Publications by authors named "Mohammad Reza Razeghinejad"

46 Publications

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

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

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

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

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

Glaucoma Surgery in Pregnancy: A Case Series and Literature Review.

Iran J Med Sci 2016 Sep;41(5):437-45

Glaucoma Service, Wills Eye Institute, Jefferson Medical College, Philadelphia, USA.

Glaucoma management in pregnant patients is a real challenge, especially when the glaucoma is not controlled with medications. We report the results of 6 incisional glaucoma surgeries for the management of medically uncontrolled glaucoma patients during pregnancy. This retrospective, case series was conducted on the 6 eyes of 3pregnant patients with uncontrolled glaucoma using maximum tolerable medications. Details of the glaucoma surgical management of these patients as well as their postoperative care and pregnancy and clinical outcomes on longitudinal follow-up are discussed. All 3 patients had juvenile open-angle glaucoma and were on various anti-glaucoma medications, including oral acetazolamide. The first case described underwent trabeculectomy without antimetabolites in both eyes because of uncontrolled intraocular pressure with topical medications. The surgery was done with topical lidocaine jelly and subconjunctival lidocaine during the second and third trimesters. The second patient had an Ahmed valve implantation in both eyes during the second and third trimesters because of uncontrolled IOP with topical medications and no response to selective laser trabeculoplasty. Surgery was done with topical tetracaine and subconjunctival and sub-Tenon's lidocaine. The third case had a Baerveldt valve implantation under general anesthesia in the second trimester. In selected pregnant glaucoma patients with medically uncontrolled intraocular pressure threatening vision, incisional surgery may lead to good outcomes for the patient with no risk for the fetus.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967489PMC
September 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

Intraocular pressure measurement by three different tonometers in primary congenital glaucoma.

J Ophthalmic Vis Res 2015 Jan-Mar;10(1):43-8

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

Purpose: To determine the agreement between intraocular pressure (IOP) measurements using an automated non-contact tonometer (NCT), Goldmann applanation tonometer (GAT), and the ocular response analyzer (ORA) in subjects with primary congenital glaucoma (PCG).

Methods: Twenty-nine eyes of 17 PCG patients underwent IOP measurements using NCT, GAT and ORA. Variables obtained by the ORA were corneal-compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal hysteresis (CH), and corneal resistance factor (CRF). A difference more than 1.5 mmHg for IOP was considered as clinically relevant.

Results: Mean age of the patients was 12 years. Mean IOP (±standard deviation, SD) was 15.3 ± 2.8 mmHg (GAT), 15.5 ± 6.0 (NCT), 19.2 ± 7.0 (IOPg), and 21.1 ± 7.9 (IOPcc); (P = 0.001). Except for NCT vs. GAT (P = 1.0), the average IOP difference between each pair of measurements was clinically relevant. The 95% limits of agreements were - 10.2 to 10.3 mmHg (NCT vs. GAT), -7.8 to 15.3 (IOPg vs. GAT), and - 8.1 to 19.0 (IOPcc vs. GAT). The differences in IOP measurements increased significantly with higher average IOP values (r = 0.715, P = 0.001, for NCT vs. GAT; r = 0.802, P < 0.001, for IOPg vs. GAT; and r = 0.806, P < 0.001, for IOPcc vs. GAT). CH showed a significant association with differences in IOP measurements only for IOPcc vs. GAT (r = 0.830, P < 0.001).

Conclusion: Mean IOP obtained by NCT was not significantly different from that of GAT, but ORA measured IOPs were significantly higher than both other devices.
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http://dx.doi.org/10.4103/2008-322X.156105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424718PMC
May 2015

A baby with primary congenital glaucoma not responding to trabeculotomy.

J Ophthalmic Vis Res 2014 Apr;9(2):276-80

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181213PMC
April 2014

Subconjunctival bevacizumab for primary pterygium excision; a randomized clinical trial.

J Ophthalmic Vis Res 2014 Jan;9(1):22-30

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

Purpose: To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium excision.

Methods: This randomized, placebo-controlled clinical trial was conducted on 44 eyes of 44 patients randomized to Group 1 (bevacizumab) and Group 2 (balanced salt solution). Group 1 underwent pterygium excision with a rotational conjunctival flap and received a total of 7.5 mg subconjunctival bevacizumab (5 mg/0.2 mL on the day of surgery and 2.5 mg/0.1 mL on the fourth day after surgery). Group 2 received balanced salt solution in the same manner. Recurrence, defined as any fibrovascular tissue crossing the limbus, and the number of patients with >1.5 mm fibrovascular overgrowth on the cornea were compared between the study groups.

Results: There was no statistically significant difference between the study groups in terms of demographics, pterygium size, daily sun exposure, preoperative visual acuity, keratomeric readings, corneal astigmatism, or IOP (P>0.05). Three and four patients in each group at the three- and six-month visits, respectively, had more than 1.5 mm fibrovascular tissue overgrowth on the cornea (P=1 and 0.62, respectively). At the three-month visit, 3 patients in Group 1 versus 7 patients in Group 2 (P=0.13), and at the six-month visit 4 patients in Group 1 versus 8 patients in Group 2 (P=0.17) had fibrovascular tissue crossing the limbus. Patients in Group 1 experienced a statistically significant rise in IOP at the one-week visit (P=0.007).

Conclusion: Bevacizumab had no significant effect on the recurrence rate of pterygium. Although the frequency of fibrovascular tissue crossing the limbus in the bevacizumab group was half that of the BSS group, the difference failed to reach a statistically significant level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074470PMC
January 2014

Intraocular Pressure Measurements by Three Different Tonometers in Children with Aphakic Glaucoma and a Thick Cornea.

Iran J Med Sci 2014 Jan;39(1):11-9

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

Background: To evaluate the agreement in intraocular pressure (IOP) measurements by Ocular Response Analyzer (ORA) and Tono-Pen XL (TXL) with the Goldmann Applanation Tonometer (GAT) and to examine corneal biomechanical properties in aphakic glaucoma patients with a central corneal thickness (CCT) >600 µ.

Methods: Thirty-six eyes of aphakic glaucoma patients (group 1) and 40 eyes of normal children (group 2) were studied. The mean ORA and TXL IOP values were compared with the GAT-IOP values. Regression analyses were used to evaluate the associations between IOP and CCT, corneal hysteresis (CH), and corneal resistance factor (CRF). Bland-Altman plots were used to evaluate the agreement between the tonometers.

Results: The mean±standard deviations of the age and male/female ratio were 16.58±5.44 and 15.75±5.04 years and 14/22 and 18/22 in group 1 and group 2, respectively. CCT in group 1 was 651.1±42 and in group 2 was 567.3±32.4. In group 1, the mean TXL (22.4, P=0.004), IOPcc (corneal compensated) (27.8, P=0.005), and IOPg (Goldmann correlated) values (28.1, P<0.0001) were greater than GAT-IOP (20.6). In group 2, only IOPg value (16.4) was higher than GAT-IOP (14.8, P=0.04). IOP reading of all the tonometers were positively and negatively associated with CRF and CH in the multiple regression analysis, respectively.

Conclusion: The TXL had a greater agreement with the GAT, and the ORA overestimated IOP in aphakic glaucoma patients. The ORA and TXL seemed to be affected by CH and CRF.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3895889PMC
January 2014

A case of primary congenital glaucoma.

J Ophthalmic Vis Res 2013 Jul;8(3):274-9

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853786PMC
July 2013

Ocular biometry in angle closure.

J Ophthalmic Vis Res 2013 Jan;8(1):17-24

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

Purpose: To compare ocular biometric parameters in primary angle closure suspects (PACS), primary angle closure glaucoma (PACG) and acute primary angle closure (APAC).

Methods: This cross-sectional study was performed on 113 patients including 33 cases of PACS, 45 patients with PACG and 35 subjects with APAC. Central corneal thickness (CCT), axial length (AL), anterior chamber depth (ACD) and lens thickness (LT) were measured with an ultrasonic biometer. Lens-axial length factor (LAF), relative lens position, corrected ACD (CACD) and corrected lens position were calculated. The parameters were measured bilaterally but only data from the right eyes were compared. In the APAC group, biometric parameters were also compared between affected and unaffected fellow eyes. Logistic regression analysis was performed to identify risk factors.

Results: No statistically significant difference was observed in biometric parameters between PACS and PACG eyes, or between affected and fellow eyes in the APAC group (P>0.05 for all comparisons). However, eyes with APAC had thicker cornea (P=0.001), thicker lens (P<0.0001), shallower ACD (P=0.009), shallower CACD (P=0.003) and larger LAF (P<0.0001). Based on ROC curve analysis, lower ACD, and larger LT, LAF and CCT values were associated with APAC. In the APAC group, LAF (P<0.0001) and CCT (P=0.001) were significant risk factors.

Conclusion: This study revealed no significant difference in biometric characteristics in eyes with PACS and PACG. However, larger LAF and CCT were predictive of APAC.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691973PMC
January 2013

Glaucoma in a patient with nanophthalmos.

J Ophthalmic Vis Res 2011 Jul;6(3):208-14

Assistant Professor, Jules Stein Eye Institute, UCLA, Los Angeles, California, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306100PMC
July 2011

Effect of intravitreal bevacizumab on retrobulbar blood flow in injected and uninjected fellow eyes of patients with neovascular age-related macular degeneration.

Retina 2012 May;32(5):967-71

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

Background: To determine the effect of intravitreal administration of bevacizumab (1.25 mg/0.05 mL) on retrobulbar circulation of the injected and the fellow (uninjected) eyes in patients with neovascular age-related macular degeneration.

Methods: In this prospective study, the retrobulbar hemodynamics of 43 patients with neovascular age-related macular degeneration was examined by color Doppler ultrasonography. Peak systolic velocity, end-diastolic velocity, and resistive index values in the central retinal artery and short posterior ciliary artery in both injected and uninjected fellow eyes were measured at baseline and 7 days after a single intravitreal injection of bevacizumab.

Results: At baseline, the peak systolic velocity, end-diastolic velocity, and the resistive index in the central retinal artery and short posterior ciliary artery of the injected eye were not significantly different compared with the fellow uninjected eye (P > 0.05 for all). However, intravitreal bevacizumab induced a significant reduction in the peak systolic velocity and end-diastolic velocity and a significant rise in the resistive index of the central retinal artery and short posterior ciliary artery of the injected eye (P ≤ 0.006 for all). Peak systolic velocity and end-diastolic velocity decreased in the central retinal artery (P = 0.023 and P = 0.030) and the short posterior ciliary artery (P = 0.001 and P < 0.000) in the uninjected eye while the resistive index did not significantly change in central retinal artery (P = 0.114) and short posterior ciliary artery (P = 0.082) of the fellow eyes.

Conclusion: Intravitreal injection of bevacizumab significantly affects ocular hemodynamic parameters of both the injected and the uninjected fellow eyes with neovascular age-related macular degeneration.
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http://dx.doi.org/10.1097/IAE.0b013e31822c28d6DOI Listing
May 2012

Gonioscopic features in patients with acute and chronic angle-closure glaucoma.

Iran J Med Sci 2011 Mar;36(1):7-13

Department of Ophthalmology, Medical School,Shiraz University of Medical Sciences, Shiraz, Iran.

Background: A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG).

Methods: The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth's convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively.

Results: There was no significant difference between patients with AACG and CACG in terms of age, gender, refraction, and laterality of the involved eyes. In intragroup analysis, no significant difference was observed for distribution of iris attachment, irido-corneal angle, iris configuration, or trabecular pigmentation. In intergroup analysis, the superior iris was attached more anterior in the involved eyes of AACG compared to that in CACG (P=0.007). Moreover, the iris root attachment was also more anterior in both the superior (P=0.001) and inferior (P=0.002) angles of the noninvolved eyes of AACG vs. than those in the less-involved eyes of CACG group.

Conclusion: The findings of the study indicate that there is no significant difference between the eyes with AACG or CACG in terms of goniscopic findings. However, the superior iris attachment was located more anterior in eyes with AACG compared to that in eyes with CACG.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559115PMC
March 2011

Sudden onset and blinding spontaneous direct carotid-cavernous fistula.

J Ophthalmic Vis Res 2011 Jan;6(1):50-3

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

Purpose: To report a case of spontaneous direct carotid-cavernous fistula causing abrupt loss of vision.

Case Report: A 50-year-old woman with systemic hypertension but no history of ocular disease developed sudden proptosis, frozen eye, subconjunctival hemorrhage and loss of vision in her left eye over 2 hours. Imaging studies revealed a direct carotid-cavernous fistula. Management for high intraocular pressure was promptly initiated and the patient was referred to a neurosurgery service, but she refused any surgical intervention. Ultimately, she accepted to undergo manual carotid artery compression which resulted in significant reduction in the proptosis, but she lost all vision permanently.

Conclusion: Direct carotid-cavernous fistula can occur spontaneously and should be taken into account in patients with signs suggestive of direct carotid-cavernous sinus fistula even without history of trauma or connective tissue disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3306070PMC
January 2011

Ocular refractive and biometric characteristics in patients with tilted disc syndrome.

Optometry 2010 Dec;81(12):688-94

Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Tilted disc syndrome (TDS) is associated with characteristic ocular findings. The purpose of this study was to evaluate the ocular, refractive, and biometric characteristics in patients with TDS.

Methods: This case-control study included 41 eyes of 25 patients who had established TDS and 40 eyes of 20 healthy control subjects. All participants underwent a complete ocular examination, including refraction and analysis using Fourier transformation, slit lamp biomicroscopy, pachymetry, keratometry, and ocular biometry. Corneal topography examinations were performed in the syndrome group only.

Results: There were no significant differences in spherical equivalent (P = 0.13) and total astigmatism (P = 0.37) between groups. However, mean best spectacle-corrected visual acuity (Log Mar) was significantly worse in TDS patients (P = 0.003). The lenticular astigmatism was greater in the syndrome group, whereas the corneal component was greater in controls (P = 0.059 and P = 0.028, respectively). The measured biometric features were the same in both groups, except for the lens thickness and lens-axial length factor, which were greater in the TDS group (P = 0.007 and P = 0.055, respectively).

Conclusions: Clinically significant lenticular astigmatism, more oblique corneal astigmatism, and thicker lenses were characteristic findings in patients with TDS.
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http://dx.doi.org/10.1016/j.optm.2010.03.009DOI Listing
December 2010

Effect of macular edema on optical coherence tomography signal strength.

Retina 2010 Jul-Aug;30(7):1084-9

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

Purpose: The purpose of this study was to examine the effect of macular edema (ME) on Stratus optical coherence tomography (OCT) (Stratus OCT, Carl Zeiss Meditec, Dublin, CA) signal strength (SS).

Methods: Part 1: Macular OCT was performed in 57 eyes with ME, at 2 different time points with different degrees of ME. The relationships between SS change and change in center point thickness and total macular volume in two scans were examined. Part 2: In 54 eyes with ME, Stratus OCT examinations with macular thickness mapping and retinal nerve fiber layer analysis protocols were performed. The paired values of SS obtained with two scan protocols were compared. The relationship between SS difference between two test protocols with center point thickness and total macular volume was evaluated.

Results: Part 1: There was a significant correlation between SS change and the change in center point thickness and total macular volume in 2 consecutive scans. Part 2: Maximum SS obtained during macular OCT examination was significantly less than that obtained during retinal nerve fiber layer OCT. Significant correlations were observed between the difference in SS obtained in two scan protocols and center point thickness as well as total macular volume.

Conclusion: Macular edema decreases macular OCT SS. In patients with ME, SS obtained during macular OCT examination was significantly lower than that obtained during retinal nerve fiber layer OCT examination.
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http://dx.doi.org/10.1097/IAE.0b013e3181d8e7d1DOI Listing
September 2010

Primary Open Angle Glaucoma and Post-LASIK Keratectasia.

J Ophthalmic Vis Res 2010 Jul;5(3):196-201

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379914PMC
July 2010

The effect of addition of low dose atracurium to local anesthetic in retrobulbar block for cataract surgery.

Middle East J Anaesthesiol 2010 Feb;20(4):535-8

Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Addition of some neuromuscular blockers to local anesthetics proved to be effective in improving the quality of anesthesia in different regional techniques. This study was carried out to determine whether the addition of low-dose atracurium to a local anesthetic has any effect on the onset and duration of akinesia in retrobulbar block.

Patients And Methods: This study was conducted on sixty-four unpremedicated, ASA I or 11 patients scheduled for cataract surgery under local anesthesia. The patients were assigned to one of the two treatment groups in a randomized, double-blind manner. The case group received 2 ml of 2% lidocaine (40 mg) and 0.5 mL atracurium (5 mg). The control group received 2 ml of 2% lidocaine (40 mg) and 0.5 ml 0.9% NaCl. The onset of akinesia (the inability to move the eye in all four directions) was scored as 0 to 2:0, no akinesia; 1, partial akinesia; and 2, complete akinesia. The onset and duration of akinesia and also adverse effects and complications of each method were recorded throughout the study.

Results: In 4 out of 64 patients, complete akinesia was not achieved and statistical analysis was done on 60 others with complete akinesia. With regard to age, sex, weight, and duration of the surgery, there were no significant differences between the case and control groups. The onset of complete akinesia was quicker and duration longer in the case group than in the control group. The onset of complete block was 4.7 +/- 1.1 minutes in the case group and 6.9 +/- 0.96 minutes in the control group (P < 0.001). The duration of akinesia was 104.07 +/- 17.6 minutes in the case group and 87.1 +/- 16.2 minutes in the control group (P < 0.001).

Conclusion: This study demonstrated that atracurium had a local action on the extraocular muscles. It shortened the onset period of retrobulbar block, prolonged its duration, and provided excellent surgical conditions without any specific complications.
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February 2010

Four-dot Artifact on Automated Perimetry.

J Ophthalmic Vis Res 2010 Apr;5(2):136-7

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

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3380685PMC
April 2010

Preliminary results of subconjunctival bevacizumab in primary pterygium excision.

Ophthalmic Res 2010 29;43(3):134-8. Epub 2009 Oct 29.

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

Purpose: To evaluate the efficacy of subconjunctival bevacizumab as an adjunctive therapy for primary pterygium surgery.

Material And Methods: This randomized prospective clinical study was conducted on 30 eyes of 30 patients. After pterygium excision and accomplishing a rotational conjunctival flap, 15 patients (case group) received 1.25 mg (0.1 ml) bevacizumab, and 15 other patients (control group) received 0.1 ml balanced salt solution subconjunctivally. The main outcome measures were recurrence of pterygia, horizontal length of the corneal epithelial defect, conjunctival erythema, lacrimation and photophobia during the first postoperative week.

Results: There were no statistically significant differences regarding age, sex or recurrence risk factors between the two groups (p > 0.05). The pterygia resolved in 13 (86.6%) of 15 eyes in both groups, with a recurrence rate of 13.4% during a mean follow-up period of 8 +/- 1.4 months in the case group and 7.4 +/- 1.5 months in the control group (p = 0.2). There were no statistically significant differences regarding reduction in refractive astigmatism, improvement in visual acuity, corneal epithelial defects, conjunctival erythema, lacrimation or photophobia between the case and control groups (p > 0.05).

Conclusions: A single intraoperative subconjunctival bevacizumab injection had no effect on recurrence rate or early postoperative conjunctival erythema, lacrimation, photophobia or healing of corneal epithelial defects following pterygium excision.
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http://dx.doi.org/10.1159/000252980DOI Listing
April 2010

Refractive error and axial length in nonarteritic anterior ischemic optic neuropathy.

Optometry 2009 Nov;80(11):639-41

Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran 14455-364, Iran.

Purpose: The aim of this study was to evaluate the ocular axial length and refractive error as risk factors for development of nonarteritic anterior ischemic optic neuropathy (NAION).

Methods: This prospective study included 78 patients with NAION and 80 normal volunteers. Axial length and refractive error of NAION eyes were compared with the normal fellow eyes and control eyes.

Results: The 2 groups were frequency matched by sex and age. The mean refractive error (in spherical equivalent) was -0.07 +/- 1.60 diopters (D) in NAION eyes, 0.00 +/- 1.6 D in normal fellow eyes (P = 0.7), and -0.04 +/- 1.1 D in control eyes (P = 0.9). No significant difference was found between axial length measurements of NAION eyes (22.86 +/- 0.82 mm) and fellow eyes (22.80 +/- 0.88 mm; P = 0.8) and control eyes (23.1 +/- 0.78 mm; P = 0.1). Most of the NAION eyes (50%) were emmetropic (between +0.5 and -0.5 D).

Conclusion: Axial length and refractive error may not be risk factors in NAION.
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http://dx.doi.org/10.1016/j.optm.2009.03.020DOI Listing
November 2009

A simple way to achieve the routine position for phacoemulsification in a patient with marked thoracic kyphosis.

J Ophthalmic Vis Res 2009 Oct;4(4):253-5

Khalili Hospital, Shiraz Medical University, Shiraz, Iran.

Purpose: To introduce a simple way for achieving the routine position for phacoemulsification in a patient with a marked thoracic kyphosis.

Case Report: A 74-year-old man with marked thoracic kyphosis and visually significant cataracts presented for surgery; he was unable to lie flat due to the severe deformity. The best possible surgical position was achieved by placing a chair with an adjustable top between a standard operating table and another small table. The wheels of the table and the chair were securely immobilized by adhesive tape. The space between the operating table and the small table was filled with rolled towels and covered with a blanket. The patient lay down with his head placed on the small table while the kyphotic portion of his thorax fitted into the free space between the small table and the operating table. The variable top of the chair allowed adjusting the space in order to accommodate his kyphotic thorax. Successful temporal approach phacoemulsification was performed comfortably while the patient lay in the standard position required for cataract surgery.

Conclusion: It is possible to position patients with thoracic problems on a standard operating table using readily available equipment in the operating theater.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498863PMC
October 2009

Association of TNFA -308 G/A and TNFRI +36 A/G gene polymorphisms with glaucoma.

Ophthalmic Res 2009 24;42(3):118-24. Epub 2009 Jun 24.

Department of Ophthalmology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: TNF-alpha is one of the most important factors recognized in the pathogenesis of open-angle glaucoma. Therefore, the association of single nucleotide polymorphisms in the TNFRI gene and the promoter region of the TNFA gene with glaucoma susceptibility was investigated in the present study.

Method: In total, 223 patients with glaucoma and 202 unrelated controls were genotyped by allele-specific oligonucleotide PCR and PCR- restriction fragment length polymorphism to determine TNFA -308 G/A and TNFRI +36 A/G polymorphisms, respectively.

Results: In contrast to TNFRI polymorphisms, the genotypes of TNFA -308 G/A polymorphisms showed a significant difference between patients and controls (p = 0.0025). Of interest, the distribution of TNFA genotypes was significantly different between patients with primary open-angle glaucoma (p = 0.001) or pseudoexfoliative glaucoma (p = 0.001) and controls, while no difference was found when chronic angle-closure glaucoma patients were compared to controls (p = 0.72).

Conclusion: In line with studies showing the role of TNF-alpha in open-angle glaucoma, the results of the present study showed that inheritance of the high producer TNFA -308 A allele might be a susceptibility factor for the development of open-angle glaucoma.
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http://dx.doi.org/10.1159/000226108DOI Listing
January 2010