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Papers by Ramin Daneshvar

Journal of Clinical & Medical Genomics, 2019

Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait a... more Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait and is more prevalent in community with consanguineous marriage. The aim of current study was to screen 27 familial cases of PCG for CYP1B1, to identify and determine common mutations, and to understand its penetrance and prevalence in the Eastern provinces of Iran. Methods: Detailed family histories up to three generations were taken, and pedigree charts were constructed. Genomic DNA was extracted from peripheral leukocytes. Primers were designed for the two coding exons of the CYP1B1 gene and the amplified products were sequenced. PolyPhen and SIFT were used to predict the functional impact of novel mutations identified in this study. Results: Seventeen of 27 subjects (62.96%) had mutations in the CYP1B1 gene. In this study, 10 specific mutations associated with disease phenotypes were found. Six missense (p. R368H, p.E229K, p.R390C, p.V364M, p.F445I, p.G61E) and one deletion mutation (c.1504_1504delA) were previously reported and 3 missense mutations (p.L480p, p.S476P and p.R175P) were novel. The most common mutation was G61E, which was identified in 8 of 17 cases (47.05%). We also notified that one of the patients was homozygous for the mutation E229K, and also R390C (tetra-allelic). Mutations in CYP1B1 was a major finding in our PCG patients. Identifying mutations in subjects at risk of developing glaucoma, particularly among relatives of PCG patients, is of clinical relevance. These findings may help in reducing the disease frequency in familial cases through proper counseling. Such studies will be of benefit in the identification of pathogenic mutations in different populations and will enable us to develop simple and rapid diagnostic tests for analyzing such cases.

Clinical Ophthalmology, 2015

Purpose: To explore utilization of the coaxially sighted corneal light reflex (CSCLR) for centrat... more Purpose: To explore utilization of the coaxially sighted corneal light reflex (CSCLR) for centration during myopic photorefractive keratectomy (PRK) for patients with relatively high angle kappa (κ) values. Methods: Patients were stratified into two groups preoperatively, on the basis of angle κ values. Group A was composed of 166 eyes with an angle κ value ,5°. Group B consisted of 182 eyes with an angle κ value .5°. Intraoperative centering of ablation was performed within group A by utilizing the pupillary center, and within group B by using the CSCLR. Visual acuities were evaluated and compared at 6 months and 12 months postoperatively between groups. Results: Mean uncorrected visual acuities (UCVA) for all patients at 6 months and 12 months were -0.073 logMAR and -0.080 logMAR, respectively. A total of 98.9% of patients had a UCVA of 0.00 logMAR (≈20/20 Snellen) 12 months postoperatively. There was not a significant between-group difference in regard to residual refractive error at 6 months or 12 months (P=0.53 and P=0.97), or in UCVA at 6 months and 12 months (P=0.76 and P=0.17). There were no subjective complaints of monocular diplopia, glare, or haloes within either group at any time during follow-up. Conclusion: Availing use of the CSCLR for centration of ablation within myopic patients with high angle κ values may aid in providing better refractive outcomes after performance of PRK.

Journal of ophthalmic and vision research, Nov 24, 2022

Purpose: To compare the frequency of dermatological manifestations between patients with pseudoex... more Purpose: To compare the frequency of dermatological manifestations between patients with pseudoexfoliative glaucoma and those with primary open-angle glaucoma. Methods: A cross-sectional study was done on all consecutive pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG) patients evaluated in a tertiary eye hospital during the study period. Eligible patients were referred to the dermatology department for complete skin, hair, nail, and mucosal examinations. Results: Twenty-one patients in the PEXG group and 26 patients in the POAG group were included in this study. The most common skin manifestations in the study were seborrheic dermatitis, dry skin, and cherry angioma. The frequency of lentigines was significantly higher in the PEXG patients than in the POAG group (P = 0.013). More than half of the study population had seborrheic dermatitis (57.1% and 61.5% in the PEXG and POAG groups, respectively); however, the difference between the groups was not statistically significant (P = 0.775). Similarly, the frequencies of skin dryness, cherry angioma, nevus, psoriasis, contact dermatitis, itching, seborrheic keratoses, notalgia paresthetica, and vitiligo in the two groups were not statistically significantly different (P > 0.1 for all comparisons). There was no significant association between the frequency of the investigated skin manifestations and patients' age, visual acuity, intraocular pressure, and cup-todisc ratio. Conclusion: Integumentary system disorders are pervasive in glaucoma patients, and dermatologic evaluation in glaucoma patients should be considered for diagnostic and therapeutic purposes.

Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal t... more Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery. Method: PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently. Result: 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included fo...

Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait a... more Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait and is more prevalent in community with consanguineous marriage. The aim of current study was to screen 27 familial cases of PCG for CYP1B1, to identify and determine common mutations, and to understand its penetrance and prevalence in the Eastern provinces of Iran. Methods: Detailed family histories up to three generations were taken, and pedigree charts were constructed. Genomic DNA was extracted from peripheral leukocytes. Primers were designed for the two coding exons of the CYP1B1 gene and the amplified products were sequenced. PolyPhen and SIFT were used to predict the functional impact of novel mutations identified in this study. Results: Seventeen of 27 subjects (62.96%) had mutations in the CYP1B1 gene. In this study, 10 specific mutations associated with disease phenotypes were found. Six missense (p. R368H, p.E229K, p.R390C, p.V364M, p.F445I, p.G61E) and one deletion mutation (...

Journal of Ophthalmic & Vision Research, 2021

Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods... more Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery. Results The patients' mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P < 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow...

Iranian Journal of Ophthalmology, 2011

Purpose: To investigate the association of primary open angle glaucoma (POAG) and systemic hypert... more Purpose: To investigate the association of primary open angle glaucoma (POAG) and systemic hypertension in patients referred to Farabi Eye Hospital Methods: In this case-control study in Farabi Eye Hospital. One hundred patients were selected randomly from POAG patients of glaucoma clinic, Farabi Eye Hospital. Control group consists of 100 patients, candidates for cataract surgery. History of any anti-hypertensive agent consumption was recorded for all participants. A complete set of systemic and ophthalmologic examinations, including several blood pressure measurements, was performed for each subject. Systolic blood pressure above 140 mmHg, diastolic blood pressure above 90 mmHg and/or any history of antihypertensive usage in each group were considered as hypertensive status. Results: Diastolic blood pressure was significantly higher in POAG patients than control group (P=0.003). Systolic blood pressure was also higher in POAG patients than control group; however, the difference wa...

Reports of biochemistry & molecular biology, 2019

Background Glaucoma is one of the main causes of irreversible blindness. The most common type of ... more Background Glaucoma is one of the main causes of irreversible blindness. The most common type of glaucoma is primary open angle glaucoma (POAG). TGF-β2, the main TGF-β isoform in the eye, is critical for extracellular matrix production and angiogenesis. Genetic studies have shown that TGF-β2 gene (TGFB2) polymorphisms affect its expression in the eye. The aim of this study was to investigate the presence of the TGFB2 rs991967 polymorphism in POAG, and the effect of this polymorphism on clinical characteristics in POAG patients. Methods This case-control study was conducted on 112 control participants and 112 POAG patients referred to Khatam-Al-Anbia Eye Hospital, Mashhad, Iran. The TGFB2 rs991967 polymorphism was genotyped by the PCR-restriction fragment length polymorphism (PCR-RFLP) method. The genotyping results and clinical findings were analyzed using SPSS version 16. Results The most common genotype was AA, observed in 54.5% of the patients (P < 0.0001, OR 12.2, CI 95% for ...

Reviews in Clinical Medicine, 2016

Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal t... more Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery.Method: PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently.Result: 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included for ...

Iranian Journal of Ophthalmology, 2013

Purpose: To compare retinal nerve fiber layer (RNFL) profile in subjects with myopia and emmetrop... more Purpose: To compare retinal nerve fiber layer (RNFL) profile in subjects with myopia and emmetropia using GDx variable corneal compensator (VCC)

Journal of Ophthalmic and Vision Research, 2021

Purpose: To quantify the microvasculature density of the optic nerve head (ONH) using optical coh... more Purpose: To quantify the microvasculature density of the optic nerve head (ONH) using optical coherence tomography angiography (OCTA) analysis in patients recovered from Coronavirus Disease 2019 (COVID-19). Methods: In a comparative cross-sectional, observational study, patients recovered from COVID- 19 whose initial diagnosis was confirmed by an rRT-PCR of a nasopharyngeal sample were included in this study. OCTA of ONH was performed in included patients and normal controls. Vascular density (VD) of the all vessels (AV) and small vessels (SV) inside the disc and radial peripapillary capillary (RPC) network density was measured in COVID-19 recovered patients and compared with similar parameters in an age-matched group of normal controls. Results: Twenty-five COVID-19 patients and twenty-two age-matched normal controls were enrolled in the study and one eye per participant was evaluated. The mean whole image SV VD in the COVID-19 group (49.31 ± 1.93) was not statistically significant...

Medical & Surgical Ophthalmology Research, 2018

To correlate corneal endothelium cell density with dry eye disease compared to an age-matched con... more To correlate corneal endothelium cell density with dry eye disease compared to an age-matched control group. In this cross-sectional study, a total of 150 eyes of 75 female students aged 19-25 years who did not have any history of eye injuries or eye disease affecting the corneal endothelium cell density, were recruited from KSU Female Campus. They were divided into groups based on their dry eye disease severity. All subjects undergone full ophthalmic examinations assessing their endothelium cell count using specular microscope and dryness level using Non-invasive Break up Time (NIBUT) using Keratograph4. The mean endothelial cell density was significantly lower in subjects with severe dryness (2620.3 ± 252.2 cell/mm²) and moderate dryness (2801 ± 221.6 cell/mm²) than normal subjects (3067± 196.7 cell/mm²), p=.000.In addition, the mean cell area was lower in normal subjects (327.4± 21.5 µm²) and increased with severity of dryness, in subjects with moderate dryness (358.9 ±27.1 µm²) and in subjects with severe dryness (384.8 ±33.7 µm²), p=.000.There was variation in the mean cell volume, in normal subjects was (25±3.6) and (27.2±4.3) in moderate dryness and (25.5±3.6) in severe dryness, p=.009. Results succeeded to demonstrate that in moderate to severe dryness, there was a significant reduction in the corneal endothelial cell density as compared to the age-and sex-matched control group. Correlation between corneal endothelial cells Characteristics and dry eye disease Correlation between corneal endothelial cell Characteristics and dry eye disease.

Survey of Ophthalmology, 2020

With the advent of spectral-domain optical coherence tomography (SD-OCT), imaging of the posterio... more With the advent of spectral-domain optical coherence tomography (SD-OCT), imaging of the posterior segment of the eye can be carried out rapidly at multiple anatomical locations, including the optic nerve head (ONH), circumpapillary retinal nerve fiber layer (cp-RNFL), and macula. There is now ample evidence to support the role of SD-OCT imaging of the macula for detection of early glaucoma. Macular SD-OCT measurements demonstrate high reproducibility, and evidence on its utility for detection of glaucoma progression is accumulating. We present a comprehensive review of macular SD-OCT imaging emerging as an essential diagnostic tool in glaucoma.

Eastern Mediterranean Health Journal, 2012

In Chaharborj, a village in north-eastern of the Islamic Republic of Iran, a high prevalence of c... more In Chaharborj, a village in north-eastern of the Islamic Republic of Iran, a high prevalence of congenital blindness (1.1%) has been reported. The clinical findings have not been fully described. We therefore assessed the clinical aspects of this condition in a case series of 20 congenitally blind patients and 24 of their parents. All patients had been blind since birth. There was anterior segment dysgenesis and retinal non-attachment in all patients. There were no systemic anomalies. Histopathologically, there was iridocorneal adhesion, normal angle structure and retinal dysplasia. No significant difference was found in the frequency of different HLA class I alleles compared with the general population. The anomaly causing congenital blindness in these patients has components of both anterior and posterior segment dysgenesis. It appears to be a distinct entity with an autosomal recessive pattern of inheritance.

Journal of Current Ophthalmology, 2018

Purpose: The aim of this study was to compare the ocular hypertensive effect of the commercially ... more Purpose: The aim of this study was to compare the ocular hypertensive effect of the commercially available Betamethasone, Fluorometholone in Iran and Loteprednol Etabonate in patients undergoing keratorefractive surgery. Methods: In this prospective randomized clinical trial, 300 eyes of 150 patients were included, and patients were randomly assigned to 3 groups and used one of the 3 steroid drops (Betamethasone 0.1%, Fluorometholone 0.1%, and Loteprednol Etabonate 0.5%) after myopic photorefractive keratectomy (PRK). Intraocular pressure (IOP) was measured 2, 4, and 6 weeks post-surgery. Twenty-two mmHg was set as the threshold IOP for starting anti-glaucoma medication and tapering steroid drops. Results: Of 300 eyes from 150 patients over the first 6 postoperative weeks, 2 eyes in Fluorometholone group (2%), 12 eyes in Betamethasone group (12%), and 16 eyes in Loteprednol group (16%) had IOP equal or more than 22 mmHg. Analysis of variance (ANOVA) test showed that the rise in IOP was significantly different between groups in the 2nd and 4th (P 0.001) postoperative weeks but not at 6th week (P ¼ 0.230). An IOP rise equal or more than 10 mmHg was detected in 13 and 15 eyes in Betamethasone and Loteprednol groups, respectively. None of the eyes in Fluorometholone group had such an IOP rise. Conclusions: Loteprednol and Fluorometholone were associated with the most and least increase in IOP, respectively. The highest pressures were detected 4 weeks after surgery in the Betamethasone and Loteprednol groups and 6 weeks after surgery in the Fluorometholone group. Fluorometholone was the safest among the three examined steroid drops in terms of IOP rise.

Minerva Oftalmologica, 2018

Investigative Opthalmology & Visual Science, 2017

To test the hypotheses that: (1) structure-function (SF) relationships between visual fields (VF)... more To test the hypotheses that: (1) structure-function (SF) relationships between visual fields (VF) and Bruch's membrane opening-based minimum rim width (BMO-MRW) measurements are superior to those for peripapillary retinal nerve fiber layer (pRNFL) in perimetric glaucoma; (2) BMO-MRW measurements may extend the utility of structural measurement across the range of glaucoma severity; and (3) to estimate the influence of Bruch's membrane opening (BMO) size on BMO-MRW measurements. METHODS. One hundred eight perimetric glaucoma eyes (68 patients) with good quality spectral-domain optical coherence tomography images of the optic disc and pRNFL, and reliable VF within 6 months were recruited. Relationship of global and sectoral BMO-MRW and pRNFL thickness with corresponding VF parameters and the influence of normalizing BMO-MRW (on BMO circumference, nBMO-MRW) on SF relationships were investigated. Broken-stick models were used to compare the point at which pRNFL and BMO-MRW parameters reached their measurement floor. The median (interquartile range) of VF mean deviation was À5.9 (À12.6 to À3.6) dB. Spearman correlation coefficients between pRNFL, BMO-MRW, and nBMO-MRW measures and corresponding VF cluster average deviations ranged between 0.55 to 0.80, 0.35 to 0.66, and 0.38 to 0.65, respectively. Bruch's membrane opening-MRW parameters demonstrated weaker SF relationships compared with pRNFL globally and in temporal, temporal-superior, and nasal-inferior sectors (P < 0.03). Normalization of BMO-MRW did not significantly influence SF relationships. CONCLUSIONS. Structure-function relationships were somewhat weaker with BMO-MRW parameters compared with pRNFL in eyes with perimetric glaucoma. Bruch's membrane opening-MRW normalization did not significantly change SF relationships in this group of eyes with mild departures from average BMO size.

Clinical and Experimental Optometry, 2017

Background: The aim was to evaluate the effect of the tilted optic disc on the visual field in hi... more Background: The aim was to evaluate the effect of the tilted optic disc on the visual field in highly myopic eyes. Methods: A total of 58 eyes from 58 highly myopic individuals underwent detailed ophthalmic examination and were categorised into two groups according to the presence of a tilted optic disc. The visual field of 20 eyes (mean age of 28.95 AE 7.22 years) with tilted optic discs were compared with 38 eyes (mean age of 27.87 AE 6.08 years) of control subjects without tilted optic discs using the 30-2 SITA standard protocol with a Humphrey Field Analyzer -HFA II-i. Optic disc tilt was assessed from retinal photographs exported to Adobe Photoshop software. Disc ovality was assessed using the ratio of minimum to maximum disc diameter. A ratio of up to 0.80 was considered a tilted optic disc. Results: Foveal threshold sensitivity showed no statistically significant difference between tilted and non-tilted groups (35.16 AE 2.71 dB versus 35.37 AE 2.35 dB, p = 0.76). The mean deviation was -3.29 AE 2.03 dB in the tilted group and -3.49 AE 2.56 dB in the nontilted group (p = 0.77). Additionally, there were no significant differences in the average deviation between the two groups in four quadrants and four hemifields; however, the lowest average deviation was observed in the superotemporal quadrant in the tilted group (-4.54 AE 3.16 dB). In the non-tilted group, 29 per cent had no visual field defect, 24 per cent had an arcuate scotoma and 20 per cent had generalised depression. In the tilted group, 30 per cent had an arcuate scotoma, 30 per cent had generalised depression and 13 per cent had no visual field defect. Other visual field defects occurred at frequencies less than 15 per cent in both groups. Conclusions: The investigation of visual field patterns may be more appropriate than quantitative indices (for example, total mean deviation, foveal threshold sensitivity, average deviation) to assess the visual field in highly myopic patients with tilted optic discs.

Journal of Ophthalmic and Vision Research, 2015

Purpose: To report a case of late iatrogenic bleb formation and hypotony maculopathy after pteryg... more Purpose: To report a case of late iatrogenic bleb formation and hypotony maculopathy after pterygium surgery applying Mitomycin C (MMC). Case Report: A 66-year-old man presented with an elevated, bleb-like, fluid-filled, cystic lesion on the nasal sclera of the right eye. The patient had undergone pterygium surgery with a combination of conjunctival autograft and adjuvant intraoperative MMC 0.02% four years before. The sclera seemed fistulized at the site of surgery and a thin layer of conjunctiva completely covered the lesion. A scleral patch graft was secured over the fistula with sutures, followed by excision of the thinned, avascular conjunctiva and advancement of the healthy adjacent conjunctiva to cover the patch graft. One month later, a small bleb re-appeared adjacent to the scleral patch graft and IOP was 2 mmHg. Argon-laser treatment of the bleb was tried to induce scarring and reduction of bleb size, and was highly effective. After one week, IOP was increased to 8 mmHg. The clinical features remained stable four months after initial presentation. Conclusion: Pterygium surgery using adjuvant MMC may result in late iatrogenic bleb formation and hypotony maculopathy. This complication can be successfully corrected surgically using a scleral patch graft combined with argon laser treatment over the inadvertent bleb.

Journal of ophthalmic & vision research

Glaucoma is the second-leading cause of vision loss in the world: the so-called "silent thief of ... more Glaucoma is the second-leading cause of vision loss in the world: the so-called "silent thief of vision" is globally the most common cause of preventable, irreversible blindness. It is estimated that the disease affects more than 60 million people worldwide, and this number is projected to increase to about 80 million by 2020. Moreover, it is proposed that nearly 8.4 million people are bilaterally blind due to glaucoma and this number will be increased to 11.1 million by 2020. To date, although intraocular pressure (IOP) is no longer an essential element for the diagnosis of glaucoma, it is regarded as the mere modifiable risk factor for the disease. The clinical management of patients suffering from various types of glaucoma has historically focused on reduction and tight control of elevated IOP through different pharmacological and surgical interventions. In open angle glaucoma, tissues of the conventional outflow pathway are diseased and are the underlying cause of elevated IOP. It is hypothesized that the cells in this pathway could not appropriately change their shape to decrease resistance to aqueous outflow and compensate the pathologically increased resistance. Greater amounts of endogenous contractility mediators, such as endothelin-1 and transforming growth factor-beta 2, in the glaucomatous eye could be a contributing factor. Considering these pathophysiological aspects of open angle glaucoma, medical and surgical treatments that specifically target and treat the diseased tissues of the conventional outflow pathway have long been aimed for its management. Several surgical procedures, including laser trabeculoplasty, canaloplasty, iStent microshunt (Glaukos Corporation, Laguna Hills,

Journal of Clinical & Medical Genomics, 2019

Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait a... more Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait and is more prevalent in community with consanguineous marriage. The aim of current study was to screen 27 familial cases of PCG for CYP1B1, to identify and determine common mutations, and to understand its penetrance and prevalence in the Eastern provinces of Iran. Methods: Detailed family histories up to three generations were taken, and pedigree charts were constructed. Genomic DNA was extracted from peripheral leukocytes. Primers were designed for the two coding exons of the CYP1B1 gene and the amplified products were sequenced. PolyPhen and SIFT were used to predict the functional impact of novel mutations identified in this study. Results: Seventeen of 27 subjects (62.96%) had mutations in the CYP1B1 gene. In this study, 10 specific mutations associated with disease phenotypes were found. Six missense (p. R368H, p.E229K, p.R390C, p.V364M, p.F445I, p.G61E) and one deletion mutation (c.1504_1504delA) were previously reported and 3 missense mutations (p.L480p, p.S476P and p.R175P) were novel. The most common mutation was G61E, which was identified in 8 of 17 cases (47.05%). We also notified that one of the patients was homozygous for the mutation E229K, and also R390C (tetra-allelic). Mutations in CYP1B1 was a major finding in our PCG patients. Identifying mutations in subjects at risk of developing glaucoma, particularly among relatives of PCG patients, is of clinical relevance. These findings may help in reducing the disease frequency in familial cases through proper counseling. Such studies will be of benefit in the identification of pathogenic mutations in different populations and will enable us to develop simple and rapid diagnostic tests for analyzing such cases.

Clinical Ophthalmology, 2015

Purpose: To explore utilization of the coaxially sighted corneal light reflex (CSCLR) for centrat... more Purpose: To explore utilization of the coaxially sighted corneal light reflex (CSCLR) for centration during myopic photorefractive keratectomy (PRK) for patients with relatively high angle kappa (κ) values. Methods: Patients were stratified into two groups preoperatively, on the basis of angle κ values. Group A was composed of 166 eyes with an angle κ value ,5°. Group B consisted of 182 eyes with an angle κ value .5°. Intraoperative centering of ablation was performed within group A by utilizing the pupillary center, and within group B by using the CSCLR. Visual acuities were evaluated and compared at 6 months and 12 months postoperatively between groups. Results: Mean uncorrected visual acuities (UCVA) for all patients at 6 months and 12 months were -0.073 logMAR and -0.080 logMAR, respectively. A total of 98.9% of patients had a UCVA of 0.00 logMAR (≈20/20 Snellen) 12 months postoperatively. There was not a significant between-group difference in regard to residual refractive error at 6 months or 12 months (P=0.53 and P=0.97), or in UCVA at 6 months and 12 months (P=0.76 and P=0.17). There were no subjective complaints of monocular diplopia, glare, or haloes within either group at any time during follow-up. Conclusion: Availing use of the CSCLR for centration of ablation within myopic patients with high angle κ values may aid in providing better refractive outcomes after performance of PRK.

Journal of ophthalmic and vision research, Nov 24, 2022

Purpose: To compare the frequency of dermatological manifestations between patients with pseudoex... more Purpose: To compare the frequency of dermatological manifestations between patients with pseudoexfoliative glaucoma and those with primary open-angle glaucoma. Methods: A cross-sectional study was done on all consecutive pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG) patients evaluated in a tertiary eye hospital during the study period. Eligible patients were referred to the dermatology department for complete skin, hair, nail, and mucosal examinations. Results: Twenty-one patients in the PEXG group and 26 patients in the POAG group were included in this study. The most common skin manifestations in the study were seborrheic dermatitis, dry skin, and cherry angioma. The frequency of lentigines was significantly higher in the PEXG patients than in the POAG group (P = 0.013). More than half of the study population had seborrheic dermatitis (57.1% and 61.5% in the PEXG and POAG groups, respectively); however, the difference between the groups was not statistically significant (P = 0.775). Similarly, the frequencies of skin dryness, cherry angioma, nevus, psoriasis, contact dermatitis, itching, seborrheic keratoses, notalgia paresthetica, and vitiligo in the two groups were not statistically significantly different (P > 0.1 for all comparisons). There was no significant association between the frequency of the investigated skin manifestations and patients' age, visual acuity, intraocular pressure, and cup-todisc ratio. Conclusion: Integumentary system disorders are pervasive in glaucoma patients, and dermatologic evaluation in glaucoma patients should be considered for diagnostic and therapeutic purposes.

Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal t... more Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery. Method: PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently. Result: 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included fo...

Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait a... more Background purpose: Primary Congenital Glaucoma (PCG) is typically an autosomal recessive trait and is more prevalent in community with consanguineous marriage. The aim of current study was to screen 27 familial cases of PCG for CYP1B1, to identify and determine common mutations, and to understand its penetrance and prevalence in the Eastern provinces of Iran. Methods: Detailed family histories up to three generations were taken, and pedigree charts were constructed. Genomic DNA was extracted from peripheral leukocytes. Primers were designed for the two coding exons of the CYP1B1 gene and the amplified products were sequenced. PolyPhen and SIFT were used to predict the functional impact of novel mutations identified in this study. Results: Seventeen of 27 subjects (62.96%) had mutations in the CYP1B1 gene. In this study, 10 specific mutations associated with disease phenotypes were found. Six missense (p. R368H, p.E229K, p.R390C, p.V364M, p.F445I, p.G61E) and one deletion mutation (...

Journal of Ophthalmic & Vision Research, 2021

Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods... more Purpose To evaluate the long-term outcomes of collagen crosslinking in early keratoconus. Methods Thirty eyes of twenty patients with early keratoconus were enrolled. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), objective refraction, subjective refraction, corneal topography and pachymetry were assessed before and 3, 6, 12 months and 9 years after performing collagen crosslinking surgery. Results The patients' mean age was 31.2 ± 5.59 years at nine-year follow-up (range, 25–44 years). The means of preoperative UCVA and BSCVA were 0.57 ± 0.34 and 0.15 ± 0.12 logMAR, respectively, and these values remained stable at the final follow-up (P = 0.990 and P = 0.227, respectively). The mean objective spherical equivalent decreased considerably from –6.00 ± 4.05 D preoperatively to –5.22 ± 3.71 D at the final follow-up (P < 0.05). The mean subjective spherical equivalent was –4.25 ± 2.87 D preoperatively and this value was stable at the last follow...

Iranian Journal of Ophthalmology, 2011

Purpose: To investigate the association of primary open angle glaucoma (POAG) and systemic hypert... more Purpose: To investigate the association of primary open angle glaucoma (POAG) and systemic hypertension in patients referred to Farabi Eye Hospital Methods: In this case-control study in Farabi Eye Hospital. One hundred patients were selected randomly from POAG patients of glaucoma clinic, Farabi Eye Hospital. Control group consists of 100 patients, candidates for cataract surgery. History of any anti-hypertensive agent consumption was recorded for all participants. A complete set of systemic and ophthalmologic examinations, including several blood pressure measurements, was performed for each subject. Systolic blood pressure above 140 mmHg, diastolic blood pressure above 90 mmHg and/or any history of antihypertensive usage in each group were considered as hypertensive status. Results: Diastolic blood pressure was significantly higher in POAG patients than control group (P=0.003). Systolic blood pressure was also higher in POAG patients than control group; however, the difference wa...

Reports of biochemistry & molecular biology, 2019

Background Glaucoma is one of the main causes of irreversible blindness. The most common type of ... more Background Glaucoma is one of the main causes of irreversible blindness. The most common type of glaucoma is primary open angle glaucoma (POAG). TGF-β2, the main TGF-β isoform in the eye, is critical for extracellular matrix production and angiogenesis. Genetic studies have shown that TGF-β2 gene (TGFB2) polymorphisms affect its expression in the eye. The aim of this study was to investigate the presence of the TGFB2 rs991967 polymorphism in POAG, and the effect of this polymorphism on clinical characteristics in POAG patients. Methods This case-control study was conducted on 112 control participants and 112 POAG patients referred to Khatam-Al-Anbia Eye Hospital, Mashhad, Iran. The TGFB2 rs991967 polymorphism was genotyped by the PCR-restriction fragment length polymorphism (PCR-RFLP) method. The genotyping results and clinical findings were analyzed using SPSS version 16. Results The most common genotype was AA, observed in 54.5% of the patients (P < 0.0001, OR 12.2, CI 95% for ...

Reviews in Clinical Medicine, 2016

Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal t... more Introduction: Intraocular pressure (IOP) can be influenced by several factors including corneal thickness, gender, refractive error, and the presence of diabetes mellitus. In the present study, we systematically reviewed published literature to find association between variations of IOP due to strabismus surgery.Method: PubMed and Scopus were systematically searched with the following search terms: (intraocular pressure OR IOP) AND (strabismus) for the articles in which the fluctuation of IOP before and after strabismus surgery had been evaluated. All types of articles including case series, cross-sectional, clinical trials, and cohort studies with no time limitation were included in this study. Systematically searches, selection of articles, and the extraction of data were performed by two reviewers independently.Result: 1617 out of 1674 articles were excluded due to duplication or irrelevancy. After step by step process of article selection, 57 relevant articles were included for ...

Iranian Journal of Ophthalmology, 2013

Purpose: To compare retinal nerve fiber layer (RNFL) profile in subjects with myopia and emmetrop... more Purpose: To compare retinal nerve fiber layer (RNFL) profile in subjects with myopia and emmetropia using GDx variable corneal compensator (VCC)

Journal of Ophthalmic and Vision Research, 2021

Purpose: To quantify the microvasculature density of the optic nerve head (ONH) using optical coh... more Purpose: To quantify the microvasculature density of the optic nerve head (ONH) using optical coherence tomography angiography (OCTA) analysis in patients recovered from Coronavirus Disease 2019 (COVID-19). Methods: In a comparative cross-sectional, observational study, patients recovered from COVID- 19 whose initial diagnosis was confirmed by an rRT-PCR of a nasopharyngeal sample were included in this study. OCTA of ONH was performed in included patients and normal controls. Vascular density (VD) of the all vessels (AV) and small vessels (SV) inside the disc and radial peripapillary capillary (RPC) network density was measured in COVID-19 recovered patients and compared with similar parameters in an age-matched group of normal controls. Results: Twenty-five COVID-19 patients and twenty-two age-matched normal controls were enrolled in the study and one eye per participant was evaluated. The mean whole image SV VD in the COVID-19 group (49.31 ± 1.93) was not statistically significant...

Medical & Surgical Ophthalmology Research, 2018

To correlate corneal endothelium cell density with dry eye disease compared to an age-matched con... more To correlate corneal endothelium cell density with dry eye disease compared to an age-matched control group. In this cross-sectional study, a total of 150 eyes of 75 female students aged 19-25 years who did not have any history of eye injuries or eye disease affecting the corneal endothelium cell density, were recruited from KSU Female Campus. They were divided into groups based on their dry eye disease severity. All subjects undergone full ophthalmic examinations assessing their endothelium cell count using specular microscope and dryness level using Non-invasive Break up Time (NIBUT) using Keratograph4. The mean endothelial cell density was significantly lower in subjects with severe dryness (2620.3 ± 252.2 cell/mm²) and moderate dryness (2801 ± 221.6 cell/mm²) than normal subjects (3067± 196.7 cell/mm²), p=.000.In addition, the mean cell area was lower in normal subjects (327.4± 21.5 µm²) and increased with severity of dryness, in subjects with moderate dryness (358.9 ±27.1 µm²) and in subjects with severe dryness (384.8 ±33.7 µm²), p=.000.There was variation in the mean cell volume, in normal subjects was (25±3.6) and (27.2±4.3) in moderate dryness and (25.5±3.6) in severe dryness, p=.009. Results succeeded to demonstrate that in moderate to severe dryness, there was a significant reduction in the corneal endothelial cell density as compared to the age-and sex-matched control group. Correlation between corneal endothelial cells Characteristics and dry eye disease Correlation between corneal endothelial cell Characteristics and dry eye disease.

Survey of Ophthalmology, 2020

With the advent of spectral-domain optical coherence tomography (SD-OCT), imaging of the posterio... more With the advent of spectral-domain optical coherence tomography (SD-OCT), imaging of the posterior segment of the eye can be carried out rapidly at multiple anatomical locations, including the optic nerve head (ONH), circumpapillary retinal nerve fiber layer (cp-RNFL), and macula. There is now ample evidence to support the role of SD-OCT imaging of the macula for detection of early glaucoma. Macular SD-OCT measurements demonstrate high reproducibility, and evidence on its utility for detection of glaucoma progression is accumulating. We present a comprehensive review of macular SD-OCT imaging emerging as an essential diagnostic tool in glaucoma.

Eastern Mediterranean Health Journal, 2012

In Chaharborj, a village in north-eastern of the Islamic Republic of Iran, a high prevalence of c... more In Chaharborj, a village in north-eastern of the Islamic Republic of Iran, a high prevalence of congenital blindness (1.1%) has been reported. The clinical findings have not been fully described. We therefore assessed the clinical aspects of this condition in a case series of 20 congenitally blind patients and 24 of their parents. All patients had been blind since birth. There was anterior segment dysgenesis and retinal non-attachment in all patients. There were no systemic anomalies. Histopathologically, there was iridocorneal adhesion, normal angle structure and retinal dysplasia. No significant difference was found in the frequency of different HLA class I alleles compared with the general population. The anomaly causing congenital blindness in these patients has components of both anterior and posterior segment dysgenesis. It appears to be a distinct entity with an autosomal recessive pattern of inheritance.

Journal of Current Ophthalmology, 2018

Purpose: The aim of this study was to compare the ocular hypertensive effect of the commercially ... more Purpose: The aim of this study was to compare the ocular hypertensive effect of the commercially available Betamethasone, Fluorometholone in Iran and Loteprednol Etabonate in patients undergoing keratorefractive surgery. Methods: In this prospective randomized clinical trial, 300 eyes of 150 patients were included, and patients were randomly assigned to 3 groups and used one of the 3 steroid drops (Betamethasone 0.1%, Fluorometholone 0.1%, and Loteprednol Etabonate 0.5%) after myopic photorefractive keratectomy (PRK). Intraocular pressure (IOP) was measured 2, 4, and 6 weeks post-surgery. Twenty-two mmHg was set as the threshold IOP for starting anti-glaucoma medication and tapering steroid drops. Results: Of 300 eyes from 150 patients over the first 6 postoperative weeks, 2 eyes in Fluorometholone group (2%), 12 eyes in Betamethasone group (12%), and 16 eyes in Loteprednol group (16%) had IOP equal or more than 22 mmHg. Analysis of variance (ANOVA) test showed that the rise in IOP was significantly different between groups in the 2nd and 4th (P 0.001) postoperative weeks but not at 6th week (P ¼ 0.230). An IOP rise equal or more than 10 mmHg was detected in 13 and 15 eyes in Betamethasone and Loteprednol groups, respectively. None of the eyes in Fluorometholone group had such an IOP rise. Conclusions: Loteprednol and Fluorometholone were associated with the most and least increase in IOP, respectively. The highest pressures were detected 4 weeks after surgery in the Betamethasone and Loteprednol groups and 6 weeks after surgery in the Fluorometholone group. Fluorometholone was the safest among the three examined steroid drops in terms of IOP rise.

Minerva Oftalmologica, 2018

Investigative Opthalmology & Visual Science, 2017

To test the hypotheses that: (1) structure-function (SF) relationships between visual fields (VF)... more To test the hypotheses that: (1) structure-function (SF) relationships between visual fields (VF) and Bruch's membrane opening-based minimum rim width (BMO-MRW) measurements are superior to those for peripapillary retinal nerve fiber layer (pRNFL) in perimetric glaucoma; (2) BMO-MRW measurements may extend the utility of structural measurement across the range of glaucoma severity; and (3) to estimate the influence of Bruch's membrane opening (BMO) size on BMO-MRW measurements. METHODS. One hundred eight perimetric glaucoma eyes (68 patients) with good quality spectral-domain optical coherence tomography images of the optic disc and pRNFL, and reliable VF within 6 months were recruited. Relationship of global and sectoral BMO-MRW and pRNFL thickness with corresponding VF parameters and the influence of normalizing BMO-MRW (on BMO circumference, nBMO-MRW) on SF relationships were investigated. Broken-stick models were used to compare the point at which pRNFL and BMO-MRW parameters reached their measurement floor. The median (interquartile range) of VF mean deviation was À5.9 (À12.6 to À3.6) dB. Spearman correlation coefficients between pRNFL, BMO-MRW, and nBMO-MRW measures and corresponding VF cluster average deviations ranged between 0.55 to 0.80, 0.35 to 0.66, and 0.38 to 0.65, respectively. Bruch's membrane opening-MRW parameters demonstrated weaker SF relationships compared with pRNFL globally and in temporal, temporal-superior, and nasal-inferior sectors (P < 0.03). Normalization of BMO-MRW did not significantly influence SF relationships. CONCLUSIONS. Structure-function relationships were somewhat weaker with BMO-MRW parameters compared with pRNFL in eyes with perimetric glaucoma. Bruch's membrane opening-MRW normalization did not significantly change SF relationships in this group of eyes with mild departures from average BMO size.

Clinical and Experimental Optometry, 2017

Background: The aim was to evaluate the effect of the tilted optic disc on the visual field in hi... more Background: The aim was to evaluate the effect of the tilted optic disc on the visual field in highly myopic eyes. Methods: A total of 58 eyes from 58 highly myopic individuals underwent detailed ophthalmic examination and were categorised into two groups according to the presence of a tilted optic disc. The visual field of 20 eyes (mean age of 28.95 AE 7.22 years) with tilted optic discs were compared with 38 eyes (mean age of 27.87 AE 6.08 years) of control subjects without tilted optic discs using the 30-2 SITA standard protocol with a Humphrey Field Analyzer -HFA II-i. Optic disc tilt was assessed from retinal photographs exported to Adobe Photoshop software. Disc ovality was assessed using the ratio of minimum to maximum disc diameter. A ratio of up to 0.80 was considered a tilted optic disc. Results: Foveal threshold sensitivity showed no statistically significant difference between tilted and non-tilted groups (35.16 AE 2.71 dB versus 35.37 AE 2.35 dB, p = 0.76). The mean deviation was -3.29 AE 2.03 dB in the tilted group and -3.49 AE 2.56 dB in the nontilted group (p = 0.77). Additionally, there were no significant differences in the average deviation between the two groups in four quadrants and four hemifields; however, the lowest average deviation was observed in the superotemporal quadrant in the tilted group (-4.54 AE 3.16 dB). In the non-tilted group, 29 per cent had no visual field defect, 24 per cent had an arcuate scotoma and 20 per cent had generalised depression. In the tilted group, 30 per cent had an arcuate scotoma, 30 per cent had generalised depression and 13 per cent had no visual field defect. Other visual field defects occurred at frequencies less than 15 per cent in both groups. Conclusions: The investigation of visual field patterns may be more appropriate than quantitative indices (for example, total mean deviation, foveal threshold sensitivity, average deviation) to assess the visual field in highly myopic patients with tilted optic discs.

Journal of Ophthalmic and Vision Research, 2015

Purpose: To report a case of late iatrogenic bleb formation and hypotony maculopathy after pteryg... more Purpose: To report a case of late iatrogenic bleb formation and hypotony maculopathy after pterygium surgery applying Mitomycin C (MMC). Case Report: A 66-year-old man presented with an elevated, bleb-like, fluid-filled, cystic lesion on the nasal sclera of the right eye. The patient had undergone pterygium surgery with a combination of conjunctival autograft and adjuvant intraoperative MMC 0.02% four years before. The sclera seemed fistulized at the site of surgery and a thin layer of conjunctiva completely covered the lesion. A scleral patch graft was secured over the fistula with sutures, followed by excision of the thinned, avascular conjunctiva and advancement of the healthy adjacent conjunctiva to cover the patch graft. One month later, a small bleb re-appeared adjacent to the scleral patch graft and IOP was 2 mmHg. Argon-laser treatment of the bleb was tried to induce scarring and reduction of bleb size, and was highly effective. After one week, IOP was increased to 8 mmHg. The clinical features remained stable four months after initial presentation. Conclusion: Pterygium surgery using adjuvant MMC may result in late iatrogenic bleb formation and hypotony maculopathy. This complication can be successfully corrected surgically using a scleral patch graft combined with argon laser treatment over the inadvertent bleb.

Journal of ophthalmic & vision research

Glaucoma is the second-leading cause of vision loss in the world: the so-called "silent thief of ... more Glaucoma is the second-leading cause of vision loss in the world: the so-called "silent thief of vision" is globally the most common cause of preventable, irreversible blindness. It is estimated that the disease affects more than 60 million people worldwide, and this number is projected to increase to about 80 million by 2020. Moreover, it is proposed that nearly 8.4 million people are bilaterally blind due to glaucoma and this number will be increased to 11.1 million by 2020. To date, although intraocular pressure (IOP) is no longer an essential element for the diagnosis of glaucoma, it is regarded as the mere modifiable risk factor for the disease. The clinical management of patients suffering from various types of glaucoma has historically focused on reduction and tight control of elevated IOP through different pharmacological and surgical interventions. In open angle glaucoma, tissues of the conventional outflow pathway are diseased and are the underlying cause of elevated IOP. It is hypothesized that the cells in this pathway could not appropriately change their shape to decrease resistance to aqueous outflow and compensate the pathologically increased resistance. Greater amounts of endogenous contractility mediators, such as endothelin-1 and transforming growth factor-beta 2, in the glaucomatous eye could be a contributing factor. Considering these pathophysiological aspects of open angle glaucoma, medical and surgical treatments that specifically target and treat the diseased tissues of the conventional outflow pathway have long been aimed for its management. Several surgical procedures, including laser trabeculoplasty, canaloplasty, iStent microshunt (Glaukos Corporation, Laguna Hills,