Publications by authors named "Nazanin Ebrahimiadib"

55 Publications

Expanded Spectrum of Optical Coherence Tomography Findings in Patients with Ocular Toxoplasmosis.

Ocul Immunol Inflamm 2021 Jul 8:1-8. Epub 2021 Jul 8.

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

: To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity.: Observational case series.: A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature 'hourglass configuration'.: Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.
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http://dx.doi.org/10.1080/09273948.2021.1933065DOI Listing
July 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

Acquired Immunodeficiency Syndrome Presented as Atypical Ocular Toxoplasmosis.

Case Rep Ophthalmol Med 2021 1;2021:5512408. Epub 2021 May 1.

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

Background: The aim is to report an atypical presentation of ocular toxoplasmosis which led to the diagnosis of Acquired Immunodeficiency Syndrome (AIDS). . The 38-year-old woman was referred with metamorphopsia and reduced vision in the right eye over the past 3 weeks. Slit-lamp examination revealed granulomatous keratic precipitates (KPs), 2+ cells in the anterior chamber, and posterior synechiae. Fundus examination was remarkable for a white patch surrounding a scar, inferonasal to the optic disc with fibrous bands emanating from the lesion, and the retina around this region was detached with considerable extension towards the periphery, while no breaks could be appreciated. She mentioned anorexia and losing 10 kg in the past three months, and signs of anemia like paleness of face skin, bed nails, and bilateral angular cheilitis were observed on systemic evaluation. The results of the patient's complete blood count revealed anemia and leukopenia and CD4 lymphocytes: 79 cells/L. Enzyme-linked immunosorbent assays (ELISA) for HIV antibodies came back positive which was later confirmed with the Western blot test. Brain magnetic resonance imaging (MRI) showed multiple ring-enhancing lesions in both cerebral cortices. The patient underwent antitoxoplasmosis and anti-HIV treatment and serous retinal detachment completely resolved.

Conclusion: This report highlights the fact that sometimes, the eyes are the site of the first presentation of a systemic life-threatening condition and emphasizes the role of ophthalmologists in such cases. In cases of atypical presentation, appropriate laboratory tests and CNS imaging should be requested. Systemic treatment with antitoxoplasmosis regimens and highly active antiretroviral therapy (HAART) is mandatory in AIDS patients with ocular toxoplasmosis.
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http://dx.doi.org/10.1155/2021/5512408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110419PMC
May 2021

Retinal displacement following pars plana vitrectomy with silicone oil tamponade for rhegmatogenous retinal detachment.

Int Ophthalmol 2021 Apr 29. Epub 2021 Apr 29.

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

Purpose: To evaluate the frequency of retinal displacement after pars plana vitrectomy (PPV) using silicone oil tamponade in patients with rhegmatogenous retinal detachment (RRD).

Methods: Patients with fresh RRD were enrolled in this prospective interventional case series. A standard 3-port PPV with silicone oil tamponade was performed in all cases. A complete ocular examination, optical coherence tomography and fundus autofluorescence (FAF) imaging were performed at 1 and 3 months follow-up. Orthoptic examinations including synoptophore and light on-off tests were also performed at 3 months.

Results: Twenty-three eyes from 23 patients with mean age of 56.6 ± 11 (range: 38-82) years were included. All patients were pseudophakic. Downward retinal displacement was found in 2 eyes (8.7%) showing hyperautofluorescent lines parallel to retinal vessels in FAF image. The patients with retinal displacement did not complain of metamorphopsia and did not show abnormality in orthoptic tests.

Conclusion: Unintentional retinal shift following PPV with silicone oil tamponade for RRD is uncommon and might have little clinical significance.
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http://dx.doi.org/10.1007/s10792-021-01861-7DOI Listing
April 2021

Automated measurement of iris surface smoothness using anterior segment optical coherence tomography.

Sci Rep 2021 Apr 19;11(1):8505. Epub 2021 Apr 19.

Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences and Research Center for Science and Technology in Medicine, Tehran, Iran.

Fuchs uveitis (FU) is a chronic and often unilateral ocular inflammation and characteristic iris atrophic changes, other than heterochromia, are common in FU and are key to the correct diagnosis in many cases. With the advent of anterior segment optical coherence tomography (AS-OCT), some investigators attempted to quantitatively study these atrophic changes; mostly by introducing various methods to measure iris thickness in AS-OCT images. We aimed to present an automated method in an observational case series to measure the smoothness index (SI) of the iris surface in AS-OCT images. The ratio of the length of the straight line connecting the most peripheral and central points of the anterior iris border (in nasal and temporal sides) to the actual length of this border on AS-OCT images, was defined as SI. In a uveitis referral center, twenty-two eyes of 11 patients with unilateral Fuchs uveitis (FU) (7 female) and 22 eyes of 11 healthy control subjects underwent AS-OCT imaging. Image J and a newly developed MATLAB algorithm were used for manual and automated SI measurements, respectively. Agreement between manual and automated measurements was evaluated with Bland-Altman analysis and interclass correlation coefficient. The inter-eye difference of SI was compared between the FU group and the control group. Automated mean overall SI was 0.868 ± 0.037 and 0.840 ± 0.039 in FU and healthy fellow eyes, respectively (estimated mean difference =  - 0.028, 95% CI [- 0.038, - 0.018], p < 0.001). Bland- Altman plots showed good agreement between two methods in both healthy and FU eyes. The interclass correlation coefficient between the manual and automated measurements in the FU and healthy fellow eyes was 0.958 and 0.964, respectively. The inter-eye difference of overall SI was 0.029 ± 0.015 and 0.012 ± 0.008 in FU group and control group, respectively (p = 0.01). We concluded that the automated algorithm can rapidly and conveniently measure SI with results comparable to the manual method.
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http://dx.doi.org/10.1038/s41598-021-87954-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8055699PMC
April 2021

Efficacy of Biosimilar Adalimumab in the Treatment of Behçet's Uveitis.

Ocul Immunol Inflamm 2021 Apr 7:1-6. Epub 2021 Apr 7.

Medical Department, Orchid Pharmed Company, Tehran, Iran.

: This study aimed to evaluate biosimilar adalimumab's efficacy and safety in patients with Behçet's uveitis in Iran.: We performed a study on patients who mostly (79.2%) had a failure on conventional treatment with the mean follow-up time of 19.24 months (95% confidence interval (CI), 16.52-21.96). All the enrolled patients were anti-tumor necrosis factor (anti-TNF) naiive. The primary endpoint was best-corrected visual acuity (BCVA) improvement, and the secondary endpoints were changes in macular thickness, vitreous haze grade, anterior chamber (AC) cell grade, prednisolone dose, and the incidence of adverse reactions.: Forty-eight patients were enrolled in the study. After adalimumab use, visual acuity improved significantly (-value˂.001); vitreous haze grade decreased (-value˂.001), and AC cell grade improved (-value = .002). Macular thickness decreased, but its change was not statistically significant (-value = .1). Moreover, adalimumab showed a corticosteroid-sparing effect (-value = .03).: Biosimilar adalimumab (CinnoRA®) is effective and well-tolerated in Behçet's uveitis.
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http://dx.doi.org/10.1080/09273948.2021.1900276DOI Listing
April 2021

Treatment of Inflammatory Macular Hole: Case Series and Review of Literature.

Ocul Immunol Inflamm 2021 Apr 7:1-7. Epub 2021 Apr 7.

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

: To present the success rate of nonsurgical management of full-thickness inflammatory macular hole (IMH): Retrospective case series of five patients with IMH.: Five eyes from five patients with IMH enrolled in the current case series. All five eyes had successful closure with corticosteroid in the form of topical, periocular, or intravitreal injections. Systemic immunomodulatory treatment was employed for two patients, in addition to local therapy. For local therapy, one patient received topical eye drops, subtenon injection of corticosteroid, and intravitreal injection of combination of corticosteroid and anti-VEGF was performed in two patients. The closed macular hole reopened in one patient after two years, which required pars plana vitrectomy and anatomical and visual success achieved.: Inflammatory macular holes can be closed with non-surgical interventions, although reopening may occur which requires surgery.
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http://dx.doi.org/10.1080/09273948.2020.1867871DOI Listing
April 2021

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Correspondence.

Retina 2021 03;41(3):e37-e38

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

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http://dx.doi.org/10.1097/IAE.0000000000003120DOI Listing
March 2021

Vascular abnormalities in uveitis.

Surv Ophthalmol 2021 Jul-Aug;66(4):653-667. Epub 2021 Jan 5.

The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA; Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA. Electronic address:

Inflammation can involve several ocular structures, including the sclera, retina, and uvea, and cause vascular changes in these tissues. Although retinal vasculitis is the most common finding associated with uveitis involving the posterior segment, other vascular abnormalities may be seen in the retina. These include capillary nonperfusion and ischemia, vascular occlusions, preretinal neovascularization, microaneurysms and macroaneurysms, and telangiectasia. Moreover, vasoproliferative tumors and subsequent coat-like response can develop secondary to uveitis. Fluorescein angiography is ideal for the investigation of retinal vascular leakage and neovascularization, while optical coherence tomography angiography can provide depth resolved images from the superficial and deep capillary plexus and can demonstrate vascular remodeling. Choroidal vascular abnormalities primarily develop in the choriocapillaris or in the choroidal stroma and can appear as flow void in optical coherence tomography angiography and filling defect and vascular leakage in indocyanine green angiography. Extensive choriocapillaris nonperfusion in the presence of choroidal inflammation can increase the risk of choroidal neovascular membrane development. Iris vascular changes may manifest as dilation of vessels in stroma due to inflammation or rubeosis that is usually from ischemia in retinal periphery secondary to chronic inflammation. More severe forms of scleral inflammation, such as necrotizing scleritis, are associated with vascular occlusion in the deep episcleral plexus, which can lead to necrosis of sclera layer and uveal exposure.
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http://dx.doi.org/10.1016/j.survophthal.2020.12.006DOI Listing
January 2021

A Solitary Choroidal Mass with Spontaneous Resolution.

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

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

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

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

Ocular Neuropathic Pain: An Overview Focusing on Ocular Surface Pains.

Clin Ophthalmol 2020 25;14:2843-2854. Epub 2020 Sep 25.

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

Objective: This paper reviews ocular pain with the main focus on ocular surface discomfort and dry eye pain. Anatomy, physiology, epidemiology, assessment, and treatment are discussed in this paper.

Methods: A PubMed search was conducted for studies published from 2000 to 2019 on the anatomy, pathophysiology, epidemiology, assessment, and treatment of ocular pain. Reviews, meta-analyses, and randomized clinical trials were included. Inclusion criteria focused on ocular surface discomfort, dry eye pain and neuropathic pain.

Results: A total of 112 articles were found through searches, 45 of which were selected and studied in this review.

Discussion: Pain in general can be acute or chronic. Acute pain is usually a physiologic response to a serious damage to the tissues and alleviates with pain relief treatments. Chronic pain is defined as the persistence of pain for more than three months. From another point of view, pain has been classified into either nociceptive or neuropathic. Nociceptive pain is a physiologic response to a noxious stimulus. Both central and peripheral nervous systems can be involved in the development of a neuropathic pain, which is characterized by positive or negative sensory signs, a pain perceived disproportionate to a noxious stimulus, and/or not responsive to analgesics. Chronic pain usually has a neuropathic component. Ocular surface pain is a well-known complaint after any corneal surgery. This is mainly due to abnormal regeneration of damaged corneal nerve endings and abnormal connections with adjacent nerve endings which produce spontaneous activity. Tear hyperosmolarity and the resultant ocular surface inflammation can also trigger voluntary activity of corneal nerve endings. Referral pain to the first and second division of the trigeminal nerve has been reported. Interference with vision and even sleep, which is out of proportion to the examination are among patients' complaints. All of these elements proposed the new concept of ocular neuropathic pain syndrome. The first step in conventional evaluation of ocular discomfort is search for tear insufficiency. Pathologies of lid and blinking as well as conjunctival irregularities should be addressed. Anti-inflammatory agents and, in resistant cases, systemic neuromodulators are shown to be helpful. Education on behavioral changes and reassurance are essential steps. Considering the neuropathic origin for the ocular pain, treatment modalities used for such pain in other parts of the body can be considered for this syndrome.
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http://dx.doi.org/10.2147/OPTH.S262060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524198PMC
September 2020

Quantitative Analysis of the Iris Surface Smoothness by Anterior Segment Optical Coherence Tomography in Fuchs Uveitis.

Ocul Immunol Inflamm 2020 Sep 23:1-6. Epub 2020 Sep 23.

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

Objective: To demonstrate the value of "smoothness index (SI)" as a novel tool for quantitative analysis of iris surface findings in unilateral Fuchs' uveitis (FU).

Methods: Both phakic eyes from patients with unilateral FU as well as healthy control subjects underwent anterior segment optical coherence tomography (AS-OCT). The ImageJ software was used for calculating the SI.

Results: Forty eyes from 20 patients with unilateral FU and 40 eyes from 20 healthy subjects were enrolled. In FU eyes, mean overall SI (0.876 ± 0.030) was significantly higher than fellow control eyes (0.841 ± 0.041) ( = .001). Mean inter-eye difference for overall SI in the FU patients (0.037 ± 0.030) was significantly larger than the healthy control subjects (0.018 ± 0.014) ( = .033).

Conclusion: Iris "smoothness index" can be used to quantitatively assess iris surface smoothness and may facilitate the diagnosis of subtle iris atrophic changes in eyes affected by FU especially in the absence of heterochromia.
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http://dx.doi.org/10.1080/09273948.2020.1823424DOI Listing
September 2020

Optical coherence tomography angiography changes in macula-off rhegmatogenous retinal detachments repaired with silicone oil.

Int Ophthalmol 2020 Dec 27;40(12):3295-3302. Epub 2020 Jul 27.

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

Purpose: To evaluate the changes on optical coherence tomography angiography (OCTA) in macula-off rhegmatogenous retinal detachments (RRD) treated with pars plana vitrectomy (PPV) and silicone oil (SO) 5000-cSt tamponade.

Materials And Method: Forty-five eyes with macula-off RRD treated with PPV and SO tamponade were enrolled with the fellow eye being used as a control. OCT-A was obtained using the RTVue XR 100 Avanti (Optovue, Inc., Fremont, CA, USA) at the 1-week, 1-month, and 3-month postoperative visit. Retinal vascular density, choroidal flow area, retinal thickness, and foveal avascular zone area were evaluated at each follow-up visit. Changes in these parameters in the postoperative eye were tracked at each follow-up visit as were the relative differences between the postoperative eye and the contralateral eye.

Results: Vascular density of parafoveal superficial capillary plexus and total retina demonstrated significant decrease in the postoperative silicone-filled eye when compared to the fellow eye (P < 0.0001). Although there was some improvement in these values at subsequent follow-ups, they remained less than the fellow eye. Foveal (P = 0.002) and parafoveal (P < 0.0001) thickness were less than the fellow eye. Choroidal flow area did not show a significant change in operated eye compared with the fellow eye.

Conclusion: Eyes with macula-off RRD repaired with PPV and SO, at 3-month follow-up, demonstrated less retinal vascular density at parafoveal area as well as lower retinal thickness at fovea when compared to the healthy fellow eyes.
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http://dx.doi.org/10.1007/s10792-020-01516-zDOI Listing
December 2020

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

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

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

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

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

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

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

Acute retinal necrosis: Clinical manifestation and long-term visual outcomes in a series of polymerase chain reaction-positive patients.

Eur J Ophthalmol 2020 Jun 21:1120672120936181. Epub 2020 Jun 21.

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

Purpose: To report the clinical spectrum, viral etiologies, therapeutic interventions, timing of rhegmatogenous retinal detachments (RRD), and visual outcomes in acute retinal necrosis (ARN) syndrome in a series of polymerase chain reaction (PCR)-positive eyes.

Methods: From January 2010 to January 2017, consecutive patients with the clinical diagnosis of ARN and a positive aqueous viral PCR were included in this observational, retrospective study.

Results: Nineteen eyes found to have a clinical diagnosis of ARN, of which 18 (94.7%) had a positive viral PCR. ARN was unilateral, except in one patient. None of the fellow eyes manifested ARN during follow-up. Varicella-zoster virus (VZV) was detected in 78.0% of ARN eyes. 61.1% of eyes experienced RRD. The median time for the occurrence of RRD was 12 weeks (range: 6-25 weeks) after disease onset. No correlation was found between the etiologic viral agent (VZV vs non-VZV;  = 1.000), extent of retinitis (1-2 quadrant vs 3-4 quadrants;  = 0.326), administration of intravitreal ganciclovir (injected vs not injected;  = 0.332), application of prophylactic laser retinopexy (applied vs not applied;  = 0.326), and subsequent occurrence of RRD. At a 2-year follow-up, visual impairment (VA ⩽ 20/200) and severe visual loss (VA ⩽ light perception) were significantly higher in those complicated by RRD compared to non-RRD eyes (81.8% vs 28.6%;  = 0.047, and 45.4% vs 0.0%;  = 0.004, respectively).

Conclusion: Aqueous PCR results are highly consistent with the clinical diagnosis of ARN. Regardless of the method of management, the rate of RRD is high and is associated with a poor visual outcome.
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http://dx.doi.org/10.1177/1120672120936181DOI Listing
June 2020

Ocular flare-up in patients with systemic lupus erythematosus following discontinuation of hydroxychloroquine.

Lupus 2020 Jul 2;29(8):987-992. Epub 2020 Jun 2.

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

In this report, we describe two patients with systemic lupus erythematosus (SLE) who manifested with posterior segment flare-up approximately three months after cessation of hydroxychloroquine (HCQ). They were stable systemically with no history of hypertension or nephropathy at the time of referral. Our first patient presented with bilateral retinal vein occlusion, while evidence of choroidal involvement such as vascular leakage and wedge-shaped filling delay was present in indocyanine green angiography of both patients. HCQ is well known to have a role in the treatment of SLE for its immunomodulatory and antithrombotic effects. Although reports of systemic flare-up of SLE following HCQ cessation exist in the literature, this is the first report of ocular flare-up in such settings.
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http://dx.doi.org/10.1177/0961203320928409DOI Listing
July 2020

Atypical Keratic Precipitates in Fuchs Uveitis.

Ocul Immunol Inflamm 2020 May 28:1-3. Epub 2020 May 28.

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

Purpose: Here, we report a case of otherwise typical Fuchs uveitis (FU) who presented with atypical keratic precipitates (KPs).

Case Report: A 38 year-old man presented with decreased vision in the right eye. Best corrected visual acuity was 2/10 in the right eye and 10/10 in the left eye. He was known to have advanced glaucoma in the right eye. The presence of KPs, iris smoothness, posterior subcapsular cataract, vitreous cells, as well as imaging characteristics were in complete agreement with the classical picture of FU in this eye. However, KPs varied in size from small to large and had a triangular distribution over the inferior corneal endothelium. A tendency to confluence and pigments were also observed in some KPs. This is in sharp contrast with the description of typical diffuse, small, white, stellate KPs, which has been emphasized as a defining feature of FU in recent publications. To rule out other uveitis entities, a comprehensive laboratory workup was done, as well as a molecular assay on aqueous for common infectious uveitides with the similar clinical picture.

Conclusion: Ophthalmologists should be aware that FU can manifest with atypical KPs in a minority of patients to prevent erroneous diagnosis and unnecessary treatments.
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http://dx.doi.org/10.1080/09273948.2020.1754433DOI Listing
May 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 Ziv-Aflibercept in Patients With Diabetic Macular Edema Refractory to Intravitreal Bevacizumab.

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

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

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

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

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

Intermediate Uveitis Associated with Tattooing of Eyebrows as a Manifestation of Systemic Sarcoidosis: Report of Two Cases.

Ocul Immunol Inflamm 2020 Jan 16:1-4. Epub 2020 Jan 16.

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

Permanent make-up tattooing as a cosmetic procedure is gaining popularity especially among women. Although it is considered a relatively safe intervention, the ink used can rarely be a trigger of sarcoidosis. Uveitis can occur as part of this inflammatory process. In this study, we describe two ladies presented with tattoo-associated uveitis as the first manifestations of systemic sarcoidosis. They developed intermediate uveitis shortly after skin inflammation several months after permanent make-up tattooing of eyebrows. Lung involvement, high ACE levels, and negative PPD were present. Skin granuloma formation was diffuse over the area of tattoo in one patient and localized in the other one. This is the first report of uveitis following make-up tattoo.
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http://dx.doi.org/10.1080/09273948.2019.1699581DOI Listing
January 2020

Using anterior segment optical coherence tomography to compare the smoothness of anterior iris surface between two eyes in unilateral Fuchs' uveitis syndrome.

Graefes Arch Clin Exp Ophthalmol 2019 12 3;257(12):2799-2800. Epub 2019 Nov 3.

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

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http://dx.doi.org/10.1007/s00417-019-04477-xDOI Listing
December 2019

Prevalence and Risk Factors of Retinopathy of Prematurity in Iran.

J Ophthalmic Vis Res 2019 Jul-Sep;14(3):291-298. Epub 2019 Jul 18.

Eye Monitoring Center, Kaiser Permanente Southern California, CA, USA.

Purpose: The present study aimed to evaluate the frequency and risk factors of retinopathy of prematurity (ROP) among Iranian infants.

Methods: A retrospective cohort study was conducted on infants who had undergone screening for ROP at Farabi Eye Hospital, between March 2016 and March 2017. Data were analyzed based on the presence of extreme prematurity (gestational age 28 weeks), extremely low-birth-weight ( 1000 g), and multiple-gestation (MG) infants.

Results: The prevalence of ROP was 27.28% ( = 543) among all screened infants, 74.4% for extremely preterm (EP) infants, 77.5% for extremely low birth weight (ELBW) babies, and 27.25% for infants from MG pregnancies. On multivariate analysis, gestational age, birth weight, and history of transfusion ( < 0.0001, < 0.0001, and = 0.04, respectively) were found to be significantly associated with ROP. More advanced stages of ROP ( < 0.0001) were observed in EP and ELBW infants. Birth weight ( = 0.088), history of transfusion ( = 0.066), and intubation ( = 0.053) were not associated with increased risk of ROP in EP infants, while gestational age ( = 0.037) and history of transfusion ( = 0.040) were significant risk factors for ROP in ELBW infants. Gestational age (P < 0.001) and birth weight ( = 0.001) were significantly associated with ROP in infants from MG pregnancies in multivariate analysis.

Conclusion: ROP remains a commonly encountered disease, especially in ELBW and EP infants. The history of transfusion may have a role in stratifying the risk for ROP and guiding future screening guidelines.
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http://dx.doi.org/10.18502/jovr.v14i3.4785DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6815327PMC
July 2019

Multimodal imaging in posterior microphthalmos.

J Curr Ophthalmol 2019 Sep 4;31(3):335-338. Epub 2019 Feb 4.

Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: To evaluate the multimodal imaging including optical coherence tomography angiography (OCTA) findings in patients with posterior microphthalmos (PM).

Methods: In an observational case series, four eyes of two patients, eight and twenty-three years old, with clinical proven PM underwent complete ophthalmic examination, including refraction, fluorescein angiography, optical coherence tomography (OCT), OCTA, B-scan ultrasonography, axial length measurement using IOL Master optical measuring, and Pentacam evaluation.

Results: Both patients were high hyperopic with partial thickness retinal fold in macula, retinoschisis, and foveal hypoplasia. Axial length was less than 17 mm with scleral thickening in all eyes. OCTA showed absence of foveal avascular zone (FAZ) in both superficial and deep capillary plexuses. Pentacam showed corneal steepness, shallow anterior chamber, and low anterior chamber volume.

Conclusion: OCTA findings showed absence of avascular zone in both superficial and deep capillary plexuses, while OCT shows partial thickness retinal fold and retinoschisis.
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http://dx.doi.org/10.1016/j.joco.2019.01.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6742752PMC
September 2019

The Accuracy of Digital Imaging in Diagnosis of Retinopathy of Prematurity in Iran: A Pilot Study.

J Ophthalmic Vis Res 2019 Jan-Mar;14(1):38-41

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

Purpose: To evaluate sensitivity and specificity of digital retinal image reading in the diagnosis of referral-warranted retinopathy of prematurity (ROP).

Methods: Infants referred to the ROP clinic underwent fundus examination through indirect ophthalmoscopy. Fundus photographs were acquired using RetCam (shuttle 2; Clarity medical systems, Pleasanton, CA, USA). Four retinal specialists who were blind to patients' information reviewed the RetCam fundus photographs. By comparing the results of photographs' readings with that of indirect ophthalmoscopy as the gold standard, the sensitivity and specificity of telescreening was determined.

Results: A total of 147 treatment-naïve patients met the inclusion criteria and were enrolled in the study. Mean gestational age (GA) was 28.6 ± 2.0 weeks. Digital retinal imaging had sensitivity of 85% and specificity of 35% in detecting referral-warranted ROP in our study. Positive predictive value of digital photography was 80%, and negative predictive value was 43%.

Conclusion: Digital photography for diagnosis of ROP may show good potential as a screening modality in developing countries. It can facilitate early diagnosis, prevent unnecessary referrals, and be implemented for investigational purpose. However, the overall study result did not provide evidence to propose digital photography as a substitute for indirect ophthalmoscopy in the diagnosis of ROP.
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http://dx.doi.org/10.4103/jovr.jovr_187_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388530PMC
March 2019

Incidence and Risk Factors for Post-Intravitreal Injection Endophthalmitis in a Modified Operating Room Setting.

Ocul Immunol Inflamm 2019 10;27(8):1314-1321. Epub 2018 Oct 10.

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

To evaluate the incidence and risk factors of post-intravitreal injection (IVI) endophthalmitis in a single center modified operating room (OR) setting. In a retrospective chart review study, patients who underwent IVI in a modified OR between September 2014 and November 2016 were included. Cases of post-IVI endophthalmitis were identified from the Hospital Infection Control Committee records, which tracks all post-procedure infections. 51 472 IVIs (37 814 patients) including 13 658 bilateral simultaneous injections were performed during the study period. There were 17 cases of endophthalmitis (0.033%, 95% CI 0.019%-0.052%). There were no cases of bilateral endophthalmitis. Age, sex, indication for IVI, simultaneous bilateral injections, number of previous injections, and type of injected drug were not significantly associated with incidence of endophthalmitis. Post-IVI endophthalmitis is rare in this modified OR setting. Simultaneous bilateral IVIs and on-site preparation of injections are safe under these conditions.
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http://dx.doi.org/10.1080/09273948.2018.1526306DOI Listing
May 2020

Ubiquitin Associated and SH3 Domain Containing B (UBASH3B) Gene Association with Behcet's Disease in Iranian Population.

Curr Eye Res 2019 02 22;44(2):200-205. Epub 2018 Oct 22.

d Eye Research Center, Farabi Eye Hospital , Tehran University of Medical Science (TUMS) , Tehran , Iran.

Purpose: To evaluate the possible association of UBASH3B gene rs4936742 (T > C) polymorphism with Behcet's disease (BD) and posterior uveitis in BD.

Materials And Methods: One hundred and thirty-one patients with BD (51 Behcet's posterior uveitis and 80 non-ocular Behcet's patients) and 61 unrelated age-matched healthy individuals as a control group without any inflammatory disease were selected. All BD cases were under follow-up and treatment in uveitis or rheumatology clinics for at least 5 years. All research subjects, including control individuals, received a comprehensive rheumatologic evaluation. All patients and controls were genotyped for UBASH3B rs4936742 (T > C) polymorphism by PCR-RFLP technique.

Results: The observed frequencies of genotypes were significantly different among patients and controls (19.7% versus 30.5% for TT, OR = 2.9, P = 0.011 and 36.1% versus 45.8% for CT, OR = 2.38, P = 0.017). Frequencies of T allele showed significantly higher values in Behcet's patients (OR = 1.9, P = 0.004). Subgroup genotypic and allelic analyses disclosed no significant difference between Behcet's posterior uveitis and control groups, neither between Behcet's posterior uveitis and non-ocular BD groups. However, genotypic and allelic analyses between non-ocular BD and control groups revealed statistically significant difference (36.3% versus 19.7% for TT, OR = 4.08, P = 0.003 and 43.8% versus 36.1% for CT, OR = 2.68, P = 0.018, 58.1% versus 37.7% for T allele, OR = 2.29, P = 0.001). Individuals carrying the TT genotype for UBASH3B were four times more likely to develop non-ocular BD than unaffected, control individuals.

Conclusion: Our results showed that the UBASH3B gene rs4936742 (T > C) polymorphism is associated with an increased risk of Behcet's disease, especially non-ocular BD, in Iranian population. We could not find any susceptibility role of this genetic locus for posterior uveitis in Behcet's disease.
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http://dx.doi.org/10.1080/02713683.2018.1524913DOI Listing
February 2019

Atypical Perinuclear Anti-Neutrophil Cytoplasmic Antibodies in Ocular Inflammatory Diseases.

Ocul Immunol Inflamm 2019 19;27(6):937-941. Epub 2018 Sep 19.

Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA.

: To characterize the clinical features of patients with ocular inflammatory diseases (OID) who tested positive for atypical perinuclear anti-neutrophil cytoplasmic antibodies (P-ANCA). : Retrospective case series of patients with OID seen at the Massachusetts Eye Research and Surgery Institute (MERSI) from April 2014 to April 2016. : 813 patients were tested for ANCA with 34 patients (4%) being positive for atypical P-ANCA. Among those with positive atypical P-ANCA, the most frequent diagnoses were anterior uveitis in 62% ( = 21) followed by scleritis in 20% ( = 7). Only one patient had an episode of recurrent disease flare-up. All but one patient, who had concomitant C-ANCA seropositivity and granulomatosis with polyangiitis, had a favorable disease course with controlled inflammation using topical and/or systemic immunomodulatory therapy. : In contrast to typical C-ANCA and P-ANCA, atypical P-ANCA seropositivity was not associated with severe vasculitis or poor prognosis in patients with the OID.
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http://dx.doi.org/10.1080/09273948.2018.1502787DOI Listing
February 2020
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