Ehsan Rahimy - Academia.edu (original) (raw)

Papers by Ehsan Rahimy

Ophthalmic Surgery, Lasers and Imaging Retina

BACKGROUND AND OBJECTIVE: To evaluate outer retinal changes present on spectral-domain optical co... more BACKGROUND AND OBJECTIVE: To evaluate outer retinal changes present on spectral-domain optical coherence tomography (SD-OCT) in eyes pre-and postsilicone oil (SiO) removal (SOR). PATIENTS AND METHODS: Retrospective case series of patients who underwent pars plana vitrectomy with SiO instillation and had SD-OCT completed pre-and post-SOR. SD-OCT parameters included presence of subretinal fluid, epiretinal membrane, ellipsoid zone disruption (EZD), external limiting membrane disruption, central subfield thickness (CST), and choroidal thickness. Visual acuities (VAs) and duration of SiO instillation were recorded. RESULTS: Thirty eyes of 30 patients were included. Mean Snellen VA pre-and post-SOR was 20/762 and 20/206, respectively (P < .001). Eyes with EZD under SiO had significantly longer duration of SiO tamponade (P = .029) along with worse VA post-SOR (P = .002). EZD was noted in 20 eyes with SiO and only 10 eyes post-SOR. Of these 10 eyes with resolution of EZD post-SOR, mean VA was significantly better (Snellen equivalent 20/133) compared to eyes with persistent EZD (Snellen equivalent 20/513; P = .01). CST and choroidal thickness decreased post-SOR (P = .117, P = .07). CONCLUSION: Outer retinal abnormalities on SD-OCT in SiO-filled eyes may improve in some patients following SOR. Some changes may be related to duration of SiO tamponade. EZD in SiO-filled eyes may portend a worse clinical outcome post-SOR despite surgical success.

Journal of VitreoRetinal Diseases

Purpose: To investigate how the optical density ratio (ODR) of subretinal fluid (SRF) obtained by... more Purpose: To investigate how the optical density ratio (ODR) of subretinal fluid (SRF) obtained by optical coherence tomography (OCT) in eyes with chronic central serous retinopathy (CSR), defined as symptoms >3 months, treated with eplerenone correlates with treatment response and visual outcomes. Methods: This retrospective, single-center observational study included patients with chronic CSR treated with eplerenone who had at least 6 weeks of follow-up. Eyes with poor-quality OCT scans, shallow SRF precluding sampling of optical density (OD), and macular pathology other than CSR were excluded. Optical density of the vitreous and SRF was measured using ImageJ and used to calculate ODR (ODR = ODSRF/ODVIT). Peak SRF height, foveal SRF height, central macular thickness (CMT), and Snellen visual acuity (VA) were measured. The Mann-Whitney U test was used to compare continuous variables. Pearson correlation coefficient was used to determine the statistical significance of applied lin...

British Journal of Ophthalmology

PurposeTo evaluate the association between subfoveal choroidal thickness (SFCT) and branch retina... more PurposeTo evaluate the association between subfoveal choroidal thickness (SFCT) and branch retinal vein occlusion (BRVO) eyes treated with antivascular endothelial growth factor (anti-VEGF) therapy.MethodsRetrospective cohort study of treatment naïve BRVO eyes treated with 3 monthly anti-VEGF injections. All patients received enhanced depth imaging spectral-domain optical coherence tomography scans to determine SFCT and central macular thickness (CMT). Baseline predictors (particularly SFCT) for functional response (best-corrected visual acuity (BCVA) gain ≥2 lines) were assessed at 3 months using univariate and multivariate analyses.ResultsForty eyes from 39 patients were included. Mean baseline SFCT was higher in functional responders (240.4±73.1 µm), compared with both non-responders (193.3±63.6 µm; p=0.036) and their corresponding fellow eye (202.2±67.1 µm; p=0.022). A higher baseline SFCT (for every 100 µm increase in SFCT) was found to be a positive predictor for functional re...

Ophthalmology

To understand the impact of deep learning diabetic retinopathy (DR) algorithms on physician reade... more To understand the impact of deep learning diabetic retinopathy (DR) algorithms on physician readers in computer-assisted settings. Evaluation of diagnostic technology PARTICIPANTS: 1,796 retinal fundus images from 1,612 diabetic patients. 10 ophthalmologists (5 general ophthalmologists, 4 retina specialists, 1 retina fellow) read images for DR severity based on the International Clinical Diabetic Retinopathy disease severity scale in one of 3 conditions: Unassisted, Grades Only, or Grades + Heatmap. For Grades Only assistance, we surfaced a histogram of DR predictions ("grades") from a trained deep-learning model. For Grades + Heatmap, we additionally showed explanatory heatmaps. For each experiment arm we computed sensitivity and specificity of each reader and the model for different levels of DR severity against an adjudicated reference standard. We also measured accuracy (exact 5-class level agreement and Cohen's quadratically-weighted kappa); reader-reported confidence (5-point Likert scale); and time on task. Readers graded more accurately with model assistance than without for the Grades Only condition (p < 0.001). Grades + Heatmaps improved accuracy for cases with DR (p < 0.001), but reduced accuracy for cases without DR (p = 0.006). Both forms of assistance increased readers' sensitivity (For Moderate NPDR or worse, Unassisted: mean 79.4% [72.3, 86.5]; Grades Only: 87.5% [85.1, 89.9]; Grades + Heatmap: 88.7% [84.9, 92.5]) without a corresponding drop in specificity (Unassisted: 96.6% [95.9, 97.4]; Grades Only: 96.1% [95.5, 96.7], Grades + Heatmap: 95.5% [94.8, 96.1]). Model assistance increased the accuracy of retina specialists above that of the unassisted reader or model alone. Model assistance increased grading confidence and time on task. For most cases, Grades + Heatmap was only as effective as Grades Only. Over the course of the experiment, time on task decreased across all conditions, although most sharply for Grades + Heatmap. Deep learning algorithms can improve the accuracy of, and confidence in, DR diagnosis in an assisted read setting. They also may increase time on task, although these effects may be ameliorated with experience.

Current Opinion in Ophthalmology

Ophthalmology, 2018

Use adjudication to quantify errors in diabetic retinopathy (DR) grading based on individual grad... more Use adjudication to quantify errors in diabetic retinopathy (DR) grading based on individual graders and majority decision, and to train an improved automated algorithm for DR grading. Retrospective analysis. Retinal fundus images from DR screening programs. Images were each graded by the algorithm, U.S. board-certified ophthalmologists, and retinal specialists. The adjudicated consensus of the retinal specialists served as the reference standard. For agreement between different graders as well as between the graders and the algorithm, we measured the (quadratic-weighted) kappa score. To compare the performance of different forms of manual grading and the algorithm for various DR severity cutoffs (e.g., mild or worse DR, moderate or worse DR), we measured area under the curve (AUC), sensitivity, and specificity. Of the 193 discrepancies between adjudication by retinal specialists and majority decision of ophthalmologists, the most common were missing microaneurysm (MAs) (36%), artif...

International ophthalmology, Jan 8, 2018

Presentation of two typical cases with characteristic leopard retinopathy secondary to bilateral ... more Presentation of two typical cases with characteristic leopard retinopathy secondary to bilateral diffuse uveal melanocytic proliferation (BDUMP) and idiopathic uveal effusion syndrome (IUES) and brief review of the literature about leopard spot retinopathy. A 43-year-old women, who was a known case of ovarian carcinoma, referred with gradual bilateral visual loss. In ophthalmic examination, subretinal fluid, multiple patchy subretinal hyperpigmented lesions and leopard spot chorioretinopathy were evident in her both eyes. Fluorescein angiography showed multiple nummular hyperfluorescent lesions surrounded by zones of hypofluorescence. Spectral domain optical coherence tomography revealed increased retinal thickness, subretinal fluid and RPE irregularities in both eyes. Enhanced depth imaging OCT (EDI-OCT) showed bilateral subfoveal choroidal thickening. During next 2-year follow-up, she underwent cataract surgery and later on developed neovascular glaucoma in her both eyes. The seco...

Retina (Philadelphia, Pa.), Jan 5, 2018

To evaluate the effect of intraocular pressure-lowering medications on treatment outcomes in the ... more To evaluate the effect of intraocular pressure-lowering medications on treatment outcomes in the Comparison of AMD Treatments Trials. Secondary analysis of Comparison of AMD Treatments Trials data. Medication logs were reviewed for continuous 2-year use of agents that increased aqueous outflow (Group A: topical prostaglandins) or suppressed aqueous production (Group B: topical beta blockers and carbonic anhydrase inhibitors). Eyes were excluded if mixed-mechanism intraocular pressure-lowering agents or medications from more than one group were taken. Anatomical and vision responses to treatment at years 1, 2, and over the entire 2-year period in each group were compared with controls (no intraocular pressure-lowering medications). Inclusion criteria were met by 28 Group A patients, 19 Group B patients, and 857 controls. After 2 years, the control group had a mean visual acuity improvement of +6.3 letters from baseline, compared with +3.5 letters in Group A (P = 0.38), and +13.8 lett...

Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie, 2017

Niacin, a treatment for dyslipidemia, is known to induce vasodilation as a secondary effect. Prev... more Niacin, a treatment for dyslipidemia, is known to induce vasodilation as a secondary effect. Previous instances of patients with chronic central retinal vein occlusion (CRVO) and cystoid macular edema (CME) have been observed to spontaneously improve when placed on systemic niacin for hypercholesterolemia. The purpose of this study was to evaluate the effects of niacin on CRVO and associated ocular complications. A prospective, single-center, non-randomized, interventional case series of niacin for CRVO was conducted. Best-correct visual acuity (BCVA), central macular thickness (CMT), and ocular complications were analyzed in 50 patients over 1 year. Eight patients were controls. The mean initial logMAR BCVA was 0.915, and improved with niacin to 0.745 (P = 0.12), 0.665 (P = 0.02) and 0.658 (P = 0.03) after 3, 6, and 12 months of follow-up, respectively. At baseline, mean CMT was 678.9 μm, and improved to 478.1 μm (P = 0.001), 388.6 μm (P < 0.001), and 317.4 μm (P < 0.001) for...

Retina (Philadelphia, Pa.), Jan 10, 2017

To report a prospective, randomized comparative study assessing clinical outcomes of plain gut ve... more To report a prospective, randomized comparative study assessing clinical outcomes of plain gut versus polyglactin 910 (PG910) sutures for sclerotomy closure after 23-gauge pars plana vitrectomy. A single-masked, randomized, prospective study was undertaken with 49 eyes of 49 patients undergoing 23-gauge pars plana vitrectomy randomized to sclerotomy closure with either plain gut suture, PG910 (Vicryl) suture or a combination of the two. Assessment was based on both a postoperative pain scale and a standardized assessment of scleral inflammation at each suture site. No wound leakage was noted postoperatively in any patient. Across all groups, scleral inflammation was significantly higher at the PG910 suture sites compared with the plain gut suture sites at both the 1-week (P = 0.04) and 1-month postoperative visits (P < 0.001). Patients with PG910 sutures reported greater pain at the 1-month postoperative visit than those with plain gut sutures (P = 0.018). This prospective study ...

Retina (Philadelphia, Pa.), Jan 19, 2017

To evaluate the safety and effects of oral eplerenone in chronic central serous chorioretinopathy... more To evaluate the safety and effects of oral eplerenone in chronic central serous chorioretinopathy. Prospective, randomized, double-blind, placebo-control study at a tertiary referral academic private practice. For a diagnosis of chronic central serous chorioretinopathy, patients must have had at least 3 months clinical follow-up demonstrating persistent symptoms, subfoveal fluid on spectral-domain optical coherence tomography, and <50% reduction in fluid thickness. Patients were randomized 2:1 (treatment:placebo) to receive eplerenone (25 mg daily for 1 week, then up to 50 mg daily for 8 weeks) or placebo once daily. Fifteen patients completed the study. Ten patients (15 eyes) were randomized into the eplerenone treatment arm, while the remaining 5 patients (6 eyes) received placebo. After 9 weeks of eplerenone therapy, mean logarithm of the minimal angle of resolution visual acuity improved from 0.394 (Snellen equivalent: 20/50) to 0.330 (20/43, P = 0.04). In the placebo group, ...

Ophthalmology Retina, 2017

Retinal Cases & Brief Reports, 2017

To report the imaging findings of a single case of paracentral acute middle maculopathy associate... more To report the imaging findings of a single case of paracentral acute middle maculopathy associated with bilateral Purtscher-like retinopathy in the setting of recent viral illness. Case report, multimodal imaging. A 21-year-old woman who awoke with sudden-onset bilateral finger count vision in the setting of a recent viral illness. Initial examination and imaging was consistent with a bilateral Purtscher-like retinopathy with evidence of paracentral acute middle maculopathy and ellipsoid zone thickening and hyperreflectivity on spectral domain optical coherence tomography (OCT). Baseline fluorescein angiography and OCT angiography revealed normal perfusion and flow, respectively. All laboratory investigation was negative for possible causative etiology. The patient was followed for 6 months with steady visual improvement to 20/20 in both eyes. En face OCT demonstrated near-complete restoration of the ellipsoid layer. The patient still noted bilateral scotomas which were mapped out on microperimetry and found to correlate to en face OCT findings. Purtscher-like retinopathy in the setting of recent viral illness is a rare cause of vision loss that may be associated with the finding of paracentral acute middle maculopathy on spectral domain OCT. Despite poor presenting vision, in the presence of normal perfusion near total visual recovery is possible.

Ophthalmology, Sep 21, 2016

Seminars in ophthalmology, 2016

To describe the clinical features and management of six patients with ocular complications associ... more To describe the clinical features and management of six patients with ocular complications associated with direct oral anticoagulants (DOACs). The medical records of all adult patients known to be taking a DOAC and with an unusual bleeding event at a large tertiary referral center over a one-year period were reviewed. Patients with less than one-month follow-up were excluded. Data collection included relevant clinic notes, operative reports, surgical videos, and clinical images (fundus photography, optical coherence tomography, B-scan ultrasonography, and fluorescein angiography). Six eyes in six patients were identified with an unusual bleeding event associated with DOAC use. One patient was taking apixaban, two patients were taking dabigatran, and three patients were taking rivaroxaban. Two patients had large submacular hemorrhage (including one with vitreous hemorrhage breakthrough), three patients had vitreous hemorrhage, and one patient had recurrent hyphema. Presenting visual ...