Publications by authors named "Zahra Ashena"

16 Publications

  • Page 1 of 1

Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty.

Ther Adv Ophthalmol 2021 Jan-Dec;13:25158414211027705. Epub 2021 Jul 6.

Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK.

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet's Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.
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http://dx.doi.org/10.1177/25158414211027705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264843PMC
July 2021

Recurring themes during cataract assessment and surgery.

Eye (Lond) 2021 09 29;35(9):2482-2498. Epub 2021 Apr 29.

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK.

The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes.
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http://dx.doi.org/10.1038/s41433-021-01548-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376990PMC
September 2021

Re-Endothelialization of Bare Stroma after Descemet's Detachment due to Macroperforation during Deep Anterior Lamellar Keratoplasty.

J Curr Ophthalmol 2020 Oct-Dec;32(4):423-426. Epub 2020 Dec 12.

Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.

Purpose: To report a case with spontaneous re-endothelialization of bare stroma after subtotal detachment of Descemet's membrane (DM) due to macroperforation during deep anterior lamellar keratoplasty (DALK).

Methods: Case report.

Results: A 64-year-old patient underwent DALK for deep stromal scarring secondary to herpetic keratitis. During manual dissection, DM macroperforation occurred, and this was successfully managed intraoperatively and postoperatively. The DM with host posterior stroma remained attached for 10 months when it detached from the bare donor stroma. The cornea remained clear, with uncorrected distance visual acuity (UCVA) of 0.17 logMAR. After graft suture removal 30 months later, he was noted to have regular astigmatism and cataract for which he underwent phacoemulsification with toric intraocular lens implantation. Twenty-four months following his cataract surgery and 58 months following his DALK, his UCVA remains 0.17 logMAR and the cornea remains clear with no evidence of edema. His average specular count at 58 months was 1296 cell/mm .

Conclusion: This case shows a very good visual outcome with clear cornea at 58 months despite of large DM detachment which happened 10 months following manual DALK with intraoperative macroperforation.
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http://dx.doi.org/10.4103/JOCO.JOCO_79_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861102PMC
December 2020

Scanning Electron Microscopic of Intraocular Lens Pits after Nd:YAG Capsulotomy.

Ophthalmology 2020 11;127(11):1538

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, United Kingdom.

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http://dx.doi.org/10.1016/j.ophtha.2020.07.002DOI Listing
November 2020

Comparison of intraocular lens calculation methods after myopic laser-assisted in situ keratomileusis and radial keratotomy without prior refractive data.

Br J Ophthalmol 2020 Oct 22. Epub 2020 Oct 22.

Sussex Eye Hospital, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK

Aim: To compare intraocular lens (IOL) calculation methods not requiring refraction data prior to myopic laser-assisted in situ keratomileusis (LASIK) and radial keratotomy (RK).

Methods: In post-LASIK eyes, the methods not requiring prior refraction data were Hagis-L; Shammas; Barrett True-K no-history; Wang-Koch-Maloney; 'average', 'minimum' and 'maximum' IOL power on the American Society of Cataract and Refractive Surgeons (ASCRS) IOL calculator. Double-K method and Barrett True-K no-history, 'average', 'minimum' and 'maximum' IOL power on ASCRS IOL calculator were evaluated in post-RK eyes. The predicted IOL power was calculated with each method using the manifest postoperative refraction. Arithmetic and absolute IOL prediction errors (PE) (implanted-predicted IOL powers), variances in arithmetic IOL PE and percentage of eyes within ±0.50 and ±1.00 D of refractive PE were calculated.

Results: Arithmetic or absolute IOL PE were not significantly different between the methods in post-LASIK and post-RK eyes. In post-LASIK eyes, 'average' showed the highest and 'minimum' showed the least variance, whereas 'average' and 'minimum' had highest percentage of eyes within ±0.5 D and 'minimum' had the highest percentage of eyes within ±1.0 D. In the post-RK eyes, 'minimum' had highest variance, and 'average' had the least variance and highest percentage of eyes within ±0.5 D and ±1.0 D.

Conclusion: In post-LASIK and post-RK eyes, there are no significant differences in IOL PE between the methods not requiring prior refraction data. 'Minimum' showed least variance in PEs and more chances of eyes to be within ±1.0 D postoperatively in post-LASIK eyes. 'Average' had least variance and more chance of eyes within ±1.0 D in post-RK eyes.
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http://dx.doi.org/10.1136/bjophthalmol-2020-317681DOI Listing
October 2020

Reply.

J Cataract Refract Surg 2020 10;46(10):1448-1450

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http://dx.doi.org/10.1097/j.jcrs.0000000000000383DOI Listing
October 2020

Autoimmune Dry Eye without Significant Ocular Surface Co-Morbidities and Mental Health.

Vision (Basel) 2020 Oct 10;4(4). Epub 2020 Oct 10.

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK.

Dry eye symptoms can negatively affect the psychological, physical, and social functioning, which can potentially impair the health-related quality of life. This review evaluated the association between autoimmune related dry eye in the absence of significant ocular surface co-morbidities and mental health. This review found a significantly higher prevalence of mental health disorders (such as depression and anxiety) in systemic lupus erythematous, rheumatoid arthritis, systemic sclerosis, Behcet's disease, and primary Sjogren's syndrome patients when compared to the general population. Moreover, patients with depression and anxiety interpret ocular sensations differently than healthy controls and the perception of dry eye symptoms can be influenced by their mood. Somatization is common in depression, and this could influence the perception of ocular discomfort. Anti-depressants and anxiolytics with their potential side effects on the tear film status may also contribute or aggravate the dry eye symptoms in these patients. Although ophthalmologists manage the dry eye disease, as per standardized algorithms, they should be mindful of different ocular sensation interpretation and coexistent mental health issues in a large number of this patient group and initiate a multidisciplinary management plan in certain cases. While rheumatologists look after their autoimmune condition, it may be worth liaising with GP and/or psychiatrist colleagues in order to address their neuropathic type pain and mental health co-morbidities.
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http://dx.doi.org/10.3390/vision4040043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711510PMC
October 2020

Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations.

Vision (Basel) 2020 Sep 14;4(3). Epub 2020 Sep 14.

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK.

Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2-3° tilt and a 0.2-0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients' satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt.
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http://dx.doi.org/10.3390/vision4030041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559075PMC
September 2020

Comparison of Optical Low-Coherence Reflectometry and Swept-Source OCT-Based Biometry Devices in Dense Cataracts.

J Refract Surg 2020 Aug;36(8):557-564

Purpose: To investigate agreement between biometric measurements obtained from the Lenstar LS 900 (Haag-Streit AG) based on optical low-coherence reflectometry (OLCR) and the Tomey OA-2000 (Tomey Corporation) based on swept-source optical coherence tomography (SS-OCT) in dense cataracts.

Methods: In this prospective observational study, axial length, keratometry, anterior chamber depth (ACD), lens thickness, and central corneal thickness (CCT) were measured in 124 eyes of 76 patients. Intraocular lens prediction errors and absolute prediction errors were assessed based on postoperative manifest refraction. Analyses used were paired t test, Pearson correlation coefficient (r), and Bland-Altman plots.

Results: Failure in axial length measurements was noted in 28 eyes (22.58%) with OCLR compared to 2 eyes (1.6%) with SS-OCT. Although not statistically significant, axial length measurements were clinically higher with SS-OCT (23.78 ± 1.76 mm) compared to OCLR (23.72 ± 1.58 mm) (P = .81) (r = 0.23; P = .01). There was a significant trend toward myopic intraocular lens prediction with SS-OCT (-0.09 ± 0.48) compared to OLCR (0.09 ± 0.41, P < .01) (r = 0.25, P = .01). There was good agreement for keratometric and ACD values between the two devices. SS-OCT gave significantly higher values of lens thickness compared to OCLR (4.44 ± 0.44 vs 4.18 ± 0.48 mm, P < .01) (r = 0.39, P < .01). CCT measured with OCLR was significantly higher than SS-OCT (525.64 ± 27.0 vs 513.21 ± 29.24 µm; P < .01) (r = 0.98, P < .01).

Conclusions: One-fifth of the patients with dense cataracts failed axial length measurement on OCLR. SS-OCT gives clinically higher axial length measurements leading to more myopic intraocular lens prediction errors postoperatively. OCLR provides higher pachymetry and lower lens thickness values compared to the SS-OCT device. [J Refract Surg. 2020;36(8):557-564.].
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http://dx.doi.org/10.3928/1081597X-20200612-03DOI Listing
August 2020

Aerosol generation through phacoemulsification.

J Cataract Refract Surg 2020 09;46(9):1290-1296

From the Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust (Lee, Naveed, Ashena, Nanavaty), and Brighton & Sussex Medical School, University of Sussex (Naveed, Nanavaty), Brighton, United Kingdom.

Purpose: To evaluate whether phacoemulsification is an aerosol-generating procedure in an ex vivo experimental model.

Setting: Sussex Eye Hospital, Brighton, United Kingdom.

Design: Experimental study.

Methods: In this ex vivo study on 15 porcine eyes, an optical particle counter was used to measure particles of 10 µm and less using the cumulative mode based on the 6 in-built channel sizes. The 2 parts of the study were to: (1) assess the efficacy of the particle counter in the theater environment where there are dynamic changes in temperature and humidity; and (2) to measure aerosol generation with 3 phacoemulsification settings: (i) continuous power with 80% longitudinal (5 eyes); (ii) continuous power with 100% torsional (5 eyes); and (iii) continuous power with 80% longitudinal with application of hydroxypropyl methylcellulose (HPMC) on the ocular surface (5 eyes). Five measurements were taken prephacoemulsification and 5 during phacoemulsification per eye therefore totaling 75 measurements.

Results: Maximum aerosols were captured when the counter faced the aerosol source. There was no significant difference in aerosol generation of all sizes during each phacoemulsification setting with torsional, longitudinal, and longitudinal with HPMC (P > .01). Combining data of all 3 phacoemulsification settings (150 measurements from 15 eyes), there was no significant difference comparing prephacoemulsification and during phacoemulsification for aerosols of 5 µm or less (1455 vs 1363.85, P = .60), more than 5 to 10 μm (1.5 vs 1.03, P = .43), and of 10 µm or less (1209 vs 1131.55, P = .60).

Conclusions: Phacoemulsification did not generate aerosols of 10 μm or less with continuous power using 80% longitudinal, 100% torsional, and 80% longitudinal setting with HPMC on the surface.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000288DOI Listing
September 2020

'Face down' anterior vitrectomy for unexpected posterior capsule rupture as an alternative to pars plana vitrectomy.

Eye (Lond) 2021 05 28;35(5):1515-1517. Epub 2020 May 28.

Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BF, UK.

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http://dx.doi.org/10.1038/s41433-020-0985-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182825PMC
May 2021

Refractive lens exchange with a trifocal intraocular lens in Fuchs endothelial dystrophy.

J Cataract Refract Surg 2020 03;46(3):478-481

From the Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust (Nanavaty, Ashena), and Brighton & Sussex Medical School, University of Sussex (Nanavaty), Falmer, Brighton, United Kingdom.

A 57-year-old man with myopia presented with advanced Fuchs endothelial dystrophy, a refraction of -6.00 diopters (D) and -6.25 D, an endothelial cell count of 1100 cells/mm and 1000 cells/mm in right and left eyes, respectively, and corrected distance visual acuity of 20/30 in each eye. The patient was deemed unsuitable for excimer or femtosecond laser-based refractive surgery or refractive lens exchange (RLE) with a trifocal intraocular lens (IOL) alone because of the advanced Fuchs endothelial dystrophy and high risk of corneal decompensation and reduced optical quality postoperatively. A successful RLE with a hydrophobic trifocal IOL and Descemet membrane endothelial keratoplasty in both eyes was performed at an interval of 2 months between the eyes. At 12 months, the uncorrected distance visual acuity was 20/16 in each eye, with uncorrected near visual acuity of 20/20 for 40 to 60 cm from the face. The endothelial cell count at 12 months was 2250 cells/mm and 2120 cells/mm in right and left eyes, respectively.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000104DOI Listing
March 2020

Langerhans cell histiocytosis manifesting as recurrent simultaneous bilateral spontaneous pneumothorax in early infancy.

Pediatr Int 2007 Dec;49(6):1020-2

Department of Pediatric Hematology/Oncology, Mofid Children's Hospital, Shahid Beheshti Medical University, Tehran, Iran.

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by infiltration of either single or multiple organs by a distinct cell type that is S-100 and CD1a positive and contains ultrastructural Birbeck granules on electron microscopy. Historically, LCH included four main clinical forms: Letter-Siwe disease, Hand-Schuller-Christian disease, eosinophilic granuloma (together grouped as histiocytosis) and Hashimoto-Pritzker disease. The writing group of the Histiocytotic Society in 1987 proposed the uniform term of 'Langerhans cell histiocytosis' to encompass all the aforementioned eponymous forms. Lung involvement occurs in up to half of all children with multisystem disease and usually parallels overall disease activity. Spontaneous pneumothorax (SP) occurs in approximately 10% of children with pulmonary disease and may be a fatal complication. Patients with pulmonary LCH are likely predisposed to the development of pneumothorax based on destructive changes in the lung parenchyma. Here, we report a case of multisystem LCH in which the patient presented at 2 months of age because of simultaneous bilateral pneumothorax.
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http://dx.doi.org/10.1111/j.1442-200X.2007.02460.xDOI Listing
December 2007

Nail involvement in langerhans cell histiocytosis.

Pediatr Hematol Oncol 2007 Jan-Feb;24(1):45-51

Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Nail involvement, which is distinctly uncommon in Langerhans cell histiocytosis (LCH), is characterized by various features like longitudinal grooving, purpuric striae, hyperkeratosis, subungual pustules, deformity, loss of nail plate, paronychia, onycholysis, and pitting. Here the authors report the case of a child who presented with isolated nail unit changes due to Langerhans cell histiocytosis before the evolution of systemic features. The authors suggest that LCH should be considered in differential diagnoses of nail changes that are resistant to therapy.
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http://dx.doi.org/10.1080/08880010601001362DOI Listing
December 2006

Tumor lysis syndrome in children with non-Hodgkin lymphoma.

Pediatr Hematol Oncol 2006 Jan-Feb;23(1):65-70

Department of Hematology and Oncology, Mofid Children Hospital, Shahid Beheshti Medical University, Tehran, Iran.

This study was designed to evaluate the incidence of tumor lysis syndrome (TLS) among children with non-Hodgkin lymphoma and to define whether renal involvement can be associated with higher incidence of TLS after chemotherapy. Medical charts of 59 patients were reviewed. TLS was diagnosed using laboratory and clinical criteria. Renal involvement was diagnosed based on ultrasound and CT scan findings. Laboratory TLS occurred in 7 patients (11.85%) and clinical TLS was observed in 7 patients (11.85%) as well. In 5 out of 14 TLS patients, hemodialysis was required to correct electrolyte abnormalities and TLS related death was reported overall in 3 patients. Sex, age, pretreatment LDH, and initial WBC count were not associated with higher incidence of TLS after chemotherapy, but a significant correlation was found between pretreatment renal involvement at imaging studies and development of TLS after chemotherapy (p = .027). The results indicate that despite all preventive measures, tumor lysis syndrome still occurs in children with non-Hodgkin lymphoma following chemotherapy. Patients who have evidence of renal involvement at imaging studies are more likely to develop TLS after chemotherapy.
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http://dx.doi.org/10.1080/08880010500313561DOI Listing
July 2006
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