Publications by authors named "M Reza Razeghinejad"

95 Publications

Outcomes of trabecular microbypass surgery: Comparison of resident trainees and attending surgeons.

J Cataract Refract Surg 2019 12;45(12):1704-1710

Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Purpose: To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons.

Setting: Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

Design: Retrospective case series.

Methods: Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed.

Results: Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy.

Conclusion: Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.
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http://dx.doi.org/10.1016/j.jcrs.2019.07.021DOI Listing
December 2019

Pneumotonometer Accuracy Using Manometric Measurements after Radial Keratotomy, Clear Corneal Incisions and Lamellar Dissection in Porcine Eyes.

Curr Eye Res 2020 01 22;45(1):1-6. Epub 2019 Aug 22.

Stanley M Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA.

: Measured intraocular pressure (IOP) after corneal incisions may not be reflective of the true IOP because of changes in corneal biomechanical properties. The purpose of this study is to investigate the effect of various corneal incisions on pneumotonometer accuracy in enucleated porcine eyes.: A pneumotonometer was used to measure IOP (IOPp) at manometrically controlled pressure levels of 10, 20, 30 and 40 mmHg in enucleated porcine eyes. IOP measurements at each level were repeated after one of the following corneal incisions: radial keratotomy (8 eyes), lamellar dissection (10 eyes), clear cornea standard phacoemulsification incisions (10 eyes). The pneumotonometer error, defined as the difference between IOPp and manometric pressure (IOPm), was calculated for each pressure level. The error before the corneal incisions was compared to the error after the corneal incisions to assess the accuracy of the pneumotonometer.: The pneumotonometer underestimates true IOP at all pressure levels, both before and after the corneal procedures. There was a statistically significant greater underestimation of IOP after radial keratotomy incisions at pressure levels of 20, 30 and 40 mmHg ( = .013, 0.004, and 0.002, respectively). There was no statistically significant difference in the amount of pneumotonometer underestimation error after lamellar dissection or standard cataract incisions.: The pneumotonometer underestimates true IOP in enucleated porcine eyes at all pressure levels between 10-40 mmHg. Radial keratotomy incisions caused a statistically significant greater underestimation error in pneumotonometry measurements at pressures of 20-40 mmHg. Lamellar dissection and clear corneal cataract incisions did not cause an additional error in pneumotonometry measurements in enucleated porcine eyes.
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http://dx.doi.org/10.1080/02713683.2019.1652915DOI Listing
January 2020

Large Capsulorhexis Related Uveitis-Glaucoma-Hyphema Syndrome Managed by Intraocular Lens Implant Exchange and Gonioscopy Assisted Transluminal Trabeculotomy.

J Ophthalmic Vis Res 2019 Apr-Jun;14(2):215-218

Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, USA.

Purpose: To report a case of uveitis-glaucoma-hyphema syndrome (UGHS) secondary to a large capsulorhexis with an intracaspular intraocular lens (IOL) managed with IOL exchange and gonioscopy assisted transluminal trabeculotomy (GATT).

Case Report: A 73-year-old male patient presented with UGHS of the right eye in the setting of an intracapsular single-piece acrylic IOL with circumferential optic and partial haptics exposure due to a large capsulorhexis. In lieu of the patient's uncomplicated surgical history, subtle symptoms, and clinical findings, the diagnosis and referral was delayed until intraocular pressure reached a peak of 50 mmHg with recurrent anterior chamber cells. The patient underwent combined IOL exchange with placement of a 3-piece sulcus IOL and GATT, which finally resolved the UGHS.

Conclusion: With respect to the increasing prevalence of intracapsular single-piece IOL implantation, it is important to recognize UGHS and thus fashion proper sized capsulorhexis to prevent this vision threatening complication. GATT may be considered to be one of the glaucoma surgeries combined with the IOL surgical procedures in UGHS.
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http://dx.doi.org/10.4103/jovr.jovr_122_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504713PMC
May 2019

Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Intraocular Pressure Measurements Found in a Population at High Risk for Glaucoma.

J Glaucoma 2019 04;28(4):294-301

Wills Eye Hospital, Glaucoma Research Center.

Precis: Intraocular pressure (IOP) measurements, when used during telemedicine eye screening alongside nonmydriatic fundus photography, were shown to improve the likelihood of accurate glaucoma and glaucoma-related diagnoses at the follow-up eye examination.

Purpose: To determine if IOP measurements, used as an adjunct to nonmydriatic fundus photography, are useful in glaucoma telemedicine screening.

Materials And Methods: A total of 902 high-risk individuals were screened for glaucoma at 7 primary care practices and 4 Federally Qualified Health Centers using telemedicine. Screening at visit 1 included fundus photography, assessing family history of glaucoma, and IOP measurements using a hand-held rebound tonometer. Participants with suspicious nerve findings for glaucoma, IOP>21 mm Hg or other ocular pathologies were invited for a follow-up appointment with an ophthalmologist (visit 2).

Results: Of the 902 individuals screened at visit 1, 19.6% (n=177/902) had elevated IOP (>21 mm Hg). Fifteen participants were found to have an IOP>30 mm Hg at visit 1, including 2 with an IOP of >40 mm Hg. Among all who attended visit 2 (n=347), 10.9% had glaucoma and 7.2% had ocular hypertension. For participants having both suspicious nerve findings and IOP>21 mm Hg compared with those with neither, the odds ratio (OR) of being diagnosed with glaucoma was 4.48 (95% CI, 1.50-13.93; P=0.007), whereas for participants with suspicious discs and IOP≤21 mm Hg the OR was 2.04 (95% CI, 0.83-5.53; P=0.15).

Conclusions: In this telemedicine vision screening setting, having a higher IOP at the screening visit increased the likelihood of receiving a final diagnosis of glaucoma. Therefore, this study supports incorporating IOP measurements, using a portable tonometer, into vision screening programs in high-risk populations.
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http://dx.doi.org/10.1097/IJG.0000000000001207DOI Listing
April 2019

Authors' response.

Surv Ophthalmol 2019 Jul - Aug;64(4):589-590. Epub 2019 Mar 13.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1016/j.survophthal.2019.03.004DOI Listing
November 2019

Hidden False Positives in the Visual Field.

J Ophthalmic Vis Res 2019 Jan-Mar;14(1):118-120

Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA.

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http://dx.doi.org/10.4103/jovr.jovr_98_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388533PMC
March 2019

Effect of Anticoagulants and Surgeon-Related Factors on Short-term Outcomes of Laser Peripheral Iridotomy.

Ophthalmol Glaucoma 2019 Jul - Aug;2(4):204-209. Epub 2019 Jun 13.

Wills Eye Hospital, Glaucoma Research Center, Philadelphia, Pennsylvania.

Purpose: To assess the effects of surgeon-related factors on laser peripheral iridotomy (LPI) outcomes by comparing residents and glaucoma specialists, and to look for demographic and clinical predictive factors associated with LPI complications.

Design: Retrospective cohort study.

Participants: Patients who underwent LPI performed by a resident physician were included as cases, and patients who underwent LPI performed by a glaucoma specialist were included as controls. In patients who underwent multiple sessions of laser therapy, only the information from the first session of each eye was included in the study.

Methods: Demographic and clinical information were gathered from the pre-LPI, 1-week, 1-month, and 3-month follow-up visits. The following information was recorded from the LPI session: total laser energy, presence of bleeding, and post-laser intraocular pressure (IOP). Information gathered from the follow-up visits included visual acuity (VA), IOP, hyphema, and need to repeat LPI. A logistic regression analysis with modification for rare events was used to examine the relationship between the dependent variables and the group, adjusted for the clinical and demographic characteristics of patients.

Main Outcome Measures: The LPI procedure parameters (total energy), postoperative VA and IOP, risk for complications, and need for re-treatment were compared between groups using odds ratio (OR) measurements.

Results: A total of 333 eyes were included in the study. The residents used statistically significant higher total energy compared with the glaucoma specialists' group (P < 0.001). After adjusting for demographic characteristics, antiplatelet/anticoagulant use, and laser energy parameters, we found that the patients of the residents group had a significantly increased likelihood for re-treatment within 3 months (OR, 3.38; 95% confidence interval [CI], 1.31-8.73) and anterior chamber bleeding (OR, 7.48; 95% CI, 1.07-52.02).

Conclusions: Although LPI is an effective and minimally invasive procedure, evidence shows that a higher level of experience leads to clinically and statistically significant better outcomes.
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http://dx.doi.org/10.1016/j.ogla.2019.05.002DOI Listing
June 2019

Glaucoma medications in pregnancy.

Oman J Ophthalmol 2018 Sep-Dec;11(3):195-199

Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA.

Glaucoma is a chronic, progressive disease of the optic nerve which is relatively uncommon in childbearing age; however, its management is a real challenge. Although the intraocular pressure decreases in pregnancy, many glaucoma patients continue to require treatment. In addition to the side effects, antiglaucoma medications on the mother, the possible side effects of drugs on the fetus must be taken into account. The only antiglaucoma medication categorized in Category B is brimonidine, and all others are in Category C. Most evidence on glaucoma medications in pregnancy comes from single case reports or animal studies with the limitations that these impose. Theoretically, glaucoma medications may damage the fetus; however, they may not have substantial clinical significance with routine dosages and no topical antiglaucoma agents have strong evidence of safety to the fetus based on the human studies. When discussing possible options for glaucoma management with the pregnant patient, it is important to emphasize the lack of definitive studies and the patient may be involved in the therapeutic decision-making process.
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http://dx.doi.org/10.4103/ojo.OJO_212_2017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6219332PMC
December 2018

Cyclodialysis cleft repair: A multi-centred, retrospective case series-Response.

Clin Exp Ophthalmol 2019 03 22;47(2):304-308. Epub 2018 Nov 22.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.

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http://dx.doi.org/10.1111/ceo.13427DOI Listing
March 2019

Managing normal tension glaucoma by lowering the intraocular pressure.

Surv Ophthalmol 2019 Jan - Feb;64(1):111-116. Epub 2018 Oct 6.

Wills Eye Hospital, Glaucoma Service, Philadelphia, Pennsylvania, USA. Electronic address:

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http://dx.doi.org/10.1016/j.survophthal.2018.07.003DOI Listing
January 2019

Efficacy of the combination of carteolol hydrochloride + latanoprost in the treatment of glaucoma and ocular hypertension.

Expert Opin Pharmacother 2018 Oct 8;19(15):1731-1738. Epub 2018 Oct 8.

a Wills Eye Hospital, Sidney Kimmel Medical College , Thomas Jefferson University , Philadelphia , PA , USA.

Introduction: The only evidence-based mechanism for prevention and treatment of glaucomatous optic neuropathy is decreasing the intraocular pressure (IOP). Prescribing multiple ocular hypotensive agents, such as the combination of carteolol and latanoprost, may synergistically improve IOP; however, doing so may increase the complexity of a medication regimen, in turn, impairing patient adherence. Fixed-combination glaucoma medications offer convenience and effectiveness. New to this class of glaucoma medication is fixed combination carteolol-latanoprost (FCCL). Area covered: This review intends to give the reader a better understanding of the efficacy of the combination of carteolol and latanoprost separately, and where FCCL fits into the vast medical arsenal of IOP drops. Furthermore, it outlines the particular pharmacologic mechanisms targeted, the pharmacokinetics, effectiveness, the advantages of fixed-combination administration, and tolerability. Expert opinion: The combination of carteolol and latanoprost, separately or in a fixed-combination, is more effective than either drug alone. Given the early stage in development of FCCL, it has yet to be determined how FCCL compares to other fixed-combination medications. However, pending further approval, fixed-combination carteolol-latanoprost may represent a reasonable alternative for a patient whose IOP is inadequately controlled on a prostaglandin analog alone and for whom a simplified combination is preferred.
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http://dx.doi.org/10.1080/14656566.2018.1518432DOI Listing
October 2018

Corneal Biomechanical Properties and Thickness in Primary Congenital Glaucoma and Normal Eyes: A Comparative Study.

Med Hypothesis Discov Innov Ophthalmol 2018 ;7(2):68-72

Poostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.

The correct estimation of Intraocular Pressure (IOP) is the most important factor in the management of various types of glaucoma. Primary congenital glaucoma is a type of glaucoma that can cause blindness in the absence of control of the IOP. In this retrospective observational study, 95 eyes, including 48 healthy eyes and 47 eyes with Primary Congenital Glaucomatous (PCG) were studied. Two groups were matched for age, gender, and Goldman Applanation Tonometry (GIOP). Corneal Hysteresis (CH), Corneal Resistance Factor (CRF), and Goldman intraocular pressure were measured by ORA (IOPg), and corneal compensated Intraocular Pressure (IOPcc) was measured for each patient using the Ocular Response Analyzer (ORA). Central Corneal Thickness (CCT) was measured by ultrasonic pachymetry. For each patient, one eye was selected randomly. Student's t-test and analytical regression were used for statistical analysis. The two groups were matched for age (P = 0.34), gender (P = 0.47), and GIOP (P = 0.17). Corneal hysteresis and CRF were significantly lower in PCG than in normal eyes (P < 0.0001), yet CCT was significantly thicker in PCG than normal eyes (P < 0.0001). The regression equation on the effect of CH, CRF, and CCT on GIOP in the PCG group showed that CH and CRF (P-value = 0.001 and P-value<0.0001) also had a significant effect yet CCT did not (P-value = 0.691). A significant decrease in CH and CRF was found in the PCG group compared to the normal controls. In the PCG group, the CCT was greater than normal. These results showed the usefulness of biomechanical properties (CH, CRF) in order to interpret IOP measurements. Furthermore, GIOP measurement may not be confined to consideration of CCT alone. A low CH and CRF value could be responsible for under-estimation of GIOP in the PCG group, in comparison to the normal controls.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146241PMC
January 2018

Psychometric properties of the Glaucoma Quality of Life-15 questionnaire: Use of explanatory factor analysis.

J Curr Ophthalmol 2018 Sep 17;30(3):211-216. Epub 2018 Jan 17.

Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA.

Purpose: The purposes of this study were to validate the Persian translation of the Glaucoma Quality of Life-15 (GQL-15) questionnaire, evaluate its psychometric properties, and identify new composite items and item numbers.

Methods: This cross-sectional study was conducted from August to November 2016, at the Glaucoma Clinic of the Ophthalmology Department at Shiraz University of Medical Sciences, Iran. One hundred ninety patients with glaucoma were enrolled. Habitual-corrected visual acuity (HCVA), intraocular pressure (IOP), slit-lamp biomicroscopy, fundus exam, and mean deviation (MD) of the visual field were recorded in the course of clinical examination by glaucoma professional. Psychometric properties, i.e. test-retest reliability, internal consistency, content validity, and construct validity were evaluated with factor analysis. Based on the Disc Damage Likelihood Scale (DDLS), patients were stratified to mild, moderate, and severe disc damage. The association between the GQL-15 scores and disease severity (mild, moderate and severe) were evaluated by the analysis of variance (ANOVA).

Results: Of 190 eligible glaucoma patients, reliable clinical data were available for 140 participants. Mean age [standard deviation (SD)] of the patients was 58.7 (13.3) years. Cronbach's α coefficient ranged from 0.74 to 0.91, and the correlation coefficient for total score was 0.53. The content validity ratio (CVR) was 0.91 based on evaluations in expert panel. Exploratory factor analysis (EFA) based on eigenvalue higher than one identified two factors after varimax rotation for the GQL-15 which explained 66.5% of the total variance. Discriminant validity analysis disclosed statistically significant differences in mean quality of life scores between levels of disease severity.

Conclusion: The Persian version of the GQL-15 is a reliable and valid questionnaire for use in glaucoma clinics as a complementary tool for evidence-based decision-making.
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http://dx.doi.org/10.1016/j.joco.2017.12.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127367PMC
September 2018

Cyclodialysis cleft repair: A multi-centred, retrospective case series.

Clin Exp Ophthalmol 2019 03 22;47(2):201-211. Epub 2018 Nov 22.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

Importance: There is a paucity of evidence analysing the treatment of cyclodialysis clefts.

Background: We describe outcomes following the treatment of this rare condition at six centres internationally.

Design: Retrospective case series.

Participants: Thirty-six patients with a cyclodialysis cleft from 2003 to 2017 were recruited.

Methods: Clefts were treated with cycloplegic agents, laser therapy and/or surgery.

Main Outcome Measures: Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure.

Results: The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow-up required IOP lowering medication.

Conclusions And Relevance: There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP.
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http://dx.doi.org/10.1111/ceo.13378DOI Listing
March 2019

Comment on internal cyclopexy for complicated traumatic cyclodialysis cleft.

Acta Ophthalmol 2018 12 28;96(8):e1046. Epub 2018 Jun 28.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

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http://dx.doi.org/10.1111/aos.13861DOI Listing
December 2018

Contemporary approach to the diagnosis and management of primary angle-closure disease.

Surv Ophthalmol 2018 Nov - Dec;63(6):754-768. Epub 2018 May 17.

Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.

The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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http://dx.doi.org/10.1016/j.survophthal.2018.05.001DOI Listing
November 2018

Response to: 'Comment on: 'Immediate IOP elevation after transscleral cyclophotocoagulation'.

Eye (Lond) 2018 07 9;32(7):1289. Epub 2018 Mar 9.

Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.1038/s41433-018-0036-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043490PMC
July 2018

Results for Water-drinking Test, before and after Laser Iridotomy, in Primary Angle-closure Suspects.

Optom Vis Sci 2018 02;95(2):150-154

Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Significance: Intraocular pressure and ocular biometric changes were similar before and after laser iridotomy in response to the water-drinking test in a cohort of patients at risk of angle closure. The water-drinking test does not seem to be a good provocative test to determine which eyes would benefit from a laser iridotomy. Our data call into question the preoperative predictive value of this test.

Purpose: The aim of this study was to evaluate the effect of water-drinking test on intraocular pressure and ocular biometric parameters, before and after laser peripheral iridotomy, in patients with an occludable angle.

Methods: Twenty-seven patients, who met the inclusion criteria and had at least 180 degrees of iridotrabecular apposition, underwent a complete eye examination followed by the measurement of ocular biometric (using LenStar LS-900; Haag-Streit AG, Koeniz, Switzerland) and anterior chamber parameters (using Pentacam HR; Oculus Optikgerate GmbH, Wetzlar, Germany). All the measurements were repeated 30 minutes after the water-drinking test. Two weeks after laser peripheral iridotomy, all the measurements were repeated both before and after the water-drinking test.

Results: The mean ± SD of the age of the participants was 57 ± 9 years, and 23 (85.2%) were male. Intraocular pressure increased after the water-drinking test in both pre-laser peripheral iridotomy (17.0 vs. 19.3 mmHg, P < .001) and post-laser peripheral iridotomy (15.6 vs. 18.6 mmHg, P < .001) conditions. The thickness values of central cornea increased slightly after the water-drinking test in pre-laser peripheral iridotomy (535 vs. 538 μm, P = .001) compared with post-laser peripheral iridotomy (532 vs. 536 μm, P = .003). The water-drinking test had no significant effect on other biometric or anterior chamber parameters, before or after laser peripheral iridotomy.

Conclusions: The water-drinking test increased intraocular pressure, both before and after laser peripheral iridotomy. Laser peripheral iridotomy had no significant effect on the amount of intraocular pressure change after the water-drinking test. The water-drinking test has no effect on other biometric or anterior chamber parameters.
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http://dx.doi.org/10.1097/OPX.0000000000001167DOI Listing
February 2018

Water Drinking Test: Intraocular Pressure Changes after Tube Surgery and Trabeculectomy.

J Ophthalmic Vis Res 2017 Oct-Dec;12(4):390-396

Poostchi Ophthalmology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test.

Methods: In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups.

Results: In both groups, intraocular pressure significantly increased from baseline at all measured time-points ( < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; = 0.03).

Conclusion: Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.
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http://dx.doi.org/10.4103/jovr.jovr_204_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5644405PMC
November 2017

The Effect of Latanaprost on Intraocular Inflammation and Macular Edema.

Ocul Immunol Inflamm 2019 13;27(2):181-188. Epub 2017 Oct 13.

a Glaucoma Service , Wills Eye Institute , Philadelphia , Pennsylvania , USA.

There is debate concerning whether the use of Latanoprost in early postoperative period of cataract surgery and in glaucoma patients with uveitis as it may aggravate the inflammation and results in macular edema (ME), because of blood-ocular barrier disruption. However, there is no solid evidence for disruption of blood-ocular barrier with Latanoprost and aggravation of uveitis or ME formation. Similar to pseudophakic ME, the imaging ME in cases claimed to be secondary to Latanoprost is greater than clinical ME, happens mostly in complicated surgeries, and the vast majority resolve within weeks to months with using a non-steroidal anti-inflammatory drug. The current literature suggests that Latanoprost can be used in patients with uveitis and early after cataract surgery with or without concomitant topical non-steroidal anti-inflammatory drugs that are currently used by many ophthalmologists as a preventive measure for ME even in non-glaucoma uncomplicated cataract surgeries.
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http://dx.doi.org/10.1080/09273948.2017.1372485DOI Listing
January 2020

Traumatic optic neuropathy treatment trial (TONTT): open label, phase 3, multicenter, semi-experimental trial.

Graefes Arch Clin Exp Ophthalmol 2018 Jan 6;256(1):209-218. Epub 2017 Oct 6.

Eye Research Center, Khalili Eye Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: Intravenously administered erythropoietin (EPO) was firstly commenced (phase 1) in patients with indirect traumatic optic neuropathy (TON) by this group in 2011. It was re-tested by another group (phase 2) in 2014. This multicenter clinical trial was designed to compare its effect with intravenous steroid and observation.

Methods: Included were TON patients ≥5 years of age and with trauma-treatment interval of ≤3 weeks. Follow-up visits were set at 1, 2, 3, 7, 14, 30, and at least 90 days after treatment. EPO and methylprednisolone were infused intravenously every day for three consecutive days. Primary outcome measure was change in the best corrected visual acuity (BCVA). Secondary outcomes included change in color vision and relative afferent pupillary defect (RAPD), side effects, and factors affecting the final visual improvement.

Results: Out of 120 patients, 100 (EPO: 69, steroid: 15, observation: 16) were finally included. All three groups showed a significant improvement of BCVA which was not significantly different between the groups (adjusted for pretreatment BCVA). Color vision was significantly improved in the EPO group. Late treatment (>3 days) (odds ratio = 2.53) and initial BCVA of NLP (odds ratio = 5.74) significantly worsened visual recovery. No side effect was observed in any group.

Conclusion: EPO, steroid, and observation showed a significant improvement of BCVA in patients with TON. Initial BCVA of NLP and late treatment (>3 days) were significant risk factors for visual improvement.
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http://dx.doi.org/10.1007/s00417-017-3816-5DOI Listing
January 2018

Agreement of Corneal Diameter Measurements Obtained by a Swept-source Biometer and a Scheimpflug-based Topographer.

Cornea 2017 Nov;36(11):1373-1376

*Department of Opthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; †Salouti Eye Clinic, Salouti Cornea Research Center, Shiraz, Iran; ‡Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; and §Glaucoma Service, Wills Eye Institute, Philadelphia, PA, USA.

Purpose: To assess the agreement between a swept-source optical biometry device (IOLMaster 700) and a Scheimpflug-based topography device (Pentacam HR) in measuring the corneal diameter.

Methods: A total of 100 eyes from 100 cataract surgery candidates were enrolled. The white-to-white (WTW) distance measurements provided by both devices were recorded and analyzed. A paired t test was performed to compare the mean values of the WTW distance between the IOLMaster 700 and Pentacam HR. The Bland-Altman analysis was used to evaluate the agreement between the measurements of both devices.

Results: Mean age (±SD) of the participants was 65.9 ± 3.3 years, and 58 (58%) were men. The mean WTW distances measured by the IOLMaster 700 and Pentacam HR were 11.72 ± 0.45 mm and 11.41 ± 0.42 mm, respectively (P < 0.001). The overall 95% limits of agreement were -0.17 and 0.78 mm. The 95% limits of agreement between the measurements of the 2 devices were -0.30 and 0.84 versus -0.07 and 0.72 for eyes with WTW distances of ≤11.50 mm versus >11.50 mm, respectively.

Conclusions: According to the results of this study, the IOLMaster 700 may overestimate the WTW distance measurements by up to 0.78 mm compared with the Pentacam HR, so these 2 devices should not be used interchangeably for this purpose. The agreement is somehow weaker for eyes with WTW distances of 11.50 mm or less than those with WTW distances greater than 11.50 mm.
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http://dx.doi.org/10.1097/ICO.0000000000001300DOI Listing
November 2017

Agreement in central corneal thickness measurements between optical and ultrasound pachymeters in patients with primary congenital glaucoma.

Eye (Lond) 2017 09 2;31(9):1382. Epub 2017 Jun 2.

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

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http://dx.doi.org/10.1038/eye.2017.103DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5601436PMC
September 2017

The Water-Drinking Test Revisited: An Analysis of Test Results in Subjects with Glaucoma.

Semin Ophthalmol 2018 24;33(4):517-524. Epub 2017 May 24.

b Truhlsen Eye Institute, University of Nebraska Medical Center , Omaha , NE , USA.

Purpose: The Water-Drinking Test (WDT) has been shown to predict the diurnal IOP change. This study evaluates the factors that may affect the WDT results.

Methods: This study was conducted on 203 glaucoma patients who had undergone trabeculectomy (53) or tube surgery (31), or had a medically controlled open-angle (82) or closed-angle (37) glaucoma. IOP was measured at baseline and then every 15 minutes over a one-hour period after drinking water. The main outcome measures were IOP change (increase in IOP from baseline) at all measurement time points, IOP peak (highest IOP after drinking water), IOP fluctuation (difference between IOP peak and baseline), and assessing the association of these IOPs with a patient's demographic and management modalities.

Results: The mean age of the participants was 54±18 years, and 113 (56%) were male. Female patients showed greater IOP fluctuation than males (7.28 vs. 5.92 mm Hg; P=0.016), and a greater IOP peak (22.7 vs. 20.1 mm Hg; P=0.001). The observed associations between gender and IOP changes were only significant in <50 years. IOP at 60 minutes was greater in tube than trabeculectomy (5.6 vs. 3.1 mm Hg; P=0.007). The number of topical medications showed a direct independent association with IOP changes (P<0.001). Compared to other classes of topical medications, latanoprost showed lower WDT-IOP profile (P=0.0003).

Conclusions: WDT-IOP change was diminished in subjects on latanoprost, and was greater in females <50 years, and those on greater number of medications.
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http://dx.doi.org/10.1080/08820538.2017.1324039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701879PMC
June 2018

Optic disk hemorrhage in health and disease.

Surv Ophthalmol 2017 Nov - Dec;62(6):784-802. Epub 2017 Apr 8.

Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Optic disk hemorrhage occurs in all age groups from neonates to the elderly. Optic disk hemorrhage is best known for its association with visual field loss and progression in patients with glaucoma; however, it may occur in conjunction with other ocular or systemic conditions as well as in healthy individuals. It may also be the first sign of a sight-threatening condition. Variations in the shape, location, and size of the optic disk hemorrhage, as well as associated ocular and systemic signs or symptoms, may help determine the underlying pathology. We address the epidemiology, demographics, pathophysiology, clinical presentations and implications, differential diagnoses, and management of eyes with optic disk hemorrhage in diseased and healthy subjects.
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http://dx.doi.org/10.1016/j.survophthal.2017.04.001DOI Listing
December 2017

Immediate IOP elevation after transscleral cyclophotocoagulation.

Eye (Lond) 2017 08 7;31(8):1249-1250. Epub 2017 Apr 7.

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

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http://dx.doi.org/10.1038/eye.2017.59DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558227PMC
August 2017

Trabeculectomy bleb-associated infections.

Surv Ophthalmol 2017 Sep - Oct;62(5):591-610. Epub 2017 Feb 8.

Wills Eye Institute, Jefferson Medical School, Philadelphia, Pennsylvania, USA.

Trabeculectomy with antimetabolites is the most commonly performed surgery worldwide for glaucoma patients with progressive optic nerve head injury and visual field loss despite maximum pharmacologic intraocular pressure-lowering therapy. Trabeculectomy bleb-associated infections remain one of the most feared early and long-term complications of trabeculectomy surgery because of their poor prognosis and variable response to antimicrobial therapy. Several studies have evaluated how surgical technique, conjunctival incision location, comorbid ocular pathology, concurrent medication use, and bleb morphology affect the risk of bleb-associated infection. New surgical techniques and devices aim to achieve a similar intraocular pressure reduction profile to trabeculectomy while avoiding the presence of a conjunctival bleb. We provide a comprehensive review of studies evaluating risk factors for bleb-associated infection after trabeculectomy and propose a diagnostic and therapeutic approach to bleb-associated infection.
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http://dx.doi.org/10.1016/j.survophthal.2017.01.009DOI Listing
September 2017

Current and Future Techniques in Wound Healing Modulation after Glaucoma Filtering Surgeries.

Open Ophthalmol J 2016 29;10:68-85. Epub 2016 Feb 29.

Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, USA.

Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly, filtering surgery in high-risk patients could end up in bleb failure. Several strategies have been developed so far to overcome excessive scarring after filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant scarring after filtration surgery. Conventionally, corticosteroids and anti-fibrotic agents (including 5-fluorouracil and Mitomycin-C) have been used for over three decades with semi-acceptable outcomes. Blebs and bleb associated complications are catastrophic side effects of anti-fibrotic agents, which occasionally are encountered in a subset of patients. Therefore, research continues to find a safer, yet effective adjuvant for filtering surgery. Recent efforts have primarily focused on selective inhibition of growth factors that promote scarring during wound healing process. Currently, only anti-VEGF agents have gained widespread acceptance to be translated into routine clinical practice. Robust evidence for other agents is still lacking and future confirmative studies are warranted. In this review, we explain the importance of wound healing process during filtering surgery, and describe the conventional as well as potential future adjuvants for filtration surgeries.
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http://dx.doi.org/10.2174/1874364101610010068DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780518PMC
March 2016

Editorial: Update on Glaucoma Diagnosis and Management.

Open Ophthalmol J 2016 29;10:33-4. Epub 2016 Feb 29.

Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA.

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http://dx.doi.org/10.2174/1874364101610010033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4780510PMC
March 2016

Changes in ocular biometry and anterior chamber parameters after pharmacologic mydriasis and peripheral iridotomy in primary angle closure suspects.

J Optom 2016 Jul-Sep;9(3):189-95. Epub 2016 Feb 28.

Poostchi Eye Research Centre, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: The aim of this study was to evaluate the effects of pharmacologic mydriasis and Peripheral Iridotomy (PI) on ocular biometry and anterior chamber parameters in primary angle closure suspects.

Methods: In this prospective interventional case series, 21 primary angle closure suspects were enrolled. Intraocular pressure, refraction, ocular biometry (Lenstar, LS900), and anterior chamber parameters (Pentacam HR) were measured at four occasions: before PI (before and after mydriasis with phenylephrine) and two weeks after PI (before and after mydriasis). The study was conducted on both eyes and only one eye per patient, in random, was included in the analysis.

Results: The mean age of the participants was 60±7 years and 17 (81%) were female. There were no significant differences in intraocular pressure, refraction, keratometry, biometric and anterior chamber parameters between groups, except for anterior chamber volume, which showed increments with PI and mydriasis. The corresponding values for anterior chamber volume were as follows: 88.2±13.7mm(3) before PI, undilated; 106.3±18.8 before PI, dilated; 99.0±14.6 after PI, undilated, and 107.4±16.5 after PI, dilated (P<0.001).

Conclusions: This study showed no change in the ocular biometric and anterior chamber parameters including iridocorneal angle after PI and/or pharmacologic mydriasis except for increments in anterior chamber volume. This factor has the potential to be used as a numerical proxy for iris position in evaluating and monitoring patients with primary angle closure suspects after PI.
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http://dx.doi.org/10.1016/j.optom.2016.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4912478PMC
April 2017