Publications by authors named "Nasser Karimi"

42 Publications

A Systematic Review on the Role of Antioxidants in Thyroid Eye Disease.

J Curr Ophthalmol 2022 Jan-Mar;34(1):16-24. Epub 2022 Apr 16.

Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To systematically review the role of antioxidants in management of patients with thyroid eye disease (TED).

Methods: A literature search of the electronic databases was performed without restrictions on the date of publication till the end of March 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical trials, case-control studies, cohorts, case series, case reports, and experimental (including ) studies in the English language were included. The primary outcome in human studies was improvement in severity, activity scores, and/or quality of life scores. There was a decrease in the level of HO-dependent oxidative stress, Hyaluronic acid release, reactive oxygen species, cell proliferation, or antifibrotic/antiproliferative actions in the studies.

Results: Out of 374 initially screened articles, 157 studies were selected, the full texts of 82 were reviewed, and 14 papers were finally included. There were 4 clinical and 10 studies from 1993 to 2018. While β-carotene, retinol, Vitamin E, Vitamin C, melatonin, resveratrol, N-acetyl-l-cysteine, and quercetin showed some efficacy in studies; allopurinol, nicotinamide, pentoxifylline, and selenium (Se) were effective in both clinical and experimental reports. Se was the only recommended antioxidant based on one high-level randomized controlled trial.

Conclusion: While different antioxidants could potentially be effective in the management of TED, no strong recommendation for any or combination of antioxidants could be made to be implemented in the daily practice.
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http://dx.doi.org/10.4103/joco.joco_266_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9128423PMC
April 2022

Prevalence of Masked versus Unmasked Blepharoptosis in Subjects Seeking for Blepharoplasty and or Eyebrow Lift.

Semin Ophthalmol 2022 Jul 22;37(5):651-656. Epub 2022 Mar 22.

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran.

Purpose: To report the prevalence of unmasked versus masked in subjects seeking for eyelid and eyebrow rejuvenation.

Methods: This retrospective study included subjects (>18 years) who were seeking for blepharoplasty and/or eyebrow lift procedures in the year 2020. They were either having (complaining of simultaneous droopy eyelid, which was confirmed on examination), or (not complaining of simultaneous droopy eyelid, but its presence was revealed on the examination). Margin reflex distance 1 (MRD1) and levator function (LF) were recorded. Associated ptosis was defined as MRD1 of ≤3 mm and regarded as mild (3 and 2.5 mm), moderate (2 and 1.5 mm), and severe (≤1 mm).

Results: Included were 1401 subjects with a mean age of 47.2 years. The prevalence of masked and unmasked ptosis was 31% (90% unilateral) and 15.6% (59% bilateral), respectively. A significantly younger mean age (45.6 vs. 59.7 years), higher MRD1 (2.6 vs. 1.9 mm), and better LF (13.3 vs. 11.3 mm) were observed in the masked vs. unmasked ptosis group. More than 80% of the subjects with masked ptosis presented with indirect signs. A majority of both groups (68.8% of masked and 63.5% of unmasked ptosis) were mild to moderate.

Conclusion: Almost half of the subjects seeking for eyelid and eyebrow rejuvenation had either (2/3) or (1/3) associated ptosis. Masked ptosis was mostly unilateral and presenting with indirect signs of ptosis.
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http://dx.doi.org/10.1080/08820538.2022.2053727DOI Listing
July 2022

Antibacterial, hemoglobin/albumin-interaction, and molecular docking properties of phytogenic AgNPs functionalized by three antibiotics of penicillin, amoxicillin, and tetracycline.

Microb Pathog 2022 Mar 31;164:105427. Epub 2022 Jan 31.

Nanobiotechnology Laboratory, Department of Biology, Razi University, Kermanshah, Iran; Department of Biology, Faculty of Science, Razi University, Kermanshah, Iran. Electronic address:

Phyto-derived silver nanoparticles (AgNPs) were modified by three antibiotics including penicillin, amoxicillin, and tetracycline to measure antibacterial activity against Gram-positive and Gram-negative bacteria. According to disc diffusion assay, Staphylococcus aureus exhibited a higher sensitivity compared to Escherichia coli and Pseudomonas aeruginosa under AgNPs/tetracycline stress. Damage of the cell envelops of S. aureus and E. coli as sensitive bacteria under MIC concentrations of Ag NPs/tetracycline was observed by SEM images. AFM technique showed a smaller size of albumin protein (8-13 nm) with a higher level of roughness equals to 74.87 nm relative to hemoglubin (5-6.9 nm) by roughness value of 47.04 nm. Interaction of main secondary metabolites includes nootkatone, nootkatin, daphnauranol C, α-Cyperone, (E)-Nerolidol, and (Z)-α-Bisabolene epoxide surrounding phyto-derived AgNPs with the binding cavities of exfoliative toxin A and exfoliative toxin B as virulence factors of S. aureus was evaluated by molecular docking study. Among these natural compounds, daphnauranol C had the suitable binding affinity as value of - 6.4 kcal/mol compared with other metabolites. Based on the results of this study, tetracycline and daphanuranol C can be considered to further evaluations to obtain novel formulation of AgNPs as an efficient weapon against bacterial infections.
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http://dx.doi.org/10.1016/j.micpath.2022.105427DOI Listing
March 2022

Long-term Results of Palpebral Fissure Transfer With No Lower Eyelid Spacer in Chronic Progressive External Ophthalmoplegia.

Am J Ophthalmol 2022 02 30;234:99-107. Epub 2021 Jul 30.

Skull Base Research Center, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To evaluate the long-term outcomes of the palpebral fissure transfer (PFT) technique without lower eyelid spacer in patients with chronic progressive external ophthalmoplegia (CPEO).

Design: Retrospective interventional case series.

Methods: Consecutive patients with CPEO with PFT surgery (2006-2017) and a minimum follow-up of 24 months were included. The PFT included simultaneous levator resection or frontalis sling (based on the levator function and Bell's phenomenon) and lower eyelid retractor recession without spacer. Primary outcome measures included the change in margin reflex distance 1 (MRD-1), MRD-2, and palpebral fissure height (PFH) in the course of time. Potential predictors of keratopathy were also explored.

Results: There were 32 patients (64 eyelids) with the mean age and follow-up of 34.1 years (range 15-56 years) and 37.9 months (range 24-72 months), respectively. Mean MRD-1 significantly increased from -0.9 mm to 3.4 mm in postoperative weeks 1 and 2 and 1.8 mm at the last follow-up. Mean MRD-2 significantly decreased from 5.6 mm to 3.7 mm in postoperative weeks 1 and 2 and 5 mm at the last follow-up. Eyes with frank lower eyelid retraction (MRD-2 >5 mm) gained more reduction in MRD-2 compared with those with no sclera show (-0.9 mm vs -0.3 mm, P < .001). Reoperation was performed in 9 eyelids for under- (n = 5) and overcorrection (n = 4). Persistent keratopathy was observed in 3 eyes (4.5%).

Conclusion: Lower eyelid retractor recession without spacer yields significant protective corneal coverage at the critical early postoperative period when the risk of keratopathy is highest.
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http://dx.doi.org/10.1016/j.ajo.2021.07.027DOI Listing
February 2022

Short- and Long-term Patient Satisfaction and Complications in 650 Endoscopic Forehead Lift Procedures.

Ophthalmic Plast Reconstr Surg 2022 Mar-Apr 01;38(2):138-145

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran.

Purpose: The aims are to compare short- versus long-term patient satisfaction and report temporary versus permanent complications in 650 patients with endoscopic forehead lift procedure (EFL).

Methods: This is a retrospective study on all of the consecutive patients with EFL. Patients with previous trauma and surgery and less than 2 years follow up were excluded. Short- (6 months) and long-term (≥2 years) patient satisfaction (visual analog score [VAS], 0-100) were recorded. Patients' perspectives on temporary versus permanent complications were also documented.

Results: Mean age and follow up were 46.4 and 7.1 (2-13) years, respectively. Long-term satisfaction (79.9) was significantly lower than the short term (96.6). The long-term satisfaction decreased in 95.7%, increased in 2.7%, and remained the same in 1.6% of the patients. Intraoperative skin laceration occurred in 3 patients (0.5%). Mean time of forehead numbness recovery was 2.3 months. Temporary complications were itching (13.7%), headache (6.3%), unilateral facial nerve palsy (5.8%), acne (3.2%), and remained staples (1.7%). Permanent complications included undercorrection (7.1%), alopecia (4.2%), forehead irregularities (2.3%), surprised look (2.2%), incision site complications (2%), and glabellar depression (0.9%). Reoperation (1.2%) was performed for undercorrection and alopecia. While short-term satisfaction was significantly lower in patients with temporary facial nerve paresis, long-term satisfaction was lower in patients with undercorrection and reoperation.

Conclusion: A high satisfaction scores of 96.6 and 80 were observed in the short- and long-term follow up after the EFL. Frequency of temporary and permanent postoperative complications was 30.3% and 15.8%. Reoperation rate was 1.2%.
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http://dx.doi.org/10.1097/IOP.0000000000002003DOI Listing
April 2022

Conversion Rate of Web-based Versus Non-web-based Patient Referral Sources in a Facial Plastic Surgery Practice.

Ophthalmic Plast Reconstr Surg 2022 Jan-Feb 01;38(1):59-64

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran.

Purpose: To compare the conversion rate (number of procedures/referrals) of web-based and non-web-based referrals to a facial plastic surgery practice (2012-2019).

Method: Data on demographics, referral source, patient's concern, and their facial procedures were recorded. Web-based referral sources include website and Instagram. Non-web-based counterparts were the word-of-mouth, medical professionals, and others (TV, radio, printed media). Patient concerns were either cosmetic or noncosmetic (functional). Patients who underwent facial cosmetic surgery and injections (botulinum toxin A, filler, fat) were categorized in the cosmetic procedure group. Patients with functional procedures with or without facial injections were categorized in the noncosmetic procedure group. The conversion rate was defined as the ratio of the number of referrals with different facial procedures to the total number of referrals.

Results: Included were 19,965 patients, majority of whom (63.3%) had cosmetic concern. Total, cosmetic, and noncosmetic conversion rates were 30.1%, 27.7%, and 2.4% for the web-based and 24.1%, 19.8%, and 4.3% for the non-web-based referrals, respectively (0.3 < p < 0.4). Cosmetic conversion rate grew from 6.7% in referrals ≤20 to more than 23% in >20 years of age (p = 0.03). It was also significantly (p < 0.001) higher in the referrals with cosmetic (28.3%) than noncosmetic (12.1%) concern. Gender and year of practice did not have a significant effect on the conversion rates.

Conclusion: Conversion rates were not significantly different between the web-based and non-web-based referrals. A significantly higher cosmetic conversion rate was observed for the referrals with cosmetic concern and older than 20 years.
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http://dx.doi.org/10.1097/IOP.0000000000001988DOI Listing
January 2022

Computational insight into the protective mechanism of Wendelbo. Alliaceae in a mouse model of Staphylococcosis: focus on dietary phytocannabinoid -caryophyllene.

In Silico Pharmacol 2021 7;9(1):17. Epub 2021 Feb 7.

Department of Biology, Faculty of Science, Razi University, Kermanshah, 67149-67346 Iran.

This study was aimed to investigate the prophylactic effects of hydro-alcoholic extract derived from bulbs of Wendelbo. (Alliaceae; AI) on mouse model of Staphylococcosis, and to decipher which phytochemicals of AI may involve in its anti-staphylococcal property. Male mice were allocated into four groups, i.e. normal control (NC) and three other groups received AI at 0.192, 0.384 and 0.768 mg/ml in drinking water for 9 days. Thereafter, mice were intravenously injected 10 colony forming unites (CFUs/ml) of suspension at 10th day and tissue homogenates were colony counted for  9 days post-inoculation. Molecular docking among cardinal proteins involved in Staphylococcosis and phytochemicals of AI has been performed using PyRx software and the best ligand submitted to compute molecular and biological attributes. Induction of murine Staphylococcosis and inclusion of AI did not adversely alter bodyweights of mice while colony counts in selected tissues of mice infected with were different among groups (P = 0.016). Generally, the colony counts tended to decrease in AI 0.192 (P = 0.099) and AI 0.768 (P = 0.818) groups as compared to NC, however AI 0.384 (P = 0.005) group showed lesser colony counts than NC. In addition, colony counts decreased in AI 0.384 as compared to AI 0.768 (P = 0.009). The colony counts in kidneys of AI 0.0384 group were lesser than those of NC (P = 0.051) and AI 0.768 (P = 0.048). Among target proteins, -caryophyllene () showed reliable binding affinities (kcal/mol) to three hydrolase enzymes [beta toxin (sphingomyelin phosphodiesterase - 8.1), sortase B (protease - 8.1), and FtsZ (GTPase - 8.7) of ]. The ADMET properties of showed that it followed the Lipinski's rule of five with one violation with respect to its miLogP 5.17. In addition, Molinspiration bioactivity score indicated ion channel modulatory and enzyme inhibitory effect for . Computational findings of admetSAR software revealed that leads to carcinogenicity, , fish, rat, and honey bee toxicities, weak inhibition of human ether-a-go-go-related gene, and cytochromes inhibitory promiscuity. The showed promising in human intestinal absorption, blood-brain barrier permeability, Caco-2 penetration, and solubility. The results of Toxtree software showed that is not an endogenous molecule of the body and contains no functional groups associated with enhanced toxicity and considered as class I toxic compound close to terpenes. In conclusion, we found the hydro-alcoholic extract derived from of bulbs AI has a significant protective effect against Staphylococcosis in mouse model. In silico findings demonstrated that has acceptable ADMET score to be considered as a bioactive compound for designing phytobiotics.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40203-021-00078-x.
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http://dx.doi.org/10.1007/s40203-021-00078-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867674PMC
February 2021

Dermatochalasis Through Decades: A Histopathologic Study.

Ann Plast Surg 2021 03;86(3):340-344

Eye Research Center, The Five Senses Institute.

Objectives: Three prior studies (2008, 2011, 2018) histopathologically compared the eyelid specimens of patients with dermatochalasis (DC, undergoing blepharoplasty) with a control group and proposed that DC may begin with subclinical inflammation leading to elastolysis and lymphostasis. With growing number of younger patients consulting for blepharoplasty, the unanswered question is whether histopathologic changes of DC differ between the younger and the older.

Patients And Methods: In this prospective case series, 20 right upper eyelid skin of 20 nonsmoker, class 3 Fitzpatrik skin type women (30-68 years old) were histopathologically examined. Patients were divided into 2 age groups of 50 years or older and older than 50 years. Upper eyelid skin was preoperatively marked, intraoperatively removed, postoperatively divided into 3 sections: lateral (lateral limbus to lateral canthus), central (between medial and lateral limbi), and medial (medial limbus to medial canthus), and separately (totally 60 specimens) sent for histopathological examination. A masked pathologist recorded skin thickness in all specimens (60) as well as lymphatic vessels diameter and density, elastic fiber density, macrophage number, collagen intrafibril edema, and depth of collagen stromal bed in central sections (20 specimens).

Results: There were 10 patients at each age group. Histopathological measurements were not significantly different between the 2 age groups except mean lymphatic vessel diameter (P = 0.034) that was larger in the second group (>50 years). A significant positive correlation was also observed between the age and lymphatic vessel diameter (rs = 0.3, P = 0.009).

Conclusions: Lymphangiectasia progresses significantly by age. Histopathological characteristics of DC are the same in the 2 age groups.
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http://dx.doi.org/10.1097/SAP.0000000000002489DOI Listing
March 2021

Vision-related quality of life in patients with a history of congenital glaucoma.

Eur J Ophthalmol 2021 Nov 21;31(6):3074-3079. Epub 2020 Dec 21.

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

Purpose: To assess the vision-related quality of life in adult patients with a history of primary congenital glaucoma.

Methods: In a cross-sectional hospital-based study eligible patients with a history of primary congenital glaucoma aged more than 18 were recruited in the study. Patients with secondary glaucoma and monocular patients were excluded. All patients underwent a complete ophthalmologic examination. The subjects were requested to answer a Persian approved version of the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) questionnaire.

Results: A total of 23 congenital glaucoma patients have enrolled in the study. The mean age was 29.22 (9.3 SD) and mean IOP was 13.82 (5.19 SD) and 15.69 (5.26 SD) in right and left eyes, respectively. The mean number of medications was 1.13 (1.25 SD) in the right and 1.30 (1.18 SD) in the left eyes. Among all scores of NEI-VFQ-25, the lowest score belonged to mental health 53.71 (29.72) and the highest score was color vision score 83.69 (20.79). We found a significant influence of visual field defect on many subscales including general health and general vision ( = 0.007,  = +0.65) and ( = 0.002,  = +0.71) respectively. The Mean Defect (MD) was associated with low social functioning and peripheral vision too ( = 0.035,  = +0.53) and ( = 0.001,  = +0.76) respectively. Age had a negative impact on the general vision subscale ( = 0.003,  = -0.59).

Conclusion: Our study showed that visual field defect was strongly associated with many subscales scores in (NEI VFQ-25) questionnaire.
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http://dx.doi.org/10.1177/1120672120977354DOI Listing
November 2021

Web-Based Versus Non-Web-Based Patient Referral Patterns and Factors Affecting Them.

Ophthalmic Plast Reconstr Surg 2021 Sep-Oct 01;37(5):470-475

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Tehran, Iran.

Purpose: To analyze the 8-year (2012-2019) change in the patient referral source trends to a plastic surgery practice and the factors affecting them.

Methods: Data on demographics, referral source, and patient's concern were recorded. The web-based referral sources were website and Instagram and non-web-based included other patients (word-of-mouth), medical professionals (physician, nurse, and optometrist), and others (printed media, TV, and radio). Patients' concerns were divided into cosmetic and noncosmetic. The first (2012-2015) and second (2016-2019) half of the study period were also compared.

Results: Included patients were 19,965. The 8-year referral sources, in order of frequency, were medical professionals (34%), other patients (32.7%), web-based sources (32.5%), and the others (0.7%). The web-based sources significantly increased by 2.4 times in the second half. While they had a third rank after the medical professionals and other patients in the first half of the study period, they became the first in the second half. The non-web-based source showed a decline during the study period. Type of referral sources was not significantly different between the 2 genders. A significantly higher percentage of the patients between 21 and 50 years of age were referred through web-based sources than the other age groups. Patients with cosmetic concerns were 2 times more likely to be referred through web-based sources.

Conclusion: The web-based referral sources have significantly grown from the third rank in the beginning to the first one from 2015 till the end of study.
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http://dx.doi.org/10.1097/IOP.0000000000001918DOI Listing
October 2021

Postoperative Blepharoptosis After Pars Plana Vitrectomy Procedure.

Ophthalmic Plast Reconstr Surg 2021 Sep-Oct 01;37(5):431-434

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure.

Methods: In a prospective study, patients were recruited consecutively from October 2016 to June 2018. Upper eyelid margin reflex distance 1 and 2 (MRD1 and 2), upper eyelid crease height, and levator function were measured before, 1 and at least 6 months after surgery by the same investigator. Clinical and Clinically significant ptosis were defined as ≥0.5 and ≥2 mm drop of MRD1.

Result: There were 60 eyes from 57 patients. The majority of surgeries were performed by the fellows (63.3%, 38/60) and under general anesthesia (95.0%, 57/60). Clinical and clinically significant ptosis following PPV were 47.2% (25/53) and 11.3% (6/53) at the last follow up (at least 6 months), respectively. MRD2 (p = 0.389) and eyelid crease height (p = 0.057) did not significantly change. Surgeons' level, time of the procedure and other variables were not significantly impacting the frequencies.

Conclusion: Persistent clinically significant ptosis was observed in 11% of patients undergoing PPV. No variable was significantly associated with persistent postoperative ptosis after PPV.
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http://dx.doi.org/10.1097/IOP.0000000000001890DOI Listing
October 2021

Revisiting Anchor Epicanthoplasty in Mild to Moderate Asian Epicanthal Folds: A Clinicopathological Study.

Aesthetic Plast Surg 2021 02 6;45(1):181-190. Epub 2020 Aug 6.

Eye and Skull Base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Science, Sattarkhan Niayesh St, 1455364, Tehran, Iran.

Background: To assess the epicanthal fold (EF), eyelid, eyebrow, scar, and patients' satisfaction after anchor epicanthoplasty and upper blepharoplasty and histopathologically compare Asian epicanthal fold skin with non-Asian counterpart.

Methods: Asian Iranians with grade 2 and 3 EF were included. Photographs were taken before and at least 12 months after the surgery. Photoanalysis included EF grade, inter-canthal distance (ICD), margin reflex distance 1 (MRD1), tarsal plate show (TPS), brow fat span (BFS), and eyebrow height. Manchester scar scale score (5-28) and patients' satisfaction score (0-100) were documented. The most medial skin of 5 Asian and 5 non-Asian subjects was histologically compared for the thickness and elastic fiber density and morphology.

Results: Included were 89 patients (178 eyelids) with a mean age of 31.6 years and follow-up of 13.1 months. Mean ICD significantly decreased by 3.5 mm (shortening ratio of 9.7%). All grade 2 and almost half of the grade 3 EF disappeared. Significant postoperative increase in mean MRD1 (0.3 mm) and TPS (1.1-1.4 mm) and decrease in BFS (3.3-3.6 mm) and eyebrow height (1.7-3.4 mm) were observed. Revision rate of epicanthoplasty was 7.3%. Mean satisfaction and scar scores were 97.1 and 5.4, respectively. Histopathologically, Asian and non-Asian medial upper eyelid skin was not significantly different.

Conclusion: Anchor epicanthoplasty eliminated grade 2 and improved grade 3 EF with a high satisfaction and negligible scar. Simultaneous upper blepharoplasty significantly increased MRD1 and TPS and decreased eyebrow height. EF skin was not histologically different from non-Asians.

Level Of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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http://dx.doi.org/10.1007/s00266-020-01901-0DOI Listing
February 2021

Effects of reducing crude protein concentration in starter feed containing constant rumen undegradable protein on dairy calves performance.

J Anim Physiol Anim Nutr (Berl) 2020 Sep 7;104(5):1287-1293. Epub 2020 May 7.

Department of Animal and Poultry Science, College of Aburaihan, University of Tehran, Tehran, Iran.

This study aimed at investigating the effects of decreasing crude protein (CP) in diets with constant rumen undegradable protein (RUP) content on dry matter (DM) intake, growth, feed efficiency (FE) and blood parameters in calves in a randomized complete block design. Dietary treatments included: (a) a calf starter containing 200 g/kg CP (62 g/kg RUP, based on DM), (b) a starter containing 180 g/kg CP (65 g/kg RUP, based on DM) and (c) a starter containing 160 g/kg CP (65 g/kg RUP, based on DM). A total 42 newborn male and female Holstein calves were fed 8 L milk/day until day 45, after which they were weaned and continued the experiment until day 75. Solid feed intake and total DM intake were measured daily, and body weight and skeletal growth parameters including withers height and heart girth were recorded weekly. Blood samples were collected on days 45 and 75. Solid feed intake, total DM intake, weaning weight, average daily gain from birth to weaning and from birth to 75 days, final weight and FE were not affected by the experimental treatments. In addition, skeletal growth parameters were similar among groups. Glucose concentration was similar among treatments; however, calves fed the starter containing 160 g/kg CP had significantly lower plasma concentrations of albumin and urea nitrogen compared with those fed starters containing 180 and 200 g/kg CP. These results indicate that CP level in the calf starter could be decreased to 160 g/kg DM if RUP levels stay at 65 g/kg DM, without negatively affecting feed intake and calf performance.
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http://dx.doi.org/10.1111/jpn.13380DOI Listing
September 2020

Techniques of Eyebrow Lifting: A Narrative Review.

J Ophthalmic Vis Res 2020 Apr-Jun;15(2):218-235. Epub 2020 Apr 6.

Eye and Skull Base Research Centers, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran.

None of brow lift techniques are completely satisfactory because of their limited effectiveness, lack of longevity, and potential complications. The aim of this study was to provide a comprehensive review of the literature on the pros and cons of the most popular techniques in brow and forehead lift. Relevant original articles in the PubMed database (English language) were sought using the search terms "eyebrow lift", "forehead lift", "periorbital rejuvenation", "eyebrow ptosis", "blepharoplasty and eyebrow change", "surgical eyebrow lift", and "non-surgical eyebrow lift", No date limitation was considered. Titles and abstracts were scanned to include the most pertinent articles. Subsequently, full texts of included articles (111 articles) were skimmed and finally 56 references were selected for the review. A narrative synthesis of data was finally undertaken with particular attention to the indications, techniques, and common complications of the eyebrow lift procedures. Ten popular techniques including two non-surgical methods (Botulinum toxin A and soft tissue fillers) were reviewed in this article. In general, non-surgical methods of forehead/brow lift are temporary, need less experience and correction would be easier should any complication occur. Surgical methods are divided into three categories: trans-blepharoplasty eyebrow lift, direct eyebrow lift, and trans-forehead eyebrow/forehead lift. Currently, the most popular method is the endoscopic forehead lift approach even though its longevity is limited. Direct brow-lift is particularly useful in patients with facial palsy and those who are more likely to be accepting of the scar (male gender, high forehead hair line).
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http://dx.doi.org/10.18502/jovr.v15i2.6740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151508PMC
April 2020

Endoscopic-Assisted Lateral Orbitotomy for Large Orbital Roof Dermoid Cysts With Dural Invasion.

Ophthalmic Plast Reconstr Surg 2020 Sep/Oct;36(5):508-511

Eye Department, Eye and Skull Base Research Center, The Five Senses Institute, Iran University of Medical Science, Tehran, Iran.

Purpose: To demonstrate the technique and report the results of endoscopic-assisted lateral orbitotomy for 6 patients with huge intraorbital dermoid cyst causing orbital roof bone erosion and dural invasion.

Methods: Patients had unilateral cystic tumor with proptosis and hypoglobus for more than 6 months. There was no compressive optic neuropathy. Lateral orbitotomy procedure was performed from 2004 to 2016 by 1 surgeon. Cysts were dissected, and fluid content was aspirated to reduce the size. Solid contents were then suctioned, its cavity was repeatedly irrigated, and orbital part of epithelial lining was removed. The remained epithelial lining and keratinized content at the orbital roof (abutting the dura) were removed using the rigid endoscope lenses (4 mm, 0° and 30°) and curettage. Orbital tissue was pulled away from the roof (inferior) by an assistant surgeon to make a space for introducing the lens and curette. The surgical field was frequently irrigated. No orbital drain was used, and all the patients were discharged on the same day after 8-10 hours of observation. Skin sutures were removed 1 week later.

Results: They were 4 men and 2 women with age range of 19-48 years. A large superolateral orbital tumor with roof erosion and dural invasion was observed on imaging. Procedures were performed uneventfully. Dermoid was the pathological diagnosis. While one patient lost to follow up after 1 week, others had 6-18 months follow-up time with no recurrence.

Conclusions: Endoscopic-assisted lateral orbitotomy approach provided a good field of view, illumination, and magnification to totally remove all the content and epithelial lining of very large orbital roof dermoid cysts with dural invasion.
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http://dx.doi.org/10.1097/IOP.0000000000001661DOI Listing
March 2021

Diabetic versus non-diabetic rhino-orbito-cerebral mucormycosis.

Mycoses 2020 Jun 18;63(6):573-578. Epub 2020 Apr 18.

Eye and skull base Research Centers, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Objective: To compare the characteristics and outcomes of rhino-orbito-cerebral mucormycosis (ROCM) in diabetic versus non-diabetic patients.

Method: It is a retrospective comparative case series on consecutive patients with biopsy-proven ROCM. Systemic and ophthalmic manifestations, imaging, management and final outcomes were compared between diabetic versus non-diabetic ROCMs referred the eye clinic of a university-based hospital (2008-2016).

Results: Forty-three diabetics (55 eyes) with mean age of 54.6 (SD:12.5) years and 20 non-diabetics (24 eyes) with mean age of 57.5 (SD:13.8) years were enrolled. Patients' survival was observed in 51% of diabetics and 70% of non-diabetics (P = .1). The mortality rate was 7.4 times (CI95%: 1.85-29.96) higher in diabetic ROCM treated with non-liposomal amphotericin (P = .01). Exenteration did not significantly change the mortality rate in either group. Globe survival was 40% and 50% in diabetics and non-diabetics (P = 1), respectively. Vision survival was observed in 20% of diabetics and 37% of non-diabetics (P = .2).

Conclusion: Patients', globe and vision survivals were not different between diabetic and non-diabetic patients with ROCM. They were 51%, 40% and 20% in diabetic and 70%, 50% and 37% in non-diabetic ROCM.
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http://dx.doi.org/10.1111/myc.13078DOI Listing
June 2020

Pressure ulcer following circumferential head dressing.

Orbit 2020 Oct 30;39(5):350-356. Epub 2020 Jan 30.

Eye Research Center, The Five Senses Institute, Iran University of Medical Sciences , Tehran, Iran.

Purpose: To report four patients with forehead pressure ulcer (PU) following encircling head dressing and review the literature.

Methods: Uneventful endoscopic forehead lift procedure was performed with moderate skin elevation in three patients. Left upper eyelid crease incision was made to remove the sub-brow dermoid cyst uneventfully in one patient. All procedures were performed under general anesthesia. Mixed topical antibiotic and steroid ointments were placed on the incision sites before putting the encircling forehead dressing (using gauze and elastic bandage). The dressing was then removed on the first postoperative examination.

Results: Forehead and eyebrow PUs were observed on the first follow-up visit (16-72 h) after removing the dressing. Patients were otherwise healthy. They did not have significant pain or burning postoperatively. Management included pressure release, wound debridement, daily dressing, topical antibiotic and steroid, and silicone-based anti-scar cream. None had infected ulcer and all except one ended up with atrophic scar in the last follow-up (2-14 months). External pressure and shearing forces were assumed to be the main causative factors, even though reperfusion injury could contribute in the development of PU.

Conclusion: Encircling head dressing can cause PU and result in scar formation in healthy immunocompetent patients. If there is a low risk of postoperative hematoma, encircling dressing should be avoided. Early loosening of the dressing and frequent examination of the skin are the best preventive and diagnostic measures. Treatment includes pressure removal, daily debridement, and topical medications.
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http://dx.doi.org/10.1080/01676830.2020.1719521DOI Listing
October 2020

Postoperative Blepharoptosis After Modern Phacoemulsification Procedure.

Am J Ophthalmol 2020 05 9;213:17-23. Epub 2020 Jan 9.

Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To investigate the frequency of transient (1 month) and persistent (at least 6 months) postoperative ptosis following clear corneal sutureless phacoemulsification and to analyze the factors affecting them.

Design: Cohort study.

Methods: Patients who underwent phacoemulsification cataract surgery from October 2016 to June 2018 in a tertiary center were enrolled. Margin reflex distance 1 (MRD1), MRD2, and levator function were measured and facial photography was taken before, 1 month, and at least 6 months after the surgery. Clinical ptosis was defined as any postoperative drop of MRD1 and clinically significant ptosis as MRD1 drop of ≥2 mm. Photo-based ptosis was assessed by a masked oculofacial plastic surgeon at the end of the study.

Results: A total of 234 patients (313 eyelids) were included. The majority of surgeries were performed by senior residents (65.5%, 205/313) and under topical anesthesia (78.0%, 244/313). Persistent clinical, clinically significant, and photo-based ptosis were 25.4% (71/279), 3.2% (9/279), and 3.3% (9/276). Eyelids with persistent postoperative ptosis showed a significantly (P = .03) lower preoperative levator function (13.9 vs 15.8 mm). No other factor was significantly different between the eyelids with and without postoperative ptosis.

Conclusion: Persistent clinically significant ptosis was observed in more than 3% of patients undergoing clear corneal sutureless phacoemulsification cataract surgery. It should be counseled preoperatively. Lower preoperative levator function was significantly associated with a higher frequency of postoperative ptosis. Duration of surgery, level of surgeons, and other variables did not have any significant effect on the frequency of postoperative ptosis.
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http://dx.doi.org/10.1016/j.ajo.2019.12.023DOI Listing
May 2020

Change in Lower Eyelid Position After Ptosis Repair in Patients With Unilateral Myogenic Versus Aponeurotic Blepharoptosis.

Ophthalmic Plast Reconstr Surg 2019 Jul/Aug;35(4):383-386

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

Purpose: To compare preoperative and postoperative lower eyelid scleral show in patients with unilateral myogenic (MP) and aponeurotic (AP) ptosis, analyze the factors correlated with them, and assess the rate of postoperative lower eyelid symmetry in both groups.

Methods: Patients (older than 5 years old) with unilateral MP (58) and AP (20) were included from June 2015 to April 2017. Excluded were patients with previous eyelid surgery, strabismus, levator function of ≤3, and associated procedures. Margin reflex distance (MRD) 1 and 2 and levator function were measured by the same observer before and at least 6 months after the ptosis repair.

Results: Lower scleral show was observed in 56.8% and 80% of MP and AP, respectively. Margin reflex distance 2 was significantly (r = -0.37, p = 0.002) associated with MRD1 in the MP group (multiple regression analysis). Both groups showed a significant improvement of MRD2, postoperatively resulting in symmetric MRD2 in 91.4% of MP and 80% of AP group. It was not changed in 43% of MP and 25% of AP group. Multiple regression analysis showed that preoperative MRD2 was the only significant factor associated with postoperative improvement of scleral show in the MP group.

Conclusions: Lower scleral show was significantly improved after ptosis repair in both MP and AP. The more severe MP was significantly associated with more severe preoperative scleral show. Preoperative MRD2 was the only factor predicting postoperative improvement of scleral show in the MP. No factor was significantly associated with MRD2 in the AP group.
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http://dx.doi.org/10.1097/IOP.0000000000001287DOI Listing
December 2019

Surgical management of congenital nasolacrimal duct obstruction; one procedure for all versus all procedures for one.

Curr Opin Ophthalmol 2019 Sep;30(5):364-371

Eye Department, Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Purpose Of Review: After failed conservative management, most clinicians treat congenital nasolacrimal duct obstruction (CNLDO) in a conventional stepwise fashion: starting with probing, then repeat probing, next silicone intubation and/or balloon dilatation, and finally dacryocystorhinostomy. This approach is based on the patient's age and previously failed procedures and recruits 'one procedure for all' CNLDO. A newly introduced approach is based on the type of obstruction and recruits 'all procedures for one' CNLDO. The aim of this review is to examine the best available evidence regarding CNLDO management.

Recent Findings: Recent articles support the concept that through intraoperative evaluation of obstruction in CNLDO, clinicians may predict probing failure and instantaneously employ more appropriate treatment modalities. This review addresses whether an age-based approach should be changed into a one-stage obstruction-based approach.

Summary: An age-based approach treats CNLDO as a homogeneous disease and thus treats all patients with one predetermined procedure. A one-stage obstruction-based approach, however, considers CNLDO to be a heterogeneous disease, and therefore allows recruitment of all procedures simultaneously and selects the best intraoperatively. It may allow replacement of the conventional stepwise approach to CNLDO treatment provided that randomized trials verify its efficacy, safety, and cost-effectiveness.Video abstract http://links.lww.com/COOP/A30.
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http://dx.doi.org/10.1097/ICU.0000000000000584DOI Listing
September 2019

Supine Test: A New Test for Detecting Lacrimal Gland Prolapse Before Upper Blepharoplasty.

Ophthalmic Plast Reconstr Surg 2019 Nov/Dec;35(6):581-585

Eye Department, Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.

Purpose: To introduce a new (Supine) test and assess the values of lateral eyelid bulging for diagnosis of lacrimal gland (LG) prolapse before upper blepharoplasty.

Methods: In a prospective case series (2011-2017), lateral eyelid bulging and Supine Test were recorded, preoperatively. Lacrimal gland prolapse was graded as mild (<4 mm), moderate (4-7 mm), and severe (>7 mm). A few spots of cautery on LG capsule was performed in patients with bilateral mild and suture repositioning in unilateral or bilateral moderate and severe LG prolapse. Patients with asymmetric LG prolapse were treated based on more severe grade, bilaterally.

Results: Included were 1,207 patients. Frequency of positive Supine Test (11.8%, 142/1,207) increased from almost 10% in patients less than 41 years of age to 15% in more than 60 years of age. Their mean age was significantly older, and 53.2% showed asymmetric LG prolapse. Septum was just opened in patients with positive Supine Test, and all had LG prolapse of ≥3 mm (mean: 5.6 mm, range: 3-14 mm). Mild LG prolapse, moderate LG prolapse, and severe LG prolapse were observed in 22.5%, 62.6%, and 14.7% of the patients, respectively. Mean follow-up time was 22 months (12-60 months). Recurrence was observed in 1 patient (bilateral) after suture repositioning. Lateral eyelid bulging had a high negative (96.2%) and low positive (30.6%) predictive value when compared with the Supine Test.

Conclusions: Positive Supine Test means LG prolapse of ≥3 mm (100% positive predictive value). Negative lateral eyelid bulging was highly predictive of no LG prolapse.
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http://dx.doi.org/10.1097/IOP.0000000000001397DOI Listing
January 2020

How reliable is the lacrimal scintigraphy report? An inter-observer agreement and reliability study.

Int J Ophthalmol 2019 18;12(3):401-406. Epub 2019 Mar 18.

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

Aim: To assess the inter-observer agreement and reliability as well as intra-observer repeatability for lacrimal scintigraphy (LS) reports with and without considering the irrigation test results.

Methods: A prospective, observational, cross sectional study. Two masked clinicians (lacrimal surgeon and nuclear medicine specialist) independently reported 100 LS images (50 patients of >6 years of age with unilateral anophthalmic socket) in a university hospital. The lacrimal surgeon performed a diagnostic irrigation test and repeated the report of the same LS images 2y after the first report (intra-observer agreement). A weighted Kappa analysis was performed to determine inter-observer agreement and reliability as well as intra-observer repeatability for the type (normal, partial and complete obstruction) and location (presac, preduct, and intraduct) of the obstruction. Subgroup analysis was also performed with consideration of irrigation test results.

Results: A significantly moderate agreement was found between lacrimal surgeon and nuclear medicine specialist for both the type (Kappa=0.55) and location (Kappa=0.48) of obstruction. Agreement values were higher for the type (Kappa=0.61 0.41) and location (Kappa=0.56 0.31) of obstruction in cases with normal than abnormal irrigation test. Strong and significant intra-observer (lacrimal surgeon) repeatability was found for both the type (Kappa=0.66) and location (Kappa=0.69) of obstruction. LS showed no to slight reliability based on irrigation test.

Conclusion: A moderate agreement is found between lacrimal surgeon and nuclear medicine specialist regarding the interpretation of LS suggesting the importance of consensus groups among nuclear medicine specialists and lacrimal surgeons to create a common language for interpretation of LS. Intra-observer repeatability is strong for the lacrimal surgeon.
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http://dx.doi.org/10.18240/ijo.2019.03.08DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423397PMC
March 2019

Outcomes and factors affecting them in patients with rhino-orbito-cerebral mucormycosis.

Br J Ophthalmol 2019 10 4;103(10):1460-1465. Epub 2018 Dec 4.

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

Aim: To report the frequency and factors affecting patients', globe and vision survivals in rhino-orbito-cerebral mucormycosis (ROCM).

Methods: This is a retrospective study of 63 patients (79 eyes) with biopsy-proven ROCM at a university hospital 2008-2016. Systemic and ophthalmic manifestations, imaging, management and final outcomes were recorded. Globe survival was defined as no exenteration and vision survival as final visual acuity of light perception and more.

Results: Mean age was 55.5 (SD 12.9) years with no gender preference. Diabetes was the most common underlying disease (68.3%). Patient survival was observed in 57.1 % (36/63). Presence of frozen eye (OR 4.6), nasal mucosal involvement (OR 7.3) and shorter duration of antifungal therapy (OR 1.03) were significantly associated with lower patient survival. Exenteration did not significantly change the survival. Globe survival was detected in 43% (34/79). Higher white blood cell (WBC) count was associated with a lower globe survival (p=0.02). Vision survival was observed in 25.3% (20/79) in whom younger age was significantly associated with a worse vision survival.

Conclusion: Patient, globe and vision survivals were 57%, 43% and 25%, respectively. Exenteration did not affect the patients' survival. While frozen eye and nasal mucosal involvement were significantly associated with a lower survival, higher WBC count significantly increased the risk of exenteration.
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http://dx.doi.org/10.1136/bjophthalmol-2018-312688DOI Listing
October 2019

Is primary optic nerve sheath schwannoma a misnomer? Report of two cases and literature review.

Orbit 2019 Oct 16;38(5):419-423. Epub 2018 Nov 16.

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

: To report clinicopathological characteristics of two patients with optic nerve sheath schwannoma (ONSS) and review the literature. : The first patient (22-year-old man) presented with left eye proptosis and decreased vision in 2012 whose orbital imaging showed a large cystic lesion around the optic nerve. The second patient (52-year-old man) presented with decreased vision in the left eye (without proptosis) in the 2006. His imaging showed a small orbital apex lesion between the medial rectus and optic nerve. Both lesions were histopathologically consistent with ONSS. ONSS has previously been reported in 12 patients. : Orbital biopsy and subsequently external beam radiotherapy were performed for the first patient who showed a temporary improvement of vision. However, his proptosis progressed and vision decreased to light perception (LP) a few months after radiotherapy when the lesion was resected in April 2013. Second patient declined any procedure until his vision gradually decreased to LP in October 2007. It was then removed through a combined medial and lateral orbitotomy procedure. Both patients ended up with visual acuity of no LP and no recurrence in their last follow up visits in April 2018. No histopathological evidence was found to show that optic nerve sheath could be the origin for presenting and previously reported cases in the literature. : Presenting cases and literature review imply that ONSS is a misnomer and all the lesions are different types of orbital schwannomas with optic nerve sheath attachment.
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http://dx.doi.org/10.1080/01676830.2018.1545239DOI Listing
October 2019

Inadvertent inferior oblique extirpation during orbital decompression.

Eur J Ophthalmol 2019 Jul 1;29(4):NP13-NP15. Epub 2018 Oct 1.

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

Purpose: To report a case of inadvertent inferior oblique extirpation during orbital decompression, its management, and postoperative result.

Methods: A 38-year-old female with thyroid eye disease underwent cosmetic right orbital decompression during whichinferior oblique extirpation was noticed.

Result: The muscle was repaired on the same session (illustrated in the article) with no postoperative diplopia at 3-month follow-up.

Conclusion: Inferior oblique injury should be considered among the uncommon yet important complications of orbital decompression. It can be easily found and repaired in the same session as demonstrated in this case report.
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http://dx.doi.org/10.1177/1120672118803516DOI Listing
July 2019

Computational approaches to the in vitro antibacterial activity of Boiss against gentamicin-resistant : focus on ribosome recycling factor.

In Silico Pharmacol 2016 30;5. Epub 2017 Aug 30.

Department of Biology, Faculty of Science, Razi University, 67149-67346 Kermanshah, Iran.

Persian shallot, Boiss. (AH), is an Iranian native medicinal plant belongs to Alliaceae family. Here, we investigated in vitro antibacterial activity of hydro-alcoholic extract derived from bulbs of AH. We also employed in silico molecular docking to decipher mechanisms of its antibacterial effects. Minimum inhibitory concentrations (MIC) and minimum bactericidal concentration (MBC) against ATCC 25922 were determined. Molecular docking was performed for major phytochemicals of AH against ribosome recycling factor (RRF). ATCC 25922 was gentamicin-resistant while AH showed MIC (42 ± 18 μg/ml) and MBC (106 ± 36 μg/ml) against . In silico results reported all phytochemicals of AH shown acceptable negative binding affinity (kcal/mol) with RRF. In essence, the binding affinities of alliogenin (-11.6), gitogenin (-11.6), kaempferol (-10.2), linoleic acid (-8.4), oleic acid (-8.0), palmitic acid (-7.4), palmitoleic acid (-8.4), quercetin (-10.8), and shallomin (-13.4) with RRF were comparable to that of gentamicin (-12.6). In sum, hydro-alcoholic extract of bulbs of AH could be considered as a commercial phytobiotics if in-depth antibacterial assays employed in future studies. More interestingly, shallomin showed more promising binding affinity with RRF and can be considered as lead molecule for future drug discovery.
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http://dx.doi.org/10.1007/s40203-017-0027-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577348PMC
August 2017

Effect of Lactation on myocardial vulnerability to ischemic insult in rats.

Arq Bras Cardiol 2017 05 20;108(5):443-451. Epub 2017 Apr 20.

Tehran University of Medical Sciences - International Campus, Tehran, Iran.

Background: Cardiovascular diseases are the leading cause of mortality and long-term disability worldwide. Various studies have suggested a protective effect of lactation in reducing the risk of cardiovascular diseases.

Objective: This study was designed to assess the effects of pregnancy and lactation on the vulnerability of the myocardium to an ischemic insult.

Methods: Eighteen female rats were randomly divided into three groups: ischemia-reperfusion (IR), in which the hearts of virgin rats underwent IR (n = 6); lactating, in which the rats nursed their pups for 3 weeks and the maternal hearts were then submitted to IR (n = 6); and non-lactating, in which the pups were separated after birth and the maternal hearts were submitted to IR (n = 6). Outcome measures included heart rate (HR), left ventricular developed pressure (LVDP), rate pressure product (RPP), ratio of the infarct size to the area at risk (IS/AAR %), and ventricular arrhythmias - premature ventricular contraction (PVC) and ventricular tachycardia (VT).

Results: The IS/AAR was markedly decreased in the lactating group when compared with the non-lactating group (13.2 ± 2.5 versus 39.7 ± 3.5, p < 0.001) and the IR group (13.2 ± 2.5 versus 34.0 ± 4.7, p < 0.05). The evaluation of IR-induced ventricular arrhythmias indicated that the number of compound PVCs during ischemia, and the number and duration of VTs during ischemia and in the first 5 minutes of reperfusion in the non-lactating group were significantly (p < 0.05) higher than those in the lactating and IR groups.

Conclusion: Lactation induced early-onset cardioprotective effects, while rats that were not allowed to nurse their pups were more susceptible to myocardial IR injury.
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http://dx.doi.org/10.5935/abc.20170042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5444891PMC
May 2017

The spectrum of Vogt-Koyanagi-Harada disease in Iran.

Int Ophthalmol 2018 Apr 4;38(2):443-449. Epub 2017 Mar 4.

Ophthalmic Research Center, Labbafinejad Medical Center, Shahid Beheshti Medical University, Tehran, Iran.

Purpose: To report the spectrum of Vogt-Koyanagi-Harada (VKH) disease in Persians.

Materials And Methods: This is a retrospective chart review of patients diagnosed with VKH disease at four referral centers in Iran. Patients' demographics, ocular and extraocular manifestations, treatment modalities, complications, and visual outcomes were collected and analyzed.

Results: Eighty-eight patients with a mean age of 32.1 ± 12.6 years (range 7-79 years) were studied. Fifty-nine patients (67.0%) were female. Sunset glow fundus was seen in 40.9%, and nummular peripheral chorioretinal scars in 55.7% of eyes. Integumentary findings were noticed in 14.8% of the patients. In patients with acute presentation, exudative retinal detachment was the most common ocular finding (87.8%) followed by optic disk swelling (71.4%). Anterior uveitis and vitritis each were found in about half of the studied eyes. Auditory symptoms were reported by 38.8% of the patients. Overall, immunomodulatory agents were used in 72.7% of the patients. Ocular complications occurred in 36.4% of eyes (mean follow-up 3.8 years, range 6-228 months). Final visual acuity was 20/40 or better in 73.3% of eyes. Four patients (4.5%) were classified as having 'complete' type of the disease, 36 (40.9%) 'incomplete' type, and 48 (54.5%) 'probable' type.

Conclusion: In our series, there are clinical features that differ from those reported in other studies. While auditory symptoms occurred in more than one-third of patients, integumentary findings were rather rare. Most patients exhibited the 'probable' type of VKH disease. The overall visual prognosis was favorable.
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http://dx.doi.org/10.1007/s10792-017-0478-6DOI Listing
April 2018
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