Publications by authors named "Yadollah Eslami"

36 Publications

Combined phacoviscocanalostomy versus phacoemulsification alone in patients with coexisting cataract and mild-to-moderate open-angle glaucoma; a randomized-controlled trial.

Eye (Lond) 2022 Jun 25. Epub 2022 Jun 25.

Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.

Background/objective: Management of concomitant cataract and glaucoma depends on the stage of glaucoma and the patient's situation. There are different surgical options for handling visually significant cataract and mild-to-moderate open-angle glaucoma (OAG). We aimed to compare the one-year results of phacoemulsification alone versus phacoviscocanalostomy in these patients.

Subjects/methods: This was a parallel-arm, single-masked, randomized-controlled trial, conducted at Farabi Eye Hospital, Tehran, Iran between January 2016 and January 2018. We enrolled 89 eyes from 89 patients with mild-to-moderate primary OAG or pseudoexfoliative glaucoma (PEXG) with visually significant age-related cataract. They randomly underwent phacoemulsification alone (n = 44) or combined phaco-viscocanalostomy (n = 45). All patients had a 12-month follow-up period, and the mean intraocular pressure (IOP), the number of antiglaucoma medications, and complete and qualified success rates were compared.

Results: After the 1st and 3rd months, the mean IOP showed significantly decreased in the phaco-visco group compared to the phaco group (P < 0001 and P = 0.004, respectively), but it was not statistically significant at 6th and 12th months (P = 0.540 and P = 0.530). The need for antiglaucoma medication and the complete and qualified success rates were significantly in favour of the phaco-visco group in all postoperative visits (P < 0.05).

Conclusions: Although both phacoemulsification alone and phacoviscocanalostomy procedures can be considered for patients with mild-to-moderate OAG, we found better success rates using phacoviscocanalostomy. Therefore, if the surgeon is an expert in performing this technique, this non-penetrating procedure can be applied in patients with visually significant cataract and earlier stages of OAG, especially in patients with PEXG.
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http://dx.doi.org/10.1038/s41433-022-02152-wDOI Listing
June 2022

Comparison of Vascular Density and Structural Patterns Between Primary Open Angle Glaucoma and Primary Angle Closure Glaucoma.

J Glaucoma 2022 08 14;31(8):645-650. Epub 2022 Jun 14.

Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA.

Purpose: To compare the pattern of vascular density and structural damage in primary open angle glaucoma (POAG) with primary angle closure glaucoma (PACG) using optical coherence tomography (OCT) and OCT angiography (OCTA) in the optic nerve head, circumpapillary, and macular regions, respectively.

Materials And Methods: One hundred thirty-one eyes of 82 patients (53 eyes with PACG and 78 eyes with POAG) were enrolled in this study. The patients underwent complete ophthalmic examination, Bruch membrane opening minimum rim width, circumpapillay retinal nerve fiber layer (cpRNFL), and macular ganglion cell complex (GCC) measurements and vascular density determination of the peripapillary and macular area with OCT and OCTA. A linear mixed model was used for the statistical analysis.

Results: There was no significant difference between the 2 groups in terms of age ( P =0.94) and visual field mean deviation ( P =0.78). Female-to-male ratio was higher in PACG patients than the POAG group ( P =0.02), and AL was shorter in PACG eyes ( P <0.001). cpRNFL and GCC were not different between the 2 groups (all P values>0.05, except for nasal segment cpRNFL). Vessel densities in the peripapillary and macular areas were comparable between the 2 groups (all P values>0.05). Although Bruch membrane opening minimum rim width was thicker in PACG eyes on univariate analysis, the multivariable analysis showed no significant difference between the 2 groups ( P >0.05).

Conclusions: PACG and POAG eyes with similar visual field damages have comparable structural damage patterns in the peripapillary and inner macular thickness and vessel density measurements.
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http://dx.doi.org/10.1097/IJG.0000000000002065DOI Listing
August 2022

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension.

Indian J Ophthalmol 2022 Jun;70(6):2030-2035

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

Purpose: Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN).

Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan-Meier graph was used to demonstrate the survival status of the eyes.

Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%).

Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).
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http://dx.doi.org/10.4103/ijo.IJO_2969_21DOI Listing
June 2022

The role of optical coherence tomography angiography in moderate and advanced primary open-angle glaucoma.

Int Ophthalmol 2022 May 17. Epub 2022 May 17.

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

Purpose: To evaluate the relationship between structure and function in moderate and advanced primary open-angle glaucoma (POAG) and to determine the accuracy of structure and vasculature for discriminating moderate from advanced POAG.

Methods: In this cross-sectional study, 25 eyes with moderate and 40 eyes with advanced POAG were enrolled. All eyes underwent measurement of the thickness of circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (GCC), and optical coherence tomography angiography (OCTA) of the optic nerve head (ONH) and macula. Visual field (VF) was evaluated by Swedish interactive threshold algorithm and 24-2 and 10-2 patterns. The correlation between structure and vasculature and the mean deviation (MD) of the VFs was evaluated by a partial correlation coefficient. The area under the receiver operating characteristic curve (AUC) was applied for assessing the power of variables for discrimination moderate from advanced POAG.

Results: Including all eyes, whole image vessel density (wiVD) of the ONH area, and vessel density (VD) in the inferior quadrant of perifovea were the parameters with significant correlation with the mean deviation (MD) of the VF 24-2 in OCTA of the ONH and macula (r = .649 and .397; p < .05). The greatest AUCs for discriminating moderate and advanced POAG belonged to VD of the inferior hemifield of ONH area (.886; 95% CI (.805, .967)), and VD in the inferior quadrant of perifovea (.833; 95% CI (.736, .930)) without statistically significant difference (.886 Versus .833; p = .601).

Conclusion: Among vascular parameters of the ONH area, wiVD had the strongest correlation with the MD of the VF 24-2 while VD of the inferior hemifield of the ONH area had the greatest AUC for discriminating moderate and advanced POAG. Vessel density in the inferior quadrant of perifovea had a significant correlation with the MD of VF 24-2 and also the greatest AUC for discriminating moderate and advanced POAG.
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http://dx.doi.org/10.1007/s10792-022-02360-zDOI Listing
May 2022

Reply to Comment on: "Evaluation of Anterior Segment Parameters in Pseudoexfoliation Disease Using Anterior Segment Optical Coherence Tomography".

Am J Ophthalmol 2022 06 2;238:198. Epub 2022 Feb 2.

Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, USA.

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http://dx.doi.org/10.1016/j.ajo.2022.01.021DOI Listing
June 2022

Intraocular pressure trend following myopic photorefractive keratectomy.

Int Ophthalmol 2022 Aug 21;42(8):2313-2321. Epub 2022 Jan 21.

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

Purpose: To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK).

Patients And Methods: One eye of each patient undergone PRK for myopia was randomly assigned to this study. All eyes underwent tonometry by CorVis Scheimpflug Technology (CST) tonometer (Oculus Optikgeräte GmbH, Wetzlar, Germany) 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months after surgery. The eyes with IOP rise more than 5 mmHg and the risk factors were evaluated by Kaplan-Meier graph and multiple Cox regression analysis.

Results: A total of 348 eyes of 348 patients were enrolled in this study. Forty-three eyes (12.35%) experienced a steroid-induced IOP rise of more than 5 mmHg. Eyes with IOP rise had higher baseline IOP (Median 19 mmHg (IQR 18-22) versus Median 15 mmHg (IQR 14-16); p < 0.001). Baseline central corneal thickness (CCT) was higher in eyes without IOP rise (Median 520 µm (IQR 509-541) versus Median 535 µm (IQR 518-547); p = 0.009). In multivariate Cox regression analysis, higher baseline IOP was a risk factor for IOP rise (Hazard Ratio (HR) 1.59 (95% CI 1.43-1.77); p < 0.001) while higher baseline CCT was protective (HR 0.97 (95% CI 0.95-0.98); p < 0.001).

Conclusion: Eyes with higher baseline IOP and lower baseline CCT are at increased risk of IOP rise after PRK and should be monitored more frequently.
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http://dx.doi.org/10.1007/s10792-022-02228-2DOI Listing
August 2022

Evaluation of Anterior Segment Parameters in Pseudoexfoliation Disease Using Anterior Segment Optical Coherence Tomography.

Am J Ophthalmol 2022 02 28;234:199-204. Epub 2021 Jul 28.

From the Farabi Eye Hospital (M.M., M.J., Y.E., S.M., R.Z., G.F., M.S.), Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Purpose: To compare anterior segment and angle parameters between pseudoexfoliation syndrome (PEX) and PEX glaucoma (PEXG) and normal control subjects using anterior segment optical coherence tomography (AS-OCT) imaging.

Design: Cross-sectional study.

Methods: One hundred and two subjects with PEXG, PEX, and normal eyes as the control group were recruited from an academic referral institution. All subjects underwent a complete ophthalmologic examination, axial length measurement, and AS-OCT imaging. Anterior segment and angle parameters were evaluated.

Results: After excluding 4 eyes because of poor imaging of the scleral spur, data from 34 eyes with PEXG, 33 eyes with PEX, and 31 eyes of normal control subjects were analyzed. Anterior chamber depth was significantly shallower in eyes with PEXG compared with eyes of control subjects (P < .001). The differences in anterior chamber angle parameters (AOD500, AOD750, TISA500,and TISA750) were significant among study groups, with lower values in the PEXG group compared with the PEX and control subject groups. Lens vault (mean [mm]±SD) was higher in the PEXG (0.46 ±0.21) and PEX (0.427 +0.28) groups compared with the control group (0.305+ 0.20).

Conclusions: PEXG eyes have the narrowest anterior chamber angle parameters. There is a progressive decrease in angle parameters from control subjects to the PEX group to the PEXG group. Narrow anterior chamber angle and anterior chamber depth may have a role in the progression of PEX to PEXG. Detection of narrow angle in these patients may help clinicians manage the disease more properly.
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http://dx.doi.org/10.1016/j.ajo.2021.07.025DOI Listing
February 2022

Comparison between sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant.

Int Ophthalmol 2021 May 21;41(5):1875-1881. Epub 2021 Feb 21.

Glaucoma Service, Farabi Eye Hospital, Tehran, Iran.

Purpose: To compare sutureless scleral tunnel phacotrabeculectomy with and without placement of anterior capsule remnant in the tunnel.

Methods: In this comparative interventional case series, 41 eyes of 40 patients having open-angle glaucoma (OAG) underwent sutureless scleral tunnel phacotrabeculectomy (Group A) and 28 eyes of 24 patients underwent the same procedure with placement of anterior capsule remnant in the tunnel (Group B). Baseline intraocular pressure (IOP) and IOP at 1 day, 1 month and 6 months after surgery were recorded. IOP < 21 mmHg and 20% reduction in IOP from baseline without and with antiglaucoma medication(s) were considered as complete and qualified success, respectively. Any further procedures or complications that require returning the patient to the operating room or becoming no light perception (NLP) were defined as failure.

Results: Mean preoperative IOP was 26.6 ± 10.08 and 26.64 ± 6.31 mmHg in group A and B, respectively (P-value = 0.984). Mean IOP at 1 month was significantly lower in group B (14.24 ± 4.4 versus. 12.07 ± 3.1, P = 0.027) but at 6 months there was no significant difference between groups (14.38 ± 3.56 versus. 14.8 ± 1.85, P = 0.590). The qualified success rate in group B was higher than group A (78.6 versus. 58.5%) at month 1, while the complete success rate was higher in group A than B (34.1% versus. 17.9%). Neither of any group had complete success at month 6. The qualified success rate was 94.7% and 100% in group A and B, respectively, at 6 months.

Conclusion: Placement of anterior capsule remnant in the ostomy during combined phacotrabeculectomy may improve the outcome of the procedure.
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http://dx.doi.org/10.1007/s10792-021-01749-6DOI Listing
May 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

Peripapillary Retinal Nerve Fiber Layer Thickness in Normal Iranian Children Measured with Optical Coherence Tomography.

J Ophthalmic Vis Res 2018 Oct-Dec;13(4):453-457

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

Purpose: This study aimed to measure the peripapillary retinal nerve fiber layer (RNFL) thickness using spectral-domain optical coherence tomography (SD-OCT) in normal Iranian children aged below 18 years.

Methods: Peripapillary RNFL imaging was performed in the right eye of normal Iranian children aged below 18 years using Spectralis SD-OCT (Heidelberg Engineering; Vista, CA). The effects of age, gender, cup-to-disc ratio, and spherical equivalent (SE) on global and sectoral RNFL thicknesses were evaluated.

Results: A total of 115 eyes were imaged. Approximately 51 (44.3%) of the cases were female children. The mean age was 12.44 ± 2.52 years. The SE of refractive error was 0.39 ± 1.38 diopters (range: -3.00 to +4.5 D). The RNFL thickness measurements in the superior, inferior, nasal, and temporal quadrants were 129.25 ± 14.52, 128.16 ± 13.46, 76.76 ± 10.58, and 69.58 ± 9.94 μm, respectively. The global RNFL thickness was 101.01 ± 7.74 μm. In both univariate and multiple regression analyses, SE was the only determinant of RNFL thickness (all values < 0.05).

Conclusion: OCT analysis can effectively measure RNFL thickness in children, and SE is the only determinant of RNFL thickness in normal Iranian patients aged below 18 years.
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http://dx.doi.org/10.4103/jovr.jovr_186_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210867PMC
November 2018

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

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

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

Comparison of surgically induced astigmatism between horizontal and X-pattern sutures in the scleral tunnel incisions for manual small incision cataract surgery.

Indian J Ophthalmol 2015 Jul;63(7):606-10

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

Background: Two types of popular scleral tunnel sutures in the manual small incision cataract surgery (MSICS) are horizontal and X-pattern sutures. Surgically induced corneal astigmatism (SIA) is a useful indicator of the suturing effect.

Aims: To compare SIA between horizontal and X-pattern sutures in the scleral tunnel incisions for MSICS.

Design: Prospective, nonrandomized comparative trial.

Materials And Methods: After superior scleral tunnel incision and capsulorhexis, the nucleus was prolapsed into the anterior chamber and delivered. The wound was sutured with either horizontal or X-pattern suture. The simulated keratometry values were derived from the corneal topography preoperatively and 1.5 and 3 months postoperatively.

Statistical Analysis: The SIA was calculated by Cartesian coordinates based analysis.

Results: Sixty-four patients (32 patients in each group) were included in the study. In the horizontal suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.87 × 1° and 1.11 × 180°, respectively, showing induction of against-the-rule astigmatism. In the X-pattern suture group, the SIA centroid values at 1.5 and 3 months after the surgery were 0.61 × 97° and 0.66 × 92°, respectively, showing induction of mild with-the-rule astigmatism. The difference between the amount of SIA at 1.5 and 3 months after surgery was small.

Conclusion: In the MSICS, the X-pattern sutures were preferred to the horizontal sutures in the patients without significant preoperative steepening in line with the central meridian of the incision. In the cases with significant preoperative steepening, sutureless surgery or horizontal sutures were preferred. Corneal astigmatism in the patients undergoing MSICS was stable at 1.5 months after the surgery.
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http://dx.doi.org/10.4103/0301-4738.167113DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4652252PMC
July 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

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

Cataract surgery in eyes with filtered primary angle closure glaucoma.

J Ophthalmic Vis Res 2013 Jan;8(1):32-8

Farabi Eye Research Center, Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran ; Division of Glaucoma, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA.

Purpose: To evaluate the effect of cataract surgery on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG).

Methods: In this prospective interventional case series, 37 previously filtered eyes from 37 PACG patients with mean age of 62.1±10.4 years were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 12 months after trabeculectomy. Visual acuity, IOP and the number of glaucoma medications were recorded preoperatively, and 1, 3, 6 and 12 months after surgery. Anterior chamber (AC) depth was measured preoperatively and 3 months after cataract surgery with A-scan ultrasonography. The main outcome measure was IOP at 12 months.

Results: IOP was decreased significantly from 18.16±5.91 mmHg at baseline to 15.37±2.90 mmHg at final follow-up (P<0.01). The mean number of glaucoma medications was significantly decreased from 1.81±0.24 to 0.86±1.00 (P=0.001) at 1 year postoperatively. At final follow up, 36 (97.2%) eyes and 32 (86.4%) eyes had IOP≤21 and IOP≤18 mmHg, respectively; 14 (37.8%) eyes and 9 (24.3%) eyes had IOP≤21 and IOP≤18 mmHg without medications, respectively. The magnitude of IOP reduction was correlated with higher preoperative IOP (r=0.85, P<0.001), shallower preoperative AC depth (r=-0.38, P=0.01) and greater changes in AC depth (r=-0.39, P=0.01).

Conclusion: Cataract surgery reduces IOP and the number of glaucoma medications in previously filtered PACG eyes. This reduction seems to be greater in patients with higher preoperative IOP and shallower anterior chambers.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691976PMC
January 2013

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

Early-onset Pseudoexfoliation Syndrome following Multiple Intraocular Procedures.

J Ophthalmic Vis Res 2012 Jul;7(3):190-6

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

Purpose: To present early-onset ocular manifestations of pseudoexfoliation syndrome in young patients who had undergone multiple intraocular procedures.

Methods: This is an observational case series, introducing four cases with histories of multiple intraocular procedures for glaucoma.

Results: All reported cases demonstrated typical manifestations of pseudoexfoliation unilaterally in the eye that had undergone multiple surgeries. The diagnosis of pseudoexfoliation was made prior to the age of 50 in all subjects and the earliest manifestation was at the age of 18 in a case with primary congenital glaucoma

Conclusion: The role of multiple surgical procedures, in addition to genetic predisposition, should be further investigated as a possible inciting factor predisposing to pseudoexfoliation in younger individuals.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520586PMC
July 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
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