Publications by authors named "Reza Zarei"

38 Publications

Anti-Proliferative and Anti-Telomerase Effects of Blackberry Juice and Berry-Derived Polyphenols on HepG2 Liver Cancer Cells and Normal Human Blood Mononuclear Cells.

Anticancer Agents Med Chem 2021 Mar 14. Epub 2021 Mar 14.

Department of Biochemistry, Shiraz University of Medical Sciences, School of Medicine, Shiraz. Iran.

Background: Previous studies have provided strong evidence for anticancer activity of berry fruits.

Objective: In this study, we investigated the effects of blackberry juice and three berry- polyphenolic compounds on cell proliferation and telomerase activity in human hepatoma HepG2 and normal peripheral blood mononuclear cells (PBMCs).

Methods: The cell viability and telomerase activity were measured by MTT and TRAP assay, respectively. Berry effects on the expression of genes were determined by quantitative RT-PCR assay.

Results: Blackberry, gallic acid, and resveratrol inhibited proliferation of both HepG2 and PBMC cells in a dose-dependent manner. Resveratrol was more effective than gallic acid for reducing the viability of HepG2 cells, but both showed the same level of growth inhibition in PBMC cells. Berry, resveratrol, and gallic acid significantly inhibited telomerase activity in HepG2 cells. The antiproliferative effect of berry was associated with apoptotic DNA fragmentation. Gallic acid was more effective for reducing telomerase activity than resveratrol, but anthocyanin moderately increased telomerase activity in cancer cells. Telomerase activity was induced by all three polyphenols in PBMCs. Overall, Krumanin chloride was more effective to induce telomerase than gallic acid and resveratrol in PBMC cells. There was no significant difference in hTERT, hTR, and Dnmts expressions between berry treated and the control untreated HepG2 cells. But, a significant downregulation of HDAC1 and HDAC2 and upregulation of SIRT1 were observed in berry-treated cells.

Conclusion: These data indicate that the berry anticancer effect is associated with antitelomerase activity and changes in HDACs expression. The data also suggest that berry antitelomerase activity is mainly related to its gallic acid and resveratrol, but not anthocyanin content.
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http://dx.doi.org/10.2174/1871520621666210315092503DOI Listing
March 2021

Ahmed glaucoma valve implantation with and without subconjunctival bevacizumab in refractory glaucoma.

Int Ophthalmol 2021 Feb 9. Epub 2021 Feb 9.

Farabi Eye Hospital, Tehran, Iran.

Purpose: To evaluate the effects of subconjunctival bevacizumab injection on intraocular pressure (IOP), hypertensive phase, and failure and success rates of Ahmed Glaucoma Valve (AGV) implantation.

Methods: A total of 63 eyes of 63 patients (30 cases in control and 33 cases in bevacizumab group) were included in this randomized masked prospective clinical trial. Pre- and postoperative BCVA, IOP, number of medications, complications and success rates were compared between AGV + bevacizumab and AGV alone group.

Results: Both groups showed statistically significant reductions in IOP in all their follow-up visits (P < 0.05). The mean IOP was lower in the AGV + Bevacizumab group than AGV group in all follow-up visits. However, the difference was only significant at the 3rd month (17.3 ± 6.2 vs. 20.7 ± 4.6, p = 0.04). The number of medications was not differed significantly between the two groups at their last visit (p value = 0.84) Complete success rate was higher in AGV + Bevacizumab. However, the difference was not significant (p = 0.73). The qualified and overall success rate, failure rate and the need for second tube were not statistically different between the two groups. The hypertensive phase was not statistically significant between the 2 groups (33.3% in AGV + Bevacizumab group and 50% in AGV group, p = 0.06) CONCLUSION: Adjunctive use of Bevacizumab during AGV implantation is beneficial in controlling hypertensive phase and IOP control and may lead to higher success rates and lower failure rates after AGV implantation. However, whether it's clearly beneficial or its exact role remains to be investigated.
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http://dx.doi.org/10.1007/s10792-021-01691-7DOI Listing
February 2021

Cystoid macular edema with prostaglandin analogue use after uneventful cataract surgery in glaucoma patients.

J Cataract Refract Surg 2019 10;45(10):1436-1445

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

Purpose: To evaluate the effect of postoperative latanoprost administration on central macular thickness (CMT) after uneventful cataract surgery in glaucoma patients.

Setting: Farabi Eye Hospital, Tehran, Iran.

Design: Prospective randomized clinical trial.

Methods: In this single-masked trial, glaucoma patients treated with latanoprost who had no other risk factor for the development of pseudophakic macular edema were randomly allocated to continuation of latanoprost or discontinuation of the drop after uneventful cataract surgery. At baseline and postoperatively at 1 month and 3 months, patients had complete ocular examinations and CMT measurements using optical coherence tomography. The main outcome measure was the change in the CMT between baseline measurements and postoperative measurements at 1 month and 3 months.

Results: One hundred fifty-six eyes (latanoprost 76; discontinuation 80) finished the trial. There were no differences in baseline patient demographics or characteristics, including the CMT, between the two groups. There was transient increase in the mean CMT by 12 μm ± 49 (SD) in the latanoprost group at 1 month (P = .03); however, the value returned to baseline by 3 months (6 ± 55 μm; P = .27). The between-group difference in the mean change in the CMT from baseline was -3.1 μm (95% confidence interval [CI], -18.4 to 12.0; P = .68) after 1 month and -10.5 μm (95% CI, -26.6 to 5.5; P = .19) after 3 months; the differences were not significant.

Conclusion: Latanoprost administration after cataract surgery had no measurable effect on macular thickness.
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http://dx.doi.org/10.1016/j.jcrs.2019.05.026DOI Listing
October 2019

Single long scleral tunnel technique for prevention of Ahmed valve tube exposure.

Eur J Ophthalmol 2019 Jan 3;29(1):52-56. Epub 2018 Apr 3.

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

Purpose:: To evaluate the outcome of single long scleral tunnel technique for the prevention of conjunctival erosions caused by the Ahmed glaucoma valve.

Methods:: This study was a retrospective case series that included 30 eyes of 30 patients who underwent glaucoma valve implantation surgery by the single long scleral tunnel technique.

Results:: The mean age of patients at the time of surgery was 52 ± 21.6 years (range: 10-90 years). The mean visual acuity was 1.5 ± 0.81 logMAR preoperatively. The intraocular pressure was 40.7 ± 9.18 mm Hg (range: 25-58) before surgery that decreased significantly to 19.7 ± 3.1 mm Hg (range: 14-25; p < 0.0001) after a mean follow-up of 37.2 ± 5.9 months. During follow-up, no case of tube exposure was detected in patients.

Conclusion:: Single long scleral technique was efficacious with no occurrence of tube exposure in relatively long period of follow-up. In this method, there is no need to harvest any additional material, and in situations with limited access to patch grafts, it is performable with the minimal facilities.
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http://dx.doi.org/10.1177/1120672117753701DOI Listing
January 2019

Shortening subtrochanteric osteotomy and cup placement at true acetabulum in total hip arthroplasty of Crowe III-IV developmental dysplasia: results of midterm follow-up.

Eur J Orthop Surg Traumatol 2018 Jul 25;28(5):923-930. Epub 2017 Nov 25.

Department of Orthopedic and Trauma Surgery, Qazvin University of Medical Sciences, Qazvin, Iran.

Introduction: The anatomic abnormalities in developmental dysplasia of hip (DDH) often make total hip replacement (THR) inevitable at a younger age. However, there is no universal gold standard technique of THR for high dislocated dysplastic hips.

Materials And Methods: Here we present the outcomes of midterm follow-up after THR in patients diagnosed with DDH Crowe type III and IV hospitalized in a tertiary center in Iran for whom placement of a cup in true acetabulum and selective transverse subtrochanteric osteotomy was performed. Pre- and postoperative Harris Hip Score, leg length discrepancy and postoperative complications were evaluated.

Results: A total of 48 patients with DDH Crowe type III and IV (uni- or bilateral which made 52 hips) were studied. Mean age of patients was 41 years with minimum follow-up ranging from 12 months to 3 years. Mean Harris Hip Score significantly improved from 41.70 preoperatively to 88.1 at last follow-up postoperatively. Leg length discrepancy of less than 2 cm was observed which was well tolerated using shoe lifts. Regarding postoperative complications, two patients had transient peroneal nerve palsy in early postoperative period which recovered within 2 months. No other major complication was encountered.

Conclusion: THR in patients with DDH (Crowe III and IV) with a cup positioned in true acetabulum and transverse subtrochanteric osteotomy is a safe successful procedure.
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http://dx.doi.org/10.1007/s00590-017-2076-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003979PMC
July 2018

Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve.

J Glaucoma 2017 Dec;26(12):1144-1148

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

Purpose: To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV).

Patients And Methods: In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded.

Results: Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (P<0.001). Average number of glaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (P<0.001). Qualified and complete success rates at 12-month follow-up were 65.5% and 6.9%, respectively. Younger age and higher number of previous glaucoma surgeries were significantly associated with the failure of excisonal bleb revision.

Conclusion: Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.
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http://dx.doi.org/10.1097/IJG.0000000000000806DOI Listing
December 2017

Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab Versus Mitomycin C: A Randomized Controlled Trial.

J Glaucoma 2017 Sep;26(9):829-834

*Glaucoma Service, Farabi Eye Hospital †Farabi Eye Hospital, Tehran, Iran.

Purpose: To compare the outcome of trabeculectomy using adjunctive intracameral bevacizumab versus intraoperative mitomycin C (MMC).

Materials And Methods: In this double-blind, randomized clinical trial 87 eyes of 87 patients with primary open-angle or pseudoexfoliation glaucoma were assigned to each treatment group (44 cases received 1.25 mg intracameral bevacizumab at the end of operation and in 43 cases MMC was applied during surgery). Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg and at least 30% IOP drop with (qualified) or without (complete) glaucoma medications without additional glaucoma surgery.

Results: The follow-up time was 17.12±2.58 months in the bevacizumab group and 17.23±2.42 months in the MMC group (P=0.845). The preoperative IOP was 29.17±3.94 and 28.8±4.08 mm Hg in the bevacizumab and MMC groups, respectively (P=0.689). Last visit IOP was 17.41±3.11 mm Hg in the bevacizumab group and 15.34±3.62 mm Hg in the MMC group (P<0.009). Compared with baseline, IOP drop at last visit was 11.76±5.51 and 13.43±5.92 in the bevacizumab and MMC groups, respectively (P=0.207). At last visit, complete success was achieved in 25 cases (61%) of bevacizumab group and 23 cases (66%) of MMC group (P=0.669). Early filtering bleb leak was more prevalent in bevacizumab group (29% vs. 11%).

Conclusions: A single 1.25 mg dose of intracameral bevacizumab improves the success of trabeculectomy comparable with MMC; however, it increases the risk of early filtering bleb leakage.
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http://dx.doi.org/10.1097/IJG.0000000000000741DOI Listing
September 2017

Evaluation of topical bevacizumab as an adjunct to mitomycin C augmented trabeculectomy.

J Curr Ophthalmol 2017 Jun 27;29(2):85-91. Epub 2016 Dec 27.

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

Purpose: To investigate the safety and synergistic effect of topical bevacizumab after trabeculectomy surgery with mitomycin C (MMC).

Methods: In this prospective, non-randomized, comparative interventional study, 40 eyes from 40 patients with uncontrolled open-angle glaucoma were studied after they underwent primary trabeculectomy with mitomycin C (0.02% for 2 min). Following the procedure topical bevacizumab (4 mg/mL) was used for 2 weeks 4 times daily in group A. Patients in group B received routine postoperative care. The outcome measures were the intraocular pressure (IOP), number of anti-glaucoma medications, complications, and bleb evaluation.

Results: Of the 32 eyes that had at least 6 months follow-up, 16 were treated with adjuvant topical bevacizumab. The mean preoperative IOP in group A improved from 26.7 ± 9.3 mmHg with 2.8 ± 1.3 anti-glaucoma medications to 10.5 ± 2.8 mmHg with 0.7 ± 1 anti-glaucoma medications at last follow-up ( < 0.001). The mean preoperative IOP in group B improved from 21.8 ± 6.6 mmHg with 3 ± 0.8 anti-glaucoma medications to 11.4 ± 3.6 mmHg with 0.8 ± 1.2 anti-glaucoma medications at last follow-up ( < 0.001). There was an overall reduction of 54.4% and 43.7% in the IOP in groups A and B, respectively ( = 0.18). The cystic type of bleb was less common in group A ( = 0.043). One patient in group A developed a streptococcal corneal ulcer 1.5 months after surgery.

Conclusion: Administration of topical bevacizumab 4 mg/ml for two weeks following trabeculectomy with mitomycin-C did not significantly affect the IOP trend, but significantly decreased the cystic bleb formation in short-term follow-up.
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http://dx.doi.org/10.1016/j.joco.2016.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5463009PMC
June 2017

Design and Development of a Web-Based Self-Monitoring System to Support Wellness Coaching.

Authors:
Reza Zarei Alex Kuo

Stud Health Technol Inform 2017 ;234:401-406

School of Health Information Science, University of Victoria, BC, Canada.

We analyzed, designed and deployed a web-based, self-monitoring system to support wellness coaching. A wellness coach can plan for clients' exercise and diet through the system and is able to monitor the changes in body dimensions and body composition that the client reports. The system can also visualize the client's data in form of graphs for both the client and the coach. Both parties can also communicate through the messaging feature embedded in the application. A reminder system is also incorporated into the system and sends reminder messages to the clients when their reporting is due. The web-based self-monitoring application uses Oracle 11g XE as the backend database and Application Express 4.2 as user interface development tool. The system allowed users to access, update and modify data through web browser anytime, anywhere, and on any device.
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June 2018

Distribution of intraocular pressure, central corneal thickness and vertical cup-to-disc ratio in a healthy Iranian population: the Yazd Eye Study.

Acta Ophthalmol 2017 Mar 25;95(2):e144-e151. Epub 2016 Oct 25.

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

Purpose: To determine the distribution of intraocular pressure (IOP), central corneal thickness (CCT) and vertical cup-to-disc ratio (VCDR) in the healthy Iranian population.

Methods: This population-based, epidemiologic study evaluated Iranian aged 40-80 years, residing in Yazd, Iran, in 2010-2011. Eligible subjects were selected by cluster random sampling. Each participant underwent an interview and ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, binocular optic disc evaluation, stereoscopic fundus photography, ultrasonic pachymetry and visual field testing.

Results: Of 2320 eligible individuals, 2098 subjects (response rate of 90.4%) participated in the study. One eye from 1159 subjects (total of 2262 normal eyes) were randomly selected for the purpose of the study. Mean age was 53.1 ± 9.6 years. Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 37 μm and 0.32 ± 0.14, respectively. Multiple regression analysis showed a significant correlation between IOP and age (regression coefficient = 0.02 per year, p = 0.015), CCT (regression coefficient = 0.02 per micron, p < 0.001), Spherical equivalent (regression coefficient = -0.15 per dioptre, p = 0.0.024) and smoking (regression coefficient = 0.89 higher for smokers, p = 0.009); it also showed a significant correlation between CCT with spherical equivalent (regression coefficient = 3.6 per dioptre, p = 0.002) and IOP (regression coefficient = 3.6 per mmHG, p < 0.001). There was no significant correlation with VCDR.

Conclusions: Mean IOP, CCT and VCDR were 14.2 ± 2.5 mmHg, 543 ± 35 μm and 0.32 ± 0.14, respectively, in healthy Iranians that is different from other ethnicities. It seems advisable to pay attention to ethnicity for interpretation of each person's variables.
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http://dx.doi.org/10.1111/aos.13231DOI Listing
March 2017

Lens Extraction for Management of Coexisting Cataract and Post-filtering Surgery Ocular Hypotony.

J Ophthalmic Vis Res 2015 Oct-Dec;10(4):385-90

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

Purpose: To evaluate the safety and efficacy of phacoemulsification for management of post-filtering ocular hypotony.

Methods: This prospective interventional case series study recruited 21 consecutive patients with an established diagnosis of ocular hypotony with or without maculopathy. Clear corneal incision phacoemulsification was done for all patients. Nineteen cases that completed a follow-up of at least 6 months were considered for final analysis.

Results: Mean baseline intraocular pressure (IOP) was 2.95 ± 1.43 mm Hg, which increased to 8.84 ± 4.67 mm Hg at 6 months (P < 0.001). Hypotony was resolved in 13 cases (68%) at 6 months while 6 cases (32%) showed persistent hypotony at this time point. Postoperative IOP change at all follow-up time points was not correlated with patient age, time interval between filtering surgery and phacoemulsification, baseline IOP, baseline anterior chamber depth and IOP on the first postoperative day. Three cases (16%) showed filtering bleb failure with dramatic IOP rise around the first postoperative month and required glaucoma medication for IOP control. No significant intra- or postoperative complications were noted.

Conclusion: Cataract surgery alone seems promising in resolving hypotony in patients with post-filtering ocular hypotony, and can be considered as an effective treatment modality before proceeding to more complicated procedures.
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http://dx.doi.org/10.4103/2008-322X.176908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795387PMC
April 2016

Evaluation of Lamina Cribrosa and Choroid in Nonglaucomatous Patients With Pseudoexfoliation Syndrome Using Spectral-Domain Optical Coherence Tomography.

Invest Ophthalmol Vis Sci 2016 Mar;57(3):1293-300

Koret Vision Center, University of California, San Francisco Medical School, San Francisco, California, United States.

Purpose: To evaluate the lamina cribrosa (LC) and peripapillary choroid in patients with pseudoexfoliation syndrome (PXS).

Methods: In this cross-sectional study, one eye each of 32 nonglaucomatous PXS cases and 29 healthy volunteers were enrolled. The optic discs were scanned using enhanced depth imaging spectral-domain optical coherence tomography, and measurements were obtained using HEYEX software 6.0. LC and other related variables at three areas (mid-superior, center, and mid-inferior) and peripapillary choroidal thickness were determined. Linear mixed modeling was used to adjust the variables.

Results: After adjustment for age, sex, and axial length, there was no significant difference between the two groups in peripapillary choroidal thickness or in retinal nerve fiber layer thickness. The LC was significantly thinner in all three areas in the PXS group when compared with the control group, even after adjustment. Although no significant difference in central laminar depth was observed between the two groups (P = 0.74), the superior and inferior laminar depth were significantly deeper in the PXS group when compared with the control group (P = 0.04 and P = 0.006, respectively). Although there was a significant negative association between age and central choroidal thickness in the control group (β = -2.820, P = 0.02), this correlation was not significant in the PXS group.

Conclusions: We found that LC is significantly thinner in all three areas of the optic nerve head in nonglaucomatous PXS patients than in controls. Although no significant difference in peripapillary choroidal thickness was observed between the two groups, peripheral posterior displacement of LC in nonglaucomatous PXS eyes was noted.
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http://dx.doi.org/10.1167/iovs.15-18312DOI Listing
March 2016

Long-term Outcomes of Ahmed Glaucoma Valve Implantation in Refractory Glaucoma at Farabi Eye Hospital, Tehran, Iran.

Middle East Afr J Ophthalmol 2016 Jan-Mar;23(1):104-9

Department of Health Sciences, California State University, Northridge and Translational Pathology Core Laboratory, University of California, Los Angeles, USA.

Purpose: To describe long-term outcomes and complications of Ahmed glaucoma valve (AGV) implantation in subjects with refractory glaucoma at Farabi Eye Hospital, Tehran, Iran.

Materials And Methods: This retrospective cohort study evaluated patient records of all subjects with refractory glaucoma who had undergone AGV implantation up to January 2013. The main outcome measure was the surgical success rate. Complete success was defined as intraocular pressure (IOP) <22 mmHg, without anti-glaucoma medications or additional surgery. Qualified success was IOP <22 mmHg regardless of number of anti-glaucoma medications. In all cases, loss of vision (no light perception) was considered an independent indicator of failure. Data were also collected on intraoperative and postoperative complications.

Results: Twenty-eight eyes were included in the study. With a mean follow-up of 48.2 ± 31.7 months (median: 40.50 months; range: 3-124 months), the IOP decreased from a mean preoperative value of 30.8 ± 5.6 mmHg to 20.0 ± 6.4 mmHg at last visit. The number of medications decreased from 3.7 ± 0.4 preoperatively to 2.5 ± 1.1 postoperatively. Cumulative qualified success was achieved in 69% of eyes. Mean time to failure according to qualified success criteria was 92.3 ± 9.4 months. Postoperative complications were recorded in 16 (57.1%) eyes. The most common complication was focal endothelial corneal decompensation at the site of tube-cornea touch.

Conclusion: AGV implantation with adjunctive topical anti-glaucoma drops controlled IOP in approximately 70% of eyes with refractory glaucoma with a median of 40.5 months of follow-up. However, complication rates were higher.
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http://dx.doi.org/10.4103/0974-9233.164611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4759886PMC
August 2016

Effect of Mitomycin-C Augmented Trabeculectomy on Corneal Endothelial Cells.

J Ophthalmic Vis Res 2015 Jul-Sep;10(3):257-62

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

Purpose: To evaluate the effect of mitomycin-C (MMC) on corneal endothelial cell density (ECD) and morphology after trabeculectomy.

Methods: In this prospective comparative case series, 31 eyes with glaucoma underwent trabeculectomy with (group I), or without (group II) MMC. Specular microscopy was performed pre-, and postoperatively at months 1 and 3. Outcome measures included central corneal endothelial cell count and coefficient of variation (CV) of cell size.

Results: Overall, mean preoperative ECD was 2,135.8 ± 397.6 cells/mm(2); corresponding values at postoperative months 1 and 3 were 2,019.6 ± 447.2 cells/mm(2), and 1,991.4 ± 425.5 cells/mm(2), respectively (P > 0.05). Cell loss from month 1 to 3 was 1.3 % (P > 0.05). Subgroup analysis showed significant differences in endothelial cell loss at month 1 (P = 0.048) and month 3 (P = 0.014) between the MMC and control groups with no significant difference between the two groups in terms of cell loss from months 1 to 3, postoperatively (P = 0.968). Overall, mean pre-and postoperative CVs at months 1 and 3 were 27.38 ± 4.55, 27.96 ± 4.26, and 28.35 ± 4.47, respectively, with no significant difference between the two groups (P > 0.05). There was no correlation between preoperative central endothelial cell density (CECD) and MMC related cell loss.

Conclusion: MMC application in trabeculectomy seems to cause a small but significant corneal endothelial loss. Most of the damage occurs intraoperatively, or in the early postoperative period, however progressive endothelial cell loss is not a major concern.
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http://dx.doi.org/10.4103/2008-322X.170345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687258PMC
January 2016

Retinal venous pressure in chronic smokers.

EPMA J 2015 8;6(1). Epub 2015 Apr 8.

Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Sq., South Kargar Ave., Tehran, 1336616351 Iran.

Background: The overall aim of this study was to determine retinal venous pressure (RVP) in healthy chronic smokers and compare values to those of healthy non-smokers.

Methods: Both eyes of 25 healthy chronic smokers and 41 healthy non-smokers were included. Measurements of RVP were performed by means of contact lens ophthalmodynamometry. Ophthalmodynamometry is done by applying increasing force on the eye via a contact lens. If a spontaneous venous pulsation was present, it was noted. If not, the compressive force was increased until the first venous pulsation was detected, and the measurement value was fixed and read. RVP was calculated as the sum of pressure increase induced by the instrument and intraocular pressure.

Results: Smokers had a significantly higher frequency of spontaneous venous pulsations than non-smokers (p < 0.001). Mean values of RVP were slightly lower in smokers than in non-smokers: 15.3 and 15.5 (smokers) versus 15.9 and 16.2 (non-smokers) for the right and left eye, respectively; however, the difference in RVP between the two groups did not reach significance. There was no significant difference in blood pressure between the two groups, but heart rate was significantly higher in smokers (p = 0.043).

Conclusions: RVP values may differ in healthy smokers than in non-smokers. Therefore, smoking habits should be considered when interpreting RVP results.
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http://dx.doi.org/10.1186/s13167-015-0031-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4413992PMC
April 2015

COMPARISON OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY PARAMETERS BETWEEN CENTRAL RETINAL VEIN OCCLUSION AND NORMAL EYES: Is Primary Angle Closure a Risk Factor for Central Retinal Vein Occlusion?

Retina 2015 Sep;35(9):1795-9

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

Purpose: To compare anterior segment parameters in patients with central retinal vein occlusion (CRVO) with normal control subjects by anterior segment optical coherence tomography (AS-OCT).

Methods: In this coss-sectional case-control study, 42 eyes from 21 patients with unilateral CRVO and 21 eyes from 21 age- and sex-matched healthy control subjects were recruited. Study eyes were divided into three groups: involved eyes of CRVO patients (CRVO eyes), fellow eyes of CRVO patients (fellow eyes), and control eyes. Complete ocular examination and AS-OCT were performed for each eye. The AS-OCT parameters (anterior chamber depth, scleral spur angle, angle opening distance [AOD] at 500 and 750 μm from scleral spur [AOD500 and 750] and trabecular-iris space area [TISA] at 500 and 750 μm from scleral spur [TISA500 and 750]) and the rate of narrow angles (based on gonioscopy) in CRVO and fellow eyes were compared with control eyes.

Results: The mean (SD) age of the patients and the control group were 60.09 (9.43) and 59.52 (6.66), respectively. The mean intraocular pressure in both eyes of the patients was significantly higher than the control eyes (P < 0.05). All AS-OCT parameters were significantly different among the three groups (P < 0.05). Comparing with the control eyes, CRVO eyes had shallower anterior chamber depth (2.53 vs. 2.85 mm; P = 0.002) and narrower AS-OCT angle parameters (scleral spur angle, AOD500 and 750, TISA500 and 750). Fellow eyes had also shallower anterior chamber depth (2.56 vs. 2.85 mm; P = 0.005) than control eyes and smaller scleral spur angle, AOD500 and AOD750. Five CRVO patients (23.8%) were diagnosed with narrow angles in both eyes based on gonioscopy, whereas no eye in the control group had narrow angles (P = 0.05).

Conclusion: Imaging with AS-OCT showed that CRVO patients had shallower anterior chamber depth and narrower angle parameters in both eyes in comparison with control eyes. Furthermore, CRVO patients had higher rates of narrow angles on gonioscopic examination.
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http://dx.doi.org/10.1097/IAE.0000000000000549DOI Listing
September 2015

Pseudoexfoliation syndrome: Effect of phacoemulsification on intraocular pressure and its diurnal variation.

J Curr Ophthalmol 2015 Mar-Jun;27(1-2):12-5. Epub 2015 Nov 25.

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

Purpose: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) in pseudoexfoliation (PEX) syndrome and its diurnal variation.

Methods: In this prospective, non-comparative, interventional case series, phacoemulsification was done for patients with PEX and concomitant visually significant cataract. Follow-up examinations including IOP measurement were done at postoperative day 1, week 1, month 1, month 3, and month 6. All IOP measurements were performed twice daily: once in the morning between 8 and 10 AM and the other in the evening between 6 and 8 PM. The minimum and maximum IOP and the mean IOP were recorded. IOP variation was defined as the difference between maximum and minimum pressures.

Results: Sixty-eight eyes of 68 patients were analyzed. The mean IOP dropped from 17.45 ± 3.32 mm Hg to 12.57 ± 1.58 mm Hg at 6 months. The minimum and maximum IOP dropped from 14.97 ± 3.46 mm Hg and 20.03 ± 3.39 to 11.53 ± 1.79 mm Hg and 13.01 ± 1.81 after 6 months, respectively. Diurnal IOP variation dropped from 5.06 ± 1.85 mm Hg (range 2-10) at baseline to 1.49 ± 0.93 mm Hg (range 0-4) at postoperative month 6 (p < 0.001 for all). This drop was not correlated with age and CCT, but was strongly correlated with baseline IOP variation (r = 0.847, p < 0.001).

Conclusion: Phacoemulsification without any additional intervention can be an attractive choice in managing the IOP and its diurnal variations in pseudoexfoliation patients, even with elevated IOP, who do not have advanced optic nerve damage.
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http://dx.doi.org/10.1016/j.joco.2015.09.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4877725PMC
May 2016

Short-term Results of Trabeculectomy Using Adjunctive Intracameral Bevacizumab: A Randomized Controlled Trial.

J Glaucoma 2016 Mar;25(3):e182-8

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

Purpose: To investigate the outcome of trabeculectomy with or without adjunctive intracameral bevacizumab.

Materials And Methods: In this prospective, double-blind, randomized clinical trial, 71 patients with primary open-angle or pseudoexfoliation glaucoma were randomly assigned to receive either 1.25 mg intracameral bevacizumab (n=36) or balanced salt solution as placebo (n=35) at the end of trabeculectomy. Success was defined as at least a 30% drop in intraocular pressure (IOP) compared with baseline values and an IOP between 6 and 21 mm Hg at the last postoperative visit with (qualified) or without (complete) glaucoma medications.

Results: Thirty-two patients in bevacizumab group and 33 in placebo group completed a mean follow-up of 10.7±2.1 and 10.5±2.5 months, respectively (P=0.731). The mean preoperative IOP was 28.25±5.64 and 29.11±4.65 mm Hg in the bevacizumab and placebo groups, respectively (P=0.485). Last visit IOP was 14.5±3.7 mm Hg in the bevacizumab group and 18.55±3.64 mm Hg in the placebo group (P<0.001). At last visit, complete success was achieved in 26 cases (81.3%) of bevacizumab group and 16 cases (48.5%) of placebo group (P<0.006). Filtering bleb leak during the first postoperative month was seen in 11 (34%) and in 3 (9%) cases of bevacizumab and placebo groups, respectively (P=0.013).

Conclusions: A single 1.25 mg dose of intracameral bevacizumab significantly improves the success of trabeculectomy; however, it increases the risk of early filtering bleb leakage.
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http://dx.doi.org/10.1097/IJG.0000000000000202DOI Listing
March 2016

Spontaneous wound dehiscence after penetrating keratoplasty.

Int J Ophthalmol 2014 18;7(5):905-8. Epub 2014 Oct 18.

Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran.

Spontaneous wound separation may be developed even months after suture removal especially in the context of long-term corticosteroid therapy. A 68-year-old Caucasian woman presented to our cornea clinic with spontaneous wound dehiscence after her third penetrating keratoplasty (PKP) which was performed three years ago. An Ahmed glaucoma valve (New World Medical, Ranchos Cucamonga, CA) was inserted ten months after the third PKP, which successfully controlled intraocular pressure (IOP). At the examination, the last sutures were removed eight months ago and she was using flourometholone 0.1 % (Sina Darou, Tehran, Iran) with a dose of once a day. There was one quadrant of wound dehiscence from 8 to 11 òclock associated with anterior wound gape and severe corneal edema. Resuturing was performed for the patient. At the one month examination, the corneal edema was resolved and best corrected visual acuity was 20/200 mainly due to previous glaucomatous optic neuropathy. Caution about the prolonged use of corticosteroids is necessary. Topical immunosuppressives could be a promising choice in this field.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2014.05.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4206902PMC
October 2014

Outcomes of same-site re-operation with minimal use of mitomycin in failed trabeculectomy.

Int Ophthalmol 2014 Jun 14;34(3):501-4. Epub 2013 Aug 14.

Eye Research Center, Farabi Eye Hospital, Medical Sciences, Tehran University, Qazvin Square, South Karegar Avenue, Tehran, Iran.

To evaluate efficacy and safety of same site re-operation in eyes with failed trabeculectomy. A retrospective, noncomparative, interventional case series. We reviewed the medical records of 35 eyes of 35 patients who underwent same-site re-operation for failed trabeculectomy. The surgery involved a fornix-based peritomy at the same site as the previous trabeculectomy with application of 0.2 mg/mL mitomycin for 1 min. Primary outcome measures were intraocular pressure (IOP) control and number of antiglaucoma medications at last follow-up. Success rates were defined according to criteria (A) IOP ≤ 21 mmHg or (B) IOP ≤ 18 mmHg, with or without antiglaucoma medication. The mean age of the patients was 43.3 ± 18.0 years and 62.9 % were male. The mean follow-up was 13.6 ± 12.0 months (range 6-49 months). At final follow-up, mean baseline IOP was reduced from 27.2 ± 8.0 to 16.6 ± 7.5 mmHg (p < 0001). The mean number of antiglaucoma medications was reduced from 2.8 ± 0.8 to 1.0 ± 1.3 (p < 0001). This study supports the efficacy and safety of same-site re-operation with minimal use of mitomycin C for management of failed filtering blebs following trabeculectomy.
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http://dx.doi.org/10.1007/s10792-013-9840-5DOI Listing
June 2014

Topical latanoprost does not cause macular thickening after uncomplicated cataract surgery.

J Ophthalmic Vis Res 2012 Oct;7(4):289-94

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

Purpose: To explore changes in central macular thickness (CMT) after a two-month period of glaucoma therapy with topical latanoprost after uneventful phacoemulsification.

Methods: Forty-one eyes of 31 patients with primary open angle or pseudoexfoliative glaucoma who required glaucoma medications after cataract surgery were prospectively enrolled. All eyes had undergone uneventful phacoemulsification with intraocular lens implantation at least 4 months before initiation of latanoprost. After a complete ophthalmic examination, spectral-domain optical coherence tomography (SD-OCT) and fluorescein angiography (FA) were performed at baseline before starting latanoprost. All eyes received latanoprost for 2 months, and clinical examinations were repeated one and two months afterwards; OCT and FA were repeated after 2 months. Outcome measures were CMT and loss of more than 2 lines of best corrected visual acuity (BCVA).

Results: Mean patient age was 71.6±7.8 years. Intraocular pressure decreased from 21.5±3.4 mmHg to 14.4±2.6 mmHg (p<0.001) at 2 months. None of the eyes developed reduction of BCVA exceeding 2 lines, or angiographic cystoid macular edema (CME). Likewise no significant change was noted in CMT (249.9±29.8 vs 248.8±30.7µm), average macular thickness (274.5±15.0 vs 273.8±17.0µm), or macular volume (9.6±1.0 vs 9.6±1.1µm2) after treatment as compared to baseline (P>0.05 for all comparisons).

Conclusion: Topical use of latanoprost later than 4 months after uncomplicated cataract surgery does not seem to predispose to increased macular thickness or CME and may safely be used in this setting.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3595585PMC
October 2012

Ocular biometry in the subtypes of angle closure: an anterior segment optical coherence tomography study.

Am J Ophthalmol 2013 Apr 13;155(4):664-673, 673.e1. Epub 2012 Dec 13.

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

Purpose: To evaluate ocular biometric parameters in different subtypes of angle-closure disease in the Iranian population and compare them with normal eyes.

Design: Prospective, cross-sectional.

Methods: In this clinic-based study, 189 eyes of 154 patients consisting of 40 acute angle-closure glaucoma (AACG) eyes, 40 fellow eyes of AACG, 42 chronic angle-closure glaucoma (CACG) eyes, 40 primary angle-closure suspect (PACS) eyes, and 27 normal eyes underwent complete examination including gonioscopy, A-scan biometry, and anterior segment optical coherence tomography. Only 1 eye of CACG, PACS, and control subjects were selected. Main outcome measures included angle opening distance and trabeculo-iris space area at 500 μm from the scleral spur (AOD500, TISA-500), anterior chamber angle, lens vault, lens thickness, anterior chamber depth (ACD), and lens position.

Results: Anterior chamber angle, AOD500, TISA500, ACD, and lens position were less and lens thickness and lens vault were greater in angle-closure than open-angle eyes. ACD was less in AACG than CACG and PACS (P < .001). It was also less in fellow eyes than PACS eyes (P = .04). Lens vault was highest in AACG eyes, followed by fellow eyes, PACS, and CACG. It was significantly more in AACG eyes than CACG and PACS eyes (P < .001 and P = .007, respectively). No difference was observed between AACG and fellow eyes.

Conclusions: The anterior segment was crowded in closed-angle compared to open-angle eyes. Higher lens vault may play a role in the development of an acute attack of angle closure.
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http://dx.doi.org/10.1016/j.ajo.2012.10.014DOI Listing
April 2013

Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial.

Clin Exp Ophthalmol 2013 May-Jun;41(4):368-78. Epub 2012 Oct 29.

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

Background: To compare the anatomic effects of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco-VGP) on drainage angle status in primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT).

Design: Prospective, randomized clinical trial.

Participants: Sixty-seven eyes of 57 patients with the diagnosis of PACG.

Method: Patients were randomized to undergo Phaco alone (33 eyes) or Phaco-VGP (34 eyes). Patients were examined postoperatively on day 1, week 1 and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery.

Main Outcome Measures: Angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy.

Results: Sixty-five eyes of 55 patients completed the trial. The mean extent of PAS was significantly reduced from 127.7 to 95.0 degrees (P < 0.001) by Phaco alone, and from 174.0 to 77.3 degrees (P < 0.001) by Phaco-VGP. Phaco-VGP resulted in significantly greater reduction in PAS extent (P = 0.002). Angle-opening distance and trabecular-iris space-area measured by AS-OCT increased significantly after Phaco alone and Phaco-VGP (P < 0.001 for both). Although the change was higher in the Phaco-VGP group, this did not reach statistical significance. Anterior chamber depth (ACD) increased, and lens vault (LV) decreased after both procedures. The amount of change in ACD and LV was not significant between the two groups.

Conclusion: Both Phaco alone and Phaco-VGP resulted in widening of the drainage angle, deepening of the anterior chamber and reduction of intraocular pressure (IOP) and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS. However, it seems that additional VGP has no significant effect on short-term IOP.
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http://dx.doi.org/10.1111/j.1442-9071.2012.02871.xDOI Listing
September 2013

Effect of phacoemulsification on drainage angle status in angle closure eyes with or without extensive peripheral anterior synechiae.

Eur J Ophthalmol 2013 Jan 3;23(1):70 - 79. Epub 2012 Aug 3.

Farabi Eye Research Center, Tehran University of Medical Science, Tehran - Iran.

Purpose. To evaluate the anatomic effects of phacoemulsification on drainage angle status in primary angle closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). Methods. A total of 62 eyes of 58 patients underwent cataract surgery in Farabi Rye Hospital, Tehran, Iran. Patients were examined postoperatively on day 1, week 1, and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. Main outcome measures were angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. Thirty-five eyes had PAS =180 degrees (group 1) and 27 eyes had >180-degree synechial closure (group 2). Results. Mean age of the patients was 64.3±9.0 years. The mean extent of PAS was significantly reduced from 45.9 to 32.2 degrees (p<0.03) in group 1, and from 277.4 to 159.0 degrees (p<0.001) in group 2. Group 2 showed significantly greater reduction in PAS extent (p<0.001). Angle opening distance and trabecular-iris space area at 500 µm from the scleral spur measured by AS-OCT increased significantly in both groups (p<0.001 for both). Anterior chamber depth (ACD) increased and lens vault (LV) decreased after both procedures. However, the amount of change in ACD and LV and angle parameters were not significant between the 2 groups. Conclusions. Phacoemulsification resulted in opening of the drainage angle, deepening of the anterior chamber, and reduction of PAS extent in PACG eyes with or without extensive PAS. Greater reduction of PAS could be considered in eyes with PAS >180 degrees.
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http://dx.doi.org/10.5301/ejo.5000191DOI Listing
January 2013

Ahmed glaucoma valve implantation with tube insertion through the ciliary sulcus in pseudophakic/aphakic eyes.

J Glaucoma 2014 Feb;23(2):115-8

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

Purpose: To report the efficacy and safety of Ahmed glaucoma valve (AGV) insertion into the ciliary sulcus in pseudophakic/aphakic patients.

Patients And Methods: A chart review was done on patients with uncontrolled glaucoma, who underwent AGV implantation with tube inserted into the ciliary sulcus. Baseline intraocular pressure (IOP) and number of medications were compared with that of postoperative follow-up visits. Surgical success was defined as last IOP <21 mm Hg and 20% reduction in IOP, without further surgery for complications or glaucoma control, and without loss of light perception. Postoperative complications were recorded.

Results: Twenty-three eyes of 23 patients were recruited with the mean follow-up of 9 months (range, 3 to 24 mo). The mean (SD) age of patients was 49.9 (16.9) years (range, 22 to 80 years). The mean (SD) IOP (mm Hg) was reduced from 37.9 (12.4) before surgery to 16.2 (3.6) at the last follow-up visit (P<0.001). The mean (SD) number of medications was reduced from 3.3 (0.9) preoperatively to 1 (1.1) at the last follow-up (P<0.001). Success rate was 18/23 (78.6%). Complications included endophthalmitis in 1 eye, tube exposure in 1 diabetic patient, and vitreous tube occlusion in 1 eye. No case of corneal decompensation or graft failure was seen during follow-up.

Conclusions: Ciliary sulcus placement of the tube of AGV effectively reduces IOP and medication use in short term. It has the potential to lower corneal complications of anterior chamber tube insertion and avoids the need for pars plana vitrectomy and tube insertion in patients at higher risk of corneal decompensation.
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http://dx.doi.org/10.1097/IJG.0b013e318265bc0bDOI Listing
February 2014

Sutureless tunnel trabeculectomy without peripheral iridectomy: a new modification of the conventional trabeculectomy.

Int Ophthalmol 2012 Oct 18;32(5):449-54. Epub 2012 Jul 18.

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

The purpose of this study was to describe the results of a new modification of the trabeculectomy technique, sutureless tunnel trabeculectomy without peripheral iridectomy (PI), in a group of patients with chronic open-angle glaucoma (COAG). Patients with uncontrolled COAG who were candidates for trabeculectomy underwent sutureless tunnel trabeculectomy without PI. Patients were examined before surgery and at 1, 3, 6 and 12 months after surgery. Pre- and post-operative data including intraocular pressure (IOP), visual acuity, number of anti-glaucoma medications and intraoperative and post-operative complications were recorded. Surgical success was defined as final IOP < 21 mmHg and > 20 % reduction from baseline (criterion A) and as final IOP < 18 mmHg and > 25 % reduction from baseline (criterion B), without further glaucoma surgery or complications that required returning the patient to the operating room. Success was further classified as complete when these criteria were obtained without medications and qualified with or without medical therapy. Eighteen eyes of 18 patients were recruited into the study. All patients had 6 months of follow-up and 15 patients (83.3 %) completed 12 months of follow-up. Mean (SD) age of the patients was 57.2 (5.7) years. Mean (SD) IOP decreased from 23.7 (4.5) mmHg pre-operatively to 14.7 (3.4) mmHg at final follow-up visit (p < 0.001), and the mean (SD) number of glaucoma medications decreased from 2.89 (0.32) pre-operatively to 1 (0.84) at last visit (p < 0.001). Post-operatively, IOP and number of glaucoma medications were decreased in comparison with baseline at all follow-up visits (p < 0.001 for all visits). Qualified and complete surgical success rates were 78 and 50 % for criterion A, and 72 and 50 % for criterion B. Sutureless tunnel trabeculectomy without PI effectively reduced IOP and number of medications in COAG patients during 6-12 months of follow-up. Further controlled studies are needed to better characterize the safety and efficacy of this technique.
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http://dx.doi.org/10.1007/s10792-012-9607-4DOI Listing
October 2012

Office-based slit-lamp needle revision with adjunctive mitomycin-C for late failed or encapsulated filtering blebs.

Middle East Afr J Ophthalmol 2012 Apr-Jun;19(2):216-21

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

Purpose: The purpose of this study was to assess the results of bleb needling in glaucomatous patients with late failed filtering blebs.

Materials And Methods: A retrospective case series of 27 eyes of 27 patients was considered. All patients underwent needle bleb revision with adjuvant mitomycin-C performed at the slit lamp, during an office visit. Complete success was defined as postneedling intraocular pressure (IOP) ≤ 21 mmHg without any antiglaucoma medications and qualified success was IOP ≤ 21 mmHg with topical antiglaucoma medications.

Results: There were 12 eyes with encapsulated blebs and 15 eyes with flat blebs. The mean interval between index filtering surgery and bleb revision was 32.74 ± 15.36 months. Mean IOP was 25.07 ± 4.80 mmHg before surgery and 19.66 ± 4.97 mmHg at last postoperative follow-up. The mean follow-up was 20.31 ± 15.63 months. Complete and qualified successes were 7.4% and 51.9%, respectively. Cumulative rates of success at 1, 2, 3, and 4 years were 76%, 65%, 49%, and 37%, respectively. The mean number of antiglaucoma medications was reduced from 3.15 ± 0.36 preoperatively to 2.33 ± 1.21 postoperatively (P<0.001).

Conclusion: Slit-lamp needle revision in office is a simple and effective method for treating late encapsulated or flat filtering blebs without significant complications even for late bleb failure.
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http://dx.doi.org/10.4103/0974-9233.95255DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353671PMC
February 2013

Phacoemulsification and goniosynechialysis for the management of refractory acute angle closure.

Eur J Ophthalmol 2012 Sep-Oct;22(5):714-8

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

Purpose: To evaluate the effectiveness of phacoemulsification with goniosynechialysis in the management of refractory acute angle closure (AAC).

Methods: In this prospective, noncomparative interventional case series, patients with AAC who were unresponsive to medical and laser therapy were included. Success was defined as complete if intraocular pressure (IOP) had a drop of at least 30% and was between 6 and 21 mmHg without medication, and qualified if IOP was within that range with medication.

Results: A total of 24 patients with a mean age of 56 years (range 39-77) were treated. Mean follow-up time was 15.7 ± 4.2 months (range 6-24). Mean preoperative and last visit IOPs were 34.27 ± 7.23 mmHg and 17.5 ± 3.21 mmHg, respectively (p<0.001). Mean number of glaucoma medication dropped from 3.67 ± 0.48 to 0.63 ± 1.05 (p<0.001). There was a positive correlation between the attack-surgery interval and last visit IOP (p<0.001, r=0.697). There was a negative correlation between the preoperative anterior chamber depth and last visit IOP drop (p=0.03, r=-0.56). Also, a positive correlation was found between the preoperative IOP and last visit IOP drop (p<0.001, r=0.896). At final visit, complete and qualified success was achieved in 17/24 (71%) and 5/24 (21%) cases, respectively. The most common intraoperative and postoperative complications were hyphema and anterior chamber fibrinous reaction, respectively.

Conclusions: Phacoemulsification with goniosynechialysis seems to be a safe and effective method for the management of patients with refractory AAC. This procedure can be considered for these patients before proceeding with filtering surgery.
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http://dx.doi.org/10.5301/ejo.5000101DOI Listing
December 2012

Influence of visual field testing frequency on detection of glaucoma progression with trend analyses.

Arch Ophthalmol 2011 Dec 8;129(12):1521-7. Epub 2011 Aug 8.

Jules Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90095, USA.

Objective: To explore whether increased frequency of visual field testing leads to earlier detection of glaucoma progression with trend analyses.

Methods: The visual fields of 468 eyes (381 patients) from the Advanced Glaucoma Intervention Study with 10 or more reliable visual field tests and 3 or more years of follow-up were studied. Starting at year 1, every other visual field examination was deleted to create a low-frequency data set, and the original group was kept as the high-frequency data set. The proportion of progressing eyes and the time to progression were compared between the 2 data sets with global and pointwise linear regression criteria.

Results: The median number of visual field examinations was 20 and 12 for the high- and low-frequency data sets, respectively. Based on primary mean deviation criteria, 204 eyes (43.6%) in the high-frequency data set and 160 eyes (34.2%) in the low-frequency data set progressed (P < .001), whereas 185 eyes (39.5%) in the high-frequency data set and 167 eyes (35.7%) in the low-frequency data set progressed according to pointwise linear regression (P = .02). The high-frequency data set was more likely to detect progression with mean deviation (hazard ratio [HR], 1.69 [95% confidence interval {CI}, 1.36-2.10]) or pointwise linear regression criteria (HR, 1.52 [95% CI, 1.21-1.90]). A similar number of improving eyes were detected with mean deviation criteria (HR, 0.95 [95% CI, 0.58-1.60]), but pointwise linear regression criteria were more likely to detect improvement in the high-frequency data set (HR, 2.27 [95% CI, 1.43-3.62]). The results did not significantly change after censoring data at 5 years.

Conclusions: Increasing the frequency of visual field testing leads to earlier detection of glaucoma progression, especially with global trend analyses. This finding has significant implications for the care of patients with glaucoma.
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http://dx.doi.org/10.1001/archophthalmol.2011.224DOI Listing
December 2011

Ocular toxoplasmosis in Iran: 40 cases analysis.

Int J Ophthalmol 2011 18;4(2):199-201. Epub 2011 Apr 18.

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

Aim: To report ocular symptoms, funduscopic findings and demographic distribution of ocular toxoplasmosis in Iran

Methods: In this cross-sectional study, a total of 40 patients with ocular toxoplasmosis (24 female, 16 male) were enrolled. The distribution of symptoms and funduscopic findings were studied.

Results: The patients' age was in the range of 13-52 with the most common age of 19 years old. Twenty-four patients were female (60.0%). The most common presenting sign was visual loss. There was anterior chamber (AC) inflammation in 23 patients (57.5%). Vitritis was presented in 36 patients (90.0%). In 35 patients (87.5%), the retinal lesion was central. In patients with peripheral lesion, 3 patients (60.0%) had flashing vs 12.5% chance of flashing in all patients. Older patients had larger lesion (P=0.04).

Conclusion: Ocular toxoplasmosis substantially varies among patients with different age, gender, status of immunity, site of lesion and other undetermined factors. One of ocular symptoms, flashing, may necessitate a more precise peripheral fundus examination.
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http://dx.doi.org/10.3980/j.issn.2222-3959.2011.02.19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340695PMC
September 2012