Publications by authors named "Narges Hassanpoor"

25 Publications

  • Page 1 of 1

Tonometry by Ocular Response Analyzer in Keratoconic and Warpage Eyes in Comparison with Normal Eyes.

J Curr Ophthalmol 2021 Apr-Jun;33(2):118-123. Epub 2021 Jul 5.

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

Purpose: To compare intraocular pressure (IOP) values measured by ocular response analyzer (ORA) in contact lens-induced corneal warpage, normal, and keratoconic eyes.

Methods: In a prospective, observational case-control study, 94 eyes of 47 warpage-suspected cases and 46 eyes of 23 keratoconic patients were enrolled. Warpage-suspected cases were followed until a definite diagnosis was made (warpage, nonwarpage normal, or keratoconus). ORA tonometry and corneal biomechanics testing were performed for all cases in each visit. We had 2-3 measured corneal-compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) for each patient (based on group) with at least 2-week interval.

Results: After following up of warpage-suspected patients, finally 44 eyes of 22 patients had confirmed soft contact lens-related corneal warpage. Forty-six eyes of 23 people were finally diagnosed as nonwarpage normal eyes. Forty-six eyes of 23 known keratoconus patients were also included for comparison. The demographic and refractive data were not different between the warpage and nonwarpage normal groups but were different in the keratoconus group. Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups; the same trend was observed in central corneal thickness (CCT). The mean of IOPg was 14.94 ± 2.65, 13.7 ± 2.33, and 10.86 ± 3 and IOPcc was 15.73 ± 2.4, 15.28 ± 2.43, and 14.08 ± 2.55 in the warpage, normal, and keratoconus groups, respectively. IOPg and IOPcc in the warpage group (based on baseline diagnosis) did not regress to become closer to IOP of normal eyes after discontinuation of contact lens in their follow-up visits ( value for IOPg and IOPcc trends in the warpage group was 0.07 and 0.09 controlling for CCT, respectively). Both IOPcc and IOPg were significantly lower in keratoconic eyes in comparison with normal eyes. After correction for the confounding effect of CCT, a lower IOPcc in keratoconus versus warpage remained significant ( = 0.02).

Conclusion: Both IOPcc and IOPg were statistically different with the highest value in the warpage group followed by normal and keratoconus groups, just like their CCT. After correction for the confounding effect of CCT, there was no statistically significant difference between the three groups in their measured IOPcc and IOPg except for IOPcc in keratoconus versus warpage ( = 0.02).
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http://dx.doi.org/10.4103/JOCO.JOCO_147_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8365575PMC
July 2021

Photopigment Bleaching Phenomenon on Fluorescein Angiography in a Patient with Impending Central Retinal Vein Occlusion.

J Ophthalmic Vis Res 2021 Apr-Jun;16(2):291-294. Epub 2021 Apr 29.

Retina & Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: To present the second case of photopigment bleaching phenomenon in fluorescein angiography (FA) and the first case of this phenomenon due to impending central retinal vein occlusion (CRVO).

Case Report: A 32-year-old healthy female noticed blurred vision in her right eye one day before presentation. Despite the 20/20 visual acuity at presentation, mild increased retinal vascular tortuosity and unilateral photopigment bleaching phenomenon in FA was observed in the right eye. Three weeks later, she developed a complete CRVO with visual acuity reduction to 20/40 that responded well to the intravitreal injection of aflibercept.

Conclusion: Impending CRVO can cause unilateral photopigment bleaching phenomenon in FA that may be due to retinal ischemia.
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http://dx.doi.org/10.18502/jovr.v16i2.9093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126737PMC
April 2021

Bilateral Type 1 Idiopathic Macular Telangiectasia in a Female Patient: Multimodal Imaging of a Rare Presentation.

Case Rep Ophthalmol 2021 May-Aug;12(2):373-379. Epub 2021 May 10.

Ophthalmology Resident, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

We report a bilateral case of type 1 idiopathic macular telangiectasia (IMT) in a female patient. A 40-year-old otherwise healthy female with gradual vision loss since 2 years ago with best-corrected visual acuity of 20/400 in both eyes was referred. Her past medical history was negative for any systemic disease including diabetes and systemic hypertension. Color fundus photography showed bilateral loss of normal foveal reflex with macular edema. Fluorescein angiography demonstrated symmetric perifoveal telangiectasia mainly in the superior and nasal macula in both eyes with late staining and leakage. Spectral-domain optical coherence tomography revealed significant intraretinal fluid bilaterally and subretinal fluid in the left eye. Optical coherence tomography angiography (OCTA) revealed obvious saccular parafoveal capillary telangiectasia and capillary dropout as well as decreased vascular density in both superficial and deep capillary plexus. Deep capillary plexus involvement in OCTA was more evident than superficial plexus. Based on the patient's medical history and multimodal imaging, the diagnosis of bilateral IMT type 1 was made. The patient underwent 5 intravitreal monthly injection of bevacizumab in both eyes, which resulted in macular edema resolution. However, after 3 months of discontinuation of intravitreal bevacizumab, macular edema relapsed. In conclusion, type 1 IMT can occur bilaterally in an otherwise healthy female patient as a very rare presentation. To the best of our knowledge, this case is the 4th case of bilateral type 1 IMT reported in a female.
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http://dx.doi.org/10.1159/000513095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136330PMC
May 2021

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

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

Acute Lymphoblastic Leukemia Presenting as Acute Vogt-Koyanagi-Harada Syndrome.

Case Rep Ophthalmol 2020 May-Aug;11(2):481-485. Epub 2020 Aug 11.

Retina and Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

We aimed to describe a case of acute lymphoblastic leukemia (ALL) that initially presented and was managed as Vogt-Koyanagi-Harada syndrome (VKH). A 62-year-old man was referred for vision loss starting 1 week ago. There was no prior systemic or ocular history. Visual acuity was 20/200 in both eyes. Anterior segment exam was also normal in both eyes. On funduscopy, foveal reflex was significantly reduced. On optical coherence tomography, subretinal fluid was evident in both eyes. Fluorescein angiography showed a hypofluorescent area compatible with subretinal fluid and multiple pinpoint hyper- and hypofluorescent dots surrounding the detached retina. After 4 days, we were informed that the patient had been admitted to a general hospital due to spontaneous ecchymosis and melena. On complete blood count, there was a high white cell count, thrombocytopenia, and low hemoglobin concentration with a probable diagnosis of leukemia. On bone marrow biopsy, ALL with B-cell precursor was confirmed. In conclusion, exudative retinal detachment can be a primary presentation of leukemia and/or lymphoma. In atypical VKH or acute central serous chorioretinopathy cases with multiple pinpoint leakages distributed mostly in the periphery of the subretinal fluid area (not randomly scattered throughout the subretinal fluid), we should consider leukemia.
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http://dx.doi.org/10.1159/000509341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7506254PMC
August 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

Presumed Intraocular Lymphoma Masquerading as Age-Related Macular Degeneration: A Case Report.

J Curr Ophthalmol 2020 Apr-Jun;32(2):207-210. Epub 2020 Apr 30.

Retina and Vitreous Service, Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: To describe a case of primary vitreoretinal lymphoma (PVRL) that initially presented and managed as dry type age-related macular degeneration (AMD).

Methods: A 69-year-old male was referred to us by decreased vision.

Results: On funduscopy, a few small hard drusen at the posterior pole of the right eye and many large confluent drusen in the left eye were observed. Optical coherence tomography findings included the hyperreflective drusenoid materials in the subretinal pigment epithelium (sub- RPE) space which was similar to previous imaging records except for decreased area and height of pigment epithelial detachments and RPE and ellipsoid zone attenuation in some areas appeared. The thickness of the retina was normal, but the choroid appeared to be slightly decreased compared to the left eye. Patient has been followed up with the diagnosis of AMD for 1 year. After the right hemiparesis presentation, he underwent craniotomy and biopsy that made the diagnosis evident.

Conclusion: PVRL/primary central nervous system lymphoma may be one of the most important masquerades of AMD, but a significantly waxing and waning course may help to make correct diagnosis.
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http://dx.doi.org/10.4103/JOCO.JOCO_106_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337019PMC
April 2020

Correspondence.

Retin Cases Brief Rep 2020 May 6. Epub 2020 May 6.

Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

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http://dx.doi.org/10.1097/ICB.0000000000001004DOI Listing
May 2020

The effect of scleral buckling on accommodative amplitude.

Int J Retina Vitreous 2020 20;6:14. Epub 2020 Apr 20.

Eye Monitoring Center, Kaiser Permanente Southern California, 1011 Baldwin Park Blvd, Baldwin Park, CA 91706 USA.

Purpose: To evaluate the effect of scleral buckling on accommodative amplitude.

Design: Non-randomized, prospective, double masked clinical trial in which the fellow eye of patients undergoing scleral buckling served as a control.

Methods: Patients who underwent scleral bucking for the management of retinal detachment in at least one eye were enrolled. Accommodative amplitude was measured monocularly 1 month and 3 months post operatively by two masked optometrists using a near-point "push" technique and minus-to-blur technique. Accommodative amplitude in eyes that underwent scleral buckle surgery were compared to their fellow eyes. Buckle type, buckle location, lens status and age were analyzed. Generalized Estimation Equations (GEE) were used to compare means and percentages between two groups.

Results: Seventy-four eyes of 37 patients were included in the study. Median age was 44 years old (range: 31-67 years old) and 68.4% of patients were male (n = 24). Two patients required bilateral surgery. Thirty-six of 39 operated eyes (92.3%) were phakic and three were pseudophakic. In phakic eyes there was a significantly higher amplitude of accommodation in operated eyes compared to their fellow eyes at post-operative month one (0.99 diopters, p value = 0.002) and three (1.17 diopters, p value = 0.001). The difference in accommodative amplitude in post-operative eyes compared to control eyes did not reach statistical significance in pseudophakic eyes nor did it differ between those who had an encircling band and those with a segmental buckle at both one and 3 months after surgery (p value = 0.37 and 0.38, respectively). In those with a segmental buckle, inferior fixation resulted in a larger difference in accommodative amplitude compared to control eyes than any other location fixation. Age under 40 years old and better post-operative best corrected visual acuity (BCVA) both correlated with greater difference in accommodative amplitude compared to fellow eyes.

Conclusion: Compared to fellow eyes not undergoing surgery, those eyes that underwent scleral buckling had a greater accommodative amplitude with larger differences correlating with better post-operative BCVA and younger age.
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http://dx.doi.org/10.1186/s40942-020-00218-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7168864PMC
April 2020

Intravitreal bevacizumab injection in aggressive posterior retinopathy of prematurity compared with type I retinopathy of prematurity.

Int Ophthalmol 2020 Feb 11;40(2):477-482. Epub 2019 Nov 11.

Retina and Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: To compare type I retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity (AP-ROP) regarding risk factors, complications and treatment outcomes.

Methods: A prospective cohort approach was applied on premature newborns diagnosed as type I ROP and AP-ROP. An intravitreal injection of bevacizumab (Avastin) was given to each patient. Demographic features such as gestational age, birth weight, age at the initial injection, involved eye, treatment response, relapses and need to extra interventions were compared.

Results: Seventy-seven patients underwent an initial intravitreal injection of bevacizumab (IVB), and 108 eyes were type I ROP and 30 eyes were AP-ROP. There was no significant difference in birth weight and gestational age between two groups. ROP relapsed in eight eyes of four patients with AP-ROP (26.6%), of which six eyes of three patients received re-injection of bevacizumab, and two eyes of one patient underwent a laser treatment. Recurrence occurred in two eyes of one patient with type I ROP (1.8%), which were treated by laser.

Conclusion: Bilateral eye involvement, relapse and retreatment (IVB, laser and surgical intervention) are more frequent in AP-ROP than type I ROP even when treated with intravitreal bevacizumab injection.
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http://dx.doi.org/10.1007/s10792-019-01208-3DOI Listing
February 2020

Sclerotherapy for eyelid and anterior orbital venous-lymphatic malformation.

J Curr Ophthalmol 2019 Jun 30;31(2):214-217. Epub 2019 Jan 30.

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

Purpose: To assess the efficacy of sclerotherapy with sodium tetradecyl sulfate (STS; Fibrovein 1%) in superficial periocular venous and lymphatic malformations.

Methods: Eleven patients with low-flow venous and lymphatic malformations with extension predominantly to the eyelids, conjunctiva, and anterior orbit were selected. Sclerotherapy with STS was undertaken as an office-based procedure without any radiological guidance. Injections were repeated every 4 weeks until desired response occurred. Therapeutic effect was assessed objectively by change in the size of the lesions in serial photography.

Results: The lesions completely resolved in 4 cases with small eyelid and fornix lesions. In other 7 cases there was partial resolution to less than half of primary size. We did not have any significant complications.

Conclusion: Sclerotherapy with STS is an easy and effective modality for treatment of venous-lymphatic malformations and can be undertaken as an office-based procedure in lesions which are limited to eyelids and anterior orbit.
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http://dx.doi.org/10.1016/j.joco.2019.01.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611944PMC
June 2019

Correspondence.

Retina 2018 10;38(10):e85

Retina and Vitreous Service, Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

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http://dx.doi.org/10.1097/IAE.0000000000002306DOI Listing
October 2018

Orbital alveolar echinococcosis: A case report.

J Curr Ophthalmol 2018 Jun 9;30(2):182-185. Epub 2017 Nov 9.

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

Purpose: To report a rare case of orbital alveolar echinococcosis in Iran.

Methods: A 23-year-old woman with multi-lobular mass lesion in the right orbit underwent excisional biopsy via a deep lateral orbitotomy approach. The pathologic investigation of the lesion was a multilobulated cystic lesion shown where the cyst wall structure was compatible with alveolar Hydatid cyst in histopathology. Clinical course, surgical, and medical management of the disease is noted briefly in the case of orbital involvement of the alveolar echinococcosis.

Results: Patient was treated with anti-fungal medication, and the cysts were successfully removed by a surgical excision.

Conclusion: Although orbital alveolar echinococcosis is extremely rare, it is noteworthy to study its clinical manifestations and radiological examinations to be able to make a true diagnosis.
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http://dx.doi.org/10.1016/j.joco.2017.09.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033784PMC
June 2018

Clinical and Histopathologic Features of Consecutive Exotropia.

Strabismus 2018 06 1;26(2):84-89. Epub 2018 Mar 1.

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

Purpose: The purpose of this study is to investigate clinical and histopathologic features of consecutive exotropia.

Methods: Thirty patients with consecutive exotropia and negative forced duction testing underwent unilateral medial rectus resection and advancement. Abnormal scleral attachment (appearance of stretched scar or slipped muscle) was documented and compared with histopathology results. The term "stretched scar" is used when tendon-like scar appears between muscle fibers and scleral attachment. The term "slipped muscle" is used when a thin capsule is attached to the sclera and the muscle fibers retracted posteriorly in the capsule. Histopathologic results of resected medial rectus muscles of 11 control patients were compared with cases of consecutive exotropia. Surgical success was defined as <10 PD deviation at both distance and near, 6 months after the surgery. Dose-response and risk factors for abnormal scleral attachment were also evaluated.

Results: Forty percent of the cases had abnormal scleral attachment. Nineteen patients (63%) showed successful results. The mean dose-responses were for near 4.7 and for distance 4.2 prism diopters per millimeters of resection plus advancement. Preoperative medial rectus underaction was a risk factor for abnormal scleral attachment. The mean muscle percentage in pathology was 10 ± 18.7 in patients with abnormal scleral attachment, 28.3 ± 27.9 in other consecutive exotropia patients, and 26.5 ± 30.6 in 11 control eyes.

Conclusion: This study showed surgical success of 63% with one-muscle surgery in consecutive exotropia. Calculated dose-responses could be helpful in surgical planning. In the cases with preoperative medial rectus underaction, risk of abnormal scleral attachment is increased.
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http://dx.doi.org/10.1080/09273972.2018.1444064DOI Listing
June 2018

Determinative factors in surgical planning of eyebrow cosmetic and reconstructive surgery.

Clin Ophthalmol 2017 24;11:1333-1336. Epub 2017 Jul 24.

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

Purpose: The purpose of this study was to identify the different factors that an oculoplastic surgeon should consider while practicing cosmetic or reconstructive eyebrow surgery in order to have the final patient's satisfaction.

Subjects And Methods: In an observational case series study, five photographs were taken from each of 60 females to show ideal eyebrow positioning with fingers. Eyebrow landmarks, including tarsal plate show (TPS) and eyebrow height, were measured in the ideal position. Brow apex position and brow apex angle were evaluated in the desired position of eyebrow.

Results: The mean desired apex angle of eyebrow was measured as 135±9 mm. In all, 48.33% of our subjects preferred a wider brow angle, 28.33% a narrower one, and 23.33% a brow angle without any change. The location of brow peak was transferred to the lateral canthus in the desired position. The ideal brow peak in the lateral canthus and between lateral canthus and lateral limbus was assigned to 33.3% and 66.6% of cases, respectively. The desired eyebrow apex angle in two age groups of our subjects (>40 years and ≤40 years) was not statistically different.

Conclusion: Landmarks of the eyebrow and its desired position are somehow different between different studies, which may be explained by the variation in race, gender, culture, and age. As there is not any uniform rule in planning of cosmetic surgeries of eyebrow, oculoplastic surgeons should consider the difference in culture, race, age, and desire of the patients and have their surgical plans for every individual patient distinctively.
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http://dx.doi.org/10.2147/OPTH.S133432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533483PMC
July 2017

Effects of adjuvant omega-3 fatty acid supplementation on dry eye syndrome following cataract surgery: A randomized clinical trial.

J Curr Ophthalmol 2017 Mar 28;29(1):33-38. Epub 2016 Jun 28.

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

Purpose: To investigate the effect of omega-3 polyunsaturated fatty acid supplement on qualitative and quantitative subjective (ocular surface disease index [OSDI]) and objective (Schirmer's test, tear break up time [TBUT], and tear osmolarity) dry eye indices after cataract surgery.

Methods: In this randomized clinical study, 61 eyes of 48 patients complaining of new onset dry eye symptoms after phacoemulsification were enrolled. Subjects were randomly allocated into two groups using urn randomization. Controls received conventional treatment. The treatment group received omega-3 dietary supplement in addition to conventional therapy.

Results: There was no significant difference between the control and treatment groups in pre-treatment indices of Schirmer (3.50 ± 3.13 and 2.96 ± 3.39, respectively,  = 0.582), TBUT (6.67 ± 1.36 and 4.87 ± 2.22, respectively,  = 0.687), osmolarity (316.66 ± 8.50 and 315.4 ± 17.06, respectively,  = 0.906), and OSDI (32.99 ± 19.03 and 35.32 ± 18.99, respectively,  = 0.635). Mean pre-treatment OSDI in the control group was 32.99 ± 19.03, which improved significantly after treatment to 25.43 ± 14.49 ( = 0.003). The mean pre-treatment OSDI in the treatment group was 35.32 ± 18.99 (range: 7.5-77.77), which improved significantly after treatment to 16.31 ± 13.72 (range: 2.77-47.22) ( < 0.001). OSDI improvement was significantly higher in the treatment group than the control group ( = 0.026). TBUT improved in both the control and treatment groups after treatment ( < 0.001). However, TBUT was affected significantly more in the treatment group compared with the control group ( = 0.038). Mean tear film osmolarity in the control group was 316.67 ± 8.50 (range: 308-325), which improved insignificantly after treatment to 311.33 ± 6.35 (range: 304-315) ( = 0.157). Mean pre-treatment tear film osmolarity in the treatment group was 315.40 ± 17.06 (range: 279-340), which improved significantly after treatment to 296.90 ± 14.39 (range: 260-310) ( < 0.001). Also, post-treatment Schirmer results between the two groups were not statistically significant ( = 0.155).

Conclusion: Omega-3 dietary supplements have an additive effect on tear film indices of patients with dry eye syndrome after phacoemulsification.
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http://dx.doi.org/10.1016/j.joco.2016.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5362390PMC
March 2017

Outcomes of vitrectomy, membranectomy and internal limiting membrane peeling in patients with refractory diabetic macular edema and non-tractional epiretinal membrane.

J Curr Ophthalmol 2016 Dec 27;28(4):199-205. Epub 2016 Aug 27.

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

Purpose: To evaluate the efficacy of vitrectomy, membranectomy, and internal limiting membrane (ILM) peeling on macular thickness and best corrected visual acuity (BCVA) in patients with refractory diffuse diabetic macular edema (DME) and non-tractional epiretinal membrane (NT-ERM).

Methods: This prospective interventional case series included eyes with refractory DME (central subfield macular thickness [CSMT] > 300 μm) after at least two intravitreal injections of bevacizumab (IVB) and one intravitreal injection of triamcinolone (IVT), and accompanying NT-ERM. Complete ophthalmic examination, baseline spectral domain optical coherence tomography (SD-OCT), and fluorescein angiography (FA) were performed prior to 23 gauge pars plana vitrectomy with membranectomy and internal limiting membrane (ILM) peeling. Postoperative evaluation was done with clinical examination and SD-OCT. Linear mix model analysis was used to study postoperative results.

Results: Twelve eyes from 11 patients (5 males) with a mean age of 60.33 ± 9.01 (range 46-73 years) were included. The mean follow-up time was 13.5 ± 4.48 months (range 4-20 months). A significant reduction in CSMT was found (from 559 ± 89 μm to 354 ± 76 μm; P = 0.001), with a non-significant BCVA change (from 0.84 ± 0.32 logMAR to 0.72 ± 0.2 logMAR; P = 0.967). There was no significant correlation between CSMT and BCVA (partial correlation = -0.115, P = 0.445) and also between estimated mean CSMT change per month and estimated mean BCVA change per month (r = 0.337, P = 0.283).

Conclusion: In this series, our results did not show that vitrectomy, membranectomy, and ILM peeling result in significant improvement of BCVA in eyes with refractory DME and non-tractional ERM in spite of central macular thickness reduction.
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http://dx.doi.org/10.1016/j.joco.2016.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093778PMC
December 2016

Corneal Biomechanical Findings in Contact Lens Induced Corneal Warpage.

J Ophthalmol 2016 4;2016:5603763. Epub 2016 Sep 4.

Eye Research Center and Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Purpose. To evaluate the difference in biomechanical properties between contact lens induced corneal warpage and normal and keratoconic eyes. Method. Prospective observational case control study, where 94 eyes of 47 warpage suspicious and 46 eyes of 23 keratoconic patients were included. Warpage suspected cases were followed until a definite diagnosis was made (warpage, normal, or keratoconus). Results. 44 eyes of 22 patients had contact lens related corneal warpage. 46 eyes of 23 people were diagnosed as nonwarpage normal eyes. 46 eyes of 23 known keratoconus patients were included for comparison. The mean age of the participants was 23.8 ± 3.8 years, and 66.2% of the subjects were female. The demographic and refractive data were not different between warpage and normal groups but were different in the keratoconus group. The biomechanical properties (corneal hysteresis or CH and corneal resistance factor or CRF) were different with the highest value in the warpage group followed by normal and keratoconus groups. CRF was 10.08 ± 1.75, 9.23 ± 1.22, and 7.38 ± 2.14 and CH was 10.21 ± 1.57, 9.59 ± 1.21, and 8.69 ± 2.34 in the warpage, normal, and keratoconus groups, respectively. Conclusion. Corneal biomechanics may be different in people who develop contact lens induced warpage.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027046PMC
http://dx.doi.org/10.1155/2016/5603763DOI Listing
October 2016

Spontaneous retrobulbar hemorrhage in a patient with breast cancer: A case report.

J Curr Ophthalmol 2016 Mar 3;28(1):48-51. Epub 2016 Feb 3.

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

Purpose: We present spontaneous retrobulbar hemorrhage in a 52-year-old woman with history of breast cancer and tamoxifen intake which was first thought to be an orbital metastasis.

Case Report: A 52-year-old woman with history of breast cancer and tamoxifen intake was referred due to severe proptosis and visual loss. Orbital imaging showed an intra-conal mass. After exploration, multiple fragments of dark brown mass in the retrobulbar area were excised. Microscopic diagnosis was blood clot. All of clinical signs and symptoms were improved 1 week after operation.

Conclusion: Spontaneous retrobulbar hemorrhage is a rare condition that may have unknown etiologies, and its symptoms may mimic orbital metastasis. Since both breast cancer and tamoxifen intake can cause coagulation disorders, they might be possible causes for retrobulbar hemorrhage in this case.
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http://dx.doi.org/10.1016/j.joco.2015.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4881227PMC
March 2016

Anterior-Chamber Depth in Plateau Iris Syndrome.

J Glaucoma 2016 07;25(7):e729

*Farabi Eye Hospital, Tehran University of Medical Science, Tehran, Iran †Koret Vision Center, University of California, San Francisco Medical School San Francisco, CA.

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http://dx.doi.org/10.1097/IJG.0000000000000422DOI Listing
July 2016

Long-term postoperative azithromycin in patients with chronic rhinosinusitis: A randomized clinical trial.

Am J Rhinol Allergy 2015 Nov-Dec;29(6):421-4

Otorhinolaryngology Head and Neck Surgery Department, Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Chronic rhinosinusitis (CRS) is recognized as a common disease that imposes a big burden on the health system worldwide. There is ongoing evidence of the anti-inflammatory effect of long-term macrolide in the management of patients with CRS.

Objective: The aim of this randomized clinical trial was to evaluate the efficacy of long-term consumption of low-dose azithromycin after functional endoscopic sinus surgery.

Methods: Sixty-six patients who fulfilled the inclusion criteria were randomly divided into intervention and control groups. The subjects received the standard conventional treatment (fluticasone nasal spray plus normal saline solution irrigation) or the conventional treatment plus 250 mg of azithromycin on a daily basis for 3 months. Evaluation was made based on the 22-item Sino-Nasal Outcome Test (SNOT-22) immediately before surgery and 3 months after surgery.

Results: The intervention group showed a statistically significant improvement in SNOT-22 scores after the treatment and a higher percentage change after 3 months of therapy compared with the control group. A significant correlation was found between the percentage change of SNOT-22 scores and smoking in the placebo group. Lund-Mackay scores, patient age, and the duration of symptoms had no significant correlation with the percentage change.

Conclusion: Treatment with long-term low-dose azithromycin in combination with the conventional therapy could statistically reduce the recurrence rate of CRS symptoms after functional endoscopic sinus surgery, but there was not sufficient evidence to support clinical significance of azithromycin at the investigated dose. Further larger scale trials, along with a longer follow-up period, is needed to evaluate the effectiveness of the therapy.
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http://dx.doi.org/10.2500/ajra.2015.29.4244DOI Listing
September 2016

Bilateral Optic Nerve Head Angiomas and Retrobulbar Haemangioblastomas in von Hippel-Lindau Disease.

Neuroophthalmology 2014 19;38(5):254-256. Epub 2014 Sep 19.

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

A 39-year-old man presented with progressive visual loss in both eyes. His past medical history was remarkable for biopsy-proven bilateral adrenal phaeochromocytomas. Ophthalmoscopy revealed an optic nerve head angioma and macular lipid exudates in the right eye and a regressed optic nerve head angioma in the left eye. A fluorescein angiogram revealed a lobulated pattern of leakage and venous staining from the optic nerve head angioma. Brain and orbital magnetic resonance imaging showed haemangioblastomas of the right intraorbital and left paraclinoid optic nerves and in the left cerebellopontine angle area. These findings were consistent with a clinical diagnosis of von Hippel-Lindau disease.
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http://dx.doi.org/10.3109/01658107.2014.944622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122973PMC
September 2014

Quantification of peripapillary total retinal volume in pseudopapilledema and mild papilledema using spectral-domain optical coherence tomography.

Am J Ophthalmol 2014 Jul 12;158(1):136-43. Epub 2014 Apr 12.

Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address:

Purpose: To distinguish differences in retinal nerve fiber layer (RNFL) thickness and peripapillary total retinal volume between eyes with papilledema, pseudopapilledema, and normal findings.

Design: Cohort study.

Methods: Forty-two eyes with mild papilledema, 37 eyes with congenitally elevated optic disc (pseudopapilledema), and 34 normal eyes met the inclusion criteria at 1 academic institution (in Iran) and underwent neuro-ophthalmic examination. Spectral-domain optical coherence tomography scans surrounding the optic disc were performed in each eye of patients and subjects. Main outcome measures were mean RNFL thickness and peripapillary total retinal volume measurements (inner and outer ring volumes) that were compared between groups, using the generalized estimating equation approach. Area under receiver operating characteristic curves were also calculated.

Results: A statistically significant difference was found in mean RNFL thickness between both groups of patients with papilledema and pseudopapilledema and normal subjects. Average inner peripapillary total retinal volume in the papilledema, pseudopapilledema, and control groups were 1.95 ± 0.24 mm(3), 1.81 ± 0.23 mm(3), and 1.06 ± 0.10 mm(3), respectively. Average outer peripapillary total retinal volume in the papilledema and pseudopapilledema groups were 2.68 ± 0.49 mm(3) and 2.03 ± 0.24 mm(3), respectively (P < .001). However, the outer ring peripapillary total retinal volume was not different between pseudopapilledema and normal (1.90 ± 0.11 mm(3)) eyes (P = .17). Area under the curve to discriminate pseudopapilledema vs papilledema eyes for average RNFL thickness and inner and outer peripapillary total retinal volumes was 0.82, 0.68, and 0.88, respectively.

Conclusion: Outer peripapillary total retinal ring volumes might be useful in differentiating papilledema from pseudopapilledema.
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http://dx.doi.org/10.1016/j.ajo.2014.03.008DOI Listing
July 2014
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