Publications by authors named "Bahram Eshraghi"

48 Publications

Nonspecific orbital inflammation and thyroid eye disease, a rare comorbidity: report of two cases and review of literature.

BMC Ophthalmol 2021 Jun 5;21(1):251. Epub 2021 Jun 5.

Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: To present the very rare comorbidity of developing non-specific orbital inflammation (NSOI) in two patients with histories of definite thyroid eye disease (TED).

Case Presentation: Both patients complained of new-onset progressive proptosis although their thyroid disease was controlled and computed tomography scan revealed an intraorbital inflammatory mass. The pathological assessment indicated that both patients had developed fibrosing NSOI. Therefore, intravenous corticosteroids were administered. The mass regressed and the amount of proptosis was decreased in both patients.

Conclusions: We reviewed all related cases in the literature and extracted their clinical and radiological characteristics for this paper. Ophthalmologists should consider TED and NSOI in patients with a new-onset complaint of proptosis. Despite rare comorbidity of TED and NSOI, it should be considered especially in patients with refractory proptosis, and lead to its further evaluation and prompt management.
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http://dx.doi.org/10.1186/s12886-021-02008-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180075PMC
June 2021

Nicolau syndrome, a rare though important complication of hyaluronic acid injection.

Int J Dermatol 2021 Jul 1;60(7):e285-e286. Epub 2021 Mar 1.

Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.

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http://dx.doi.org/10.1111/ijd.15487DOI Listing
July 2021

Orbital decompression during coronavirus disease 2019 pandemic: A shared experience.

Orbit 2021 04 22;40(2):176-177. Epub 2020 Dec 22.

Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Science , Isfahan, Iran.

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http://dx.doi.org/10.1080/01676830.2020.1860093DOI Listing
April 2021

Extraocular Muscle Palsy in Patients with Chronic Orbital Myositis.

J Binocul Vis Ocul Motil 2020 Oct-Dec;70(4):177-181. Epub 2020 Oct 23.

Eye Research Center, Strabismus Department, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran, Iran.

Background: Orbital myositis (OM) is a subgroup of idiopathic orbital inflammation. It can involve single or multiple extraocular muscles and result in restriction or paresis of extraocular muscles.

Method: We reported two unusual cases of extraocular muscle paresis in the fibrotic stage of chronic OM and reviewed the literature related to this finding.

Results: The first case was of a 38-year-old woman with chronic OM with large-angle right eye exotropia and right medial rectus paresis. She received a botulinum A toxin injection into the right lateral rectus muscle as a first treatment, but it was unsuccessful in correcting her deviation. Subsequently, she underwent two strabismus surgeries, which successfully resolved her diplopia in primary gaze. The second case was of a 35-year-old woman with chronic OM and left lateral rectus palsy, which was managed with a botulinum A toxin injection.

Conclusion: OM can cause extraocular muscle palsy in the chronic fibrotic stage of the disease.
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http://dx.doi.org/10.1080/2576117X.2020.1830671DOI Listing
October 2020

Palpebral anthrax, a rare though important condition in villagers: A case report and literature review.

Int J Infect Dis 2020 Oct 3;99:260-262. Epub 2020 Aug 3.

Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran.

The aerobic Gram-positive rod Bacillus anthracis can cause potentially lethal diseases affecting different organs. Localized eyelid inflammation is a rare presentation of cutaneous anthrax. This case report involves two patients with palpebral anthrax admitted to the oculoplastic ward of Feiz Eye Hospital, Isfahan, Iran. The patients had a history of close contact with animals. Clinical presentation included palpebral swelling and necrosis of the eyelids in both cases. The patients first underwent an appropriate antibiotic regimen, and biopsy specimens were collected from their necrotic tissues. They were discharged after complete healing and followed up to manage possible complications. Cicatricial ectropion developed in both cases during healing. Reconstructive surgery was scheduled for both cases 6 months after their discharge.
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http://dx.doi.org/10.1016/j.ijid.2020.07.083DOI Listing
October 2020

Strabismus Surgery in Thyroid-Associated Ophthalmopathy; Surgical Outcomes and Surgical Dose Responses.

J Binocul Vis Ocul Motil 2020 Oct-Dec;70(4):150-156. Epub 2020 Jul 21.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran, Iran.

Purpose: To investigate the success rate and surgical dose responses in strabismus surgery of thyroid-associated ophthalmopathy (TAO).

Methods: Thirty-three patients (26 men) were included in this study and underwent strabismus surgery. The mean follow-up time was 11.3 ± 6.5 months. Success was defined as the proportion of patients with a horizontal deviation of less than 10 PD, vertical deviation of less than 4 PD, and no subjective diplopia in primary and downgaze.

Results: After the final follow-up visit, strabismus surgery was successful in 87.8% of patients. Pre-operative factors (age, gender, smoking, corticosteroid usage, radioactive iodine, orbital decompression, optic neuropathy, baseline deviations, extorsion, type of strabismus, TAO duration) were not statistically correlated with success. Dose responses were calculated to be 3.44 ± 0.66 PD/mm of medial rectus recession and 4.83 ± 1.48 PD/mm for vertical rectus recession. Patients with deviation ≥25 PD had significantly larger surgical dose response compared to the group with deviation<25 PD ( value = .003 for horizontal and -value <0.05 for vertical deviations). In eyes with predominant hypotropia, we found 1.64 ± 1.37 PD decrease in esotropia for each millimeter recession of inferior rectus muscle.

Conclusions: Surgical dose responses in large deviations were significantly higher than the moderate angle of deviation. The reported mean for vertical dose responses may vary in different patients based on the laterality and involvement of superior rectus muscles. The recession of inferior rectus muscle may correct mild-to-moderate esotropia without the need for horizontal muscle surgery.
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http://dx.doi.org/10.1080/2576117X.2020.1792029DOI Listing
July 2020

Pediatric posttraumatic orbital subperiosteal hematoma.

Eur J Ophthalmol 2020 Apr 30:1120672120919598. Epub 2020 Apr 30.

Conestoga Eye, Lancaster, PA, USA.

Aim: To report five children with posttraumatic orbital subperiosteal hematoma.

Methods: In this study, five cases with posttraumatic orbital subperiosteal hematoma were studied and reviewed along with similar cases in a systematic literature review.

Results: The mean age of our patients was 9.40 ± 3.51 years, ranging from 4 to 13 years, and all were male. Mechanisms of injuries were blunt trauma, falling from a building, car accident, and falling from a bicycle. All patients had unilateral involvement. Treatment options included needle aspiration, surgical drainage, and observation for spontaneous resolution. Except for one patient, positive outcomes were achieved.

Conclusion: The most common location for posttraumatic orbital subperiosteal hematoma is the superior orbital wall. Traumatic optic neuropathy and permanent visual loss are uncommon. Observation, surgical drainage, and aspiration are common treatment options.
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http://dx.doi.org/10.1177/1120672120919598DOI Listing
April 2020

Pressure ulcer following circumferential head dressing.

Orbit 2020 Oct 30;39(5):350-356. Epub 2020 Jan 30.

Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran.

Purpose: To report four patients with forehead pressure ulcer (PU) following encircling head dressing and review the literature.

Methods: Uneventful endoscopic forehead lift procedure was performed with moderate skin elevation in three patients. Left upper eyelid crease incision was made to remove the sub-brow dermoid cyst uneventfully in one patient. All procedures were performed under general anesthesia. Mixed topical antibiotic and steroid ointments were placed on the incision sites before putting the encircling forehead dressing (using gauze and elastic bandage). The dressing was then removed on the first postoperative examination.

Results: Forehead and eyebrow PUs were observed on the first follow-up visit (16-72 h) after removing the dressing. Patients were otherwise healthy. They did not have significant pain or burning postoperatively. Management included pressure release, wound debridement, daily dressing, topical antibiotic and steroid, and silicone-based anti-scar cream. None had infected ulcer and all except one ended up with atrophic scar in the last follow-up (2-14 months). External pressure and shearing forces were assumed to be the main causative factors, even though reperfusion injury could contribute in the development of PU.

Conclusion: Encircling head dressing can cause PU and result in scar formation in healthy immunocompetent patients. If there is a low risk of postoperative hematoma, encircling dressing should be avoided. Early loosening of the dressing and frequent examination of the skin are the best preventive and diagnostic measures. Treatment includes pressure removal, daily debridement, and topical medications.
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http://dx.doi.org/10.1080/01676830.2020.1719521DOI Listing
October 2020

Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy.

Eur J Ophthalmol 2021 Jan 10;31(1):57-60. Epub 2019 Oct 10.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Recession of levator muscle can potentially decrease the severity of corneal exposure by reducing margin-reflex distance 1. The purpose of this study is evaluation of effects of levator recession on lagophthalmos in facial palsy.

Materials And Methods: In a non-comparative case series of consecutive patients with exposure keratopathy due to facial paralysis between 2012 and 2017, levator recession was performed through lid crease incision. Small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for those with moderate-to-severe keratopathy. Preoperative and postoperative measurements of margin-reflex distance 1 and lagophthalmos were compared using paired -test.

Results: Thirty-four patients (14 men and 20 women) were enrolled with an average age of 52.3 years. Mean follow-up was 13.3 months (range, 6-36 months). The most common etiology of facial paralysis was Bell's palsy (22 cases), followed by motor vehicle accident (8), parotid surgery (3), and brain tumor surgery (1). No additional procedure was performed for eight patients, while lateral tarsorrhaphy was performed in 26 cases. Mean margin-reflex distance 1 decreased from 5.0 ± 0.4 mm to 4.0 ± 0.5 mm ( < 0.001) and mean lagophthalmos decreased from 3.3 ± 0.9 mm to 1.8 ± 0.9 mm ( < 0.001). Subgroups of patients with additional lateral tarsorrhaphy and without tarsorrhaphy experienced the same amount of reduction in margin-reflex distance 1 and lagophthalmos.

Conclusion: Recession of levator muscle was effective in reduction of margin-reflex distance 1 and lagophthalmos in facial palsy patients. This procedure can be added to the surgical armamentarium for management of patients with facial palsy and lagophthalmos.
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http://dx.doi.org/10.1177/1120672119881984DOI Listing
January 2021

Clinical characteristics, histopathology, and treatment outcomes in adult and pediatric patients with nonspecific orbital inflammation.

J Curr Ophthalmol 2019 Sep 28;31(3):327-334. Epub 2019 Mar 28.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the clinical characteristics, histopathology, and treatment outcomes in adult and pediatric patients with nonspecific orbital inflammation (NSOI).

Methods: This retrospective study evaluates 76 patients with NSOI. The patients were categorized in 9 groups according to the site of involvement and histopathology results. These groups included: anterior involvement, dacryoadenitis, myositis, perineural involvement, acute fat involvement, focal mass, orbital apex involvement, diffuse sclerosing form, and multiple tissue involvement. The course of the disease was categorized as acute, subacute, or chronic. The cases with symptom duration of less than 1 week were classified as acute, 1 week to 1 month as subacute, and more than 1 month as chronic.

Results: 36 (47.4%) patients were males. The mean age was 41.68 ± 17.62 (6-75) years. The most common signs and symptoms were periorbital pain, periorbital edema, decreased ocular movements or diplopia, and conjunctival injection. The most common group was dacryoadenitis in 29 (38.1%) cases. The most common form of disease was the acute involvement (50% of patients). Most of the patients were treated by oral corticosteroids. Duration of follow-up was 7.17 ± 6.26 months. Recurrence occurred in 9 (11.8%) of patients during the follow-up period.

Conclusions: This study presents a new categorization in which multiple tissue involvements were separated. Some of the NSOI features differ between adults and children. In most patients, treatment especially with corticosteroids, resolves the clinical findings.
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http://dx.doi.org/10.1016/j.joco.2019.03.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742620PMC
September 2019

Lacrimal gland prolapse in upper blepharoplasty.

Orbit 2020 Jun 8;39(3):165-170. Epub 2019 Aug 8.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

: To report the characteristics of lacrimal gland prolapse among the patients who underwent upper blepharoplasty.: In a retrospective study, consecutive upper blepharoplasty patients with significant lacrimal gland prolapse were included. The degree of prolapse was measured as anterior protrusion of lacrimal gland from the orbital rim. Reposition of the lacrimal gland was performed by using non-absorbable sutures to fixate the gland to the periosteum of lacrimal fossa. In cases with unusually large lacrimal glands, an incisional biopsy of the gland was obtained. The orbital septum was left unsutured.: Twenty patients (19 females and one male) out of a total of 198 patients who underwent upper blepharoplasty (10.1%) had clinically significant lacrimal gland prolapse. Mean age was 54.8 ± 9.4 years (range, 31-69). Fourteen patients (70%) were asymptomatic. Anterior protrusion of lacrimal gland was measured to be 6.4 ± 1.2 mm (range, 5-10 mm) from the orbital rim. Incisional biopsy of the lacrimal gland was obtained in 10 patients (50%). Nine biopsies showed mild chronic inflammation and one revealed only normal lacrimal gland tissue. Postoperative course was uncomplicated in 15 patients (75%), with mild symptoms in the others and only one instance of mild unilateral recurrence of lacrimal gland prolapse.: Reposition of a prolapsed lacrimal gland is a safe and effective adjunctive procedure in upper blepharoplasty, with minimal complications and acceptable postoperative outcome. Prolapsed lacrimal glands showed mild inflammation which could be due to repetitious movements of a lax gland, although various other etiologies can be involved.
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http://dx.doi.org/10.1080/01676830.2019.1649434DOI Listing
June 2020

Orbital Exenteration: A 23-year Report.

Korean J Ophthalmol 2019 Aug;33(4):366-370

Ophthalmic Plastic and Reconstructive Surgery Unit, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Orbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration.

Methods: This was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients.

Results: One hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports.

Conclusions: Frequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.
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http://dx.doi.org/10.3341/kjo.2018.0052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685828PMC
August 2019

Successful Total Resection of an Orbital Epithelioid Hemangioendothelioma with the Aid of Endovascular Embolization.

Ocul Oncol Pathol 2019 Jan 30;5(1):50-53. Epub 2018 May 30.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Hemangioendothelioma is rarely encountered in the orbit. We present a patient with a growing orbital mass for whom surgical excision was planned. Two previous attempts at removing the mass failed due to profuse bleeding. Endovascular embolization was performed before surgery to prevent massive hemorrhage. After embolization, retinal vascular accident (combined central retinal artery and vein occlusion) occurred. However, surgical excision (lateral orbitotomy and transcoronal craniotomy) was successful, and the vision improved postoperatively. Histopathologic examination and immunohistochemistry study confirmed the diagnosis of epithelioid hemangioendothelioma. The combined approach by a team of specialists, including an interventional radiologist performing preoperative embolization of the feeding vessel and joint surgery by a neurosurgeon and oculoplastic surgeon, was the key to the effective treatment of this vascular orbital neoplasm.
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http://dx.doi.org/10.1159/000489126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341328PMC
January 2019

Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty.

Aesthetic Plast Surg 2019 02 16;43(1):98-101. Epub 2018 Oct 16.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Sq, Tehran, 1336616351, Iran.

Background: Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral-ocular and ocular-oral synkinesis being the most common. Ocular-nasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between the orbicularis oculi and procerus muscles has not been reported by now.

Methods: This is an interventional case report.

Results: Two women, aged 42 and 37 years, presented with unilateral contraction of the medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, 4 and 5 months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A.

Conclusions: Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of the facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of the facial nerve and prevent subsequent aberrant innervation and synkinesis. Botulinum toxin A injection can effectively, yet temporarily, resolve the unintentional contractions and provide significant patient comfort.

Level Of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-018-1255-2DOI Listing
February 2019

Vector analysis of changes in corneal astigmatism following lateral tarsal strip procedure in patients with involutional ectropion or entropion.

Int Ophthalmol 2019 Aug 27;39(8):1679-1685. Epub 2018 Jul 27.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, Tehran, 1336616351, Iran.

Purpose: To perform vector analysis of changes in corneal astigmatism and evaluate changes in corneal topographic parameters following the lateral tarsal strip (LTS) procedure in patients with involutional ectropion or entropion.

Methods: Nineteen eyes of 15 patients (10 eyes with ectropion and 9 eyes with entropion) were included in this prospective nonrandomized interventional case series. Corneal topographic measurements (Tomey TMS 4a topographer, Tomey Corp, Nagoya, Japan) were performed at the baseline and 3 months after the LTS procedure. Relevant changes in the topographic astigmatism magnitude or axis (defined as a change more than 0.2 D or a shift in the axis greater than 10°, respectively) were analyzed following surgery. Polar astigmatic vector analysis was performed using the Astig PLOT software to calculate surgically induced astigmatism (SIA).

Results: There were no significant changes in average keratometry, steep and flat meridian keratometric values, absolute cylinder, surface regularity index and surface asymmetry index after the surgery (All P > 0.05). A relevant change in the magnitude of astigmatism and an axis change greater than 10° occurred in 14 (73.6%) and 10 (52.6%) of the operated eyes, respectively. Polar vector analysis revealed that SIA was 0.47 ± 1.34 D at 91 ± 23°, indicating induction of "with the rule" astigmatism following the surgery.

Conclusion: The LTS procedure for the correction of involutional ectropion or entropion could induce relevant changes in corneal astigmatism, sufficient to affect visual function in short term. Longer-term follow-up is required to further characterize the effect of LTS procedure on the corneal topographic features.
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http://dx.doi.org/10.1007/s10792-018-0987-yDOI Listing
August 2019

Unusual occurrence of orbital hemangiopericytoma in the zygomatic bone of an adolescent: a case report.

Eye Vis (Lond) 2018 13;5:10. Epub 2018 May 13.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Sq, Tehran, 1336616351 Iran.

Background: Hemangiopericytoma and solitary fibrous tumor are considered related variants on the same spectrum and both may essentially be the same tumor. They are infrequently encountered in the orbital region while the zygomatic bone is an extremely rare location for these neoplasms to occur.

Case Presentation: A 14-year-old boy presented with complaint of deformity of left infraorbital area and a firm, regular mass in the region. Orbital CT scan revealed a well-defined round isodense intraosseous lesion in the lowermost portion of the lateral orbital wall (zygomatic bone), expanding the bone and protruding anteriorly and medially. MRI showed the mass to be heterogenous and strongly enhancing with contrast medium. Inferior transconjunctival orbitotomy was performed and the mass was removed. The histopathologic examination and immunohistochemistry staining results (positive for CD34, CD31 and smooth muscle actin, but negative for CD99, S100, B-cell lymphoma 2 (bcl-2) and desmin) confirmed the diagnosis of hemangiopericytoma. The postoperative course was uneventful, with no evidence of recurrence after 5 years follow up.

Conclusions: This case represents the second hemangiopericytoma reported in the zygomatic bone. Although extremely rare, hemangiopericytoma/solitary fibrous tumor might be considered in the differential diagnosis of intraosseous lesions of the orbital and zygomatic region.
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http://dx.doi.org/10.1186/s40662-018-0105-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5950185PMC
May 2018

Small-incision levator resection for correction of congenital ptosis: a prospective study.

Graefes Arch Clin Exp Ophthalmol 2018 Sep 9;256(9):1747-1750. Epub 2018 May 9.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Sq, Tehran, 1336616351, Iran.

Purpose: To determine the rate of success of small-incision levator resection technique for correction of congenital ptosis.

Methods: Patients with congenital ptosis who were candidates for levator resection were enrolled if their levator function was not poor (< 5 mm). Incisions were made on upper eyelid crease with a length of 10-12 mm. After resection of adequate length of levator muscle, two sutures were used to fix it to tarsal plate. Sliding the incision to medial and lateral sides provided a wider field of access to allow the surgeon to place the sutures above nasal and temporal borders of limbus. Success was defined as margin reflex distance-1 (MRD-1) ≥ 3 mm and inter-eyelid difference of MRD-1 less than 1 mm, which was considered excellent if inter-eyelid difference was < 0.5 mm and good if the latter parameter was between 0.5 and 1 mm.

Results: Fifty eyes of 47 congenital ptosis cases (16 males and 31 females) were included. Average age was 21.7 ± 9.7 years (range, 3-44 years). Mean preoperative levator function and MRD-1 were 11.26 ± 2.79 and 1.78 ± 0.92 mm, respectively, while postoperative MRD-1 increased to 3.95 ± 0.82 mm (P < 0.001). The result was failure (undercorrection) in 12 cases (25.5%), good in 9 patients (19.2%), and excellent in 26 cases (55.3%).

Conclusions: Small-incision levator resection has previously been studied for correction of aponeurotic ptosis and proved to yield successful outcome. The findings of this study suggest that small-incision technique can be effectively used in correction of congenital ptosis, as well.
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http://dx.doi.org/10.1007/s00417-018-4008-7DOI Listing
September 2018

A rare erosive orbital mass in a child: Case report of myofibroma.

J Curr Ophthalmol 2017 Sep 4;29(3):224-227. Epub 2017 May 4.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To present the clinical, histological, and radiographic findings of a case of orbital myofibroma in an unusual location. The literature is reviewed and the clinical relevance discussed.

Methods: A 5-year-old boy was examined with a 1.5-month history of progressive swelling in the left supraorbital region.

Results: Examination revealed a firm, painless mass in the supralateral region of the left orbit with slight reddish discoloration of the overlying skin. Computerized tomography (CT) scan images showed a well demarcated, homogenous, solid mass with extension to the lacrimal gland region and adjacent to frontal bone erosion. The mass was surgically excised and was confirmed to be myofibroma in diagnostic histological studies. There has been no evidence of recurrence in the first year after surgery.

Conclusions: Clinical appearance and imaging findings are unspecific for this tumor, and histological examination still remains the definite method of diagnosis. Therefore, it is important to be able to differentiate myofibromas from other malignant tumors with a similar presentation in pediatric patients to avoid mismanagement.
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http://dx.doi.org/10.1016/j.joco.2017.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587252PMC
September 2017

Comparison of the success rate between monocanalicular and bicanalicular intubations in incomplete complex congenital nasolacrimal duct obstruction.

Orbit 2017 Aug 19;36(4):215-217. Epub 2017 Jun 19.

a Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran.

This article compares the success rate between monocanalicular (MCI) and bicanalicular intubations (BCI) in incomplete complex congenital nasolacrimal duct obstruction (CNLDO) and evaluate the factors responsible for the success of intubation. First, 99 patients with incomplete complex CNLDO underwent MCI (Monoka) or BCI (Crawford). Therapeutic success was defined as dye disappearance test grade 0-1 and complete resolution of previous symptoms at 12 months' follow-up. The success rates were compared between two groups. In all cases, the correlation of the age, gender, history of probing, and the presence of purulent discharges with the improvement in CNLDO symptoms were evaluated. 52 cases in the MCI and 47 cases in the BCI group were included. Then, 48 patients (48.5%) had history of probing. 26 patients (26.3%) had purulent discharges. The patients in the MCI group had lower success rate (59.6%) than the patients in the BCI group (74.4%) but the difference was not significant (p = 0.11). No complication occurred in the BCI group. In 4 cases (7.6%) in the MCI group, the tubes were lost before time of planned removal. In all cases, only preoperative absence of the pus was significantly correlated with success (p = 0.09 and OR = 0.39). BCI may be a better treatment for the patients with incomplete complex CNLDO. In silicone intubation for these cases, preoperative absence of purulent discharges could increase the success rate.
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http://dx.doi.org/10.1080/01676830.2017.1337161DOI Listing
August 2017

Pushed monocanalicular intubation versus probing for the treatment of simple and incomplete complex types of congenital nasolacrimal duct obstruction in children older than 18 months old.

Orbit 2017 Aug 19;36(4):218-222. Epub 2017 Jun 19.

a Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences , Tehran , Iran.

This article compares the success rate of pushed monocanalicular intubation (Masterka) versus probing for the treatment of congenital nasolacrimal duct obstruction (CNLDO) in children older than 18 months. In a non-random comparative study, 90 eyes with CNLDO underwent either Masterka (45 eyes) or probing (45 eyes). All procedures were performed by one oculoplastic surgeon. The tubes were removed 2 months after the operation. Complete resolution was defined as complete absence of clinical signs and symptoms of CNLDO at 6 months after the procedure. The mean age at the time of treatment was 28 ± 18.2 months for Masterka and 26.7 ± 18.6 months for probing group. Treatment success was achieved in 33 of 45 eyes (73.3%) in the Masterka group compared with 22 of 45 eyes (48.9%) in the probing group. The difference between the two groups was statistically significant (p = 0.017). For the treatment of CNLDO, Masterka might be more effective than probing in children older than 18 months.
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http://dx.doi.org/10.1080/01676830.2017.1337162DOI Listing
August 2017

Superior orbital fissure and orbital apex syndrome as rare complications of herpes zoster.

Acta Neurol Belg 2017 12 27;117(4):943-946. Epub 2017 May 27.

Department of Neuro-ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Ghazvin Ave, Tehran, 1336616351, Iran.

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http://dx.doi.org/10.1007/s13760-017-0797-4DOI Listing
December 2017

Trichoblastoma of the Upper Eyelid.

J Ophthalmic Vis Res 2017 Apr-Jun;12(2):219-221

Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To describe a case of trichoblsatoma on the eyelid.

Case Report: A 45-year-old woman presented with a recurring mass on her upper right eyelid. Histopathological examination revealed well-circumscribed tissue composed of an aggregation of basaloid cells. Immunohistochemistry showed positive staining for CD34 and CD10. The patient underwent total excision of the recurrent mass.

Conclusion: Although rare, trichoblastoma should be considered in differential diagnosis of skin masses of the eyelids.
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http://dx.doi.org/10.4103/2008-322X.205378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423377PMC
May 2017

Conjunctival bacterial flora in fellow eyes of patients with unilateral nasolacrimal duct obstruction and its changes after successful dacryocystorhinostomy surgery.

J Curr Ophthalmol 2017 Mar 3;29(1):59-62. Epub 2016 Dec 3.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the results of conjunctival culture in fellow eyes of patients with unilateral nasolacrimal duct obstruction (NLDO) and its changes after successful dacryocystorhinostomy (DCR) surgery.

Methods: In this prospective study, 71 adult patients with unilateral NLDO and 41 age and sex-matched controls without NLDO were evaluated. The patients were divided into 2 groups based on clinical examination; group A with purulent regurgitation and group B without purulent regurgitation. They all underwent DCR. Before DCR surgery, microbiologic specimens were taken bilaterally from the conjunctiva of both eyes. Postoperative conjunctival sampling was continued weekly until the culture became negative or the colony count reached to the range of the control group.

Results: There were 38 and 33 patients in groups A and B, respectively. Silicone tube was inserted for 17 patients (23.9%). The culture was positive for bacterial growth in 56 fellow eyes (79%). The conjunctival culture in the control group was positive in 17 eyes (41.4%). The mean count of colonies in a sample unit was 624.73 ± 2412.31, 195.75 ± 407.56, and 9.5 ± 1.5 for group A, group B, and controls, respectively. The mean time of normalization of specimens was 1.43 ± 0.69 weeks (range 1-4). Higher colony count at baseline and presence of silicone tube in infected eye were significantly associated with longer normalization time for fellow eye ( < 0.001 and  = 0.003 respectively).

Conclusions: This study suggests that after successful DCR surgery, a waiting period of 4 weeks is needed for conjunctival bacterial cultures to become negative or reach the level of the normal eyes, in the fellow eyes of patients with unilateral NLDO.
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http://dx.doi.org/10.1016/j.joco.2016.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362396PMC
March 2017

The predictive factors of diplopia and extraocular movement limitations in isolated pure blow-out fracture.

J Curr Ophthalmol 2017 Mar 25;29(1):54-58. Epub 2016 Sep 25.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the predictive factors for development of diplopia and extraocular muscle movement (EOM) limitations in the patients with isolated pure blow-out fracture.

Methods: One hundred thirty-two patients with isolated pure blow-out fracture were included. The diagnosis was done with computed tomography scan. Possible predictive factors were analyzed with logistic regression. The cases that underwent surgery were assigned in the surgical group, and other cases were assigned in the non-surgical group. Receiver operating characteristic (ROC) curve analysis was used in the surgical group to evaluate the power of time interval from trauma to the surgery to predict persistence of 6 months postoperative diplopia and EOM limitation.

Results: At the first visit, 45 of 60 cases (75%) in the surgical group and 15 of 72 cases (20.8%) in the nonsurgical group had diplopia. After 6 months follow-up, 7 cases (11.7%) in the surgical group and 1 case (1.4%) in the nonsurgical group had persistent diplopia. Type of fracture was significantly associated with first visit diplopia (P = 0.01) and EOM limitations (P = 0.06). In the surgical group, type of fracture (P = 0.02 for both) and time interval from trauma to the surgery (P = 0.006 and 0.004, respectively) were significantly associated with 1 month diplopia and EOM limitations. Only time interval from trauma to the surgery (P = 0.04) was significantly associated with 3 months EOM limitation. In the ROC curve analysis, if the surgery was done before 4.5 (sensitivity = 87.5% and specificity = 61.3%) and 7.5 (sensitivity = 87.5% and specificity = 66.9%) days, risk of 6 months postoperative diplopia and EOM limitation was reduced, respectively.

Conclusions: In the early postoperative period, a higher rate of diplopia was observed in the patients with combined inferior and medial wall fractures and longer time intervals from trauma to the surgery. The best time for blow-out fracture surgery was within 4.5 days after the trauma.
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http://dx.doi.org/10.1016/j.joco.2016.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362382PMC
March 2017

Presentation of massive orbital hidrocystoma at birth: case report and review of the literature.

Eye Vis (Lond) 2017 23;4. Epub 2017 Feb 23.

Ophthalmology Department, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Hidrocystoma, or sudoriferous cyst, is an eyelid tumor originating from apocrine or eccrine sweat glands. Its presence in the orbit is relatively rare.

Case Presentation: A full-term female child with severe right eye extrusion was referred to our department two hours after birth. We performed cyst aspiration under ultrasonic guidance; 15 cc straw-colored fluid was obtained and proptosis resolved significantly. Orbital magnetic resonance imaging (MRI) showed a large unilocular retrobulbar mass with hypo-intensity in T1 and hyper-intensity in T2. The case underwent further daily ocular assessment until day 5; when proptosis began to worsen again. On day 6, under general anesthesia, we performed aspiration and then the cyst was completely removed with an intact wall through a trans-conjunctival incision. The diameter of the aspirated cyst was about 4 cm. In pathologic consultation, a cystic cavity lined by a layer of sweat duct like epithelium with apical snouts consistent with the diagnosis of apocrine hidrocystoma was reported.

Conclusion: To date, in the literature, six other cases of orbital hidrocystoma have been reported in childhood with protean clinical pictures; none of which presented at birth. Herein, we introduce the first case report at birth and also provide a review on the literature. Our report strongly argues against the well reputed theory of traumatic origin for orbital hidrocystoma; it has been postulated that this tumor may be the result of sweat gland cells implantation through the orbit. We thereby suggest the possible presence of choristomatous ectopic sweat gland cells in the orbit during embryogenesis.
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http://dx.doi.org/10.1186/s40662-017-0069-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5324226PMC
February 2017

Orbicularis Oculi Myectomy as a Treatment for Blepharospasm in a Case of Schwartz Jampel Syndrome.

J Ophthalmic Vis Res 2016 Jul-Sep;11(3):329-32

Department of Ophthalmic Plastic and Reconstructive Surgery, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To describe a patient with Schwartz Jampel vel Aberfeld syndrome (SJS) who underwent orbicularis oculi myectomy as a treatment for blepharospasm.

Case Report: A 4-year-old child with SJS did not respond to an injection of a single dose of botulinum toxin after one month, so orbicularis myectomy was then performed under general anesthesia. During the procedure, orbicularis vermiform movements were a useful guide for the extent of myectomy that the patient needed. He responded very well to this procedure and experienced significant relief of blepharospasm documented in follow-up visits for up to 6 months.

Conclusion: Blepharospasm in patients with SJS can be treated with orbicularis oculi myectomy as a good functional method with faster and durable response in comparison to botulinum toxin injection.
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http://dx.doi.org/10.4103/2008-322X.188401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000540PMC
September 2016

Transient complete visual loss after intracameral anesthetic injection in cataract surgery.

J Curr Ophthalmol 2015 Sep-Dec;27(3-4):129-31. Epub 2016 Feb 5.

Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: We describe a case of transient visual loss following cataract surgery with unpreserved intracameral lidocaine.

Method: A 50-year-old man with posterior polar cataract underwent phacoemulsification. Following capsulorhexis and hydrodelineation with 0.5 cc of unpreserved lidocaine 1%, a portion of fluid reached behind the crystalline lens and caused the posterior capsule rupture. Cataract extraction and anterior vitrectomy were performed. Anesthetic administration was repeated to relieve the discomfort felt by the patient. A three-piece hydrophobic acrylic intraocular lens was implanted in the ciliary sulcus.

Results: On the first postoperative morning, the patient's vision was recorded as having no light perception. The relative afferent pupillary defect (RAPD) was found to be 4+. The retina and optic nerve head appeared normal. In the afternoon, the visual acuity (VA) was improved to 3-m count-finger. On the second postoperative morning, the patient's VA was improved to 4/10. On the third postoperative day, his VA returned to normal at 20/20 without RAPD.

Conclusion: In the event of posterior capsular rupture, to reduce retinal toxicity risks, intracameral lidocaine should not be repeated.
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http://dx.doi.org/10.1016/j.joco.2015.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881198PMC
May 2016

Adult Rhabdomyosarcoma of Ethmoid Sinus Recurring as an Orbital Mass.

J Clin Diagn Res 2016 Apr 1;10(4):ND06-7. Epub 2016 Apr 1.

Resident, Department of Ophthalmology, Farabi Eye Research Hospital, Tehran University of Medical Sciences , Tehran, Iran .

Alveolar rhabdomyosarcoma (RMS) is a primitive, malignant, round cell neoplasm derived from mesenchymal tissue that exhibits partial skeletal muscle differentiation. We describe a rare case of alveolar RMS of ethmoid sinus, recurring as an orbital mass. A 23-year-old man with the chief complaint of anosmia and mild proptosis was diagnosed with RMS of the left ethmoid sinus and orbit following an endoscopic biopsy of the mass. He was treated with chemotherapy and radiotherapy. At 12 months after diagnosis, while still on maintenance chemotherapy, he presented to our eye hospital with a large medial canthal mass and lateral globe displacement. Orbital computed tomography revealed an extraconal mass in the medial orbit of the left eye, extending posteriorly and compressing the medial rectus muscle. Notably, the ethmoid sinus was clear. Incisional biopsy was performed and the recurrence of alveolar RMS was confirmed. Alveolar RMS of the ethmoid sinus may recur as an orbital mass, even if the sinus where it originated is clear at the time of recurrence.
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http://dx.doi.org/10.7860/JCDR/2016/17661.7602DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866152PMC
April 2016

Medial rectus muscle elongation, a technique to treat very large-angle esotropia.

Graefes Arch Clin Exp Ophthalmol 2015 Jul 7;253(7):1005-11. Epub 2015 Apr 7.

Farabi Eye Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: The purpose was to describe the medial rectus muscle elongation (MRE) procedure to treat very large-angle esotropia (ET) with surgery on a lower number of muscles.

Methods: Twenty patients with very large-angle ET (more than 70 PD) underwent the MRE procedure. In the MRE procedure, the muscle was split longitudinally into three parts. The wider central part was sutured with 6/0 vicryl and disinserted. The distal end of the peripheral parts (still attached to the original insertion), 7-9 mm away from the insertion, was sutured to the proximal end of the central part. At the end of the procedure, the distance of the anastomosis site from the insertion was named as the final elongation. The dose-response effect of the final elongation was calculated in bilateral MRE cases. The mean of the dose-response effect, obtained in the binocular surgery group, was used in the monocular surgery group to calculate the resection effect of lateral rectus (LR) muscle.

Results: Eleven patients underwent bilateral MRE and nine patients underwent unilateral MRE and LR muscle resection. The mean preoperative far and near deviation was 94.10 ± 19.33 PD. The mean postoperative deviation was 14.60 ± 18.07 PD for far and 14.50 ± 18.23 PD for near deviation. In bilateral MRE cases, the mean dose-response effect of the elongation was 5.53 ± 0.67 PD/mm for far and 5.58 ± 0.69 PD/mm for near deviation. The mean LR muscle resection effect was 6.41 ± 1.99 PD/mm for far and 6.28 ± 1.93 PD/mm for near deviation.

Conclusion: The MRE procedure seems an acceptable method to treat very large-angle ET with surgery on a lower number of muscles.
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http://dx.doi.org/10.1007/s00417-015-2992-4DOI Listing
July 2015

Pulmonary artery pressure in patients with markedly deviated septum candidate for septorhinoplasty.

World J Plast Surg 2014 Jul;3(2):119-21

Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The nasal septal deviation (NSD) is one of the major causes of nasal obstruction. This condition increases upper airway resistance. In This study we evaluated the mean pulmonary artery pressure (MPAP) in patients with markedly deviated septum.

Methods: Sixty two patients with NSD (Age range: 26-45 years, 34 men and 28 women) were included in the study. Mean pulmonary artery pressure was measured in preoperative period by Doppler echocardiography with the assistance of an expert cardiologist.

Results: The mean preoperative MPAP value (22.5 mmHg in men and 20.03 mmHg in women) of the patients in this study was higher than normal population (20 mmHg). The MPAP of nine patients (14.5%) was greater than 25 mmHg. This value was significantly higher than values for normal population.

Conclusion: Markedly deviated septum had improper effects in cardiovascular system due to increase in MPAP.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4236997PMC
July 2014
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