Publications by authors named "Ghasem Fakhraie"

43 Publications

Ahmed glaucoma valve implantation with and without subconjunctival bevacizumab in refractory glaucoma.

Int Ophthalmol 2021 Feb 9. Epub 2021 Feb 9.

Farabi Eye Hospital, Tehran, Iran.

Purpose: To evaluate the effects of subconjunctival bevacizumab injection on intraocular pressure (IOP), hypertensive phase, and failure and success rates of Ahmed Glaucoma Valve (AGV) implantation.

Methods: A total of 63 eyes of 63 patients (30 cases in control and 33 cases in bevacizumab group) were included in this randomized masked prospective clinical trial. Pre- and postoperative BCVA, IOP, number of medications, complications and success rates were compared between AGV + bevacizumab and AGV alone group.

Results: Both groups showed statistically significant reductions in IOP in all their follow-up visits (P < 0.05). The mean IOP was lower in the AGV + Bevacizumab group than AGV group in all follow-up visits. However, the difference was only significant at the 3rd month (17.3 ± 6.2 vs. 20.7 ± 4.6, p = 0.04). The number of medications was not differed significantly between the two groups at their last visit (p value = 0.84) Complete success rate was higher in AGV + Bevacizumab. However, the difference was not significant (p = 0.73). The qualified and overall success rate, failure rate and the need for second tube were not statistically different between the two groups. The hypertensive phase was not statistically significant between the 2 groups (33.3% in AGV + Bevacizumab group and 50% in AGV group, p = 0.06) CONCLUSION: Adjunctive use of Bevacizumab during AGV implantation is beneficial in controlling hypertensive phase and IOP control and may lead to higher success rates and lower failure rates after AGV implantation. However, whether it's clearly beneficial or its exact role remains to be investigated.
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http://dx.doi.org/10.1007/s10792-021-01691-7DOI Listing
February 2021

Evaluation of Changes in Refractive Errors Before and After Trabeculectomy and Shunt Surgery.

Clin Optom (Auckl) 2020 29;12:107-112. Epub 2020 Jul 29.

Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: The aim of the present study was to investigate the change rate of astigmatism and axial, myopia, and hypermetropia in trabeculectomy and shunt surgery.

Patients And Methods: In this comparative study, two groups of 16 patients with an average age of 52.4±8.9 and 94.6±6.7 respectively underwent trabeculectomy and shunt surgery. The changes of reactive error were compared before the surgery and 1 week, 1 month, and 3 months after the surgery. Data from the two groups were analyzed via Friedman and Mann-Whitney tests.

Results: Average of intraocular pressure (IOP) before, and 1 week, 1 month, and 3 months after trabeculectomy is 31.31±7.6, 9.8±2.8, 10.5±1.29, 10.9±1.26 (<0.05) and shunt is 36.06±10.32, 13.5±3.3, 11.68±2.21, 11.18±1.27 (<0.05). Average astigmatism in trabeculectomy is -1.00±0.59, -6.00±1.9, -2.21±1.18, -1.37±0.62 (<0.05) and in shunt it is -0.89±0.46, -1.56±1.62, -1.51±1.46, -1.07±0.85 (>0.05). Percent WRT astigmatism in trabeculectomy is 37.5, 100, 37.5, 31.25 and in shunt it is 43.75, 50, 50, 56.25 and average of spherical equivalence (SE) in trabeculectomy is -0.31±1.49, 1.43±1.94, 0.27±1.74, 0.04±1.46 (<0.05) and in shunt it is 0.65±1.5, 1.03±2.03, -0.70±1.64, 0.62±1.54 (<0.05). Astigmatism and axial comparisons between trabeculectomy and shunt with Mann-Whitney test were significant (<0.05), but SE was not significant (>0.05).

Conclusion: The surgeries induced hypermetropia and reduction with the passing of time but astigmatism amount and percent of with-the-rule astigmatism in trabeculectomy were more than in shunt surgery.
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http://dx.doi.org/10.2147/OPTO.S241659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7398678PMC
July 2020

Association of IL-10 gene promoter polymorphisms with susceptibility to pseudoexfoliation syndrome, pseudoexfoliative and primary open-angle glaucoma.

BMC Med Genet 2020 02 12;21(1):32. Epub 2020 Feb 12.

Mycobacteriology Research Centre (MRC), National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: The involvement of cytokines in pathogenesis of pseudoexfoliation syndrome and glaucoma has been demonstrated in several studies. The aim of the present study was to explore the association between three promoter polymorphisms -592C/A (rs1800872), - 819C/T (rs1800871) and -1082A/G (rs1800896) of interleukin 10 (IL-10) gene with susceptibility to pseudoexfoliation syndrome (PEX), pseudoexfoliative glaucoma (PEXG), and primary open-angle glaucoma (POAG).

Methods: In this study, 114 PEX, 118 PEXG, 114 POAG patients and 126 healthy individuals from Iranian population were participated. Detailed ophthalmic examinations by an ophthalmologist including slit-lamp bio-microscopic examination, dilated examination of the lens, gonioscopy, and funduscopy were carried out on patients and controls. Genomic DNA was extracted from the blood samples and ARMS-PCR was performed to detect promoter polymorphisms of IL-10.

Results: In all three SNPs studied, there was a significant difference in the genotype distribution between patients and control subjects. Results revealed that the AA genotype of IL-10 -592C/A SNP is associated with PEX. However, TT genotype of -819C/T and AA genotype of -1082A/G SNP are significantly associated with susceptibility to either PEX or PEXG and POAG disorders. Furthermore, the ACC haplotype containing the IL-10 -1082A allele was associated with PEX (P = 0.02, OR = 5.76, 95% CI = 5.17-24.49), PEXG (P = 0.006, OR = 7.54, 95% CI = 6.62-30.76) and POAG (P = 0.003, OR = 8.11, 95% CI = 7.13-33.15).

Conclusions: Our results demonstrated that IL-10 gene promoter polymorphisms are associated with susceptibility to PEX, PEXG and POAG in Iranian population. Considering the fact that IL-10 polymorphisms are associated with various IL-10 expressions, further research is needed to explain its involvement in these disorders and the formation of extracellular fibrillar amyloid deposits in PEX and PEXG.
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http://dx.doi.org/10.1186/s12881-020-0969-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017446PMC
February 2020

Cystoid macular edema with prostaglandin analogue use after uneventful cataract surgery in glaucoma patients.

J Cataract Refract Surg 2019 10;45(10):1436-1445

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

Purpose: To evaluate the effect of postoperative latanoprost administration on central macular thickness (CMT) after uneventful cataract surgery in glaucoma patients.

Setting: Farabi Eye Hospital, Tehran, Iran.

Design: Prospective randomized clinical trial.

Methods: In this single-masked trial, glaucoma patients treated with latanoprost who had no other risk factor for the development of pseudophakic macular edema were randomly allocated to continuation of latanoprost or discontinuation of the drop after uneventful cataract surgery. At baseline and postoperatively at 1 month and 3 months, patients had complete ocular examinations and CMT measurements using optical coherence tomography. The main outcome measure was the change in the CMT between baseline measurements and postoperative measurements at 1 month and 3 months.

Results: One hundred fifty-six eyes (latanoprost 76; discontinuation 80) finished the trial. There were no differences in baseline patient demographics or characteristics, including the CMT, between the two groups. There was transient increase in the mean CMT by 12 μm ± 49 (SD) in the latanoprost group at 1 month (P = .03); however, the value returned to baseline by 3 months (6 ± 55 μm; P = .27). The between-group difference in the mean change in the CMT from baseline was -3.1 μm (95% confidence interval [CI], -18.4 to 12.0; P = .68) after 1 month and -10.5 μm (95% CI, -26.6 to 5.5; P = .19) after 3 months; the differences were not significant.

Conclusion: Latanoprost administration after cataract surgery had no measurable effect on macular thickness.
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http://dx.doi.org/10.1016/j.jcrs.2019.05.026DOI Listing
October 2019

Peripapillary Retinal Nerve Fiber Layer Thickness in Normal Iranian Children Measured with Optical Coherence Tomography.

J Ophthalmic Vis Res 2018 Oct-Dec;13(4):453-457

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

Purpose: This study aimed to measure the peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT) in normal Iranian children aged below 18 years.

Methods: Peripapillary RNFL imaging was performed in the right eye of normal Iranian children aged below 18 years using Spectralis SD-OCT (Heidelberg Engineering; Vista, CA). The effects of age, gender, cup-to-disc ratio, and spherical equivalent (SE) on global and sectoral RNFL thicknesses were evaluated.

Results: A total of 115 eyes were imaged. Approximately 51 (44.3%) of the cases were female children. The mean age was 12.44 ± 2.52 years. The SE of refractive error was 0.39 ± 1.38 diopters (range: -3.00 to +4.5 D). The RNFL thickness measurements in the superior, inferior, nasal, and temporal quadrants were 129.25 ± 14.52, 128.16 ± 13.46, 76.76 ± 10.58, and 69.58 ± 9.94 μm, respectively. The global RNFL thickness was 101.01 ± 7.74 μm. In both univariate and multiple regression analyses, SE was the only determinant of RNFL thickness (all values < 0.05).

Conclusion: OCT analysis can effectively measure RNFL thickness in children, and SE is the only determinant of RNFL thickness in normal Iranian patients aged below 18 years.
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http://dx.doi.org/10.4103/jovr.jovr_186_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210867PMC
November 2018

Single long scleral tunnel technique for prevention of Ahmed valve tube exposure.

Eur J Ophthalmol 2019 Jan 3;29(1):52-56. Epub 2018 Apr 3.

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

Purpose:: To evaluate the outcome of single long scleral tunnel technique for the prevention of conjunctival erosions caused by the Ahmed glaucoma valve.

Methods:: This study was a retrospective case series that included 30 eyes of 30 patients who underwent glaucoma valve implantation surgery by the single long scleral tunnel technique.

Results:: The mean age of patients at the time of surgery was 52 ± 21.6 years (range: 10-90 years). The mean visual acuity was 1.5 ± 0.81 logMAR preoperatively. The intraocular pressure was 40.7 ± 9.18 mm Hg (range: 25-58) before surgery that decreased significantly to 19.7 ± 3.1 mm Hg (range: 14-25; p < 0.0001) after a mean follow-up of 37.2 ± 5.9 months. During follow-up, no case of tube exposure was detected in patients.

Conclusion:: Single long scleral technique was efficacious with no occurrence of tube exposure in relatively long period of follow-up. In this method, there is no need to harvest any additional material, and in situations with limited access to patch grafts, it is performable with the minimal facilities.
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http://dx.doi.org/10.1177/1120672117753701DOI Listing
January 2019

Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve.

J Glaucoma 2017 Dec;26(12):1144-1148

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

Purpose: To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV).

Patients And Methods: In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded.

Results: Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (P<0.001). Average number of glaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (P<0.001). Qualified and complete success rates at 12-month follow-up were 65.5% and 6.9%, respectively. Younger age and higher number of previous glaucoma surgeries were significantly associated with the failure of excisonal bleb revision.

Conclusion: Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.
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http://dx.doi.org/10.1097/IJG.0000000000000806DOI Listing
December 2017

Nutritional recommendations for individuals with Flammer syndrome.

EPMA J 2017 Jun 29;8(2):187-195. Epub 2017 May 29.

Augen Glattzentrum, Zurich, Switzerland.

The Flammer syndrome (FS) describes the phenotype of people with a predisposition for an altered reaction of the blood vessels to stimuli like coldness or emotional stress. The question whether such people should be treated is often discussed. On the one hand, most of these subjects are healthy; on the other hand, FS seems to predispose to certain eye diseases such as normal tension glaucoma or retinitis pigmentosa or systemic diseases such as multiple sclerosis or tinnitus. A compromise between doing nothing and a drug treatment is the adaption of nutrition. But what do we mean by healthy food consumption for subjects with FS? The adaption of nutrition depends on the health condition. Whereas patients with e.g. a metabolic syndrome should reduce their calorie intake, this can be counterproductive for subjects with FS, as most subjects with FS have already a low body mass index (BMI) and the lower the BMI the stronger the FS symptoms. Accordingly, while fasting is healthy e.g. for subjects with metabolic syndrome, fasting can even dangerously aggravate the vascular dysregulation, as it has been nicely demonstrated by the loss of retinal vascular regulation during fasting. To give another example, while reducing salt intake is recommended for subjects with systemic hypertensions, such a salt restriction can aggravate systemic hypotension and thereby indirectly also the vascular regulation in subjects with FS. This clearly demonstrates that such a preventive adaption of nutrition needs to be personalized.
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http://dx.doi.org/10.1007/s13167-017-0093-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545990PMC
June 2017

Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab Versus Mitomycin C: A Randomized Controlled Trial.

J Glaucoma 2017 Sep;26(9):829-834

*Glaucoma Service, Farabi Eye Hospital †Farabi Eye Hospital, Tehran, Iran.

Purpose: To compare the outcome of trabeculectomy using adjunctive intracameral bevacizumab versus intraoperative mitomycin C (MMC).

Materials And Methods: In this double-blind, randomized clinical trial 87 eyes of 87 patients with primary open-angle or pseudoexfoliation glaucoma were assigned to each treatment group (44 cases received 1.25 mg intracameral bevacizumab at the end of operation and in 43 cases MMC was applied during surgery). Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg and at least 30% IOP drop with (qualified) or without (complete) glaucoma medications without additional glaucoma surgery.

Results: The follow-up time was 17.12±2.58 months in the bevacizumab group and 17.23±2.42 months in the MMC group (P=0.845). The preoperative IOP was 29.17±3.94 and 28.8±4.08 mm Hg in the bevacizumab and MMC groups, respectively (P=0.689). Last visit IOP was 17.41±3.11 mm Hg in the bevacizumab group and 15.34±3.62 mm Hg in the MMC group (P<0.009). Compared with baseline, IOP drop at last visit was 11.76±5.51 and 13.43±5.92 in the bevacizumab and MMC groups, respectively (P=0.207). At last visit, complete success was achieved in 25 cases (61%) of bevacizumab group and 23 cases (66%) of MMC group (P=0.669). Early filtering bleb leak was more prevalent in bevacizumab group (29% vs. 11%).

Conclusions: A single 1.25 mg dose of intracameral bevacizumab improves the success of trabeculectomy comparable with MMC; however, it increases the risk of early filtering bleb leakage.
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http://dx.doi.org/10.1097/IJG.0000000000000741DOI Listing
September 2017

Mutation analysis of connexin 50 gene among Iranian families with autosomal dominant cataracts.

Iran J Basic Med Sci 2017 Mar;20(3):288-293

Department of Molecular Biology and Genetics, Islamic Azad University, Bushehr Branch, Bushehr, Iran; Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Objectives: Childhood cataract is a genetically heterogeneous eye disorder that results in visual impairment. The aim of this study was to identify the genetic mutations of connexin 50 gene among Iranian families suffered from autosomal dominant congenital cataracts (ADCC).

Materials And Methods: Families, having at least two members with bilateral familial congenital cataract, were selected for the study. Probands were evaluated by detailed ophthalmologist's examination, and the pedigree analysis was performed. PCR amplifications were performed corresponding to coding region and intron-exon boundaries of , a candidate gene responsible for ADCC. PCR products were subjected to bidirectional sequencing, and the co-segregation of identified mutations was examined and finally, the impact of identified mutations on biological functions of was predicted by in silico examination.

Results: Three different genetic alterations, including c.130G>A (p.V44M), c.301G>T (p.R101L) and c.134G>T (p.W45L) in gene were detected among three probands. Two identified mutations, W45L and V44M have been already reported, while the R101L is a novel mutation and its co-segregation was examined. This mutation was exclusively detected in the ADCC and could not be found among the healthy control group. The result of bioinformatic studies of R101L mutation predicted that this amino acid substitution within could be a disease-afflicting mutation due to its potential effect on the protein structure and biological function.

Conclusion: Our results suggest that mutations of lens connexin genes such as gene could be one of the major mechanisms of cataract development, at least in a significant proportion of Iranian patients with ADCC.
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http://dx.doi.org/10.22038/IJBMS.2017.8358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378966PMC
March 2017

Post Filtering Surgery Globe Massage-induced Keratoconus in an Eye with Iridocorneal Endothelial Syndrome: A Case Report and Literature Brief Review.

J Ophthalmic Vis Res 2016 Jul-Sep;11(3):319-22

Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To report a case of unilateral post trabeculectomy globe massage-induced keratoconus (KCN).

Case Report: A 52-year-old lady with a history of trabeculectomy due to iridocorneal endothelial syndrome in her right eye was instructed to massage her globe to control gradual rise of intraocular pressure 1.5 years after surgery. The patient experienced high astigmatism and marked inferior corneal steepening after 3 years of globe massage. The left eye was normal in all aspects. Findings in different visual examinations were compatible with the diagnosis of unilateral KCN in the right eye of our patient.

Conclusion: Chronic forceful frequent eye rubbing particularly with fingertips can be assumed to be the most important causative factor for KCN formation in this patient.
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http://dx.doi.org/10.4103/2008-322X.158896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000537PMC
September 2016

Lens Extraction for Management of Coexisting Cataract and Post-filtering Surgery Ocular Hypotony.

J Ophthalmic Vis Res 2015 Oct-Dec;10(4):385-90

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

Purpose: To evaluate the safety and efficacy of phacoemulsification for management of post-filtering ocular hypotony.

Methods: This prospective interventional case series study recruited 21 consecutive patients with an established diagnosis of ocular hypotony with or without maculopathy. Clear corneal incision phacoemulsification was done for all patients. Nineteen cases that completed a follow-up of at least 6 months were considered for final analysis.

Results: Mean baseline intraocular pressure (IOP) was 2.95 ± 1.43 mm Hg, which increased to 8.84 ± 4.67 mm Hg at 6 months (P < 0.001). Hypotony was resolved in 13 cases (68%) at 6 months while 6 cases (32%) showed persistent hypotony at this time point. Postoperative IOP change at all follow-up time points was not correlated with patient age, time interval between filtering surgery and phacoemulsification, baseline IOP, baseline anterior chamber depth and IOP on the first postoperative day. Three cases (16%) showed filtering bleb failure with dramatic IOP rise around the first postoperative month and required glaucoma medication for IOP control. No significant intra- or postoperative complications were noted.

Conclusion: Cataract surgery alone seems promising in resolving hypotony in patients with post-filtering ocular hypotony, and can be considered as an effective treatment modality before proceeding to more complicated procedures.
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http://dx.doi.org/10.4103/2008-322X.176908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795387PMC
April 2016

Evaluation of Lamina Cribrosa and Choroid in Nonglaucomatous Patients With Pseudoexfoliation Syndrome Using Spectral-Domain Optical Coherence Tomography.

Invest Ophthalmol Vis Sci 2016 Mar;57(3):1293-300

Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California, United States.

Purpose: To evaluate the lamina cribrosa (LC) and peripapillary choroid in patients with pseudoexfoliation syndrome (PXS).

Methods: In this cross-sectional study, one eye each of 32 nonglaucomatous PXS cases and 29 healthy volunteers were enrolled. The optic discs were scanned using enhanced depth imaging spectral-domain optical coherence tomography, and measurements were obtained using HEYEX software 6.0. LC and other related variables at three areas (mid-superior, center, and mid-inferior) and peripapillary choroidal thickness were determined. Linear mixed modeling was used to adjust the variables.

Results: After adjustment for age, sex, and axial length, there was no significant difference between the two groups in peripapillary choroidal thickness or in retinal nerve fiber layer thickness. The LC was significantly thinner in all three areas in the PXS group when compared with the control group, even after adjustment. Although no significant difference in central laminar depth was observed between the two groups (P = 0.74), the superior and inferior laminar depth were significantly deeper in the PXS group when compared with the control group (P = 0.04 and P = 0.006, respectively). Although there was a significant negative association between age and central choroidal thickness in the control group (β = -2.820, P = 0.02), this correlation was not significant in the PXS group.

Conclusions: We found that LC is significantly thinner in all three areas of the optic nerve head in nonglaucomatous PXS patients than in controls. Although no significant difference in peripapillary choroidal thickness was observed between the two groups, peripheral posterior displacement of LC in nonglaucomatous PXS eyes was noted.
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http://dx.doi.org/10.1167/iovs.15-18312DOI Listing
March 2016

Effect of Mitomycin-C Augmented Trabeculectomy on Corneal Endothelial Cells.

J Ophthalmic Vis Res 2015 Jul-Sep;10(3):257-62

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

Purpose: To evaluate the effect of mitomycin-C (MMC) on corneal endothelial cell density (ECD) and morphology after trabeculectomy.

Methods: In this prospective comparative case series, 31 eyes with glaucoma underwent trabeculectomy with (group I), or without (group II) MMC. Specular microscopy was performed pre-, and postoperatively at months 1 and 3. Outcome measures included central corneal endothelial cell count and coefficient of variation (CV) of cell size.

Results: Overall, mean preoperative ECD was 2,135.8 ± 397.6 cells/mm(2); corresponding values at postoperative months 1 and 3 were 2,019.6 ± 447.2 cells/mm(2), and 1,991.4 ± 425.5 cells/mm(2), respectively (P > 0.05). Cell loss from month 1 to 3 was 1.3 % (P > 0.05). Subgroup analysis showed significant differences in endothelial cell loss at month 1 (P = 0.048) and month 3 (P = 0.014) between the MMC and control groups with no significant difference between the two groups in terms of cell loss from months 1 to 3, postoperatively (P = 0.968). Overall, mean pre-and postoperative CVs at months 1 and 3 were 27.38 ± 4.55, 27.96 ± 4.26, and 28.35 ± 4.47, respectively, with no significant difference between the two groups (P > 0.05). There was no correlation between preoperative central endothelial cell density (CECD) and MMC related cell loss.

Conclusion: MMC application in trabeculectomy seems to cause a small but significant corneal endothelial loss. Most of the damage occurs intraoperatively, or in the early postoperative period, however progressive endothelial cell loss is not a major concern.
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http://dx.doi.org/10.4103/2008-322X.170345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687258PMC
January 2016

Confocal scan laser ophthalmoscope for diagnosing glaucoma: a systematic review and meta-analysis.

Asia Pac J Ophthalmol (Phila) 2015 Jan-Feb;4(1):32-9

From the *Clinical Knowledge Management Unit, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences, Tehran; †Iran University of Medical Science, Tehran, Iran; ‡Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran; and §Cochrane Schizophrenia Group, the Institute of Mental Health, a partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Trust, Nottingham, UK.

This systematic review was performed to estimate the diagnostic accuracy of the confocal scanning laser ophthalmoscopy in diagnosing glaucoma. We did a sensitive electronic search to find relevant studies. Two reviewers independently screened relevant articles and extracted required data about study methods and reported results of sensitivity and specificity. A meta-analysis was conducted for pooling data to compare different editions of the Heidelberg Retina Tomograph (HRT) with one of its alternatives, scanning laser polarimetry (GDx) with the criteria of "visual field defect" and "changes of nerve fiber layer" as the reference standard. We identified 37 evaluations from 28 relevant primary studies. In these studies, 9573 eyes (4883 glaucomatous and 4689 non-glaucomatous) were assessed with regards to the reference standard using one of the HRT editions with or without GDx. Diagnostic odds ratios were 9.35 [95% confidence interval (CI): 7.58-11.53] for HRT, 11.84 (95% CI: 9.97-14.06) for HRT II, 11.86 (95% CI: 9.16-15.35) for HRT III, and 21.33 (95% CI, 13.56-33.55) for GDx. Although GDx was more accurate than HRT, all editions of HRT had acceptable performance in diagnosing glaucomatous eyes with an ophthalmologist's clinical examination as the reference standard.
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http://dx.doi.org/10.1097/APO.0000000000000085DOI Listing
March 2016

Retinal venous pressure in chronic smokers.

EPMA J 2015 8;6(1). Epub 2015 Apr 8.

Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Sq., South Kargar Ave., Tehran, 1336616351 Iran.

Background: The overall aim of this study was to determine retinal venous pressure (RVP) in healthy chronic smokers and compare values to those of healthy non-smokers.

Methods: Both eyes of 25 healthy chronic smokers and 41 healthy non-smokers were included. Measurements of RVP were performed by means of contact lens ophthalmodynamometry. Ophthalmodynamometry is done by applying increasing force on the eye via a contact lens. If a spontaneous venous pulsation was present, it was noted. If not, the compressive force was increased until the first venous pulsation was detected, and the measurement value was fixed and read. RVP was calculated as the sum of pressure increase induced by the instrument and intraocular pressure.

Results: Smokers had a significantly higher frequency of spontaneous venous pulsations than non-smokers (p < 0.001). Mean values of RVP were slightly lower in smokers than in non-smokers: 15.3 and 15.5 (smokers) versus 15.9 and 16.2 (non-smokers) for the right and left eye, respectively; however, the difference in RVP between the two groups did not reach significance. There was no significant difference in blood pressure between the two groups, but heart rate was significantly higher in smokers (p = 0.043).

Conclusions: RVP values may differ in healthy smokers than in non-smokers. Therefore, smoking habits should be considered when interpreting RVP results.
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http://dx.doi.org/10.1186/s13167-015-0031-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413992PMC
April 2015

COMPARISON OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY PARAMETERS BETWEEN CENTRAL RETINAL VEIN OCCLUSION AND NORMAL EYES: Is Primary Angle Closure a Risk Factor for Central Retinal Vein Occlusion?

Retina 2015 Sep;35(9):1795-9

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

Purpose: To compare anterior segment parameters in patients with central retinal vein occlusion (CRVO) with normal control subjects by anterior segment optical coherence tomography (AS-OCT).

Methods: In this coss-sectional case-control study, 42 eyes from 21 patients with unilateral CRVO and 21 eyes from 21 age- and sex-matched healthy control subjects were recruited. Study eyes were divided into three groups: involved eyes of CRVO patients (CRVO eyes), fellow eyes of CRVO patients (fellow eyes), and control eyes. Complete ocular examination and AS-OCT were performed for each eye. The AS-OCT parameters (anterior chamber depth, scleral spur angle, angle opening distance [AOD] at 500 and 750 μm from scleral spur [AOD500 and 750] and trabecular-iris space area [TISA] at 500 and 750 μm from scleral spur [TISA500 and 750]) and the rate of narrow angles (based on gonioscopy) in CRVO and fellow eyes were compared with control eyes.

Results: The mean (SD) age of the patients and the control group were 60.09 (9.43) and 59.52 (6.66), respectively. The mean intraocular pressure in both eyes of the patients was significantly higher than the control eyes (P < 0.05). All AS-OCT parameters were significantly different among the three groups (P < 0.05). Comparing with the control eyes, CRVO eyes had shallower anterior chamber depth (2.53 vs. 2.85 mm; P = 0.002) and narrower AS-OCT angle parameters (scleral spur angle, AOD500 and 750, TISA500 and 750). Fellow eyes had also shallower anterior chamber depth (2.56 vs. 2.85 mm; P = 0.005) than control eyes and smaller scleral spur angle, AOD500 and AOD750. Five CRVO patients (23.8%) were diagnosed with narrow angles in both eyes based on gonioscopy, whereas no eye in the control group had narrow angles (P = 0.05).

Conclusion: Imaging with AS-OCT showed that CRVO patients had shallower anterior chamber depth and narrower angle parameters in both eyes in comparison with control eyes. Furthermore, CRVO patients had higher rates of narrow angles on gonioscopic examination.
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http://dx.doi.org/10.1097/IAE.0000000000000549DOI Listing
September 2015

Pseudoexfoliation syndrome: Effect of phacoemulsification on intraocular pressure and its diurnal variation.

J Curr Ophthalmol 2015 Mar-Jun;27(1-2):12-5. Epub 2015 Nov 25.

Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in pseudoexfoliation (PEX) syndrome and its diurnal variation.

Methods: In this prospective, non-comparative, interventional case series, phacoemulsification was done for patients with PEX and concomitant visually significant cataract. Follow-up examinations including IOP measurement were done at postoperative day 1, week 1, month 1, month 3, and month 6. All IOP measurements were performed twice daily: once in the morning between 8 and 10 AM and the other in the evening between 6 and 8 PM. The minimum and maximum IOP and the mean IOP were recorded. IOP variation was defined as the difference between maximum and minimum pressures.

Results: Sixty-eight eyes of 68 patients were analyzed. The mean IOP dropped from 17.45 ± 3.32 mm Hg to 12.57 ± 1.58 mm Hg at 6 months. The minimum and maximum IOP dropped from 14.97 ± 3.46 mm Hg and 20.03 ± 3.39 to 11.53 ± 1.79 mm Hg and 13.01 ± 1.81 after 6 months, respectively. Diurnal IOP variation dropped from 5.06 ± 1.85 mm Hg (range 2-10) at baseline to 1.49 ± 0.93 mm Hg (range 0-4) at postoperative month 6 (p < 0.001 for all). This drop was not correlated with age and CCT, but was strongly correlated with baseline IOP variation (r = 0.847, p < 0.001).

Conclusion: Phacoemulsification without any additional intervention can be an attractive choice in managing the IOP and its diurnal variations in pseudoexfoliation patients, even with elevated IOP, who do not have advanced optic nerve damage.
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http://dx.doi.org/10.1016/j.joco.2015.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877725PMC
May 2016

Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab: A Randomized Controlled Trial.

J Glaucoma 2016 Mar;25(3):e182-8

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

Purpose: To investigate the outcome of trabeculectomy with or without adjunctive intracameral bevacizumab.

Materials And Methods: In this prospective, double-blind, randomized clinical trial, 71 patients with primary open-angle or pseudoexfoliation glaucoma were randomly assigned to receive either 1.25 mg intracameral bevacizumab (n=36) or balanced salt solution as placebo (n=35) at the end of trabeculectomy. Success was defined as at least a 30% drop in intraocular pressure (IOP) compared with baseline values and an IOP between 6 and 21 mm Hg at the last postoperative visit with (qualified) or without (complete) glaucoma medications.

Results: Thirty-two patients in bevacizumab group and 33 in placebo group completed a mean follow-up of 10.7±2.1 and 10.5±2.5 months, respectively (P=0.731). The mean preoperative IOP was 28.25±5.64 and 29.11±4.65 mm Hg in the bevacizumab and placebo groups, respectively (P=0.485). Last visit IOP was 14.5±3.7 mm Hg in the bevacizumab group and 18.55±3.64 mm Hg in the placebo group (P<0.001). At last visit, complete success was achieved in 26 cases (81.3%) of bevacizumab group and 16 cases (48.5%) of placebo group (P<0.006). Filtering bleb leak during the first postoperative month was seen in 11 (34%) and in 3 (9%) cases of bevacizumab and placebo groups, respectively (P=0.013).

Conclusions: A single 1.25 mg dose of intracameral bevacizumab significantly improves the success of trabeculectomy; however, it increases the risk of early filtering bleb leakage.
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http://dx.doi.org/10.1097/IJG.0000000000000202DOI Listing
March 2016

Acute angle closure: qualitative and quantitative evaluation of the anterior segment using anterior segment optical coherence tomography.

Clin Exp Ophthalmol 2014 Sep-Oct;42(7):615-22. Epub 2014 Jan 27.

Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran; Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California, USA.

Background: To evaluate different mechanisms of acute angle closure and to compare it with unaffected fellow eyes and primary angle closure suspects using anterior segment optical coherence tomography.

Design: Prospective, cross-sectional.

Participants: 116 eyes (76 patients) with angle closure disease were included.

Methods: Eyes were categorized into three groups: (i) acute angle closure (40 eyes); (ii) fellow eyes of acute angle closure (40 eyes); and (iii) primary angle closure suspect (36 eyes). Complete ophthalmic examinations including gonioscopy, A-scan biometry and anterior segment optical coherence tomography were performed.

Main Outcome Measure: Based on the anterior segment optical coherence tomography images, four mechanisms of primary angle closure including pupil block, plateau iris configuration, thick peripheral iris roll and exaggerated lens vault were evaluated among the three subtypes of angle closure disease.

Results: There was a statistically significant difference in the mechanism of angle closure disease among the three groups (P < 0.001). Although the majority of fellow and primary angle closure suspect eyes had pupil block mechanism (77.5% and 75%, respectively), only 37.5% of acute angle closure eyes had dominant pupil block mechanism. The percentage because of exaggerated lens vault was greatest in acute angle closure eyes (50%). Acute angle closure eyes had the shallowest anterior chamber depth (P < 0.001), least iris curvature (P < 0.001) and greatest lens vault (P = 0.003) compared with the other two groups.

Conclusions: A statistically significant difference in the underlying primary angle closure mechanisms among acute angle closure eyes as compared with their fellow eyes and primary angle closure suspect may exist.
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http://dx.doi.org/10.1111/ceo.12285DOI Listing
March 2015

Outcomes of same-site re-operation with minimal use of mitomycin in failed trabeculectomy.

Int Ophthalmol 2014 Jun 14;34(3):501-4. Epub 2013 Aug 14.

Eye Research Center, Farabi Eye Hospital, Medical Sciences, Tehran University, Qazvin Square, South Karegar Avenue, Tehran, Iran.

To evaluate efficacy and safety of same site re-operation in eyes with failed trabeculectomy. A retrospective, noncomparative, interventional case series. We reviewed the medical records of 35 eyes of 35 patients who underwent same-site re-operation for failed trabeculectomy. The surgery involved a fornix-based peritomy at the same site as the previous trabeculectomy with application of 0.2 mg/mL mitomycin for 1 min. Primary outcome measures were intraocular pressure (IOP) control and number of antiglaucoma medications at last follow-up. Success rates were defined according to criteria (A) IOP ≤ 21 mmHg or (B) IOP ≤ 18 mmHg, with or without antiglaucoma medication. The mean age of the patients was 43.3 ± 18.0 years and 62.9 % were male. The mean follow-up was 13.6 ± 12.0 months (range 6-49 months). At final follow-up, mean baseline IOP was reduced from 27.2 ± 8.0 to 16.6 ± 7.5 mmHg (p < 0001). The mean number of antiglaucoma medications was reduced from 2.8 ± 0.8 to 1.0 ± 1.3 (p < 0001). This study supports the efficacy and safety of same-site re-operation with minimal use of mitomycin C for management of failed filtering blebs following trabeculectomy.
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http://dx.doi.org/10.1007/s10792-013-9840-5DOI Listing
June 2014

Cataract surgery in eyes with filtered primary angle closure glaucoma.

J Ophthalmic Vis Res 2013 Jan;8(1):32-8

Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran ; Division of Glaucoma, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA.

Purpose: To evaluate the effect of cataract surgery on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG).

Methods: In this prospective interventional case series, 37 previously filtered eyes from 37 PACG patients with mean age of 62.1±10.4 years were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 12 months after trabeculectomy. Visual acuity, IOP and the number of glaucoma medications were recorded preoperatively, and 1, 3, 6 and 12 months after surgery. Anterior chamber (AC) depth was measured preoperatively and 3 months after cataract surgery with A-scan ultrasonography. The main outcome measure was IOP at 12 months.

Results: IOP was decreased significantly from 18.16±5.91 mmHg at baseline to 15.37±2.90 mmHg at final follow-up (P<0.01). The mean number of glaucoma medications was significantly decreased from 1.81±0.24 to 0.86±1.00 (P=0.001) at 1 year postoperatively. At final follow up, 36 (97.2%) eyes and 32 (86.4%) eyes had IOP≤21 and IOP≤18 mmHg, respectively; 14 (37.8%) eyes and 9 (24.3%) eyes had IOP≤21 and IOP≤18 mmHg without medications, respectively. The magnitude of IOP reduction was correlated with higher preoperative IOP (r=0.85, P<0.001), shallower preoperative AC depth (r=-0.38, P=0.01) and greater changes in AC depth (r=-0.39, P=0.01).

Conclusion: Cataract surgery reduces IOP and the number of glaucoma medications in previously filtered PACG eyes. This reduction seems to be greater in patients with higher preoperative IOP and shallower anterior chambers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691976PMC
January 2013

Large angle esotropia with high myopia and a lost medial rectus muscle: a case report.

Binocul Vis Strabolog Q Simms Romano 2013 ;28(2):110-4

A 67 year old woman presented with her left eye fixed in adduction and infraduction. She had previous complicated strabismus surgery 18 years ago with a report of intraoperative loss of left medial rectus (MR) muscle (not retrieved at the time of surgery). An Orbital MRI of the left eye showed reattachment of the MR muscle to the globe and an axially enlarged globe associated with inferior displacement of the lateral rectus and nasal displacement of the superior rectus muscles. In ultrasonography the axial lengths were 24.1 mm in the right and 29.9 mm in the left eye. She underwent staged surgery: The first stage was a recession of the left MR muscle and union procedure on the SR and LR muscles followed by a second adjustable suture procedure under topical anesthesia, of right MR recession, right LR resection and left IR recession. After 12 months her eyes were still binocularly aligned. Unilateral high myopia must be considered in progressive esotropia. Imaging and ultrasonography can demonstrate anatomical abnormality and muscle paths to confirm the definite diagnosis. Union procedure described by Yokoyama is an effective procedure in correcting this strabismus associated with high myopia.
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April 2016

Dynamic contour tonometry in primary open angle glaucoma and pseudoexfoliation glaucoma: factors associated with intraocular pressure and ocular pulse amplitude.

Middle East Afr J Ophthalmol 2013 Apr-Jun;20(2):158-62

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

Purpose: To compare the intraocular pressures (IOP) and ocular pulse amplitudes (OPAs) in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG), and to evaluate ocular and systemic factors associated with the OPA.

Materials And Methods: In this prospective study, on 28 POAG and 30 PXG patients, IOP was measured with the Goldmann applanation tonometry (GAT) and the Pascal dynamic contour tonometry (DCT). Other measurements included central corneal thickness (CCT), vertical cup-to-disc ratio (CDR), and systolic and diastolic blood pressure. Statistical significance was defined as P < 0.05.

Results: In each of the POAG and PXG groups, GAT IOP was correlated with CCT (r = 0.40, P = 0.03 and r = 0.35, P = 0.05, respectively), whereas DCT IOP and CCT were not correlated. In all patients and in the POAG group, OPA was positively correlated with DCT IOP (r = 0.39, P = 0.002). OPA was not correlated with CCT in the POAG (P = 0.80), nor in the PXG (P = 0.20) group, after adjusting for DCT IOP. When corrected for DCT IOP and CCT, there was a significant negative correlation between OPA and vertical CDR in all patients (r = -0.41, P = 0.002). There was no significant difference in OPA between groups (P = 0.55), even when OPA was adjusted for IOP and systolic and diastolic pressure (P = 0.40), in a linear regression model.

Conclusion: DCT IOP and OPA are not correlated with CCT. There is no significant difference between the OPA of PXG and POAG eyes. OPA is correlated with DCT IOP, and is lower in eyes with more advanced glaucomatous cupping.
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http://dx.doi.org/10.4103/0974-9233.110606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669493PMC
January 2014

Topical latanoprost does not cause macular thickening after uncomplicated cataract surgery.

J Ophthalmic Vis Res 2012 Oct;7(4):289-94

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

Purpose: To explore changes in central macular thickness (CMT) after a two-month period of glaucoma therapy with topical latanoprost after uneventful phacoemulsification.

Methods: Forty-one eyes of 31 patients with primary open angle or pseudoexfoliative glaucoma who required glaucoma medications after cataract surgery were prospectively enrolled. All eyes had undergone uneventful phacoemulsification with intraocular lens implantation at least 4 months before initiation of latanoprost. After a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 2 months, and clinical examinations were repeated one and two months afterwards; OCT and FA were repeated after 2 months. Outcome measures were CMT and loss of more than 2 lines of best corrected visual acuity (BCVA).

Results: Mean patient age was 71.6±7.8 years. Intraocular pressure decreased from 21.5±3.4 mmHg to 14.4±2.6 mmHg (p<0.001) at 2 months. None of the eyes developed reduction of BCVA exceeding 2 lines, or angiographic cystoid macular edema (CME). Likewise no significant change was noted in CMT (249.9±29.8 vs 248.8±30.7µm), average macular thickness (274.5±15.0 vs 273.8±17.0µm), or macular volume (9.6±1.0 vs 9.6±1.1µm2) after treatment as compared to baseline (P>0.05 for all comparisons).

Conclusion: Topical use of latanoprost later than 4 months after uncomplicated cataract surgery does not seem to predispose to increased macular thickness or CME and may safely be used in this setting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595585PMC
October 2012

Ocular biometry in the subtypes of angle closure: an anterior segment optical coherence tomography study.

Am J Ophthalmol 2013 Apr 13;155(4):664-673, 673.e1. Epub 2012 Dec 13.

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

Purpose: To evaluate ocular biometric parameters in different subtypes of angle-closure disease in the Iranian population and compare them with normal eyes.

Design: Prospective, cross-sectional.

Methods: In this clinic-based study, 189 eyes of 154 patients consisting of 40 acute angle-closure glaucoma (AACG) eyes, 40 fellow eyes of AACG, 42 chronic angle-closure glaucoma (CACG) eyes, 40 primary angle-closure suspect (PACS) eyes, and 27 normal eyes underwent complete examination including gonioscopy, A-scan biometry, and anterior segment optical coherence tomography. Only 1 eye of CACG, PACS, and control subjects were selected. Main outcome measures included angle opening distance and trabeculo-iris space area at 500 μm from the scleral spur (AOD500, TISA-500), anterior chamber angle, lens vault, lens thickness, anterior chamber depth (ACD), and lens position.

Results: Anterior chamber angle, AOD500, TISA500, ACD, and lens position were less and lens thickness and lens vault were greater in angle-closure than open-angle eyes. ACD was less in AACG than CACG and PACS (P < .001). It was also less in fellow eyes than PACS eyes (P = .04). Lens vault was highest in AACG eyes, followed by fellow eyes, PACS, and CACG. It was significantly more in AACG eyes than CACG and PACS eyes (P < .001 and P = .007, respectively). No difference was observed between AACG and fellow eyes.

Conclusions: The anterior segment was crowded in closed-angle compared to open-angle eyes. Higher lens vault may play a role in the development of an acute attack of angle closure.
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http://dx.doi.org/10.1016/j.ajo.2012.10.014DOI Listing
April 2013

Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial.

Clin Exp Ophthalmol 2013 May-Jun;41(4):368-78. Epub 2012 Oct 29.

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

Background: To compare the anatomic effects of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco-VGP) on drainage angle status in primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT).

Design: Prospective, randomized clinical trial.

Participants: Sixty-seven eyes of 57 patients with the diagnosis of PACG.

Method: Patients were randomized to undergo Phaco alone (33 eyes) or Phaco-VGP (34 eyes). Patients were examined postoperatively on day 1, week 1 and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery.

Main Outcome Measures: Angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy.

Results: Sixty-five eyes of 55 patients completed the trial. The mean extent of PAS was significantly reduced from 127.7 to 95.0 degrees (P < 0.001) by Phaco alone, and from 174.0 to 77.3 degrees (P < 0.001) by Phaco-VGP. Phaco-VGP resulted in significantly greater reduction in PAS extent (P = 0.002). Angle-opening distance and trabecular-iris space-area measured by AS-OCT increased significantly after Phaco alone and Phaco-VGP (P < 0.001 for both). Although the change was higher in the Phaco-VGP group, this did not reach statistical significance. Anterior chamber depth (ACD) increased, and lens vault (LV) decreased after both procedures. The amount of change in ACD and LV was not significant between the two groups.

Conclusion: Both Phaco alone and Phaco-VGP resulted in widening of the drainage angle, deepening of the anterior chamber and reduction of intraocular pressure (IOP) and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS. However, it seems that additional VGP has no significant effect on short-term IOP.
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http://dx.doi.org/10.1111/j.1442-9071.2012.02871.xDOI Listing
September 2013

Retinal nerve fiber thickness is reduced in sleep apnea syndrome.

Sleep Med 2013 Jan 2;14(1):53-7. Epub 2012 Sep 2.

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

Objective: To investigate the prevalence of glaucoma, visual field abnormalities, as well as changes in retinal nerve fiber layer in patients with obstructive sleep apnea syndrome (OSAS).

Methods: In this cross-sectional study, 51 patients with OSAS were included. Based on apnea hypopnea index (AHI), there were 26, 6 and 19 cases of severe (AHI⩾30), moderate (15⩽AHI<30), and mild (5⩽AHI<15) OSAS, respectively. The control group was matched for age, sex and body mass index. Prevalence of glaucoma and ocular hypertension as well as the following values were assessed and compared between two groups: best-corrected visual acuity, intraocular pressure, central corneal thickness (CCT), cup:disk ratio, mean deviation (MD), pattern standard deviation, and retinal nerve fiber layer (RNFL) parameters using glaucoma diagnosis measurement (GDx).

Results: Seven eyes (6.7%) had intraocular pressure (IOP)>21mmHg; of these, four eyes (3.9%) had glaucoma. No significant difference was detected in CCT between the two groups. IOP was significantly higher in the OSAS group before (p<0.001) and after (p<0.001) correcting for CCT. There was a significant difference between groups in MD and most GDx parameters including DISK (temporal-superior-nasal-inferior-temporal) average (p=0.002), superior average (p=0.05) and nerve fiber indicator (NFI) (p=0.03), where those in the patient group showed lower values. There was a significant positive correlation between AHI and both IOP and NFI.

Conclusions: OSAS patients had a higher prevalence of glaucoma and ocular hypertension. OSAS patients also had higher IOP, worse visual field indices, and lower RNFL parameters compared with the control group.
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http://dx.doi.org/10.1016/j.sleep.2012.07.004DOI Listing
January 2013

Effect of phacoemulsification on drainage angle status in angle closure eyes with or without extensive peripheral anterior synechiae.

Eur J Ophthalmol 2013 Jan 3;23(1):70 - 79. Epub 2012 Aug 3.

Farabi Eye Research Center, Tehran University of Medical Science, Tehran - Iran.

Purpose. To evaluate the anatomic effects of phacoemulsification on drainage angle status in primary angle closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Methods. A total of 62 eyes of 58 patients underwent cataract surgery in Farabi Rye Hospital, Tehran, Iran. Patients were examined postoperatively on day 1, week 1, and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Main outcome measures were angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Thirty-five eyes had PAS =180 degrees (group 1) and 27 eyes had >180-degree synechial closure (group 2). Results. Mean age of the patients was 64.3±9.0 years. The mean extent of PAS was significantly reduced from 45.9 to 32.2 degrees (p<0.03) in group 1, and from 277.4 to 159.0 degrees (p<0.001) in group 2. Group 2 showed significantly greater reduction in PAS extent (p<0.001). Angle opening distance and trabecular-iris space area at 500 µm from the scleral spur measured by AS-OCT increased significantly in both groups (p<0.001 for both). Anterior chamber depth (ACD) increased and lens vault (LV) decreased after both procedures. However, the amount of change in ACD and LV and angle parameters were not significant between the 2 groups. Conclusions. Phacoemulsification resulted in opening of the drainage angle, deepening of the anterior chamber, and reduction of PAS extent in PACG eyes with or without extensive PAS. Greater reduction of PAS could be considered in eyes with PAS >180 degrees.
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http://dx.doi.org/10.5301/ejo.5000191DOI Listing
January 2013

Ahmed glaucoma valve implantation with tube insertion through the ciliary sulcus in pseudophakic/aphakic eyes.

J Glaucoma 2014 Feb;23(2):115-8

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

Purpose: To report the efficacy and safety of Ahmed glaucoma valve (AGV) insertion into the ciliary sulcus in pseudophakic/aphakic patients.

Patients And Methods: A chart review was done on patients with uncontrolled glaucoma, who underwent AGV implantation with tube inserted into the ciliary sulcus. Baseline intraocular pressure (IOP) and number of medications were compared with that of postoperative follow-up visits. Surgical success was defined as last IOP <21 mm Hg and 20% reduction in IOP, without further surgery for complications or glaucoma control, and without loss of light perception. Postoperative complications were recorded.

Results: Twenty-three eyes of 23 patients were recruited with the mean follow-up of 9 months (range, 3 to 24 mo). The mean (SD) age of patients was 49.9 (16.9) years (range, 22 to 80 years). The mean (SD) IOP (mm Hg) was reduced from 37.9 (12.4) before surgery to 16.2 (3.6) at the last follow-up visit (P<0.001). The mean (SD) number of medications was reduced from 3.3 (0.9) preoperatively to 1 (1.1) at the last follow-up (P<0.001). Success rate was 18/23 (78.6%). Complications included endophthalmitis in 1 eye, tube exposure in 1 diabetic patient, and vitreous tube occlusion in 1 eye. No case of corneal decompensation or graft failure was seen during follow-up.

Conclusions: Ciliary sulcus placement of the tube of AGV effectively reduces IOP and medication use in short term. It has the potential to lower corneal complications of anterior chamber tube insertion and avoids the need for pars plana vitrectomy and tube insertion in patients at higher risk of corneal decompensation.
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http://dx.doi.org/10.1097/IJG.0b013e318265bc0bDOI Listing
February 2014