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Mohammadi SS, Nguyen QD. A User-friendly Approach for the Diagnosis of Diabetic Retinopathy Using ChatGPT and Automated Machine Learning. Ophthalmol Sci 2024; 4:100495. [PMID: 38690313 PMCID: PMC11059323 DOI: 10.1016/j.xops.2024.100495] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 05/02/2024]
Abstract
Purpose To assess the capabilities of Chat Generative Pre-trained Transformer (ChatGPT) and Vertex AI in executing code-free preprocessing, training machine learning (ML) models, and analyzing the data. Design Evaluation of diagnostic test or technology. Participants ChatGPT and Vetrex AI as publicly available large language model and ML platform, respectively. Methods ChatGPT was employed to improve the resolution of fundus photography images from the Methods to Evaluate Segmentation and Indexing Techniques in the field of Retinal Ophthalmology (Messidor-2) open-source dataset using the Contrast Limited Adaptive Histogram Equalization (CLAHE) technique by Fiji software. Subsequently, Vertex AI, an automated ML (AutoML) platform, was utilized to develop 2 classification models. The first model served as a binary classifier for detecting the presence of diabetic retinopathy (DR), while the second determined its severity. Finally, ChatGPT was used to provide scripts for R and Python programming languages for data analysis and was also directly employed in analyzing the data in a code-free method. Main Outcome Measures Evaluating the utility of ChatGPT in generating scripts for preprocessing images using Fiji and analyzing data across Python and R and assessing its potential in analyzing data through a code-free method. Investigating the capabilities of Vertex AI to train image classification models for detection of DR and its severity. Results Two ML models were trained using 1740 images from the Messidor-2 database. The first model, designed to detect the severity of DR, achieved an area under the precision-recall curve (AUPRC) of 0.81, with a precision rate of 81.81% and recall of 72.83%. The second model, tailored for the detection of the presence of DR, recorded a precision and recall of 84.48% with an AUPRC of 0.90. Conclusions ChatGPT and Vertex AI have the potential to enable physicians without coding expertise to preprocess images, analyze data, and train ML models. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- S. Saeed Mohammadi
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Quan Dong Nguyen
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
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Karaca I, Bromeo A, Ghoraba H, Lyu X, Thng ZX, Yasar C, Akhavanrezayat A, Yavari N, Kirimli GU, Than NTT, Shin Y, Gupta AS, Khatri A, Mohammadi SS, Hung JH, Or C, Do DV, Nguyen QD. Importance of Baseline Fluorescein Angiography for Patients Presenting to Tertiary Uveitis Clinic. Am J Ophthalmol 2024:S0002-9394(24)00170-3. [PMID: 38701875 DOI: 10.1016/j.ajo.2024.04.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To ascertain whether the use of ultra-wide-field fluorescein angiography (UWFFA) at baseline visit alters the assessment of disease activity and localization, as well as the management of patients presenting to a tertiary uveitis clinic. DESIGN Retrospective comparison of diagnostic approaches. METHODS Baseline visits of 158 patients who presented to the Uveitis Clinic at the Byers Eye Institute at Stanford between 2017 and 2022 were evaluated by three uveitis-trained ophthalmologists (I.K., A.B., and H.G.). Each eye had undergone clinical examination along with ultra-wide-field fundus photography (UWFFP) (Optos Plc, Dunfermline, Scotland, UK), spectral-domain optical coherence tomography (SD-OCT, Spectralis Heidelberg, Heidelberg Engineering, Heidelberg, Germany) and UWFFA (Optos Plc, Dunfermline, Scotland, UK) at the baseline visit. Investigators were asked to successively determine disease activity, localization of disease (anterior, posterior or both), and management decisions based on clinical examination and UWFFP and SD-OCT (Set 1) and Set 1 plus UWFFA (Set 2). The primary outcome was the percentage of eyes whose management changed based on the availability of UWFFA, compared with Set 1. RESULTS The mean age of the patients was 46.9±22.4 (range, 7-96) and 91 (57.6%) were female. With Set 1 alone, 138 (55.2%) eyes were found to have active disease; localization was anterior in 58 (42.0%) eyes, posterior in 53 (38.4%) eyes and anterior + posterior in 27 (19.6%) eyes. With Set 2, 169 eyes of 107 patients had active anterior, posterior or pan-uveitis. In comparison with Set 1, assessment with Set 2 identified additional 31 (18.3%) eyes with active disease (p=0.006), and additional 31 (18.3%) eyes having disease in both anterior + posterior segments (p<0.001). Regarding the primary outcome, management was changed in 68 (27.4%) eyes in Set 2, compared to Set 1. CONCLUSION Baseline UWFFA may alter assessment of disease activity, localization, and management decisions compared to clinical examination with only UWFFP and SD-OCT for eyes with uveitis. Thus, UWFFA may be considered as an essential tool in the evaluation of uveitis patients at the baseline visit.
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Affiliation(s)
- Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA; John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Albert Bromeo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Xun Lyu
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Zheng Xian Thng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Ngoc Tuong Trong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - YongUn Shin
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA; Department of Ophthalmology College of Medicine, Hanyang University, Seoul, Korea
| | - Ankur Sudhir Gupta
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Anadi Khatri
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - S Saeed Mohammadi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Jia-Horung Hung
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Diana V Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University, Palo Alto, CA, USA.
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Thng ZX, Regenold J, Bromeo AJ, Akhavanrezayat A, Than NTT, Khatri A, Mohammadi SS, Tran ANT, Shin YU, Karaca I, Ghoraba HH, Or CCM, Nguyen QD. Challenges for further successful development of tumor necrosis factor targeting therapies for uveitis. Expert Opin Investig Drugs 2024; 33:95-104. [PMID: 38299551 DOI: 10.1080/13543784.2024.2311186] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract and is one of the leading causes of vision impairment. In developed countries, noninfectious uveitis (NIU) represents most cases and is challenging to treat due to its severity, chronicity, and high recurrence rates. The advent of anti-tumor necrosis factor-α (anti-TNF-α) agents have dramatically improved outcomes and changed treatment paradigms in NIU. AREAS COVERED The index article summarizes the present experience of anti-TNF-α agents in NIU pharmacotherapy and highlights the barriers to further research and development of anti-TNF-α agents for uveitis. Common challenges faced in NIU clinical drugs trials, specific difficulties in anti-TNF-α drug development, and promising competitor drug candidates are discussed and evaluated. EXPERT OPINION Anti-TNF-α agents have revolutionized NIU pharmacotherapy and greatly improved outcomes with good safety profiles. The great success of systemic infliximab and adalimumab in NIU treatment has resulted in little impetus for further development of this class of medication. Attempts have been made to deliver anti-TNF-α agents intravitreally but that has not been successful thus far. With expiring patents, competition from biosimilars and newer, novel molecules, it may not be viable to continue pursuing anti-TNF-α drug development.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jonathan Regenold
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Asian Eye Institute, Makati, Philippines
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | | | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
- Department of Ophthalmology, Hanyang University Guri Hospital, Guri, Korea
| | - Irmak Karaca
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Thng ZX, Bromeo AJ, Mohammadi SS, Khatri A, Tran ANT, Akhavanrezayat A, T T Than N, Nguyen KS, Yoo WS, Mobasserian A, Or CCM, Nguyen QD. Recent advances in uveitis therapy: focus on selected phase 2 and 3 clinical trials. Expert Opin Emerg Drugs 2023; 28:297-309. [PMID: 38129984 DOI: 10.1080/14728214.2023.2293049] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract. It is a leading cause of blindness in developed countries and exerts significant psychological, social, and economic impact on both patients and the larger society. While there are numerous pharmacotherapy options, posterior segment noninfectious uveitis remains a significant challenge to treat due to its severity, chronicity, and high recurrence rates. AREAS COVERED The index review highlights the unmet needs of uveitis pharmacotherapy and its research and the shortcomings of existing ocular and systemic therapeutic options for noninfectious uveitis. The more promising novel ocular drug delivery methods and therapeutic targets/drugs are discussed, and evidence from the clinical trials is evaluated. EXPERT OPINION There has been incredible growth in the number of treatment options available to uveitis patients today, especially with the new generation of biologic drugs. Available evidence suggests that these newer options may be superior to conventional immunosuppressive therapies in terms of efficacy and side effect profiles. Further high-quality research and additional clinical trials will be needed to clarify their roles in the stepladder treatment approach of noninfectious uveitis.
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Affiliation(s)
- Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Albert John Bromeo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Asian Eye Institute, Makati, Philippines
| | - S Saeed Mohammadi
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Anadi Khatri
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Birat Aankha Aspatal, Biratnagar, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar, Nepal
| | - Anh N T Tran
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | | | - Ngoc T T Than
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Khiem S Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
| | - Woong-Sun Yoo
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | | | | - Quan Dong Nguyen
- Byers Eye Institute, Stanford University, Palo Alto, California, USA
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Akbari-Kamrani M, Heidarzadeh H, Naderan M, Gordiz A, Hemmati S, Chaibakhsh S, Mohammadi SS, Farsani MK, Zand A, Abdi F. Impact of first eye cataract surgery on falls among patients of advanced age: a comparative study. J Int Med Res 2023; 51:3000605231216685. [PMID: 38069864 PMCID: PMC10710751 DOI: 10.1177/03000605231216685] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To compare the incidence of falls between patients with visually significant cataracts in both eyes and those who have undergone first-eye cataract surgery. METHODS This retrospective case-control study involved patients with a history of cataracts in both eyes who had undergone first-eye cataract surgery within the past 9 to 12 months (pseudophakic group). The control group comprised patients with cataracts in both eyes (cataract group). We assessed best-corrected visual acuity (BCVA), systemic comorbidities and medications (using the Charlson comorbidity index), and independent daily activities (using the Lawton Instrumental Activities of Daily Living scale). The patients were questioned about experiencing two or more falls in the last 6 months. RESULTS Each group comprised 50 patients. Binocular BCVA was significantly better in the pseudophakic group (0.05 ± 0.06 logMAR) than in the cataract group (0.77 ± 0.34 logMAR). Of all participants, 22% reported experiencing two or more falls in the last 6 months. Multivariate analysis demonstrated significantly better BCVA in participants with less than two falls. CONCLUSIONS Patients of advanced age with visually significant cataracts in both eyes are at a higher risk of falling. First-eye cataract surgery may mitigate the occurrence of falls by improving binocular BCVA.
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Affiliation(s)
- Marjan Akbari-Kamrani
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Hamidreza Heidarzadeh
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Morteza Naderan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arzhang Gordiz
- Department of Ophthalmology, 5-Azar Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Sara Hemmati
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Department of Ophthalmology, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohsen Khosravi Farsani
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Zand
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Abdi
- Eye Research Center, The Five Senses Institute, Rasool Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Akhavanrezayat A, Khatri A, Onghanseng NGL, Halim MS, Or C, Sredar N, Razeen M, Hasanreisoglu M, Regenold J, Thng ZX, Mohammadi SS, Jain T, Yavari N, Bazojoo V, Gupta AS, Mobasserian A, Yasar C, Than NTT, Uludag Kirimli G, Karaca I, Shin YU, Yoo WS, Ghoraba H, Do DV, Dubra A, Nguyen QD. Structural and Functional Changes in Non-Paraneoplastic Autoimmune Retinopathy. Diagnostics (Basel) 2023; 13:3376. [PMID: 37958272 PMCID: PMC10649684 DOI: 10.3390/diagnostics13213376] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests. METHODS The index study is a retrospective longitudinal review of sixteen eyes of eight patients from a tertiary care eye hospital diagnosed with npAIR. Multiple diagnostic modalities such as wide-angle fundus photography (WAFP), WA fundus autofluorescence (WAFAF), spectral-domain optical coherence tomography (SD-OCT), Goldmann visual field (GVF) perimetry, microperimetry (MP), electrophysiologic testing, and adaptive optics scanning laser ophthalmoscopy (AOSLO) were reviewed and analyzed. RESULTS At the baseline visits, anomalies were detected by multimodal diagnostic tests on all patients. Subjects were followed up for a median duration of 11.5 [3.0-18.7] months. Structural changes at the baseline were detected in 14 of 16 (87.5%) eyes on WAFP and WAFAF and 13 of 16 (81.2%) eyes on SD-OCT. Eight of the ten (80%) eyes that underwent AOSLO imaging depicted structural changes. Functional changes were detected in 14 of 16 (87.5%) eyes on GVF, 15 of 16 (93.7%) eyes on MP, and 11 of 16 (68.7%) eyes on full-field electroretinogram (ff-ERG). Multifocal electroretinogram (mf-ERG) and visual evoked potential (VEP) tests were performed in 14 eyes, of which 12 (85.7%) and 14 (100%) of the eyes demonstrated functional abnormalities, respectively, at baseline. Compared to all the other structural diagnostic tools, AOSLO had a better ability to demonstrate deterioration in retinal microstructures occurring at follow-ups. Functional deterioration at follow-up was detected on GVF in 8 of 10 (80%) eyes, mf-ERG in 4 of 8 (50%) eyes, and MP in 7 of 16 (43.7%) eyes. The ff-ERG and VEP were stable in the majority of cases at follow-up. CONCLUSIONS The utilization of multimodal imaging/tests in the diagnosing and monitoring of npAIR patients can aid in identifying anomalous changes over time. Analysis of both the anatomical and functional aspects by these devices can be supportive of detecting the changes early in such patients. AOSLO shows promise as it enables the capture of high-resolution images demonstrating quantifiable changes to retinal microstructure.
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Affiliation(s)
- Amir Akhavanrezayat
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Anadi Khatri
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Birat Aankha Aspatal, Biratnagar 56613, Nepal
- Department of Ophthalmology, Birat Medical College and Teaching Hospital, Kathmandu University, Biratnagar 45200, Nepal
| | - Neil Gregory L. Onghanseng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Makati Medical Center, Manila 1229, Philippines
| | - Muhammad Sohail Halim
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Ocular Imaging Research and Reading Center, Sunnyvale, CA 94085, USA
| | - Christopher Or
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Nripun Sredar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Moataz Razeen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Murat Hasanreisoglu
- Department of Ophthalmology, Koc University School of Medicine, 34450 Istanbul, Turkey
- Koc University Research Center for Translational Medicine, Koc University, 34450 Istanbul, Turkey
| | - Jonathan Regenold
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Zheng Xian Thng
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - S. Saeed Mohammadi
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Tanya Jain
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Dr. Shroff Charity Eye Hospital, New Delhi 110002, India
| | - Negin Yavari
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Vahid Bazojoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Ankur Sudhir Gupta
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Azadeh Mobasserian
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Cigdem Yasar
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Ngoc Trong Tuong Than
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Gunay Uludag Kirimli
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Duke University, Durham, NC 27705, USA
| | - Irmak Karaca
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Yong-Un Shin
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul 04763, Republic of Korea
| | - Woong-Sun Yoo
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
- Department of Ophthalmology, Gyeongsang National University College of Medicine, and Gyeongsang National University Hospital, Jinju 52727, Republic of Korea
| | - Hashem Ghoraba
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Diana V. Do
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Alfredo Dubra
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
| | - Quan Dong Nguyen
- Spencer Center for Vision Research, Byers Eye Institute, Stanford University School of Medicine, 2370 Watson Court, Palo Alto, CA 94303, USA; (A.A.); (A.K.)
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Rajabi MT, Cheraqpour K, Mohammadi SS, Veshagh M, Lazarjani SZP, Hosseinzadeh F, Amoli FA, Hosseini S. Isolated Intraconal Meningioma. J Ophthalmic Vis Res 2021; 16:682-687. [PMID: 34840690 PMCID: PMC8593532 DOI: 10.18502/jovr.v16i4.9759] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a rare case of isolated intraconal meningioma. Case Report A 24-year-old woman presented with painless proptosis in her left eye which
started and progressed during her pregnancy about 10 months ago. Hertel
exophthalomometry revealed anterior displacement of the globe with 4 mm of
proptosis which was remarkable. Magnetic resonance imaging (MRI)
demonstrated an intraconal circumscribed oval-shaped mass with hypointense
signals on T1-weighted images and hyperintense signals on T2-weighted
images, mimicking cavernous hemangioma. This mass, however, was free of any
connections to optic nerve or bones. Due to the imaging characteristics,
more prevalent diagnoses like cavernous hemangioma were placed on the top of
the differential diagnoses list. However, during the surgical excision, the
tumor’s consistency and gross features were not compatible with cavernous
hemangioma. The pathologic findings instead determined meningotheliomatous
meningioma, a very rare condition, which was far from our expectations prior
to the surgery. Conclusion Ectopic orbital meningiomas are rare tumors that are not easily diagnosed
without postoperative histopathology. Despite its low prevalence, they
should be considered in the differential diagnosis list of intraconal masses
with hypointense signals on T1-weighted images and hyperintense signals on
T2-weighted images.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kasra Cheraqpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Abadan University of Medical Sciences, Abadan, Iran
| | - Mohammad Veshagh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Zahra Poursayed Lazarjani
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Guilan University of Medical Sciences, Rasht, Iran
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center, The Five Senses Health Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi Amoli
- Pathology Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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8
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Abdi F, Mohammadi SS, Falavarjani KG. Intravitreal Methotrexate. J Ophthalmic Vis Res 2021; 16:657-669. [PMID: 34840688 PMCID: PMC8593537 DOI: 10.18502/jovr.v16i4.9756] [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] [Received: 02/04/2021] [Accepted: 08/17/2021] [Indexed: 11/24/2022] Open
Abstract
Intravitreal methotrexate (MTX) has been proven to be an effective treatment for various intraocular diseases. In this article, a comprehensive review was performed on intravitreal applications of methotrexate. Different aspects of the administration of intravitreal MTX for various clinical conditions such as intraocular tumors, proliferative vitreoretinopathy, diabetic retinopathy, age-related macular degeneration, and uveitis were reviewed and the adverse effects of intravitreal injection of MTX were discussed. The most common indications are intraocular lymphoma and uveitis. Other applications remain challenging and more studies are needed to establish the role of intravitreal MTX in the management of ocular diseases.
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Affiliation(s)
- Fatemeh Abdi
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khalil Ghasemi Falavarjani
- Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
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9
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Soleimani M, Latifi A, Momenaei B, Tayebi F, Mohammadi SS, Ghahvehchian H. Management of refractory Acanthamoeba keratitis, two cases. Parasitol Res 2021; 120:1121-1124. [PMID: 33409641 DOI: 10.1007/s00436-020-06997-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/18/2020] [Accepted: 12/01/2020] [Indexed: 11/24/2022]
Abstract
Acanthamoeba keratitis is a serious infection of the eye that can result in permanent visual impairment or blindness, caused by free-living amoebae of the genus Acanthamoeba. Early diagnosis is necessary for effective treatment of Acanthamoeba keratitis. Acanthamoeba is abundant in nature and can be found in water, soil, and air. Acanthamoeba keratitis is usually diagnosed by culture from a scraping of the eye or by confocal microscopy. In this paper, two complicated Acanthamoeba keratitis cases are reported.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Latifi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bita Momenaei
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshte Tayebi
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Ocular Trauma and Emergency Department, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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10
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Rajabi MT, Poursayed Lazarjani SZ, Mohammadi SS, Veshagh M, Hosseinzadeh F, Rafizadeh SM, Amoli FA, Hosseini S. Giant Cell Tumor: Changing Behavior from Intraorbital to Intraosseous Mass. J Curr Ophthalmol 2020; 32:414-416. [PMID: 33553846 PMCID: PMC7861103 DOI: 10.4103/joco.joco_63_20] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To present a patient with giant cell tumor (GCT) of the orbit by changing behavior from an intraorbital mass to an intraosseous tumor. Methods A 16-year-old boy presented with pain, swelling, erythematous of the left upper and lower eyelids, proptosis, and diplopia. Ophthalmic examination revealed chemosis, conjunctival injection, limited elevation, depression as well as abduction in the left eye. Results Multislice computed tomography scan (CT scan) of the orbit and paranasal sinuses showed a hyperdense, oval, extraconal mass with bone erosion. Magnetic resonance imaging of the orbit showed an inferior lateral isointense, oval, extraconal mass that had indented the globe. The patient underwent superior lateral orbitotomy, and the orbital mass was excised. Two months later, the patient developed proptosis, severe chemosis, and eyelid erythema in the same eye. CT scan showed an intraosseous mass in the lateral wall of the orbit that had pushed the globe anteromedially. Intraosseous tumor was resected, and the lateral orbital wall was drilled during the second surgery. GCT was diagnosed based on pathological survey. Conclusion Following the resection of the orbital GCT, the tumor behavior may change to an intraosseous lesion.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - S Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Veshagh
- Eye Research Center, Labbafinejad Eye Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Hosseinzadeh
- ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohsen Rafizadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fahimeh Asadi Amoli
- Department of Pathology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Simindokht Hosseini
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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11
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Latifi G, Mohammadi SS. Repeatability and agreement of total corneal and sublayer pachymetry with 2 different algorithms of Fourier-domain optical coherence tomography in myopic and postphotorefractive keratectomy eyes. J Cataract Refract Surg 2020; 46:1644-1651. [PMID: 33259389 DOI: 10.1097/j.jcrs.0000000000000348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate repeatability and agreement of total corneal and sublayer pachymetry with 2 different algorithms of Fourier-domain optical coherence tomography (OCT) in myopic and postphotorefractive keratectomy (PRK) eyes. SETTING Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. DESIGN Prospective observational study. METHODS Total corneal, epithelial, and stromal thicknesses were measured using RTVue-XR OCT with Pachymetry + Cpwr (6.0 mm algorithm) and PachymetryWide (9.0 mm algorithm) scan patterns. The repeatability of 25 zones of 9.0 mm map and 17 zones of 6.0 mm map and the agreement between measurements of these 2 algorithms were calculated. RESULTS Ninety-five myopic and 117 post-PRK patients were evaluated. By the 9.0 mm algorithm, coefficient of variation (CoV) for total cornea was 2.33% or lesser and 2.49% or lesser and for epithelium was 5.14% or lesser and 5.18% or lesser; and by the 6.0 mm algorithm, CoV for total cornea was 1.80% or lesser and 2.59% or lesser and for epithelial thickness was 3.08% or lesser and 4.80% or lesser in myopic and post-PRK eyes, respectively. Bland-Altman mean difference for epithelial thickness was 0.69 or lesser and 1.16 or lesser and 95% limits of agreement for epithelial thickness was 6.81 or lesser and 8.56 or lesser in myopic and post-PRK eyes, respectively. CONCLUSIONS Good repeatability was seen in measurements of total corneal, stromal, and epithelial thicknesses by both algorithms. Agreement of the 2 algorithms in central zone was also good. However, large range of variation in paracentral thickness measurements did not allow us to consider these algorithms as interchangeable.
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Affiliation(s)
- Golshan Latifi
- From the Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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12
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Soleimani M, Tabatabaei SA, Mohammadi SS, Valipour N, Mirzaei A. A ten-year report of microbial keratitis in pediatric population under five years in a tertiary eye center. J Ophthalmic Inflamm Infect 2020; 10:35. [PMID: 33245477 PMCID: PMC7695777 DOI: 10.1186/s12348-020-00227-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 04/18/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To report characteristics of microbial keratitis in pediatric patients under five years. Methods Patients with infectious keratitis under the age of 5 years were included in this retrospective cross-sectional study for ten years. All patients were admitted and corneal scraping was performed in 81 children. Fortified empiric antibiotic eye drops including cefazolin (50 mg/cc) and amikacin (20 mg/cc) were started and the antibiotic regimen was continued or changed according to culture results. In the case of fungal keratitis, topical voriconazole (10 mg/cc) or natamycin (50 mg/cc) and topical chloramphenicol (5 mg/cc) were started. A tectonic procedure was done when corneal thinning or perforation was present. Results Ninety-Three Patients between 1 to 60 months with a mean age of 33 ± 18 months old with corneal ulcer were included in the study. The most common risk factor was trauma (40.9%) followed by contact lens use (8.6%). Cultures were negative for microbial growth in 28 (30.1%) patients. The most common pathogens were S. epidermidis (10.8%) and P. aeruginosa (10.8%). Fluoroquinolone antibiotics (ciprofloxacin; 93.8% sensitivity) were the most potent antibiotic against bacterial pathogens. Forty-one patients underwent tectonic procedures, which the most common ones were cyanoacrylate glue 18.3% followed by keratoplasty 16.1%. Conclusion This study emphasizes the role of trauma as the primary cause and S. epidermidis as the most frequent microorganism in pediatric keratitis; according to antibiogram results and poor cooperation of patients under five years, monotherapy with fluoroquinolones could be a good regimen in small non-central lesions without thinning.
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Affiliation(s)
- Mohammad Soleimani
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Ali Tabatabaei
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloufar Valipour
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Mirzaei
- Ocular Trauma and Emergency Department, Eye Research Center, Farabi eye hospital, Tehran University of Medical Sciences, Tehran, Iran
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13
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Latifi G, Banafshe Afshan A, Houshang Beheshtnejad A, Zarei-Ghanavati M, Mohammadi N, Ghaffari R, Ghassemi H, Mohammadi SS, Kheirkhah A. Changes in Corneal Subbasal Nerves after Punctal Occlusion in Dry Eye Disease. Curr Eye Res 2020; 46:777-783. [PMID: 33092431 DOI: 10.1080/02713683.2020.1833349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate corneal subbasal nerve plexus by in vivo confocal microscopy (IVCM) following punctal occlusion in patients with moderate to severe dry eye disease (DED). MATERIALS AND METHODS Patients with grade 3 or 4 severity of DED based on Delphi Panel dry eye severity grading scheme were enrolled in the study. Permanent inferior punctal occlusion was performed. A comprehensive ophthalmic evaluation, including Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescein staining, conjunctival Rose bengal staining, Schirmer's test, and corneal sensation by Cochet-Bonnet esthesiometry, were performed at baseline, and 1 and 3 months after punctal occlusion. Furthermore, density and number of corneal subbasal nerves were evaluated by IVCM. RESULTS Forty-one eyes of 23 patients with a mean age of 46.3 ± 9.0 years were enrolled. Corneal fluorescein staining, Rose bengal staining, and TBUT significantly improved at 3 months following punctal occlusion (p < .015). Corneal esthesiometry significantly increased at both postoperative visits (p < .03), and OSDI scores improved only at 3-month follow-up (p < .005). Nerve density and total number significantly increased 3 months after punctal occlusion (p < .045). Baseline nerve density had significant correlations with TBUT, fluorescein staining, Rose bengal staining (p < .012), but not with esthesiometry, Schirmer scores, or OSDI scores (p > .329). CONCLUSIONS Corneal subbasal nerve density and total number increased following punctal occlusion in patients with moderate to severe DED. These findings were associated with improvements in corneal sensation, and signs and symptoms of DED. This emphasizes the effect of punctal occlusion in regeneration of corneal subbasal nerve plexus.
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Affiliation(s)
- Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Neda Mohammadi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Ghaffari
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ghassemi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Kheirkhah
- Ocular Surface Imaging Center, Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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14
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Mafi M, Mirghorbani M, Ghahvehchian H, Mohammadi SS, Riazi-Esfahani H, Khalili Pour E, Mahmoudi A, Khojasteh H, Modjtahedi BS. Modified Encircling Scleral Buckle Technique Without Subretinal Fluid Drainage or Retinopexy. Ophthalmol Ther 2020; 9:641-651. [PMID: 32666396 PMCID: PMC7406596 DOI: 10.1007/s40123-020-00279-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Scleral buckling (SB) tends to be more challenging and time-consuming for compared to the pars plana vitrectomy for repairing rhegmatogenous retinal detachments (RRDs). This study characterizes a novel and simplified technique for SB. Methods In this single-masked randomized interventional study, patients with RRDs who were eligible for SB were randomly assigned to either the standard (S) or modified (M) technique of SB. In the modified approach, neither intraoperative break localization nor cryopexy or subretinal fluid drainage was done. A large tire (276/279) was placed where preoperative retinal breaks had been localized with a 240 encircling band placed for support of the remaining retina. Patients were followed for 12 months and the primary outcomes were differences between the surgical groups in operative time, anatomical success, visual acuity, and complication rate. Results Thirty-six eyes were included in the study (18 in each arm). There were no differences in baseline patient demographics or characteristics including gender, age, lens and macular status, preoperative vision, and symptom duration. The mean length of surgery was 72.2 ± 13.2 and 56.2 ± 9.5 min in groups S and M, respectively (P = 0.001). Complete retinal reattachment at the end of month 12 after single surgery was 80.6% overall; 77.8% (14/18) in group S and 83.3% (15/18) in group M (P > 0.999). After 12 months, both groups achieved similar final best-corrected visual acuity (BCVA): 0.26 ± 0.23 and 0.23 ± 0.17 logMAR in groups S and M, respectively (P = 0.231). Controlling for preoperative BCVA on ANCOVA testing, there were no significant differences in visual improvement between the two groups [F (1,26) = 0.02, P = 0.966 (95% CI) − 0.128 to 0.123)]. Scleral perforation (2:1), vitreous hemorrhage (3:2), and transient rise of intraocular pressure (3:4) all occurred at a low and similar rate between the two groups (S:M). Conclusion Modified SB technique was non-inferior compared to the standard approach for anatomical and visual outcomes. Shortening surgical time while maintaining low complication rates makes this an appropriate approach to SB, especially for vitreoretinal surgery trainees. Electronic supplementary material The online version of this article (10.1007/s40123-020-00279-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mostafa Mafi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Mirghorbani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ghahvehchian
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Riazi-Esfahani
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elias Khalili Pour
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mahmoudi
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Khojasteh
- Department of Ophthalmology, Farabi Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Bobeck S Modjtahedi
- Department of Ophthalmology, Southern California Permanente Medical Group, Baldwin Park, CA, USA.,Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena, CA, USA.,Eye Monitoring Center, Kaiser Permanente Southern California, Baldwin Park, CA, USA
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15
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Rajabi MT, Tabary M, Baharnoori S, Salabati M, Mahmoudzadeh R, Hosseinzadeh F, Mohammadi SS, Goldberg RA. Orbital anatomical parameters affecting outcome of deep lateral orbital wall decompression. Eur J Ophthalmol 2020; 31:2069-2075. [PMID: 32627588 DOI: 10.1177/1120672120941433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine orbital anatomical parameters that affect surgical outcome of deep lateral orbital wall decompression. METHODS Twenty orbits of 20 patients with moderate proptosis (maximum 25 mm) due to thyroid eye disease who were stable for at least 6 months were included in this prospective cohort study. Four parameters including lateral orbital wall distance (LOWD), removable surface area (RSA), removable surface length (RSL), and sphenoid door jamb thickness (SDJ) were evaluated by computed tomography (CT) scan prior to surgery in these patients. Deep lateral orbital wall decompression without fat removal was done in all patients. Relationship between all these factors and proptosis reduction, 6 months after surgery was assessed. RESULTS Mean proptosis before decompression surgery (mean ± SD) was 23.22 ± 1.19 mm and reduction in Hertel exophthalmometry (mean ± SD) was -3.27 ± 1.03 mm (p = 0.006). Pearson correlation showed that LOWD, RSL, and SDJ had statistically significant correlation with proptosis reduction (p = 0.017, 0.002, and 0.001, respectively.). Linear multivariate regression analysis showed SDJ as the only independent factor in predicting surgical outcome. CONCLUSION several orbital anatomical factors have significant role in predicting surgical outcome following deep lateral wall orbital decompression. Among these parameters, SDJ is an independent factor, whereas LOWD and RSL are dependent factors. Preoperative assessment of the bony sphenoid anatomy may be helpful in predicting the amount of potential decompression.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Tabary
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - SeyedMahbod Baharnoori
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mirataollah Salabati
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziyeh Mahmoudzadeh
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Hosseinzadeh
- ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Robert A Goldberg
- Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California-Los Angeles, Los Angeles, CA, USA
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16
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Asghari A, Mohammadi SS, Hosseinzadeh F. COVID-19 pandemic and physicians in training. Laryngoscope Investig Otolaryngol 2020; 5:590-591. [PMID: 32587892 PMCID: PMC7283651 DOI: 10.1002/lio2.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/05/2020] [Accepted: 05/14/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alimohamad Asghari
- Skull Base Research Center, The Five Senses Institute Iran University of Medical Sciences Tehran Iran
| | - S Saeed Mohammadi
- Farabi Eye Hospital Tehran University of Medical Sciences Tehran Iran
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center, The Five Senses Institute Iran University of Medical Sciences Tehran Iran
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Daneshi A, Hosseinzadeh F, Mohebbi S, Mohseni M, Mohammadi SS, Asghari A. New marsupialization technique in endolymphatic sac surgery. Laryngoscope Investig Otolaryngol 2020; 5:546-551. [PMID: 32596499 PMCID: PMC7314464 DOI: 10.1002/lio2.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/14/2020] [Revised: 04/26/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery. METHODS Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border. RESULTS Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated. CONCLUSION The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Ahmad Daneshi
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Farideh Hosseinzadeh
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Saleh Mohebbi
- Skull Base Research CenterThe Five Senses Institute, Iran University of Medical SciencesTehranIran
| | - Mohammad Mohseni
- ENT and Head & Neck Research Center The Five Senses Institute, Iran University of Medical SciencesTehranIran
| | | | - Alimohamad Asghari
- Skull Base Research CenterThe Five Senses Institute, Iran University of Medical SciencesTehranIran
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18
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Rajabi MT, Borjian MA, Hosseini SS, Rajabi MB, Hosseinzadeh F, Mohammadi SS. Orbital radiologic parameters of non-syndromic exorbitism patients in comparison with normal population. J Curr Ophthalmol 2019; 31:432-437. [PMID: 31844796 PMCID: PMC6896460 DOI: 10.1016/j.joco.2019.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/06/2019] [Revised: 07/20/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To measure orbital dimension of patients with exorbitism and defining criteria for its diagnosis. Methods Twelve patients with non-syndromic exorbitism (NSE) were compared with 24 control samples by means of computed tomography scan (CT-scan) findings. The proptosis severity, lateral wall length, medial wall length, optic nerve straight length, lateral wall angle, ethmoidal sinus surface area, mid-interorbital distance, anterior interorbital distance, external orbital distance, inter-pupillary distance, and lateral wall curve cord were evaluated in order to define a criterion for NSE. Results Among eleven compared radiological parameters between the study and control groups, five parameters including lateral orbital wall angle (P = 0.02), mid-interorbital distance (P = 0.007), anterior inter-orbital distance (P < 0.001), inter-pupillary distance (P = 0.01), and proptosis severity (P < 0.001) were found to be significantly different between the study groups. Therefore, NSE could be diagnosed with lateral wall angle greater than 41.74°, mid-interorbital distance more than 31.84 mm, and anterior interorbital distance more than 25.90 mm, with a sensitivity of 91% and specificity of 71%. Conclusions Using lateral wall angle, mid-interorbital distance, and anterior interorbital distance, we defined the criterion for diagnosis of NSE. Moreover, by focusing on parameters which play a role in developing exorbitism, we can determine the best approach for improvement of aesthetic and functional features of this condition.
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Affiliation(s)
- Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Amin Borjian
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Bagher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Hosseinzadeh
- ENT and Head and Neck Research Center, The Five Senses Institute, Iran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Razavi ME, Rajabi MT, Hassanpoor N, Mohammadi SS. Sclerotherapy for eyelid and anterior orbital venous-lymphatic malformation. J Curr Ophthalmol 2019; 31:214-217. [PMID: 31317102 PMCID: PMC6611944 DOI: 10.1016/j.joco.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/04/2018] [Revised: 12/26/2018] [Accepted: 01/04/2019] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To assess the efficacy of sclerotherapy with sodium tetradecyl sulfate (STS; Fibrovein 1%) in superficial periocular venous and lymphatic malformations. METHODS Eleven patients with low-flow venous and lymphatic malformations with extension predominantly to the eyelids, conjunctiva, and anterior orbit were selected. Sclerotherapy with STS was undertaken as an office-based procedure without any radiological guidance. Injections were repeated every 4 weeks until desired response occurred. Therapeutic effect was assessed objectively by change in the size of the lesions in serial photography. RESULTS The lesions completely resolved in 4 cases with small eyelid and fornix lesions. In other 7 cases there was partial resolution to less than half of primary size. We did not have any significant complications. CONCLUSION Sclerotherapy with STS is an easy and effective modality for treatment of venous-lymphatic malformations and can be undertaken as an office-based procedure in lesions which are limited to eyelids and anterior orbit.
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Affiliation(s)
- Mohammad Etezad Razavi
- Mashhad Eye Research Center, Khatam Alanbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Hassanpoor
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S. Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Ameri A, Rajabi MT, Mohammadi SS. Superior oblique tucking: a promising way of treating excyclotorsion. J AAPOS 2019; 23:188. [PMID: 30790711 DOI: 10.1016/j.jaapos.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Ahmad Ameri
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Taher Rajabi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - S Saeed Mohammadi
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Petramfar P, Mohammadi SS, Hosseinzadeh F. Treatment of Idiopathic Intracranial Hypotension With Tea: A Case Report. Iran Red Crescent Med J 2016; 18:e24620. [PMID: 27621920 PMCID: PMC5002997 DOI: 10.5812/ircmj.24620] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The syndrome of spontaneous intracranial hypotension has been increasingly diagnosed since its discovery through magnetic resonance imaging (MRI). It is a rare syndrome that is due to the leakage of cerebrospinal fluid (CSF) from a tear in the dura and can occur at any age, even among adolescents, but is most frequently seen among females in late middle age. CASE PRESENTATION Here, we describe a 32-year-old woman with a two-month history of headaches and occasional nausea and vomiting (N/V). MRI without gadolinium was normal, but meningeal enhancement was seen in MRI with gadolinium. The lumbar puncture revealed a low opening pressure. Computed tomography myelography (CT myelography) showed no leakage; Therefore, idiopathic intracranial hypotension was diagnosed. Treatment was started using tea, and the patient's headache got significantly better in about a day. CONCLUSIONS Conservative therapy, such as bed rest and caffeine treatment with eight cups of tea daily, yielded a significant improvement in our patient. Effectively, the patient constitutes a case of idiopathic intracranial hypotension due to undetectable CSF leakage or hyper-absorption, with good response to conservative management through tea-drinking. Further investigations with an appropriate sample size are needed in order to confirm this intervention in the treatment of idiopathic intracranial hypotension.
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Affiliation(s)
- Peyman Petramfar
- Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - S. Saeed Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Authors: S. Saeed Mohammadi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran. E-mail: ; Farideh Hosseinzadeh, Shiraz University of Medical Sciences, Shiraz, IR Iran. E-mail:
| | - Farideh Hosseinzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Authors: S. Saeed Mohammadi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran. E-mail: ; Farideh Hosseinzadeh, Shiraz University of Medical Sciences, Shiraz, IR Iran. E-mail:
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Petramfar P, Hosseinzadeh F, Mohammadi SS. Pseudo-Foster Kennedy Syndrome as a Rare Presentation of Vitamin B12 Deficiency. Iran Red Crescent Med J 2016; 18:e24610. [PMID: 27621919 PMCID: PMC5002969 DOI: 10.5812/ircmj.24610] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/30/2015] [Accepted: 04/18/2015] [Indexed: 12/01/2022]
Abstract
Introduction Pseudo-Foster Kennedy syndrome is a triad consisting of ipsilateral optic atrophy, contralateral optic disc edema, and ipsilateral anosmia in the absence of an intracranial mass. Vitamin B12 plays an important role in DNA synthesis, and its deficiency causes peripheral neuropathy, myeloneuropathy, and, very rarely, optic neuropathy. Case Presentation In this study, we describe a 34-year-old male who presented with progressive loss of visual acuity and field. Fundoscopy showed optic disc edema with telangiectasia in the right eye, while the left eye had optic disc atrophy. We ruled out nearly all possible and common causes of optic neuropathy, and vitamin B12 deficiency was finally diagnosed. After treatment with vitamin B12, the patient improved. Conclusions Demyelinating disease, anterior ischemic optic neuropathy, non-arteritic anterior ischemic optic neuropathy, autoimmune disease, and hereditary optic neuropathy could cause optic neuropathy. Normal CBC parameters and the absence of clinical manifestations of vitamin B12 deficiency could not rule out its diagnosis. Careful physical examinations and history-taking with a classical approach led us to the diagnosis of vitamin B12 deficiency and its treatment.
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Affiliation(s)
- Peyman Petramfar
- Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farideh Hosseinzadeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - S. Saeed Mohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: S. Saeed Mohammadi, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9364402630, Fax: +98-7733444844, E-mail:
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Davarpanah MA, Hosseinzadeh F, Mohammadi SS. Treatment Following Intoxication With Lethal Dose of Paraquat: A Case Report and Review of Literature. Iran Red Crescent Med J 2015; 17:e19373. [PMID: 26568853 PMCID: PMC4636757 DOI: 10.5812/ircmj.19373] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 09/09/2014] [Accepted: 03/30/2015] [Indexed: 12/01/2022]
Abstract
Introduction: Paraquat is a widely used nitrogen-based herbicide which is lethal and causes multi-organ failure by accumulation in cells, which subsequently leads to death. Case Presentation: The present case report introduced a 25-year-old male with nausea, vomiting, and severe substernal burning sensation after incidentally ingestion of a large amount of paraquat. The treatment of the patient with antioxidants (N-acetylcysteine and vitamin E) and hemodialysis started immediately after arriving to the hospital. Conclusions: Immediate and adequate use of antioxidants and hemodialysis has an undeniable and important role in survival of patients after ingestion of a large amount of paraquat.
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Affiliation(s)
- Mohammad Ali Davarpanah
- Department of Infectious Diseases, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Farideh Hosseinzadeh
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - S. Saeed Mohammadi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: S. Saeed Mohammadi, Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-9364402630, E-mail:
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Mehraien A, Ghafari A, Mohammadi SS. Effect of topical aprotinin on early postoperative bleeding and ICU stay after coronary artery bypass graft surgeries. Pak J Biol Sci 2009; 12:813-816. [PMID: 19806814 DOI: 10.3923/pjbs.2009.813.816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We evaluate the effect of topical application of aprotinin to the heart, pericardia and mediastinum before sternal closure, on early post operative bleeding, blood transfusion requirement and ICU staying time after coronary artery bypass graft surgeries. In a randomized double blinded clinical trial, 128 patients who were scheduled for elective coronary artery bypass graft were allocated into two groups. In group A (aprotinin), patients received 500,000KIU (50 mL) aprotinin and in group S (saline group) the same volume of normal saline was applied. The amount of blood loss collected in chest bottle, the number of pack cells requirement during first 24 h after operation and duration of ICU staying time were recorded. The amount of blood loss in group A (aprotinin) was 451 +/- 218 mL compared with 707 +/- 269 mL in group S (saline) (p = 0.003). The number of pack cells consumption was 0.5 +/- 0.7 units in group A (aprotinin) compared with 1.7 +/- 1 units in saline group (p = 0.002). Intensive Care Unit (ICU) staying time was 48.8 +/- 13.6 h in group A (aprotinin) and 69.4 +/- 16.6 h in saline group (p = 0.001). This study showed that topical application of aprotinin at the end of coronary artery surgeries, significantly reduce postoperative bleeding and blood transfusion requirement during first 24 h after operation and also ICU staying time.
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Affiliation(s)
- A Mehraien
- Department of Anesthesiology, Tehran University of Medical Sciences, Dr. Shariati Hospital, Tehran, Iran
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Mohammadi SS, Shahbazian E, Shoeibi G, Almassi F. Effect of scalp infiltration with Bupivacaine on early hemodynamic responses during craniotomy under general anesthesia. Pak J Biol Sci 2009; 12:603-606. [PMID: 19580019 DOI: 10.3923/pjbs.2009.603.606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present study was conducted to evaluate the effect of scalp infiltration with Bupivacaine on hemodynamic responses during early stimulation in craniotomy under general anesthesia. Thirty six patients were prospectively randomized to receive Bupivacaine scalp infiltration (B group) or a saline control (S group) as an adjuvant to general anesthesia using isoflurane in 50% N2O-O2. Mean Arterial Blood Pressure (MAP) and Heart Rate (HR) were recorded as base line, after scalp incision or pin insertion and then every 3 min until 12 min. The measurements were repeated every 5 min till dura was opened. The mean difference between the two groups for HR during scalp incision or pin insertion was significant (p = 0.03). The mean MAP throughout the time intervals of preincision or pin insertion to 12 min postincision and then to dural opening were statistically different between the two groups (p = 0.001). No complications related to the technique of block or drugs were recorded. Scalp infiltration with Bupivacaine as an adjuvant to general anesthesia can provide more stable hemodynamics, as measured by HR and MAP changes during early stimulation in craniotomy.
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Affiliation(s)
- S S Mohammadi
- Department of Anesthesiology, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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