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Moein HR, Pervez E, Faidhalla S, Habbal H, Khan H, Wadehra A, Khalid M, Kakos D, Naylor P, Mohamad B. Role of Bowel Preparation in Adenoma Detection Rate and Follow-up Recommendations in African American Dominant Patient Population. Cureus 2021; 13:e16065. [PMID: 34345550 PMCID: PMC8323744 DOI: 10.7759/cureus.16065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Bowel preparation quality in colonoscopy is one of the most essential components of quality assessment. According to the latest guidelines, inadequate bowel preparation warrants repeat colonoscopy in less than a year. Our aim was to investigate the role of bowel preparation in adenoma detection rate (ADR), its relationship with patients' demographics, and compliance with subsequent surveillance recommendations with guidelines. Methods: This is a retrospective chart review study. Bowel preparation quality was divided into three categories: high, intermediate, and low. ADR and polyp detection rates (PDR) were calculated as the number of patients with adenoma or polyp divided by the total number of patients. Results: Among 1,062 patients (934 African American and 128 non-African American) 81%, 11%, and 8% had high, intermediate, and low-quality bowel preparations, respectively. Race, gender, age, type of endoscopist, and body mass index did not play any role in bowel preparation quality. ADR and PDR were significantly higher in African Americans as compared to non-African Americans. ADR was significantly lower in the low-quality as compared to the high- and intermediate-quality bowel preparations (OR=2.13; p=0.0032). Bowel preparation quality was not correlated with subsequent follow-up recommendations. Academic gastroenterologists and surgeons had the highest and lowest compliance with surveillance guidelines, respectively. Conclusions: Racial and gender disparity appears to have no meaningful effect on the quality of bowel preparation. Only two categories (adequate [high/intermediate] or inadequate [low-quality]) may be used for follow-up recommendations. Non-compliance with surveillance guidelines is concerning and may inadvertently increase the interval risk of colorectal cancer.
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Affiliation(s)
- Hamid-Reza Moein
- Internal Medicine, Sinai-Grace Hospital/Detroit Medical Center, Detroit, USA
| | - Eskara Pervez
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Salina Faidhalla
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Heba Habbal
- Internal Medicine, Beaumont Hospital, Dearborn, USA
| | - Hajra Khan
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Anshu Wadehra
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Mahvish Khalid
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Diana Kakos
- Internal Medicine, Wayne State University School of Medicine, Bloomfield Hills, USA
| | - Paul Naylor
- Gastroenterology, Wayne State University School of Medicine, Detroit, USA
| | - Bashar Mohamad
- Gastroenterology and Hepatology, Wayne State University, Detroit, USA
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Abstract
Ipilimumab and nivolumab are immune checkpoint inhibitors that have recently been used in the treatment of metastatic melanoma and other cancers. Immune-mediated colitis is one of their adverse events that need to be differentiated from low-grade diarrhea as one of the most common side effects. A 51-year-old woman with relapsed metastatic melanoma presented with intractable diarrhea, nausea, vomiting, and generalized abdominal pain. The patient had been treated with ipilimumab and nivolumab in the past two months. The infectious workup was inconclusive. Colonoscopy demonstrated severe colitis, and biopsies were consistent with colitis. Combination chemotherapy was stopped. The patient was treated with intravenous and oral steroids, and her symptoms improved. A combination of ipilimumab and nivolumab increases the chance of immune-mediated colitis, and steroids should be started promptly to avoid complications such as bowel perforation and toxic megacolon.
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Affiliation(s)
- Hamid-Reza Moein
- Internal Medicine, Sinai-Grace Hospital/Detroit Medical Center, Wayne State University School of Medicine, Detroit, USA
| | - Brian Rutledge
- Gastroenterology, Wayne State University Detroit Medical Center, Detroit, USA
| | - Rafic Beydoun
- Pathology, Wayne State University Detroit Medical Center, Detroit, USA
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Moein HR, Sendra VG, Jamali A, Kheirkhah A, Harris DL, Hamrah P. Herpes simplex virus-1 KOS-63 strain is virulent and causes titer-dependent corneal nerve damage and keratitis. Sci Rep 2021; 11:4267. [PMID: 33608598 PMCID: PMC7895966 DOI: 10.1038/s41598-021-83412-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/27/2021] [Indexed: 01/31/2023] Open
Abstract
To investigate the acute clinical, immunological, and corneal nerve changes following corneal HSV-1 KOS-63 strain inoculation. Corneas of C57BL/6 mice were inoculated with either low dose (Ld) or high dose (Hd) HSV-1 KOS-63 or culture medium. Clinical evaluation was conducted up to 7 days post inoculation (dpi). Viral titers were assessed by standard plaque assay. Excised corneas were stained for CD45 and beta-III tubulin. Corneal flow cytometry was performed to assess changes in leukocyte subpopulations. Corneal sensation was measured using a Cochet-Bonnet esthesiometer. Naïve, sham-infected (post scarification), and McKrae-infected C57BL/6 corneas served as two negative and positive controls, respectively. Compared to Ld infected mice, Hd HSV-1 KOS-63 demonstrated higher incidence of corneal opacity (1.5 ×) and neovascularization (2.6 × ; p < 0.05). At 7 dpi Hd infected mice showed more severe corneal opacity (2.23 vs. 0.87; p = 0.0003), neovascularization (6.00 vs. 0.75; p < 0.0001), and blepharitis (3.11 vs. 2.06; p = 0.001) compared to the Ld group. At 3 dpi epitheliopathy was significantly larger in the Hd group (23.59% vs. 3.44%; p = 0.001). Similarly, corneal opacity was significantly higher in Hd McKrae-infected corneas as compared with Ld McKrae-infected corneas at 3 and 5 dpi. No significant corneal opacity, neovascularization, blepharitis, and epitheliopathy were observed in naïve or sham-infected mice. Higher viral titers were detected in corneas (1 and 3 dpi) and trigeminal ganglia (TG) (3 and 5 dpi) in Hd versus Ld KOS-63 groups (p < 0.05). Leukocyte density showed a gradual increase over time from 1 to 7 dpi in both KOS-63 and McKrae-infected corneas. Corneal flow cytometric analysis (3 dpi) demonstrated a higher percentage of Gr-1 + (71.6 vs. 26.3) and CD11b + (90.6 vs. 41.1) cells in Hd versus Ld KOS-63 groups. Corneal nerve density significantly decreased in both Hd KOS-63 and Hd McKrae infected corneas in comparison with naïve and sham-infected corneas. At 3 dpi corneal nerve density was lower in the Hd versus Ld KOS-63 groups (16.79 vs. 57.41 mm/mm2; p = 0.004). Corneal sensation decreased accordingly at 5 and 7 dpi in both Ld and Hd KOS-63-infected mice. Corneal inoculation with HSV-1 KOS-63 strain shows acute keratitis and nerve degeneration in a dose-dependent fashion, demonstrating virulence of this strain.
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Affiliation(s)
- Hamid-Reza Moein
- grid.67033.310000 0000 8934 4045Department of Ophthalmology, Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111 USA ,grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Victor G. Sendra
- grid.67033.310000 0000 8934 4045Department of Ophthalmology, Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111 USA ,grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Arsia Jamali
- grid.67033.310000 0000 8934 4045Department of Ophthalmology, Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111 USA ,grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Ahmad Kheirkhah
- grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Deshea L. Harris
- grid.67033.310000 0000 8934 4045Department of Ophthalmology, Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111 USA ,grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA
| | - Pedram Hamrah
- grid.67033.310000 0000 8934 4045Department of Ophthalmology, Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA 02111 USA ,grid.38142.3c000000041936754XDepartment of Ophthalmology, Schepens Eye Research Institute/Massachusetts Eye and Ear, Harvard Medical School, Boston, MA USA ,grid.67033.310000 0000 8934 4045Cornea Service, New England Eye Center, Tufts Medical Center, Tufts University School of Medicine, Boston, MA USA
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Wadehra A, Moein HR, Kakos D, Pervez E, Faidhalla S, Habbal H, Khan H, Khalid M, Naylor P, Mohamad B. Evaluating the Improvement in Colonoscopy Quality Indicators Subsequent to Publication of Professional Society Guidelines. Cureus 2021; 13:e13040. [PMID: 33680586 PMCID: PMC7925056 DOI: 10.7759/cureus.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction Quality metrics of colonoscopy should be routinely monitored with a focus on optimizing the patient’s subsequent risk of colorectal cancer development. Documentation of bowel preparation, adenoma detection rate (ADR), and post-colonoscopy follow-up recommendations are three of the most important quality indicators for colonoscopy, but significant improvement has been challenging to achieve. The goal of this study is to determine whether the publication of colonoscopy quality indicator guidelines in 2015 resulted in an improvement in quality measures of physicians in our endoscopy suite as compared to before. Methods We reviewed the electronic medical records of patients who underwent a screening or surveillance colonoscopy in 2014 and 2017. Colonoscopies were performed in an open-access medical center endoscopy suite, staffed by three groups of physicians (academic gastroenterologists (AGs), non-academic gastroenterologists (non-AGs), and surgeons). We gathered demographic data, bowel preparation reports, follow-up recommendations, and notice to patient’s primary care physician, and calculated ADR for patients. Age- and gender-matched patients in both years were analyzed for ADR. These data were further subcategorized for each group of physicians. Results There were 553 patients in 2014 and 1,095 in 2017. Overall, male gender and African American race constituted the majority of patients in both years. Among age- and gender-matched patients in 2014 and 2017 (412 and 243 patients, respectively), ADR within each group of endoscopists was not significantly different between these two years (AGs 44% vs. 50%; non-AGs 32% vs. 27%; surgeons 25% vs. 21%; p>0.05 for all). However, in 2014 and 2017, ADR was significantly higher in the AG group as compared to the non-AG group and surgeons (p<0.006 and p<0.0004, respectively). Reporting of bowel preparation quality (82% vs. 87%) and documenting the recommended period for follow-up surveillance colonoscopy in the report (68% vs. 78%) improved between 2014 and 2017 (p=0.002 and p=0.0001, respectively). Correct recommendations for follow-up surveillance colonoscopy only improved significantly in the AG group (74% in 2014 as compared with 82% in 2017, p=0.003). Conclusion Based on the current guidelines, AG physicians are far exceeding the target ADR goals, and are superior compared to other groups of endoscopists. Although improvements were noted after guideline publications, areas of needed improvement with respect to meeting gastroenterology society guidelines for quality remained. The fact that individual physicians are performing and billing in an endoscopy suite staffed and equipped by a medical center creates an environment where responsibility for improvement in quality cannot be readily assigned.
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Affiliation(s)
- Anshu Wadehra
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Hamid-Reza Moein
- Internal Medicine, Sinai-Grace Hospital/Detroit Medical Center, Detroit, USA
| | - Diana Kakos
- Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Eskara Pervez
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Salina Faidhalla
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Heba Habbal
- Internal Medicine, Beaumont Hospital, Dearborn, USA
| | - Hajra Khan
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Mahvish Khalid
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
| | - Paul Naylor
- Gastroenterology, Wayne State University, Detroit, USA
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Moein HR, Akhlaq A, Dieckmann G, Abbouda A, Pondelis N, Salem Z, Müller RT, Cruzat A, Cavalcanti BM, Jamali A, Hamrah P. Visualization of microneuromas by using in vivo confocal microscopy: An objective biomarker for the diagnosis of neuropathic corneal pain? Ocul Surf 2020; 18:651-656. [PMID: 32663518 DOI: 10.1016/j.jtos.2020.07.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate it from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivo confocal microscopy (IVCM). METHODS This was a comparative, retrospective, case-control study. Patients with clinical diagnosis of NCP (n = 25), DED (n = 30), and age- and sex-matched healthy controls (n = 16), who underwent corneal imaging with IVCM (HRT3/RCM) were included. Central corneal IVCM scans were analyzed by 2 masked observers for nerve density and number, presence of microneuromas (terminal enlargements of subbasal corneal nerve) and/or nerve beading (bead-like formation along the nerves), and dendritiform cell (DC) density. RESULTS There was a decrease in total nerve density in both NCP (14.14 ± 1.03 mm/mm2) and DED patients (12.86 ± 1.04 mm/mm2), as compared to normal controls (23.90 ± 0.92 mm/mm2; p < 0.001). However, total nerve density was not statistically different between NCP and DED patients (p = 0.63). Presence of nerve beading was not significantly different between patients and normal controls (p = 0.15). Interestingly, microneuromas were observed in all patients with NCP, while they were not present in any of the patients with conventional DED (sensitivity and specificity of 100%). DC density was significantly increased in both NCP (71.89 ± 16.91 cells/mm2) and DED patients (111.5 ± 23.86 cells/mm2), as compared to normal controls (24.81 ± 4.48 cells/mm2 (p < 0.05). However, there was no significant difference in DC density between DED and NCP patients (p = 0.31). CONCLUSION IVCM may be used as an adjunct diagnostic tool for the diagnosis of NCP in the presence of neuropathic symptoms. Microneuromas may serve as a sensitive and specific biomarker for the diagnosis of NCP.
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Affiliation(s)
- Hamid-Reza Moein
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Anam Akhlaq
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Gabriela Dieckmann
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Alessandro Abbouda
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Zeina Salem
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Rodrigo T Müller
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Andrea Cruzat
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Bernardo M Cavalcanti
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Arsia Jamali
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Pedram Hamrah
- Center for Translational Ocular Immunology and, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Moein HR, Bierman LW, Novais EA, Moreira-Neto C, Baumal CR, Rogers A, Duker JS, Witkin AJ. Short-term eplerenone for treatment of chronic central serous chorioretinopathy; a prospective study. Int J Retina Vitreous 2019; 5:39. [PMID: 31516734 PMCID: PMC6734298 DOI: 10.1186/s40942-019-0190-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/28/2019] [Indexed: 12/18/2022] Open
Abstract
Background Increased mineralocorticoid activity is one of the plausible causes of chronic central serous chorioretinopathy (CSCR) and mineralocorticoid inhibitors such as eplerenone have been investigated as its potential therapy. This study investigates the short-term safety and efficacy of oral eplerenone in patients with chronic CSCR. Patients and methods Prospective study of 13 eyes of 13 patients with the diagnosis of chronic CSCR. All patients received eplerenone 50 mg/day for 4 weeks. Enhanced depth imaging optical coherence tomography (OCT) was obtained. Best corrected visual acuity (BCVA), and OCT parameters including sub retinal fluid (SRF), choroidal thickness (CT) and central macular thickness (CMT), were measured manually. Results The mean SRF height decreased slightly at 1-month follow-up as compared to baseline, but the change was not statistically significant (94.18 ± 17.53 vs. 113.15 ± 18.69; p = 0.08). Subfoveal CT and CMT was significantly reduced as compared to baseline (6.6% [p = 0.002] and 7.05% [p = 0.04], respectively). The BCVA did not change significantly (20/28 vs. 20/30 [p = 0.16]). Conclusion This study suggests that oral eplerenone may be used as a safe and potentially effective treatment in chronic CSCR, however there are minimal short-term effects on subretinal fluid or visual acuity therefore therapeutic trials longer than one month are necessary to test its benefits.Trial registration Clinicaltrials.gov identification number: NCT01822561. Registered 3/25/13, https://clinicaltrials.gov/ct2/show/study/NCT01822561.
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Affiliation(s)
- Hamid-Reza Moein
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Lauren W Bierman
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Eduardo A Novais
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,2School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Carlos Moreira-Neto
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA.,Hospital de Olhos do Parana, Curitiba, Brazil
| | - Caroline R Baumal
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Adam Rogers
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - Jay S Duker
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
| | - André J Witkin
- 1New England Eye Center, Tufts Medical Center, 800 Washington Street, Box 450, Boston, MA 02111 USA
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Moein HR, Saeed HN, Jacobs DS, Rapoport Y, Yoon MK, Shah AS, Khan H, Raoof D, Jurkunas UV. Exposure, entropion, and bilateral corneal ulceration in a newborn as a manifestation of chromosome 22 q11.2 duplication syndrome. Am J Ophthalmol Case Rep 2019; 13:16-19. [PMID: 30505980 PMCID: PMC6247406 DOI: 10.1016/j.ajoc.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 01/24/2023] Open
Abstract
Purpose Chromosome 22q11.2 micro-duplication syndrome (MDS), is a rare autosomal dominant condition, with a highly variable phenotype that ranges from unremarkable and asymptomatic, to fatal due to cardiovascular defects. Hypertelorism, downslanting palpebral fissures, superior displacement of the eyebrows, and ptosis are the most commonly reported ocular manifestations. Here, we report a newborn with bilateral exposure, entropion, and corneal ulceration related to 22q11.2 MDS. Observation A newborn girl presented with bilateral upper eyelid entropion, bilateral lower eyelid ectropion, and lagophthalmos. She subsequently developed bilateral corneal ulcers. Topical antibacterial drops, bandage contact lenses, medroxyprogesterone 1%, and fluorometholone 0.1%, together with partial tarsorrhaphy and correction of eyelid malposition, were used to treat the ulcers and address the underlying issues of exposure and entropion. Genetic testing revealed chromosome 22q11.2.MDS; further evaluation revealed systemic manifestations of this syndrome. The ocular surface healed well with gradual improvement of corneal opacification as well as bilateral partial tarsorrhaphy. Conclusion and importance This report is the first that describes a newborn with 22q11.2 MDS presenting with sight-threatening corneal ulceration. Entropion, ectropion, and lagophthalmos were identified and treated, allowing for healing of the corneal surface. Genetic testing revealed a syndrome not known to be associated with eyelid abnormalities and corneal ulceration, but with other important systemic and ocular implications. Bilateral partial tarsorrhaphy should not be excluded as a treatment option for infants who fail more conservative measures for the treatment of exposure.
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Affiliation(s)
- Hamid-Reza Moein
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Deborah S Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.,BostonSight, Needham, MA, USA
| | - Yuna Rapoport
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Michael K Yoon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA
| | - Haumith Khan
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Duna Raoof
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Ula V Jurkunas
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Saber H, Moein HR, Rajamani K. Prophylactic Low-Dose Oxygen for Patients With Acute Stroke. JAMA 2018; 319:501-502. [PMID: 29411026 DOI: 10.1001/jama.2017.20342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Hamidreza Saber
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan
| | - Hamid-Reza Moein
- Department of Ophthalmology, Tufts Medical Center, Boston, Massachusetts
| | - Kumar Rajamani
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan
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Moein HR, Kheirkhah A, Muller RT, Cruzat AC, Pavan-Langston D, Hamrah P. Corneal nerve regeneration after herpes simplex keratitis: A longitudinal in vivo confocal microscopy study. Ocul Surf 2018; 16:218-225. [PMID: 29305292 DOI: 10.1016/j.jtos.2017.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/06/2017] [Accepted: 12/31/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE To evaluate the long-term alterations of corneal nerves in patients with herpes simplex virus (HSV) keratitis using in vivo confocal microscopy (IVCM). DESIGN Prospective, longitudinal, cross sectional. METHODS This study included 16 patients with a history of HSV keratitis and 15 age-matched normal controls. Slit-scanning IVCM was performed in all subjects at baseline and then after a mean follow-up of 37.3 ± 1.7 months in the patient group. Corneal subbasal nerve density and corneal sensation were compared between groups at baseline and follow-up. RESULTS At baseline, the mean subbasal nerve density was significantly lower in both affected eyes (1.4 ± 0.6 mm/mm2) and contralateral unaffected eyes (6.4 ± 0.7 mm/mm2) compared with the controls (14.1 ± 1.6 mm/mm2; all P < .001). At the end of follow-up, the mean nerve density in affected eyes increased to 2.8 ± 0.7 mm/mm2 (P = .006), with no significant change in contralateral unaffected eyes (6.5 ± 1.0 mm/mm2, P = .72). However, both eyes had lower nerve density than controls (all P < .001). Corneal sensation was significantly lower in affected eyes (2.6 ± 0.6 cm) than in the control group (6.0 ± 0.0, P < .001) and showed no significant change at the end of follow-up (2.5 ± 0.6 cm, P = .80). Corneal sensation in contralateral unaffected eyes was not different in comparison with controls at both baseline and follow up (all p > .05). CONCLUSIONS Our results demonstrate that although corneal nerve regeneration occurs in patients with HSV keratitis, this change is not clinically significant and does not results in changes of corneal sensation. Therefore, these patients need to be followed closely for complications of neurotrophic keratopathy and might benefit from neuro-regenerative therapies.
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Affiliation(s)
- Hamid-Reza Moein
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Rodrigo T Muller
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Andrea C Cruzat
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Deborah Pavan-Langston
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Pedram Hamrah
- Ocular Surface Imaging Center, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Cornea Service, New England Eye Center, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA; Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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10
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Galor A, Moein HR, Lee C, Rodriguez A, Felix ER, Sarantopoulos KD, Levitt RC. Neuropathic pain and dry eye. Ocul Surf 2018; 16:31-44. [PMID: 29031645 PMCID: PMC5756672 DOI: 10.1016/j.jtos.2017.10.001] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 09/05/2017] [Accepted: 10/07/2017] [Indexed: 02/06/2023]
Abstract
Dry eye is a common, multifactorial disease currently diagnosed by a combination of symptoms and signs. Its epidemiology and clinical presentation have many similarities with neuropathic pain outside the eye. This review highlights the similarities between dry eye and neuropathic pain, focusing on clinical features, somatosensory function, and underlying pathophysiology. Implications of these similarities on the diagnosis and treatment of dry eye are discussed.
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Affiliation(s)
- Anat Galor
- Miami Veterans Administration Medical Center, USA; Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.
| | - Hamid-Reza Moein
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Charity Lee
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Adriana Rodriguez
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Miami Veterans Administration Medical Center, USA; Physical Medicine and Rehabilitation, University of Miami, USA
| | - Konstantinos D Sarantopoulos
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Roy C Levitt
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA; John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
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11
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Tighe S, Moein HR, Chua L, Cheng A, Hamrah P, Tseng SCG. Topical Cryopreserved Amniotic Membrane and Umbilical Cord Eye Drops Promote Re-Epithelialization in a Murine Corneal Abrasion Model. Invest Ophthalmol Vis Sci 2017; 58:1586-1593. [PMID: 28288269 DOI: 10.1167/iovs.16-20834] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate morselized amniotic membrane and umbilical cord (AMUC) eye drops in promoting corneal re-epithelialization. Methods Following a 2-mm diameter central epithelial wound in one eye of 48 normal C57BL/6 mouse corneas, 10 μL of saline with (n = 24) or without (n = 24) AMUC was applied three times a day for 6 days. The corneal epithelial defect was measured using 0.1% fluorescein, while corneal epithelial regularity was measured by assessment of a reflected light off the corneal surface. Hematoxylin and eosin and immunohistochemistry was performed for Ki-67, CD45, βIII-tubulin, and keratin12. Safety and toxicity were also assessed by monitoring physical activity and body weight. Results Compared with the vehicle saline control, AMUC resulted in a significantly smaller corneal epithelial defect at 12 hours (P = 0.002), 1 day (P = 0.016), and 2 days (P = 0.04) post abrasion. Amniotic membrane and umbilical cord also achieved a more rapid complete epithelialization (3.15 ± 1.44 vs. 4.00 ± 1.63 days, P = 0.06) and induced a higher incidence of corneal regularity without affecting physical activity and body weight. Spearman correlation showed that epithelialization was significantly correlated with treatment groups (P < 0.001), time (P < 0.001), and corneal regularity (P = 0.04). Amniotic membrane and umbilical cord significantly decreased CD45+ cell infiltration in the peripheral cornea (P < 0.05) and promoted Ki-67+ cells in the central corneal epithelium (P < 0.05). Conclusion Topical AMUC significantly promotes corneal epithelialization and restores corneal regularity by reducing inflammation and promoting proliferation in a murine model of corneal abrasion without causing safety or toxicity concerns. This encouraging preclinical finding warrants a controlled human trial in the future.
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Affiliation(s)
- Sean Tighe
- TissueTech, Inc., Miami, Florida, United States 2Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States
| | - Hamid-Reza Moein
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | | | - Anny Cheng
- TissueTech, Inc., Miami, Florida, United States 2Florida International University, Herbert Wertheim College of Medicine, Miami, Florida, United States 4Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida, United States
| | - Pedram Hamrah
- Center for Translational Ocular Immunology, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States
| | - Scheffer C G Tseng
- TissueTech, Inc., Miami, Florida, United States 4Ocular Surface Center and Ocular Surface Research & Education Foundation, Miami, Florida, United States
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12
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Ziaei H, Katibeh M, Mohammadi S, Mirzaei M, Moein HR, Kheiri B, Taghaddos S, Rajavi Z. The Impact of Congenital Strabismus Surgery on Quality of Life in Children. J Ophthalmic Vis Res 2016; 11:188-92. [PMID: 27413500 PMCID: PMC4926567 DOI: 10.4103/2008-322x.183918] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To assess quality of life (QOL) in children undergoing strabismus surgery. Methods: This prospective cohort study included 87 children (including 41 boys, 47.1%) with mean age of 8.7 ± 4.1 years at three academic eye hospitals in Tehran. A modified version of the RAND Health Insurance Study QOL questionnaire was filled based on interviews with parents before and three months after surgery. The questionnaire consisted of 36 Likert scale items ranging in score from 0 to 100, with higher scores representing better function. Relevant items were averaged together and categorized into 11 distinct QOL dimensions. Results: The majority of QOL dimensions improved after strabismus surgery including functional limitation (92.36 ± 16.78 vs. 82.15 ± 20.92, P < 0.01), anxiety (68.61 ± 18.15 vs. 60.28 ± 19.19, P < 0.01), depression (82.31 ± 16.42 vs. 72.36 ± 17.72, P < 0.01), positive well-being (73.33 ± 14.69 vs. 70.56 ± 15.96, 0.048), social relations (79.43 ± 11.52 vs. 68.69 ± 30.98, 0.002), general health perception (76.4 ± 16.48 vs. 67.36 ± 18.9, P < 0.01), resistance/susceptibility (79.72 ± 13.4 vs. 71.02 ± 14.58, P < 0.01), satisfaction with development (73.81 ± 16.07 vs. 70.07 ± 14.98, P = 0.006), and eye alignment concerns (75.44 ± 15.89 vs. 53.14 ± 26.61, P < 0.01). Only self-reported prior health (71.73 ± 15.9 vs. 72.78 ± 15.29, P = 0.33) and parent-child closeness (72.92 ± 15.82 vs. 72.5 ± 17.99, P = 0.73) did not significantly improve. The amount of ocular realignment (more vs. less than 20 prism diopters [PD]) had a direct correlation with improvement in subscales of satisfaction with development (0.019) and eye alignment concerns (0.028). Conclusion: Strabismus surgery positively impacts physical and psychosocial function in children. Children with a greater amount of correction experienced more QOL improvement after surgery.
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Affiliation(s)
- Hossein Ziaei
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marzieh Katibeh
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadin Mohammadi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbobeh Mirzaei
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid-Reza Moein
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shoreh Taghaddos
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zhale Rajavi
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Katibeh M, Ziaei H, Panah E, Moein HR, Hosseini S, Kalantarion M, Eskandari A, Yaseri M. Knowledge and awareness of age related eye diseases: a population-based survey. J Ophthalmic Vis Res 2014; 9:223-31. [PMID: 25279125 PMCID: PMC4181206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 04/09/2014] [Indexed: 10/31/2022] Open
Abstract
PURPOSE To determine general awareness and knowledge about cataracts, glaucoma and diabetic retinopathy (DR), as common avoidable causes of blindness in an Iranian population. METHODS This cross-sectional population-based survey was performed on residents over 45 years of age in Tehran. The sampling frame was the list of all landline phone numbers registered by the Telecommunications Center of Iran, through which systematic random sampling was performed. Data was collected by phone-call interviews and completing a semi-structured questionnaire. Awareness was defined as whether the respondent had ever heard of the disease. Knowledge was assessed by realizing different aspects of each disease. RESULTS Of a total of 1,084 eligible people including 574 (52.9%) women and 510 (47.1%) men were included and 957 subjects (response rate, 88.3%) completed the interview. Awareness regarding glaucoma, cataract and DR was 46.6% (95% confidence interval [CI]:43.4 -49.8%), 82.9% (95% CI: 80.5 -85.3%) and 86.2% (95% CI: 84-88.4%). In addition, 19.2% (95% CI: 16.7 -21.7%), 57.3% (95% CI: 54.2-60.4%) and 72% (95% CI: 69.2 -74.8%) of respondents could give at least a basic definition of the mentioned diseases, respectively. Only 22.6% (95% CI: 20-25.2%) and 41.6% (95% CI: 38.5-44.7%) realized glaucoma and DR as a treatable condition; in contrast, 77.2% (95% CI: 74.5-79.9%) categorized cataract as treatable. Only 19% and 7.1% knew that DR and glaucoma may commence without any apparent symptoms. CONCLUSION Compared with cataract and DR, most participants had limited information about glaucoma. In addition, few of the respondents were familiar with the initial symptoms of DR and glaucoma.
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Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Epidemiology and Prevention of Blindness Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Marzieh Katibeh, MD, MPH. Ophthalmic Epidemiology and Prevention of Blindness Center,
Shahid Beheshti University of Medical Sciences, No 23, Paidarfard St., Boostan 9 St., Pasdaran Ave, Tehran 16666, Iran
Tel: +98 21 2259 0707, Fax: +98 21 2277 0957; e-mail:
| | - Hossein Ziaei
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elnaz Panah
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid-Reza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Hosseini
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masumeh Kalantarion
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armen Eskandari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Yaseri
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Katibeh M, Moein HR, Yaseri M, Sehat M, Eskandari A, Ziaei H. Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: a clinic-based study. Middle East Afr J Ophthalmol 2014; 20:72-6. [PMID: 23580856 PMCID: PMC3617533 DOI: 10.4103/0974-9233.106395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose: To determine the prevalence of second-eye senile cataract surgery (SECS) as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. Materials and Methods: In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years (2006-2009) was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected (1,585 out of 10,517 records). Results: First- and second-eye operations were performed in 1,139 (71.9%; 95% confidence interval [CI], 69.5-74.1) and 446 eyes (28.1%; 95% CI, 25.9-30.35), respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 (P = 0.017). The median (interquartile range) interval between the two operations was 9 (4-24) months, which remained stable during the study period. The SECS rate was 10.4% higher (P = 0.01) and the time interval was 13 months shorter (P = 0.007) in patients who underwent phacoemulsification than extracapsular cataract extraction. Conclusion: The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time.
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Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Sanjari N, Moein HR, Soheilian R, Soheilian M, Peyman GA. Enhanced Depth Imaging OCT and Indocyanine Green Angiography Changes in Acute Macular Neuroretinopathy. Ophthalmic Surg Lasers Imaging Retina 2013; 44:S36-9. [DOI: 10.3928/23258160-20131101-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Accepted: 09/12/2013] [Indexed: 11/20/2022]
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16
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Javadi MA, Feizi S, Moein HR. Simultaneous penetrating keratoplasty and cataract surgery. J Ophthalmic Vis Res 2013; 8:39-46. [PMID: 23825711 PMCID: PMC3691977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 08/18/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the clinical outcomes of simultaneous penetrating keratoplasty (PK), cataract removal and intraocular lens implantation (triple procedure), and to compare the safety and efficacy of two different cataract extraction techniques during the course of PK. METHODS This retrospective comparative study was conducted on patients who had undergone a triple procedure. The technique of cataract extraction was either open- sky extracapsular cataract extraction (ECCE) or phacoemulsification (PE). In the ECCE group, the posterior chamber intraocular lens (PCIOL) was implanted in the ciliary sulcus, while in the PE group PCIOLs were fixated within the capsular bag. Outcome measures included best spectacle corrected visual acuity (BSCVA), refractive results, graft clarity and complications. RESULTS Seventy-six eyes of 69 consecutive patients with mean age of 61.4±14.2 years were enrolled. Mean follow-up period was 61.4±37.2 months over which mean BSCVA was significantly improved from 1.40±0.68 to 0.44±0.33 LogMAR (P<0.001). Mean postoperative spherical equivalent refractive error was -2.13±3.02 D, which significantly differed from the target refraction (-0.73±0.29 D, P=0.004). At final follow-up, 89.5% of the corneal grafts remained clear. CONCLUSION The triple procedure is a safe and effective approach to restore vision in patients with coexisting corneal pathologies and cataracts. However, unacceptable postoperative refractive error can be anticipated.
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Affiliation(s)
| | - Sepehr Feizi
- Correspondence to: Sepehr Feizi, MD, MSc. Assistant Professor of Ophthalmology, Labbafinejad Medical Center, Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666, Iran; Tel: +98 21 2258 5952, Fax: +98 21 2259 0607; e-mail:
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Jafarinasab MR, Feizi S, Yazdizadeh F, Rezaei Kanavi M, Moein HR. Aspergillus flavus keratitis after deep anterior lamellar keratoplasty. J Ophthalmic Vis Res 2012; 7:167-71. [PMID: 23275826 PMCID: PMC3520469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 11/08/2011] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To report the clinical, microbiologic, confocal scan and histopathologic features of Aspergillus flavus keratitis which developed immediately after deep anterior lamellar keratoplasty (DALK). CASE REPORT A 28-year-old woman underwent DALK using the big-bubble technique for keratoconus. The operation was uneventful, yielding a bare Descemet's membrane (DM) followed by transplantation of a corneal graft devoid of DM and endothelium. Four days after keratoplasty, mild infiltrates were noticed in the inferonasal margin of the graft, which rapidly progressed to involve the adjacent recipient cornea. Confocal scan findings suggested filamentous fungal keratitis, leading to initiation of topical and systemic antifungal medications followed by immediate replacement of the graft. Histopathologic examination disclosed keratitis caused by a filamentous fungus, which was determined by microbiologic cultures to be Aspergillus flavus. Early diagnosis and appropriate management resulted in complete recovery from this potentially devastating infection. CONCLUSION Aspergillus Flavus can cause graft ulcers immediately after DALK. Confocal scan proved to be a valuable tool for early diagnosis and prompt intervention to control this otherwise devastating infection.
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Affiliation(s)
| | - Sepehr Feizi
- Sepehr Feizi, MD. Assistant Professor of Ophthalmology, Ophthalmic Research Center, #23 Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666, Iran; Tel: +98 21 2258 5952, Fax: +98 21 2259 0607;
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Faramarzi A, Feizi S, Javadi MA, Rezaei Kanavi M, Yazdizadeh F, Moein HR. Bilateral nocardia keratitis after photorefractive keratectomy. J Ophthalmic Vis Res 2012; 7:162-6. [PMID: 23275825 PMCID: PMC3520474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 12/04/2011] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report the clinical, confocal scan, and histopathologic features of nocardia keratitis in a patient who developed bilateral infection following photorefractive keratectomy (PRK). CASE REPORT A 23-year-old woman underwent bilateral PRK for low myopia. On postoperative day 3, dense central stromal infiltrates were noticed in both eyes. Empirical antibiotic therapy was initiated which was converted into specific therapy after a definite diagnosis was made based on clinical features and confirmed by confocal scan and histopathologic findings. Clinical and confocal scan features were consistent with the diagnosis of Nocardia keratitis, and topical 2% amikacin eye drops were started. Because of poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination reconfirmed the initial diagnosis. CONCLUSION Familiarity with clinical and confocal scan features facilitates early diagnosis of Nocardia keratitis leading to proper management and hence a rapid therapeutic response.
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Affiliation(s)
| | | | - Mohammad-Ali Javadi
- Mohammad-Ali Javadi, MD. Professor of Ophthalmology, Ophthalmic Research Center, #23 Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666, Iran; Tel: +98 21 2258 5952, Fax: +98 21 2259 0607; e-mail:
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Katibeh M, Moein HR, Javadi MA. Contribution of Iran to the Ophthalmic Literature over the Past Three Decades. J Ophthalmic Vis Res 2011; 6:225-6. [PMID: 22454741 PMCID: PMC3306105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marzieh Katibeh
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence to: Marzieh Katibeh, MD. Assistant Professor of Community Medicine, Ophthalmic Research Center, #23 Paidarfard St., Boostan 9 St., Pasdaran, Tehran 16666, Iran; Tel: +98 21 2258 5952, Fax: +98 21 2259 0607; e-mail:
| | - Hamid-Reza Moein
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Young Researchers Club, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | - Mohammad-Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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