Publications by authors named "Hassan Khojasteh"

20 Publications

  • Page 1 of 1

Autosomal Recessive Bestrophinopathy: Clinical and Genetic Characteristics of Twenty-Four Cases.

J Ophthalmol 2021 30;2021:6674290. Epub 2021 Apr 30.

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

Background: To describe ocular manifestations, imaging characteristics, and genetic test results of autosomal recessive bestrophinopathy (ARB). The study design is an observational case series.

Methods: Forty-eight eyes of 24 patients diagnosed with ARB underwent complete ophthalmic examinations including refraction, anterior and posterior segment examination, enhanced depth imaging optical coherence tomography (EDI-OCT), fluorescein angiography (FA), electroretinography (ERG), and electrooculography (EOG). Optical coherence tomography angiography (OCTA) and BEST1 gene sequencing were performed in selected patients.

Results: The age at onset was 4-35 years (mean: 18.6 years). The male-to-female ratio was 0.45. All patients were hyperopic, except one with less than one diopter myopia. EOG was abnormal in 18 cases with near-normal ERGs. Six patients did not undergo EOG due to their young age. Eighteen patients (75%) had a thick choroid on EDI-OCT, of which three had advanced angle-closure glaucoma, 15 patients were hyperopic, and eight of them had more than four diopters hyperopia in both eyes. Macular retinoschisis was observed in 46 eyes of 23 patients (95%) with cysts mostly located in the inner nuclear layer (INL) to the outer nuclear layer (ONL). Of the 18 patients who underwent FA, mild peripheral leakage was seen in eight eyes of four patients (22%). Subfoveal choroidal neovascularization (CNV) was seen in three eyes of two patients (6%) that responded well to intravitreal bevacizumab (IVB). Seven mutations of the bestrophin-1 (BEST1) gene were found in this study; however, only two of them (p.Gly34 = and p.Leu319Pro) had been previously reported as the cause of ARB based on ClinVar and other literature studies.

Conclusions: ARB can be presented with a wide spectrum of ocular abnormalities that may not be easily diagnosed. Pachychoroid can occur alongside retinal schisis and may be the underlying cause of angle-closure glaucoma in ARB. Our study also expands the pathogenic mutation spectrum of the BEST1 gene associated with ARB.
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http://dx.doi.org/10.1155/2021/6674290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105111PMC
April 2021

Multimodal imaging for paracentral acute maculopathy; the diagnostic role of en face OCT.

Int J Retina Vitreous 2021 Feb 16;7(1):13. Epub 2021 Feb 16.

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

Background: To describe the features of multimodal imaging and the diagnostic role of en face OCT in the paracentral acute middle maculopathy (PAMM) spectrum.

Methods: In this observational case series, 5 eyes of 5 patients with acute PAMM were identified. Demographic characteristics as well as data regarding the underlying disease, presenting visual acuity (VA) and ophthalmic examination results were recorded. All patients underwent multimodal imaging within 3 days after symptom onset.

Results: The mean age of patients was 52.2 (range, 33-67) years. Systemic comorbidities including diabetes mellitus and hypertension were identified in two patients. Except for one patient diagnosed with isolated PAMM, other patients had signs of retinal vascular disease such as a cilioretinal artery or branch retinal artery obstruction, non-ischemic central retinal vein occlusion, or a combination of these vascular disorders. The central vision was preserved in two cases; however, the remaining cases presented with profound VA reduction. Different patterns of PAMM including arterial, globular, and fern-like were observed in en face OCT at deep capillary plexus (DCP) level. En face OCT images could precisely delineate the margin of the PAMM area. Optical coherence tomography angiography (OCTA) showed decreased vascular density in DCP. Unresolved projection artifact by conventional OCTA software was observed in DCP and choriocapillaris slabs in all cases.

Conclusion: En face structural OCT in PAMM can delineate the area of ischemia and the degree of foveal involvement. Unresolved projection artifact by conventional OCTA software in the PAMM area can be seen in DCP and choriocapillaris layers.
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http://dx.doi.org/10.1186/s40942-021-00283-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885468PMC
February 2021

Oguchi Disease Associated with Keratoconus.

J Ophthalmic Vis Res 2021 Jan-Mar;16(1):137-139. Epub 2021 Jan 20.

Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.18502/jovr.v16i1.8262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841268PMC
January 2021

Intraocular Injection of StivantⓇ (A Biosimilar to Bevacizumab): A Case Series.

J Ophthalmic Vis Res 2021 Jan-Mar;16(1):28-33. Epub 2021 Jan 20.

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

Purpose: To report the results of intravitreal injection of a bevacizumab biosimilar called StivantⓇ.

Methods: This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). StivantⓇ was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection.

Results: Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean standard deviation age of the patients was 61.7 7.20 years. The mean BCVA and CMT changed from 0.63 0.3 to 0.51 0.3 LogMAR ( = 0.12 ) and from 420.4 47.3μm at baseline to 316.7 50.6 μm ( 0.001) in the DME group; from 0.79 0.3 to 0.68 0.3 LogMAR ( = 0.19) and from 376.1 31.7 μm to 303 31.3 μm ( = 0.019) in the nAMD group; and from 0.81 0.4 to 0.63 0.4 LogMAR ( = 0.05) and from 424.21 18 μm to 303.4 18.8 μm ( 0.001) in the RVO group, respectively.

Conclusion: Our limited experience showed that the intravitreal injection of StivantⓇ was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of StivantⓇ, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of StivantⓇ in comparison to bevacizumab.
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http://dx.doi.org/10.18502/jovr.v16i1.8248DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7841280PMC
January 2021

A Solitary Choroidal Mass with Spontaneous Resolution.

Case Rep Ophthalmol Med 2020 10;2020:8882617. Epub 2020 Dec 10.

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

Background: To report an atypical case of a transient choroidal mass lesion with spontaneous resolution. . A solitary choroidal mass with an overlying neurosensory retinal detachment was seen in an otherwise healthy 31-year-old female. General physical examinations and serum chemistry were unremarkable. The patient had spontaneous resolution two weeks after initial examination without treatment.

Conclusions: Inflammatory choroidal masses may be self-limited, but complete diagnostic measures must always be performed in these patients to distinguish between important causes such as tuberculosis, sarcoidosis, and tumors.
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http://dx.doi.org/10.1155/2020/8882617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7748891PMC
December 2020

Uveitis-induced Refractory Ocular Hypotony Managed with High-dose Latanoprost.

J Ophthalmic Vis Res 2020 Jul-Sep;15(3):408-411. Epub 2020 Aug 6.

Retina & Vitreous Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To report a case of refractory ocular hypotony due to chronic Behcet's disease with good response to high-dose topical latanoprost.

Case Report: We present a 26-year-old man with a known history of Behcet's disease who developed decreasing vision and severe ocular hypotony that was refractory to multiple treatment modalities including subtenon triamcinolone acetonide, ibopamine, pars plana vitrectomy, and silicone oil injection. We decided to try high-dose topical latanoprost for the management of ocular hypotony based on recent reports. After six months, intraocular pressure (IOP) increased by 5 mm Hg, became stable at 7 mm Hg, and remained unchanged at month 24.

Conclusion: High-dose topical latanoprost could lead to significant increase in IOP in uveitis-induced refractory ocular hypotony.
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http://dx.doi.org/10.18502/jovr.v15i3.7459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431716PMC
August 2020

Safety of Intravitreal Injection of Stivant, a Biosimilar to Bevacizumab, in Rabbit Eyes.

J Ophthalmic Vis Res 2020 Jul-Sep;15(3):341-350. Epub 2020 Aug 6.

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

Purpose: To evaluate the safety of intravitreal injection of Stivant, a biosimilar to bevacizumab, in rabbits using electrophysiological and histological analysis.

Methods: Both eyes of 41 New Zealand albino rabbits were injected with 0.1 mL (2.5 mg) of Stivant. The rabbits were scheduled to be sacrificed 1, 2, 7, 14, and 28 days after injection for histopathological evaluations. Clinical examinations and electroretinography (ERG) were performed at baseline and just before sacrificing the rabbits. Fourteen separate rabbits received a reference drug (Avastin) and were considered as the control group. Furthermore, three other rabbits received the same volume of saline (saline control group). Rabbits of both control groups were sacrificed four weeks after injection. ERG was performed 1, 2, 7, 14, and 28 days after injections.

Results: No significant difference was observed in a- and b-wave amplitudes and latency after intravitreal Stivant injection between baseline and different time points. Moreover, there was no statistically significant difference in wave amplitudes and latency between the Stivant and control groups. The histology of rabbit eyes of the Stivant and control groups after intravitreal injections was not distinguishable.

Conclusion: The biosimilar Stivant, up to a dose of 2.5 mg, did not appear to be toxic to the retina in albino rabbits. These results suggest that this drug could be a safe and inexpensive alternative to intravitreal bevacizumab. The efficacy of these injections was not investigated in this study and needs to be evaluated in future studies.
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http://dx.doi.org/10.18502/jovr.v15i3.7453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431730PMC
August 2020

Effect of panretinal photocoagulation on macular vasculature using optical coherence tomography angiography.

Eur J Ophthalmol 2020 Aug 21:1120672120952642. Epub 2020 Aug 21.

Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA.

Background: To evaluate the changes of macular vascular density in the superficial capillary (SCP) and the deep capillary plexus (DCP), foveal avascular area (FAZ), choroidal flow, and macular thickness after pan-retinal photocoagulation (PRP).

Methods: In this prospective interventional non-comparative case series, patients with very severe nonproliferative (NPDR) and early proliferative diabetic retinopathy (PDR) and no significant macular edema who were candidates for pan-retinal photocoagulation underwent measurement of corrected distance visual acuity (CDVA), optical coherence tomography (OCT), Optical coherence tomography angiography (OCTA) at the baseline, 1, and 6 months following completion of PRP treatment.

Results: Thirty-nine eyes from 21 patients with diabetes were enrolled. Superficial and deep capillary plexus densities in the foveal and parafoveal area didn't change significantly 1 and 6 months post-PRP ( > 0.1 in all of them). The FAZ area constricted 6 months following PRP ( = 0.075). Based on the calculated circularity index, the FAZ became significantly more circular after 6 months of follow-up ( = 0.047). Although the choroidal flow area increased after PRP this increase wasn't statically significant neither at 1 month nor at 6 months post-PRP ( = 0.31 and 0.23, respectively).

Conclusion: Although OCTA parameters were not significantly affected by PRP at both short-term (1 month) and long-term (6 months) follow-ups, the FAZ area became significantly circular after PRP may be due to redistribution of blood flow in hypoperfused foveal capillary plexus.
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http://dx.doi.org/10.1177/1120672120952642DOI Listing
August 2020

Safety of Intravitreal Injection of Biosimilar of Aflibercept in Rabbit Eyes.

J Ophthalmol 2020 3;2020:2602918. Epub 2020 Jul 3.

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

Purpose: To assess the safety of biosimilar intravitreal aflibercept (CinnaGen Co., Iran) compared to the reference product (Eylea®; Bayer Schweiz AG, Zurich, Switzerland) in rabbit eyes through functional and histologic studies.

Methods: Forty New Zealand albino rabbits were recruited to the study and were divided into four groups to be sacrificed at 48 hours, one, two, and four weeks after injections. In each group, five rabbits received 0.05 mL (2 mg) biosimilar aflibercept in the right eye and 0.05 mL saline in the left eye as the control, and in a similar manner, the remaining five rabbits received the reference drug in the right eye and saline in the left eye. All the rabbits underwent comprehensive ophthalmic examination and electroretinography (ERG) tests at baseline and also just before enucleation at the specific predefined time points. The enucleated eyes were prepared for retinal toxicity histological examination.

Results: No retinal toxicity was observed based on histologic and ERG findings in all groups. Choroidal congestion was revealed after 1 week in an eye that was injected with biosimilar aflibercept, although the similar finding was detected in the contralateral eye which received saline. Also, one subject which received the reference drug showed chronic vitritis and lymphoplasmocytic reaction of the optic disc at week 4. The remaining subjects showed no histologic changes.

Conclusion: The 2 mg intravitreal injection of biosimilar aflibercept (CinnaGen Co., Iran) was found to be nontoxic in rabbit eyes in the short-term period. Further studies are required to warrant the efficacy and safety profile of the drug in human subjects.
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http://dx.doi.org/10.1155/2020/2602918DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7354659PMC
July 2020

Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy.

Ophthalmol Ther 2020 Sep 14;9(3):641-651. Epub 2020 Jul 14.

Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.

Introduction: Scleral buckling (SB) tends to be more challenging and time-consuming for compared to the pars plana vitrectomy for repairing rhegmatogenous retinal detachments (RRDs). This study characterizes a novel and simplified technique for SB.

Methods: In this single-masked randomized interventional study, patients with RRDs who were eligible for SB were randomly assigned to either the standard (S) or modified (M) technique of SB. In the modified approach, neither intraoperative break localization nor cryopexy or subretinal fluid drainage was done. A large tire (276/279) was placed where preoperative retinal breaks had been localized with a 240 encircling band placed for support of the remaining retina. Patients were followed for 12 months and the primary outcomes were differences between the surgical groups in operative time, anatomical success, visual acuity, and complication rate.

Results: Thirty-six eyes were included in the study (18 in each arm). There were no differences in baseline patient demographics or characteristics including gender, age, lens and macular status, preoperative vision, and symptom duration. The mean length of surgery was 72.2 ± 13.2 and 56.2 ± 9.5 min in groups S and M, respectively (P = 0.001). Complete retinal reattachment at the end of month 12 after single surgery was 80.6% overall; 77.8% (14/18) in group S and 83.3% (15/18) in group M (P > 0.999). After 12 months, both groups achieved similar final best-corrected visual acuity (BCVA): 0.26 ± 0.23 and 0.23 ± 0.17 logMAR in groups S and M, respectively (P = 0.231). Controlling for preoperative BCVA on ANCOVA testing, there were no significant differences in visual improvement between the two groups [F (1,26) = 0.02, P = 0.966 (95% CI) - 0.128 to 0.123)]. Scleral perforation (2:1), vitreous hemorrhage (3:2), and transient rise of intraocular pressure (3:4) all occurred at a low and similar rate between the two groups (S:M).

Conclusion: Modified SB technique was non-inferior compared to the standard approach for anatomical and visual outcomes. Shortening surgical time while maintaining low complication rates makes this an appropriate approach to SB, especially for vitreoretinal surgery trainees.
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http://dx.doi.org/10.1007/s40123-020-00279-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406596PMC
September 2020

Central serous chorioretinopathy and achromatopsia: a case report.

Doc Ophthalmol 2020 12 18;141(3):307-312. Epub 2020 May 18.

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

Purpose: To describe a patient with combined central serous chorioretinopathy and achromatopsia.

Methods: Clinical examination, enhanced depth imaging- optical coherence tomography, fundus autofluorescence, fluorescein angiography and electroretinography were used to study a 33-year-old female presented with the complaint of poor vision since childhood in both eyes, which worsened in the left eye (LE) recently.

Results: In slit-lamp examination, there was a macular elevation in the LE and macular pigmentary change as well as optic disk pallor in both eyes. Enhanced depth imaging optical coherence tomography revealed central inner/outer segment (IS/OS) disruptions, subretinal fluid and thick choroid. Accessory tests included the full-field ERG with severe reduced photopic response (with relatively normal scotopic responses) and fluorescein angiography (FA), which found distinct leakage points in OD and barely visible hyperfluorescent spots in OS. Based on the history of nystagmus, lifelong stable poor vision, loss of foveal cone thickness with IS/OS disruption and severe reduced photopic response with relatively normal scotopic responses, we determined that the diagnosis was most consistent with achromatopsia (ACHM). On the other hand, OCT and FA findings show the simultaneous occurrence of pachychoroid-related central serous chorioretinopathy in this patient.

Conclusion: This case highlights a case of CSC and ACHM.
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http://dx.doi.org/10.1007/s10633-020-09771-2DOI Listing
December 2020

Electroretinogram Changes Following Sequential Panretinal Photocoagulation for Proliferative Diabetic Retinopathy.

Clin Ophthalmol 2020 30;14:967-975. Epub 2020 Mar 30.

Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.

Purpose: To evaluate changes in electroretinogram (ERG) response over the course of multiple sessions of panretinal photocoagulation (PRP) in patients with proliferative diabetic retinopathy (PRP).

Methods: A prospective cohort study of 11 patients with PDR who required PRP was conducted. PRP was completed over three sessions. Each patient had five ERGs done: baseline, 1 week after each PRP session, and 6 weeks after the last session of PRP. Dark-adapted 0.01 ERG, Dark-adapted 3 ERG, Dark-adapted 10 ERG, Light- adapted 3 ERG, and Light-adapted 30 Hz flicker ERG were done. The mean change in a- and b-wave amplitudes as well as implicit times compared to baseline was analyzed.

Results: A significant reduction in peak amplitudes of both a- and b-waves and delay in latencies were observed in all responses (p<0.05). The absolute amplitude reduction and delay in latency were higher for scotopic b-waves (p<0.05). The root mean square (RMS) of Dark-adapted 10.0 ERG (p<0.05) and total mean amplitude changes of a- and b-waves (p<0.001) were reduced after each laser session; however, the magnitude of change was not different between the first, second, or third sessions of PRP, and each session showed a similar deterioration rate of ERG parameters comparing to each other (p=0.4 for RMS and p=0.2 for total mean amplitude changes). In addition, the results indicated recovery of the amplitude and latency of ERG waves after 6 weeks from the final treatment (p<0.001) although not to baseline levels.

Conclusion: ERG findings following PRP show reduced retinal function after each session which partially recovers by 6 weeks after the completion of therapy. Clinicians should be mindful of these changes when planning the treatment course for patients with PDR.
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http://dx.doi.org/10.2147/OPTH.S248678DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7125331PMC
March 2020

Intravitreal Ziv-Aflibercept in Patients With Diabetic Macular Edema Refractory to Intravitreal Bevacizumab.

Ophthalmic Surg Lasers Imaging Retina 2020 03;51(3):145-151

Background And Objective: To evaluate the efficacy of intravitreal ziv-aflibercept (IVZ) in patients with diabetic macular edema (DME) resistant to intravitreal bevacizumab (IVB).

Patients And Methods: This prospective study was conducted in patients with persistent DME. Patients were switched to IVZ no longer than 6 weeks after the last three consecutive monthly IVB treatments and monitored over a course of 12 weeks. Changes in best-corrected visual acuity (BCVA), central macular thickness (CMT), and macular volume on optical coherence tomography were compared.

Results: A total of 59 eyes (38 patients) were included. Mean BCVA improved from 0.84 to 0.71 logMAR (P = .001) after first IVZ treatment and remained significant. In a subgroup analysis, this significance was observed only in the group with baseline visual acuity of less than 20/50. Mean CMT decreased from 479 μm to 364 μm (P = .004) after the first IVZ injections and remained significant.

Conclusion: IVZ may be best reserved for patients with persistent DME after initial failure with bevacizumab, with less likelihood for anatomic or functional improvement in those with mild persistent DME. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:145-151.].
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http://dx.doi.org/10.3928/23258160-20200228-03DOI Listing
March 2020

Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole.

Clin Ophthalmol 2019 27;13:2599-2606. Epub 2019 Dec 27.

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

Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole.

Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (> 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group A - hemicircular ILM peel with temporally hinged inverted flap; group B - circular ILM peel with temporally hinged inverted flap; and group C - circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery.

Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P<0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p<0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115).

Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference.
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http://dx.doi.org/10.2147/OPTH.S236169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6938193PMC
December 2019

Multifocal electroretinogram in diabetic macular edema and its correlation with different optical coherence tomography features.

Int Ophthalmol 2020 Mar 11;40(3):571-581. Epub 2019 Nov 11.

Department of Ophthalmology, Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA, USA.

Purpose: To evaluate multifocal electroretinogram (mfERG) parameters in eyes with diabetic macular edema (DME) and its correlation with vision and optical coherence tomography (OCT) features.

Methods: Fifty-four eyes of 27 subjects with DME due to nonproliferative diabetic retinopathy were evaluated. MfERG responses were measured in three concentric rings. Macular thickness was measured by OCT in each segment of the three concentric rings, and mfERG rings were superimposed on the macular thickness map. The correlation between macular thickness in specific points of the thickness map and changes of the mfERG parameters in the corresponding points of the mfERG field map was evaluated and the relationship between the OCT and mfERG changes and changes of best-corrected visual acuity (BCVA) was investigated. The central foveal B-scans of SD-OCT were used to evaluate any correlation between the external limiting membrane (ELM) status, ellipsoid zone (EZ) status, presence of cysts or disorganization of retinal inner layers (DRIL), and mfERG parameters at the central corresponding area.

Results: The mean of BCVA was 0.5 ± 0.3 in logMAR, and the central macular thickness was 392.6 ± 123.4 microns. The central ring P1 and N2 amplitudes had a significant correlation with BCVA in univariate and multivariate analyses (P = 0.001 for both, r = - 0.346 and r = - 0.646, respectively). There was a significant correlation between retinal thickness and the N1 amplitude in the central ring (P = 0.02, r = - 0.343). Outer retinal layer disruption (ELM and EZ) correlated with prolonged P1 implicit time at the corresponding location (P = 0.005, r = 0.068). The presence of the DRIL was associated with reduced P1 and N2 amplitudes (P = 0.037, r = - 0.284 and P = 0.019, r = - 0.562, respectively). A significant correlation was also found between the presence of cysts and a lower central P1 amplitude (P = 0.033, r = - 0.376).

Conclusion: In diabetic patients, discrete changes of some parameters in the central ring of the mfERG field map (e.g., P1 and N2 amplitudes) have a significant correlation with both structural OCT abnormalities in the corresponding points of the thickness map (like DRIL, intraretinal cyst and ELM/EZ disruption) and BCVA. Predictive models such as those described in this report may make it possible to identify the relationship between specific anatomical and functional characteristics in diabetic retinopathy.
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http://dx.doi.org/10.1007/s10792-019-01215-4DOI Listing
March 2020

Visual evoked potentials after panretinal photocoagulation in patients with proliferative diabetic retinopathy.

Clin Ophthalmol 2019 28;13:1635-1640. Epub 2019 Aug 28.

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

Purpose: To evaluate the changes of latency and amplitudes of pattern-reversal visual evoked potentials (PRVEP) in patients with proliferative diabetic retinopathy after panretinal photocoagulation (PRP).

Methods: PRVEP was recorded in 21 eyes of 21 patients with proliferative diabetic retinopathy prior to, 1 week after every sessions of laser therapy and 1.5 months after the final treatment. Results were compared between pre and post laser treatment sessions in the study group and paired -test was used for statistical analysis.

Results: The P100 amplitude showed a significant difference among all treatment sessions with a decreasing trend in the study group after PRP (<0.001). Also, P100 latency evaluation showed a significant increase after PRP in the study group in all post-PRP sessions (<0.05). However, 1.5 months after laser treatment, an increase in amplitudes (<0.001) and a decrease in latencies (<0.001) of PRVEP were observed and the magnitudes of the parameters approximately returned to their baseline values.

Conclusion: Although decreasing changes in the amplitude and increasing changes in the latency of PRVEP were observed after laser treatment in proliferative diabetic retinopathy patients, one and a half months after the completion of laser therapy, partial recovery of these parameters values was observed.
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http://dx.doi.org/10.2147/OPTH.S213448DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718164PMC
August 2019

The association between blood vitamins D and E with age-related macular degeneration: A pilot study.

Interv Med Appl Sci 2018 Sep;10(3):127-132

Department of Ophthalmology, Ziaeian Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: This study was aimed to evaluate the association of serum vitamins D and E level with age-related macular degeneration (AMD).

Methods: This pilot study was performed in two groups of 15 patients in treatment group and 15 patients in control group. Measurements of blood factors [such as C-reactive protein (CRP) and high-density lipoprotein (HDL)] were performed after 12 h of fasting. To measure vitamins D and E, the serum was isolated from 5 cc blood samples.

Results: HDL was higher in the control group as compared with the AMD group. However, no significant difference was found between the two groups ( = 0.08). On the other hand, serum vitamin E in the AMD group was remarkably higher as compared to the control group ( < 0.002). However, no significant difference was found in serum vitamin D levels between the two groups ( = 0.662). Our findings also revealed that there was no statistically significant relationship between BMI and AMD. Moreover, no significant correlation was determined between serum CRP and AMD ( = 0.96).

Conclusions: Our data indicated that none provides evidence for associations between AMD and serum vitamin D levels. The association between vitamin D and AMD requires further investigations in a large population studies, to elucidate whether vitamin D deficiency can be an important risk factor for AMD.
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http://dx.doi.org/10.1556/1646.10.2018.22DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343581PMC
September 2018

TOPICAL DORZOLAMIDE FOR CYSTOID MACULAR EDEMA IN BIETTI CRYSTALLINE RETINAL DYSTROPHY.

Retin Cases Brief Rep 2021 May;15(3):306-309

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

Purpose: To report a case of Bietti crystalline retinal dystrophy with cystoid macular edema (CME) that was successfully treated with topical carbonic anhydrase inhibitor.

Methods: A 35-year-old otherwise healthy woman, with a known case of Bietti crystalline retinal dystrophy, presented with progressive visual impairment in her right eye for 3 months. The best-corrected visual acuity was 20/50 in the right eye and 20/25 in the left eye. On the basis of the multimodal imaging findings, the patient was diagnosed with Bietti crystalline retinal dystrophy with unilateral CME. Carbonic anhydrase inhibitor therapy twice a day was initiated.

Results: Three months later, visual acuity improved to 20/25 in the right eye, and CME had resolved based on spectral domain ocular coherence tomography findings, although the CME reoccurred after discontinuation of the drug. Three months after resuming the therapy, the best-corrected visual acuity improved back to 20/25.

Conclusion: Cystoid macular edema is one of the main causes of central visual worsening in patients with Bietti crystalline retinal dystrophy. This complication may be resolved with topical carbonic anhydrase inhibitor, resulting in improved anatomical and visual outcomes.
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http://dx.doi.org/10.1097/ICB.0000000000000792DOI Listing
May 2021

Optical Coherence Tomography Angiography in Optic Disc Swelling.

Am J Ophthalmol 2018 07 5;191:116-123. Epub 2018 May 5.

Department of Ophthalmology, University of Colorado, School of Medicine, Aurora, Colorado, USA.

Purpose: To compare optical coherence tomography angiography (OCT-A) of peripapillary total vasculature and capillaries in patients with optic disc swelling.

Design: Cross-sectional study.

Methods: Twenty nine eyes with acute nonarteritic anterior ischemic optic neuropathy (NAION), 44 eyes with papilledema, 8 eyes with acute optic neuritis, and 48 eyes of normal subjects were imaged using OCT-A. Peripapillary total vasculature information was recorded using a commercial vessel density map. Customized image analysis with major vessel removal was also used to measure whole-image capillary density and peripapillary capillary density (PCD).

Results: Mixed models showed that the peripapillary total vasculature density values were significantly lower in NAION eyes, followed by papilledema eyes and control eyes, using commercial software (P < .0001 for all comparisons). The customized software also showed significantly lower PCD of NAION eyes compared with papilledema eyes (all P < .001), but did not show significant differences between papilledema and control subjects. Our software showed significantly lower whole image and PCD in eyes with optic neuritis than papilledema. There was no significant difference between NAION and optic neuritis using our software. The area under the receiver operating curves for discriminating NAION from papilledema eyes and optic neuritis from papilledema eyes was highest for whole-image capillary density (0.94 and 0.80, respectively) with our software, followed by peripapillary total vasculature (0.9 and 0.74, respectively) with commercial software.

Conclusions: OCT-A is helpful to distinguish NAION and papillitis from papilledema. Whole-image capillary density had the greatest diagnostic accuracy for differentiating disc swelling.
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http://dx.doi.org/10.1016/j.ajo.2018.04.017DOI Listing
July 2018

Implantation of a complete intrastromal corneal ring at 2 different stromal depths in keratoconus.

Cornea 2014 Feb;33(2):141-4

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

Purpose: The aim of this study was to evaluate the clinical outcomes of intrastromal MyoRing (Dioptex, GmbH, Linz, Austria) implantation at 2 different depths of 250 and 300 μm.

Methods: This was a prospective interventional randomized controlled trial, a pilot study. Keratoconic patients with keratometry values between 48 and 52 diopters were randomly divided into 2 groups. A continuous intrastromal corneal ring of the same size was implanted at 2 different stromal depths of 250 μm (group 1) and 300 μm (group 2) using femtosecond laser technology for both groups. Visual and refractive outcomes, keratometry, corneal biomechanical characteristics, and higher order aberrations were compared at the 1-year postoperative follow-up.

Results: In both groups, uncorrected distance visual acuity significantly improved after MyoRing implantation, whereas neither of these showed any improvement in the corrected distance visual acuity. In addition, the mean central keratometry and spherical and cylindrical refraction reduced significantly in both groups, and spherical aberration increased significantly in both groups. On one hand, coma was reduced almost significantly in both groups, and on the other hand, corneal hysteresis and corneal resistance factor did not change significantly after the operation. None of the patients in both groups had intraoperative or postoperative complications. There were no differences observed in any of the measured variables of the 2 study groups.

Conclusions: An implantation depth of 250 μm has comparable outcomes with the previously applied 300-μm implantation depth. It may be appropriate for selected cases of keratoconus with lower pachymetry.
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http://dx.doi.org/10.1097/ICO.0000000000000026DOI Listing
February 2014
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