0.6 logMAR), and severe (worse than 0.6 logMAR) amblyopia, respectively.

Results: The mean BCVA based on logMAR units improved significantly in both groups ( < .0001), but the difference between the two groups was not significant ( = .59). BCVA based on the responded letters improved in both groups (virtual reality: = .0001, patching: = .001), and change in BCVA in the virtual reality group was higher than in the patching group ( = .002).

Conclusions: Virtual reality game playing was equal or superior to patching in an analysis of linear and letter BCVA, respectively. Therefore, applying this new amblyopia therapy is recommended. .
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http://dx.doi.org/10.3928/01913913-20210108-02DOI Listing
May 2021

Secondary Piggyback Intraocular Lens for Management of Residual Ametropia after Cataract Surgery.

J Ophthalmic Vis Res 2021 Jan-Mar;16(1):12-20. Epub 2021 Jan 20.

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To investigate the indications, clinical outcomes, and complications of secondary piggyback intraocular lens (IOL) implantation for correcting residual refractive error after cataract surgery.

Methods: In this prospective interventional case series, patients who had residual refractive error after cataract surgery and were candidates for secondary piggyback IOL implantation between June 2015 and September 2018 were included. All eyes underwent secondary IOL implantation with the piggyback technique in the ciliary sulcus. The types of IOLs included Sulcoflex and three-piece foldable acrylic lenses. Patients were followed-up for at least one year.

Results: Eleven patients were included. Seven patients had hyperopic ametropia, and four patients had residual myopia after cataract surgery. The preoperative mean of absolute residual refractive error was 7.20 7.92, which reached 0.42 1.26 postoperatively ( 0.001). The postoperative spherical equivalent was within 1 diopter of target refraction in all patients. The average preoperative uncorrected distance visual acuity was 1.13 0.35 LogMAR, which significantly improved to 0.41 0.24 LogMAR postoperatively ( = 0.008). There were no intra- or postoperative complications during the 22.4 9.5 months of follow-up.

Conclusion: Secondary piggyback IOL implantation is an effective and safe technique for the correction of residual ametropia following cataract surgery. Three-piece IOLs can be safely placed as secondary piggyback IOLs in situations where specifically designed IOLs are not available.
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http://dx.doi.org/10.18502/jovr.v16i1.8244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841270PMC
January 2021

Topical 0.03% tacrolimus versus systemic mycophenolate mofetil as adjuncts to systemic corticosteroids for preventing graft rejection after repeat keratoplasty: one-year results of a randomized clinical trial.

Eye (Lond) 2021 Oct 7;35(10):2879-2888. Epub 2021 Jan 7.

Department of Ophthalmology and Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare the efficacy of topical 0.03% tacrolimus in combination with systemic corticosteroids versus systemic mycophenolate mofetil (MMF) and corticosteroids in preventing corneal allograft rejection after repeat keratoplasty.

Methods: This prospective, randomized clinical trial enrolled 63 consecutive eyes of 63 patients who underwent repeat keratoplasty after a failed penetrating keratoplasty. Group 1 (32 eyes) received MMF orally 1 g twice daily for the first 6 months and then 1 g daily for the next 6 months, and group 2 (31 eyes) received topical 0.03% tacrolimus four times a day for 12 months. All patients were treated with topical and oral corticosteroids postoperatively. The participants were observed closely for signs of graft rejection, and the rates of rejection-free graft survival were calculated and compared between the two groups at postoperative month 12.

Results: The groups were balanced in patient's age and risk factors for graft rejection (e.g., original diagnosis, number of previous grafts, and quadrants of corneal vascularization). Endothelial graft rejection occurred in 5 eyes (15.6%) of group 1 and 6 eyes (19.4%) of group 2 (P = 0.75). Irreversible endothelial graft rejection resulting in graft failure occurred in 3 eyes of each group (P = 0.99). The rate of rejection-free graft survival was 84.4% in group 1 and 80.6% in group 2 at postoperative month 12 (P = 0.74).

Conclusion: Topical 0.03% tacrolimus was as effective as systemic MMF as adjuncts to topical and systemic corticosteroids in reducing endothelial graft rejection with 12 months follow up after repeat keratoplasty.
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http://dx.doi.org/10.1038/s41433-020-01375-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8452649PMC
October 2021

Systemic supplemental oxygen therapy during accelerated corneal crosslinking for progressive keratoconus: randomized clinical trial.

J Cataract Refract Surg 2021 Jun;47(6):773-779

From the Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Faramarzi, Hassanpour, Rahmani, Kheiri, Sadoughi); Department of Ophthalmology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Hassanpour); Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Yazdani); Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (Yazdani).

Purpose: To investigate the potential additive effect of systemic supplemental oxygen administered during accelerated corneal crosslinking (CXL) for progressive keratoconus (KC).

Setting: Academic center.

Design: Randomized clinical trial.

Methods: Eyes with progressive KC randomized to 3 different CXL protocols were included. The first group (OA-CXL) included 19 eyes that underwent an accelerated CXL protocol (9 mW/cm2 for 10 minutes) while receiving systemic oxygen at a rate of 5 L/min for 10 minutes. The second group consisted of 14 eyes undergoing the same accelerated CXL protocol without supplemental oxygen therapy (A-CXL). The third group (C-CXL) comprised 14 eyes undergoing conventional CXL according to the Dresden protocol. All subjects were followed up for at least 6 months. Visual acuity, keratometry and corneal biomechanical parameters including corneal hysteresis and corneal resistance factor (CRF) were measured preoperatively and 6 months postoperatively.

Results: Reduction in maximum keratometry (Kmax) was significantly greater in the OA-CXL group (P = .01). At baseline, the mean Kmax was 54.31 ± 3.64 diopters (D) in the OA-CXL group, 54.66 ± 4.99 D in the A-CXL group, and 56.03 ± 5.28 D in the C-CXL group (P = .58), which reached 53.58 ± 3.24 D, 54.59 ± 4.65 D, and 55.87 ± 4.73 D at 6 months in the 3 study groups, respectively (P = .115). The mean CRF increased significantly only in the OA-CXL group from a baseline value of 6.32 ± 2.12 mm Hg to 7.38 ± 1.88 mm Hg at 6 months (P = .009).

Conclusions: This study suggests superior efficacy of an accelerated CXL protocol coupled with systemic oxygen supplementation when compared with the accelerated CXL protocol and the conventional protocol in eyes with progressive KC. In addition to greater reduction in Kmax as the primary outcome, improvement in corneal biomechanics was also observed at 6 months.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000513DOI Listing
June 2021

Lateral rectus resection versus lateral rectus plication in patients with residual Esotropia.

Strabismus 2020 12 21;28(4):194-200. Epub 2020 Oct 21.

Basir Eye Health Research Center, Basir Eye Clinic , Tehran.

This study was aimed to compare the surgical outcomes of lateral rectus plication and resection techniques on patients with residual esotropia. In this randomized clinical trial, a total of 57 patients with residual esotropia (31 females) who were candidates for lateral rectus resection were randomized into plication (n = 27) and resection (n = 30) groups. The inclusion criteria were residual Esotropia after uni- or bilateral medial rectus recession. Subjects with a history of prematurity, lack of central fixation, extraocular muscle palsy, systemic, ocular disorders, history of lateral rectus operation, or follow up less than 3 months were excluded. Ophthalmic examinations were conducted preoperatively and at 1, 3-, and 6-month follow-ups. Surgical success rate was considered postoperative eso- or exotropia ≤10 pd. Based on the study results, there was no statistically significant difference between the two groups regarding the pre- (plication: 27.9 ± 9.8 pd and resection: 26.4 ± 7.6 pd; P = .52) and postoperative mean angle of deviation at far distance in month 3 (plication: 5.1 ± 7.1 pd and resection: 5.4 ± 3.2 pd; P = .82). Postoperative success rate also showed similarity between these two groups at all postoperative follow-ups of months 1, 3, and 6.There was no statistically significant difference between dose responses of these groups in uni- or bilateral operations. In conclusion, lateral rectus plication and resection showed statistically similar results. Each surgical method could be selected according to surgeon's skill and comfort. We recommend plication method for patients with postoperative probability of anterior segment ischemia.
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http://dx.doi.org/10.1080/09273972.2020.1832544DOI Listing
December 2020

Comparison of medial rectus resection and plication in exotropic patients.

Int Ophthalmol 2021 Jan 18;41(1):11-19. Epub 2020 Oct 18.

Department of Optometry, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare the surgical outcomes of the plication technique with the resection method to treat exotropic patients.

Methods: In this prospective randomized clinical trial, a total of 52 exotropic patients (27 females and 25 males) who were candidates for medial rectus resection were randomly classified into the plication (n = 24) and resection (n = 28) groups. Comprehensive ophthalmic examination included cyclorefraction, assessment of the best corrected visual acuity (BCVA), evaluation of the extraocular muscle, ocular deviation measurement and stereopsis measured using a Titmus test. Ocular anterior and posterior segments were examined using slit-lamp and indirect ophthalmoscopy. Patients were randomly divided to medial rectus plication and medial rectus resection groups. The plication technique was the same as for resection, but in the last step the muscle was folded. Examinations were repeated at the 1- and 3-day as well as 1-, 2-, 3- and 6-month follow-ups. If the postoperative ocular deviation was in the range of 5 PD esotropia to 10 PD exotropia, it was considered a successful surgical outcome.

Results: Results show that there was no statistically significant difference between the two groups regarding near and far deviations (P = 0.298, P = 0.103), surgical dose response (P = 0.904) and postoperative success rate (plication, 87% and resection, 89.3%, P > 0.99). Reoperation was needed in 13% and 10.7% of the plication and resection groups, respectively (P > 0.05).

Conclusions: Medial rectus plication is an effective and appropriate alternative option for medial rectus resection in exotropic patients.
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http://dx.doi.org/10.1007/s10792-020-01546-7DOI Listing
January 2021

Choroidal Thickness in Different Types of Inherited Retinal Dystrophies.

J Ophthalmic Vis Res 2020 Jul-Sep;15(3):351-361. Epub 2020 Aug 6.

Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare the choroidal thickness among eyes with retinitis pigmentosa (RP), Stargardt disease, Usher syndrome, cone-rod dystrophy, and healthy eyes of sex- and age-matched individuals.

Methods: In this comparative study, 503 eyes with RP ( = 264), cone-rod dystrophy ( = 109), Stargardt disease ( = 76), and Usher syndrome ( = 54) were included. To validate the data, 109 healthy eyes of 56 sex- and age-matched individuals were studied as controls. Choroidal imaging was performed using enhanced depth imaging-optical coherence tomography. Choroidal thickness was measured manually using MATLAB software at 13 points in nasal and temporal directions from the foveal center with the interval of 500 µm and the choroidal area encompassing the measured points was calculated automatically.

Results: The mean age was 36.33 13.07 years (range, 5 to 72 years). The mean choroidal thickness at 13 points of the control eyes was statistically significantly higher than that in eyes with RP ( 0.001) and Usher syndrome ( 0.05), but not significantly different from that in eyes with Stargardt disease and cone-rod dystrophy. Among different inherited retinal dystrophies (IRDs), the choroidal thickness was the lowest in eyes with RP ( 0.001). Choroidal thickness in the subfoveal area correlated negatively with best-corrected visual acuity ( = 0.264, 0.001) and the duration of ocular symptoms ( = 0.341, 0.001) in all studied IRDs. No significant correlation was observed between the subfoveal choroidal thickness and central macular thickness ( = 0.24, = 0.576).

Conclusion: Choroidal thinning in four different types of IRDs does not follow a similar pattern and depends on the type of IRD and the duration of ocular symptoms. A larger cohort is required to verify these findings.
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http://dx.doi.org/10.18502/jovr.v15i3.7454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431727PMC
August 2020

The First Inherited Retinal Disease Registry in Iran: Research Protocol and Results of a Pilot Study.

Arch Iran Med 2020 07 1;23(7):445-454. Epub 2020 Jul 1.

Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: To describe the protocol for developing a national inherited retinal disease (IRD) registry in Iran and present its initial report.

Methods: This community-based participatory research was approved by the Ministry of Health and Medical Education of Iran in 2016. To provide the minimum data set (MDS), several focus group meetings were held. The final MDS was handed over to an engineering team to develop a web-based software. In the pilot phase, the software was set up in two referral centers in Iran. Final IRD diagnosis was made based on clinical manifestations and genetic findings. Ultimately, patient registration was done based on all clinical and non-clinical manifestations.

Results: Initially, a total of 151 data elements were approved with Delphi technique. The registry software went live at www. IRDReg.org based on DHIS2 open source license agreement since February 2016. So far, a total of 1001 patients have been registered with a mean age of 32.41±15.60 years (range, 3 months to 74 years). The majority of the registered patients had retinitis pigmentosa (42%, 95% CI: 38.9% to 45%). Genetic testing was done for approximately 20% of the registered individuals.

Conclusion: Our study shows successful web-based software design and data collection as a proof of concept for the first IRD registry in Iran. Multicenter integration of the IRD registry in medical centers throughout the country is well underway as planned. These data will assist researchers to rapidly access information about the distribution and genetic patterns of this disease.
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http://dx.doi.org/10.34172/aim.2020.41DOI Listing
July 2020

Preparation of endothelial keratoplasty lenticules with Gebauer SLc Original versus Moria CBm Carriazo-Barraquer and Moria One-Use Plus microkeratomes.

Indian J Ophthalmol 2020 05;68(5):762-768

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To investigate endothelial keratoplasty lenticules prepared from fresh whole eyes via Gebauer SLc Original (SLc) versus Moria CBm Carriazo-Barraquer (CBm), and those prepared from corneoscleral buttons via SLc versus Moria One-Use Plus (OUP) in terms of eye bank preparation criteria.

Methods: Fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc were compared with CBm in terms of thickness profile measurements, over/under dissection values, endothelial cell loss, and postoperative graft failures. A similar comparison was made between corneoscleral buttons-dissected endothelial keratoplasty lenticules with SLc and OUP.

Results: Means of central thicknesses and increase of thickness toward periphery were not significantly different between 33 fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc and 33 fresh whole eyes-dissected ones with CBm. There was no significant difference between 19 corneoscleral buttons-dissected endothelial keratoplasty lenticules with SLc and 19 corneoscleral buttons-dissected ones with OUP in terms of mean central thickness and post-cut endothelial cell loss. However, in the corneoscleral buttons-dissected endothelial keratoplasty lenticules, a mean increase of thickness was significantly different from central to two pericentral locations with OUP (P = 0.001) and from central to two peripheral parts with SLc (P = 0.011). Both CBm and OUP systems showed deeper dissection depths than head descriptions as compared to SLc (P < 0.001).

Conclusion: Unlike fresh whole eyes-dissected endothelial keratoplasty lenticules with SLc or CBm, thickness profiles of corneoscleral buttons-dissected endothelial keratoplasty lenticules with both SLc and OUP systems showed a partial asymmetric increase of thickness toward the periphery. A high agreement was observed between endothelial keratoplasty lenticules thicknesses and SLc nomograms.
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http://dx.doi.org/10.4103/ijo.IJO_1351_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350469PMC
May 2020

Motor and Sensory Outcomes of Infantile Exotropia: A 10-Year Study (2008-2017).

Korean J Ophthalmol 2020 04;34(2):143-149

Basir Eye Safety Research Center, Basir Eye Clinic, Tehran, Iran.

Purpose: We aimed to determine the long-term motor and sensory outcomes of patients with infantile exotropia.

Methods: In this longitudinal retrospective (historical cohort) study, the records of 76 patients with infantile exotropia were Studied. Subjects with constant exotropia manifesting before the age of 1 year who were at least 5 years old at recruitment time between 2008 and 2017 were included.

Results: The medical records of 26 patients were excluded due to not participating in follow-up examinations or having incomplete records. In total, 54 infantile exotropic patients (51.9% male) with a mean age of 11.1 ± 6.8 years and follow-up of 4.99 ± 3.58 years were studied. Postoperative sensory outcomes (central stereopsis [<60 sec/arc], peripheral fusion [60-3,000 sec/arc], and non-stereopsis [>3,000 sec/arc]) were observed in 38.9%, 38.9%, and 21.2% of patients, respectively. In terms of postoperative motor outcomes, 69%, 24%, and 7% were achieved as orthophoria, residual exotropia, and consecutive esotropia, respectively. Patients with a higher surgical age ( = 0.022) and better visual acuity ( = 0.004) had significantly better sensory outcomes, while higher preoperative deviation resulted in more suppression ( = 0.039, rs = 0.218).

Conclusions: With rates of 69% for motor success and 78.8% for sensory success, surgical outcomes of infantile exotropic patients seems to be favorable. Further studies are recommended to verify our findings.
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http://dx.doi.org/10.3341/kjo.2019.0090DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7105794PMC
April 2020

A Population-based Study on the Prevalence and Associated Factors of Age-related Macular Degeneration in Northern Iran .

Ophthalmic Epidemiol 2020 06 21;27(3):209-218. Epub 2020 Jan 21.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

: To estimate the prevalence and associated factors of AMD in an Iranian population in 2014.: In this population-based cross-sectional study, a total of 2975 Iranian residents (age: ≥50 years) from the urban and rural areas of Gilan province were included. The prevalence of different grades of AMD was determined using the International Age-Related Maculopathy Epidemiological Study Group grading system.: Of 2975 eligible individuals, 2587 (87.0%) subjects participated and 2275 (76.5%) subjects (62.6 ± 8.8 years old) had gradable fundus photographs. Age- and sex-standardized prevalence of early and late AMD based on the 2016 Iran census were 13.2% (95% confidence interval [CI], 10.6-16.2) and 0.7% (95% CI, 0.4-1.3), respectively. In multivariate analysis, each decade increase in age was associated with the adjusted odds of any (adjusted odds ratio [AOR] = 1.31, 95% CI, 1.09-1.56; = .0031), early (AOR = 1.27, 95% CI, 1.06-1.53; = .012) and late AMD (AOR = 2.39, 95% CI, 1.08-5.28; = .031). Hyperopia was identified to be less frequent in late AMD (AOR = 0.20, 95% CI, 0.04-0.80; = .024). No significant association was found between AMD and sex, smoking, outdoor working, diabetes, hypertension, pseudophakia, hyperlipidemia and myopia.: Gilan Eye Study demonstrated the first estimate of age-specific AMD prevalence in Iran being compatible with other WHO regions. With the expected increase in the life expectancy and aging of Iranians, the number of people affected by AMD will be increasing in future. Healthcare policy makers should be advised to provide more efficient eye care services and preventive strategies in this regard.
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http://dx.doi.org/10.1080/09286586.2020.1716379DOI Listing
June 2020

Proposed risk factors for failure of transplanted eye bank-prepared descemet stripping automated endothelial keratoplasty tissues.

Cell Tissue Bank 2020 Mar 6;21(1):151-158. Epub 2020 Jan 6.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

To investigate the possible risk factors for failure of transplanted eye bank-prepared Descemet stripping automated endothelial keratoplasty (DSAEK) tissues. In a retrospective study between March 2011 and March 2019, all the failed DSAEK cases (131 cases) reported to the Central Eye Bank of Iran were compared with a surgeon-matched successful DSAEK group (control, 126 cases) in terms of the donor, DSAEK tissue, and recipient characteristics. Univariate analysis indicated that the DSAEK tissue preparation from excised corneoscleral tissues (OR 2.17; P = 0.026) and donor conjunctival hyperemia (OR 1.62; P = 0.042) were more common in the re-DSAEK group than in the controls. Other donor and recipient characteristics as well as other DSAEK tissue criteria were not significantly different between the re-DSAEK and control groups. DSAEK lenticules in both re-DSAEK and control groups demonstrated symmetric contours. Subgroup analyses in the re-DSAEK group revealed a higher rate of surgeons' low to moderate experience in comparison to those of high experience (P < 0.001). Additionally, failed DSAEK was observed more commonly in donors aged over 50 years than among those under 30 years (P < 0.001). Our study showed that DSAEK tissues prepared from excised corneoscleral tissues and from donors with conjunctival hyperemia were associated with higher rates of re-DSAEK due to failed DSAEK. An increasing trend of re-DSAEK was observed with shorter surgeons' experience and more advanced donor's age.
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http://dx.doi.org/10.1007/s10561-020-09808-5DOI Listing
March 2020

Comparison between patching and interactive binocular treatment in amblyopia: A randomized clinical trial.

J Curr Ophthalmol 2019 Dec 14;31(4):426-431. Epub 2019 Aug 14.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare the effect of amblyopia therapy on cases who received interactive binocular treatment (I-BiT™) with those who received standard patching of the dominant eye with placebo I-BiT™.

Methods: In this randomized clinical trial, 38 unilateral amblyopic children (3-10 years old) were studied. All unilateral amblyopic children who had best corrected visual acuity (BCVA) worse than 0.30 logMAR or a difference of two Snellen lines of BCVA between their two eyes were included, and children who did not complete at least 75% of amblyopia treatment were excluded from this study. Eventually, a total of 19 and 21 subjects were included in case and control groups, respectively. Cases played I-BiT™ games, while controls had standard patch therapy and played with placebo I-BiT™ games, both for one month. All subjects were examined at baseline and after one-month therapy.

Results: BCVA improved significantly in both groups after one-month treatment (case:  = 0.003, control:  < 0.001), while in comparison with each other, there was not any difference between them ( = 0.52). Although stereopsis improved in the case ( < 0.001) and control ( < 0.001), there was no significant difference between them pre and post-therapy. Our children played games for about 6 h total during one month in both groups, and their compliance was 87.5% and 76% in cases and controls, respectively. Two children were excluded due to their lower compliance of playing I-BiT™ games (n = 38).

Conclusions: I-BiT™ game and patching with placebo game had similar BCVA improvement in amblyopic children after one-month treatment. It is suggested to conduct further randomized clinical trials with a larger sample size and longer duration of study and assessment of its recurrence.
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http://dx.doi.org/10.1016/j.joco.2019.07.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896467PMC
December 2019

Repeated Injection of Methotrexate into Silicone Oil-Filled Eyes for Grade C Proliferative Vitreoretinopathy: A Pilot Study.

Ophthalmologica 2019 4;242(2):113-117. Epub 2019 Jun 4.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,

Purpose: To evaluate the effects of repeated intra-silicone oil (SO) injections of methotrexate (MTX) on the outcomes of surgery for rhegmatogenous retinal detachment (RRD) with grade C proliferative vitreoretinopathy (PVR-C).

Methods: In this prospective pilot case series, eyes with RRD and PVR-C underwent pars plana vitrectomy and intraocular injection of SO. At the conclusion of the procedure, 250 µg of MTX was injected into the SO-filled vitreous cavity. Intra-SO injection was repeated at weeks 3 and 6; the minimum follow-up period was 6 months. The main outcome measure was retinal reattachment rate.

Results: Eleven eyes of 11 patients (mean age, 52.73 ± 18.01 years) were included. The mean follow-up period was 9 ± 3 months (range, 6-15 months). Total retinal detachment with anterior and/or posterior PVR-C was present in all eyes before surgery. Mean preoperative best-corrected visual acuity (BCVA) was 2.62 ± 0.04 logMAR. All operated eyes exhibited retinal reattachment posterior to the equator during the follow-up period. Mean postoperative BCVA was significantly improved to 1.02 ± 0.51 logMAR (p = 0.003). No ocular or systemic side effects were observed.

Conclusion: Repeated intra-SO injection of MTX as an adjunctive therapy for RRD complicated by PVR showed promising results and was not associated with adverse effects. Further studies are needed to confirm its possible beneficial effects on the final anatomic and functional outcomes in these cases.
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http://dx.doi.org/10.1159/000500271DOI Listing
August 2019

Comparison of toluidine blue 1% staining patterns in cytopathologically confirmed ocular surface squamous neoplasias and in non-neoplastic lesions.

Ocul Surf 2019 07 1;17(3):578-583. Epub 2019 May 1.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Iran.

Purpose: To evaluate the role of toluidine blue (TB) staining patterns in diagnosis of ocular surface squamous neoplasia (OSSN) in comparison to that of impression cytology.

Methods: TB 1% dye was applied to different ocular surface lesions, followed by impression cytology (IC). Dye distribution, intensity, and pattern of uptake by the lesion were scored and total score ≥5 was considered "positive TB staining". The TB results were then compared with those using IC to determine the presence of cellular atypia.

Results: The study enrolled 88 eyes of 82 patients. IC demonstrated cellular atypia in 50 (56.8%) cases. Forty-three of 45 "TB-positive" eyes (95.51%) had cellular atypia on IC (p < 0.001). Sensitivity and specificity of TB in identifying OSSN were 86% and 94.74%, respectively, with positive and negative predictive values of 95.56% and 83.72%. TB staining intensity of dark blue and/or mixed types and stippled pattern of TB staining were strongly correlated with dysplastic changes in IC (P ˂ 0.001). TB staining distribution whether in form of diffuse, patchy or scattered eyes with atypia did not significantly differ from those without atypia in IC (P = 0.172).

Conclusion: The sensitivity and specificity of TB vital dye in diagnosing OSSN can be increased by focusing on color intensity and a stippled pattern.
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http://dx.doi.org/10.1016/j.jtos.2019.04.010DOI Listing
July 2019

Modeling a Telemedicine Screening Program for Diabetic Retinopathy in Iran and Implementing a Pilot Project in Tehran Suburb.

J Ophthalmol 2019 4;2019:2073679. Epub 2019 Mar 4.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb.

Methods: In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital.

Results: Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively.

Conclusions: Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.
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http://dx.doi.org/10.1155/2019/2073679DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6425400PMC
March 2019

Effect of Keratoconus Severity on Clinical Outcomes After Deep Anterior Lamellar Keratoplasty.

Am J Ophthalmol 2019 06 5;202:15-22. Epub 2019 Feb 5.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the effect of keratoconus severity on the visual and refractive outcomes and complications after deep anterior lamellar keratoplasty (DALK).

Design: Consecutive interventional case series.

Methods: This study enrolled 227 keratoconus-affected eyes that underwent DALK. Amsler-Krumeich keratoconus classification was used to categorize the patients: stage II, 47 eyes; stage III, 60 eyes; and stage IV, 120 eyes. The outcome measures, including postoperative best spectacle-corrected visual acuity (BSCVA), spherical equivalent refraction, mean keratometry, keratometric astigmatism, and complications, were analyzed and compared based on keratoconus stage.

Results: The mean patient age was 27.6 ± 8.0 years, and the mean follow-up period was 38.0 ± 19.8 months. No significant differences were observed in postoperative BSCVA (P = .55), spherical equivalent refraction (P = .27), mean keratometry (P = .09), and keratometric astigmatism (P = .14) among the groups. Improvement in BSCVA were significantly greater in stage III and stage IV compared with stage II (P = .04 and P < .001, respectively). The decrease in spherical equivalent was significantly greater in stages III and IV compared with stage II (P = .04 and P = .001, respectively). Mean keratometry decreased to a greater degree in stage IV compared with stages II and III (P < .001 for both comparisons). The study groups were comparable with respect to intraoperative Descemet membrane perforation, the rate of successful big-bubble formation, suture-related complications, and graft rejection.

Conclusions: DALK is a safe and effective procedure for the treatment of all stages of keratoconus. This technique of corneal transplantation is more effective in eyes with severe keratoconus compared with those with moderate keratoconus.
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http://dx.doi.org/10.1016/j.ajo.2019.01.030DOI Listing
June 2019

Reoperation in Horizontal Strabismus and its Related Risk Factors.

Med Hypothesis Discov Innov Ophthalmol 2018 ;7(2):73-82

Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

This study was performed to determine the surgical outcomes and the related risk factors of second operation in patients with residual horizontal deviations. In this interventional case series study, a total of 119 patients with a history of reoperation were included (39 exotropia and 80 esotropia). Cases with consecutive strabismus, muscular palsy, systemic disease, lack of ocular fixation, and those, who had vertical deviation and Dissociated Vertical Deviation (DVD)>5 Prism Diopters (pd) were excluded. Medial Rectus (MR) resection in residual Exotropia (XT) and Lateral Rectus (LR) resection in residual Esotropia (ET) were performed. Unilateral or bilateral operations were considered if the preoperative residual deviation was < 20 pd or > 20 pd, respectively. Success of the reoperation was considered if the postoperative angle of deviation was ≤ 10 pd. Unilateral and bilateral MR resection was performed in 26% and 74% of patients with XT, respectively, with greater dose response in unilateral cases (2.8 versus 2.6 mm/pd). Successful surgical outcomes were observed in 94.9% of patients with XT. Unilateral and bilateral LR resection was also performed in patients with residual ET, each in 50% of patients. Unilateral cases showed greater dose-response compared to bilateral ones (2.6 versus 2 mm/pd) and successful surgical outcomes were observed in 83.8% of patients with ET. No variable was found as a risk factor of reoperation in both groups. In conclusion, both LR and MR resection are easy and predictable surgical approaches with high success rate in patients with residual ET and XT. Generally, MR resection is more effective than LR resection. Unilateral operation is less recommended in the residual exotropic group, due to its lower success compared to the bilateral operation. Unfortunately, none of the mentioned variables were found to be the risk factor of reoperation in the sampled patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146237PMC
January 2018

Goldmann applanation tonometer versus ocular response analyzer for measuring intraocular pressure after congenital cataract surgery.

Eur J Ophthalmol 2018 Sep 15;28(5):582-589. Epub 2018 Mar 15.

Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To compare intraocular pressure measured using the Goldmann applanation tonometer with that measured using the ocular response analyzer after congenital cataract surgery.

Methods: This study included 113 eyes of 64 patients who underwent lensectomy and vitrectomy. In all, 36 eyes remained aphakic after surgery. Intraocular lens implantation was performed at the time of surgery in 47 eyes and secondarily in 30 eyes. Corneal hysteresis, corneal resistance factor, and cornea-compensated intraocular pressure were measured. The influences of independent factors on the difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer were investigated using linear regression analyses. Agreement between the two tonometers was investigated using the Bland and Altman and 95% limits of agreement analysis.

Results: Central corneal thickness, corneal hysteresis, and corneal resistance factor were 591.2 ± 53.3 µm, 10.83 ± 2.27 mmHg, and 11.36 ± 2.14 mmHg, respectively. Cornea-compensated intraocular pressure (16.75 ± 4.82 mmHg) was significantly higher than intraocular pressure measured with Goldmann applanation tonometer (14.41 ± 2.27 mmHg, p < 0.001). Central corneal thickness (p = 0.02) and corneal hysteresis (p < 0.001) were identified as the main predictors of difference between cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer readings. A 95% limits of agreement for cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was between -4.86 and 9.53 mmHg in the entire group. Cornea-compensated intraocular pressure showed the best agreement with intraocular pressure measured with Goldmann applanation tonometer in the primary pseudophakic subgroup as compared to the other subgroups.

Conclusion: The Goldmann applanation tonometer and ocular response analyzer cannot be used interchangeably for measuring intraocular pressure after congenital cataract surgery. The difference between the cornea-compensated intraocular pressure and intraocular pressure measured with Goldmann applanation tonometer was primarily affected by central corneal thickness and corneal hysteresis. Among the subgroups, the primary pseudophakic subgroup had the thinnest cornea and the highest corneal hysteresis values and demonstrated the best agreement between the two tonometers.
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http://dx.doi.org/10.1177/1120672118757429DOI Listing
September 2018

Effects of fibrin glue as a three-dimensional scaffold in cultivated adult human retinal pigment epithelial cells.

J Biomater Appl 2018 10 13;33(4):514-526. Epub 2018 Sep 13.

4 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

This study was conducted to examine morphological, genotypic, and phenotypic alterations occurring in cultured adult human retinal pigment epithelial cells when encapsulated with different concentrations of fibrin glue. Cultivated adult human retinal pigment epithelial cells were encapsulated with different concentrations of fibrin glue, namely FG1 (42 mg/dl), FG2 (84 mg/dl), FG3 (124 mg/dl), FG4 (210 mg/dl), followed by the evaluation of genetic and cytomorphological changes and protein expression. Cultured adult human retinal pigment epithelial cells showed dendritiform morphology during the early days of encapsulation with fibrin glue. Moreover, an increasing inhibitory effect on cell growth was observed with increasing concentrations of fibrin glue. At the transcriptional level, the expression of MMP2, PAX6, and ITGB1 in FG1-encapsulated cells was significantly higher than that in other treated groups; however, the expression of ACTA2 was lower in all fibrin glue-encapsulated groups compared to that in the controls. Immunocytochemistry showed that FG2-encapsulated cells expressed cytokeratin 8/18, RPE65, and ZO-1 proteins, but not PAX6. In conclusion, fibrin glue at a concentration of 84 mg/dl allows proper encapsulation of adult human retinal pigment epithelial cells, while preserving the morphometric, genotypic, and phenotypic features of the cells. This three-dimensional biopolymer can be considered a reliable vehicle for retinal pigment epithelium cell transplantation in cell-based therapies.
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http://dx.doi.org/10.1177/0885328218799506DOI Listing
October 2018

Which quadrant is less painful for intravitreal injection? A prospective study.

Eye (Lond) 2019 02 10;33(2):304-312. Epub 2018 Sep 10.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the relationship between injection site and pain severity following intravitreal injection of bevacizumab (IVB).

Design: Prospective, randomized, four-armed, clinical trial.

Methods: The present study was a prospective, randomized, four-armed clinical trial, which included 1004 eyes from 1004 patients. Patients receiving IVB were randomly assigned into four groups: superotemporal (ST); superonasal (SN); inferotemporal (IT); and inferonasal (IN) injections. The visual analog scale (VAS) was used to assess pain. Primary study variables were the relationship between pain severity and injection site, number of previous injections, age, sex, and indication for injection. Secondary variables included best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes 1 month post IVB.

Results: Overall mean pain score was 2.86 ± 2.2. Indications for injection were diabetic macular edema (84.1%), neovascular age-related macular degeneration (7.7%), and macular edema secondary to retinal vein occlusion (8.2%). The mean VAS scores in the SN, IN, ST, and IT groups were 1.5 ± 1.7, 3 ± 2.3, 4 ± 2, and 3 ± 2.1, respectively. Pain severity was significantly correlated with injection site (p < 0.001) and sex (p < 0.001); females showed higher pain scores. A negative correlation existed between pain score and number of previous injections (p = 0.03). Pain severity was not associated with age (p = 0.659), lens status (p = 0.478), vitreous reflux (p = 0.648), or indication for injection (p = 0.390). No significant complications were observed.

Conclusions: ST quadrant was the most painful and SN quadrant was the least painful sites for IVB. Pain severity score was significantly associated with injection site, number of injections, and sex.
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http://dx.doi.org/10.1038/s41433-018-0208-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367313PMC
February 2019

Single versus double pass technique for preparation of ultrathin Descemet's stripping automated endothelial keratoplasty tissues from donated whole eyes.

Cell Tissue Bank 2018 Dec 14;19(4):623-628. Epub 2018 Jul 14.

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

This study was conducted to analyze the preoperative thickness profile and endothelial rating of ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK) tissues prepared with a single versus double microkeratome pass from donated whole eyes and corresponding eye bank postoperative results. Microkeratome-assisted UT-DSAEK tissues were prepared from freshly donated whole eyes with single-pass (SP) and double-pass (DP) technique in the Central Eye Bank of Iran. Preoperative thickness profiles and endothelial cell densities of UT-DSAEK tissues were obtained from optical coherence tomography and specular microscopy, respectively, and compared between groups. Corneal perforation rates during the eye bank preparation and postoperative reports of transplanted UT-DSAEK tissues were also compared. Over a 15-month period, 342 UT-DSAEK tissues were prepared: 248 via SP and 94 with DP technique. Mean donor corneal central thickness was 610 ± 58 µm with SP and 790 ± 100 µm with DP technique. Mean central thickness of UT-DSAEK tissues was not statistically different between the groups (84.8 ± 11.0 µm with SP and 85.1 ± 10.5 µm with DP technique, P = 0.857). Mean increase of UT-DSAEK thickness from central to pericentral and peripheral cornea was not significantly different with both techniques. Mean differences between thicknesses of 2 pericentral locations and between those of 2 peripheral locations were not statistically different in the study groups. Corneal perforation of 1.6 and 1.1% occurred in SP and DP groups, respectively. Failed graft was reported 6 months postoperatively in 4 (1.6%) cases with SP and in 1 (1.1%) case with DP technique. Preoperative thickness profiles of UT-DSAEK tissues prepared from donated whole eyes via SP technique were not significantly different from those prepared with DP, showing a symmetric increase of thickness towards peripheral locations.
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http://dx.doi.org/10.1007/s10561-018-9712-3DOI Listing
December 2018

Intravitreal Injection of Anti-vascular Endothelial Growth Factor Agents for Ocular Vascular Diseases: Clinical Practice Guideline.

J Ophthalmic Vis Res 2018 Apr-Jun;13(2):158-169

Standardization and CPG Development Office, Deputy of Curative Affairs, Ministry of Health and Medical Education, Tehran, Iran.

Purpose: To provide the clinical recommendations for the administration of intravitreal anti-vascular endothelial growth factor (VEGF) drugs especially bavacizumab for ocular vascular diseases including diabetic macular edema, neovascular age-related macular degeneration, myopic choroidal neovascularization, retinal vein occlusion and central serous chorioretinopathy.

Methods: Twenty clinical questions were developed by the guideline technical committee. Relevant websites and databases were searched to find out the pertinent clinical practice guidelines to answer the questions. The technical committee provided possible answers (scenarios) according to the available evidences for each question. All scenarios along with their levels of evidence and the supported articles were sent to the experts for external review. If the experts did not agree on any of the scenarios for one particular clinical question, the technical committee reviewed all scenarios and their pertinent evidences and made the necessary decision. After that, the experts were asked to score them again. All confirmed scenarios were gathered as the final recommendations.

Results: All the experts agreed on at least one of the scenarios. The technical committee extracted the agreed scenario for each clinical question as the final recommendation. Finally, 56 recommendations were developed for the procedure of intravitreal anti-VEGF injection and their applications in the management of ocular vascular diseases.

Conclusion: The implementation of this guideline can standardize the management of the common ocular vascular diseases by intravitreal injection of anti-VEGF agents. It can lead to better policy-making and evidence-based clinical decision by ophthalmologists and optimal evidence based eye care for patients.
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http://dx.doi.org/10.4103/jovr.jovr_50_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905310PMC
May 2018

Clinical outcomes of Ahmed glaucoma valve implantation in pediatric glaucoma.

Eur J Ophthalmol 2019 Jan 27;29(1):44-51. Epub 2018 Mar 27.

1 Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose:: To evaluate the outcomes of Ahmed glaucoma valve implantation in refractory primary congenital glaucoma as well as primary procedure in aphakic glaucoma.

Method:: In this retrospective study, medical records of patients who underwent Ahmed glaucoma valve implantation for refractory glaucoma and aphakic glaucoma were reviewed. Primary outcome measures were the surgical success defined as intraocular pressure ≤21 mm Hg and decreased ≥20% and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity, and intraocular pressure.

Results:: A total of 62 eyes of refractory primary congenital glaucoma patients (group 1) and 33 eyes of aphakic glaucoma patients (group 2) were included in our study. Mean follow-up was 51 ± 33 months in group 1 and 49 ± 41 months in group 2 (p = 0.82). The cumulative probability of success was 90% in both groups at the first year; however, the success rate was 52.5% in group 1 and 71.5% in group 2 at 5 years' follow-up visit. In group 1, the mean intraocular pressure ± standard deviation was 33.1 ± 8.6 mm Hg at the baseline and decreased to 17.1 ± 5.3 mm Hg at 1 year and 18.5 ± 6.4 at 3 years postoperatively (all p's < 0.001). Corresponding values for group 2 were 28.9 ± 6.1, 15.2 ± 4.6, and 16.0 ± 5.9 mm Hg, respectively (all p's < 0.001). The baseline number of glaucoma medications was 3 ± 0.7 that decreased to 2 ± 0.8 at final follow-up (p = 0.02).

Conclusion:: Ahmed glaucoma valve implantation has a moderate success rate in the management of refractory primary congenital glaucoma with an increased chance of tube-related complications. The surgical success rate is higher in case of primary Ahmed glaucoma valve implant for aphakic glaucoma with acceptable safety profile.
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http://dx.doi.org/10.1177/1120672118761332DOI Listing
January 2019

Choroidal Thickness in Healthy Subjects.

J Ophthalmic Vis Res 2018 Jan-Mar;13(1):39-43

Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: To measure the choroidal thickness by enhanced depth imaging optical coherence tomography (EDI-OCT) in normal eyes.

Methods: In a prospective case series, 208 eyes of 104 normal Iranian subjects were enrolled. Complete ophthalmic examination was performed. Inclusion criteria were best corrected visual acuity (BCVA) ≥20/20, ≤ ±1 diopter of refractive error in either spherical or cylindrical components, normal intraocular pressure (IOP) and no systemic or ocular diseases. The choroidal thickness was measured by EDI-OCT subfoveally, and 1500 μm and 3000 μm nasal and temporal to the fovea.

Results: Mean age was 34.6 ± 9.8 years (range, 18-57 years). Mean subfoveal choroidal thickness was 363 ± 84 μm. Choroidal thickness was 292 ± 76 and 194 ± 58 μm at 1500 and 3000 μm nasal to the fovea, respectively, and 314 ± 77 and 268 ± 66 μm at 1500 and 3000 μm temporal to the fovea, respectively. There was no statistically significant difference in the choroidal thickness between sexes and laterality of the eyes. Choroidal thickness at fovea ( < 0.001) and at all extrafoveal locations decreased significantly for every 10 years increase in age.

Conclusion: In normal Iranian subjects participating in this study, mean choroidal thickness was comparable with other reports.
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http://dx.doi.org/10.4103/jovr.jovr_148_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782455PMC
February 2018

Aspheric versus wavefront-guided aspheric photorefractive keratectomy in eyes with significant astigmatism.

J Cataract Refract Surg 2017 12;43(12):1534-1540

From the Ophthalmic Research Center and Department of Ophthalmology (Faramarzi, Karimian, Delfazayebaher, Kheiri), Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; John A Moran Eye Center (Moshirfar), Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, Utah, USA.

Purpose: To compare the refractive and higher-order aberrations (HOAs) outcomes after photorefractive keratectomy (PRK) in patients with significant astigmatism using aspheric versus wavefront-guided aspheric profiles.

Setting: Ophthalmic Research Center and Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Negah Eye Hospital, Tehran, Iran.

Design: Prospective randomized case series.

Methods: One eye of each patient with a refractive astigmatism more than 2.00 diopters (D) randomly received aspheric PRK. In the other eye, wavefront-guided and aspheric treatment was performed using a personalized treatment advanced algorithm. Visual acuity, refractive errors, and HOAs were compared between the 2 groups preoperatively and 12 months postoperatively.

Results: The study comprised 32 patients (64 eyes). The mean preoperative refractive astigmatism was -4.07 D ± 1.64 (SD) and -4.02 ± 1.55 D in the aspheric group and wavefront-guided aspheric group, respectively (P = .2). The mean postoperative astigmatism was -0.46 ± 0.37 D and -0.82 ± 0.53 D in the aspheric group and wavefront-guided aspheric group, respectively (P = .02). Postoperatively, the root mean square of total HOAs was significantly increased in both groups. However, compared with wavefront-guided aspheric PRK, aspheric PRK induced fewer HOAs (P = .003).

Conclusions: In eyes with high astigmatism, post-PRK residual astigmatism was lower in the aspheric group than in the wavefront-guided aspheric group. The increase in HOAs was significantly higher in the wavefront-guided aspheric group than in the aspheric group.
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http://dx.doi.org/10.1016/j.jcrs.2017.09.022DOI Listing
December 2017

Ahmed Glaucoma Valve Implantation: Graft-Free Short Tunnel Small Flap versus Scleral Patch Graft after 1-Year Follow-up: A Randomized Clinical Trial.

Ophthalmol Glaucoma 2018 Nov - Dec;1(3):206-212. Epub 2018 Oct 25.

Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Purpose: To compare the efficacy and safety of the graft-free short tunnel small flap (STSF) technique with that of the scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) (New World Medical Inc, Rancho Cucamonga, CA) implantation.

Design: Randomized clinical trial.

Participants: A total of 203 eyes of 203 patients with medically uncontrolled glaucoma, including 102 in the STSF group and 101 in the SPG group.

Methods: Patients were enrolled and assigned randomly to STSF or SPG.

Main Outcome Measures: Tube exposure, intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity, surgical complications, and success rate (defined as IOP >5 mmHg, ≤21 mmHg, and IOP reduction ≥20% from baseline at 2 consecutive visits after 3 months, no reoperation for glaucoma).

Results: Only 1 patient in the SPG group developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF group and 65% in the SPG group (P = 0.36). The IOP decreased significantly from 29.6±8.6 mmHg at baseline to 16.4±3.6 mmHg at the final follow-up in the STSF group (P = 0.001). The corresponding numbers for the SPG group were 30.9±11.2 and 15.8±4.7, respectively (P = 0.001). The final IOP was comparable between both groups (P = 0.65). Mean ± standard deviation of the number of glaucoma medications was 1.8±0.9 in the STSF group and 1.6±0.9 in the SPG group at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in the STSF group and 9 patients (23%) in the SPG group (P = 0.81).

Conclusions: The STSF and SPG techniques had a comparable complication rate at the 1-year follow-up. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.
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http://dx.doi.org/10.1016/j.ogla.2018.10.008DOI Listing
August 2021
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