Majid Moshirfar - Academia.edu (original) (raw)

Papers by Majid Moshirfar

American Journal of Ophthalmology, 2011

Ophthalmology, 2007

To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery ... more To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. Retrospective, multicenter, observational case series. Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. Number and rate of endophthalmitis cases after uncomplicated cataract surgery. During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were tre...

The Open Ophthalmology Journal, 2014

Purpose: Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after bl... more Purpose: Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after blunt trauma and review the published literature on this topic.

Journal of Ophthalmology, 2012

properly cited.

Ophthalmology, 2007

To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery ... more To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. Retrospective, multicenter, observational case series. Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. Number and rate of endophthalmitis cases after uncomplicated cataract surgery. During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were treated with topical moxifloxacin as antiinfective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 endophthalmitis patients in the gatifloxacin group and 5 endophthalmitis patients in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the 2 groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients. The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.

Clinical Ophthalmology, 2014

Numerous brands and types of artificial tears are available on the market for the treatment of dy... more Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient's clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived.

Ophthalmology, 2005

(1) To evaluate the accuracy of nomogram-based adjustment of intraocular lens (IOL) power to achi... more (1) To evaluate the accuracy of nomogram-based adjustment of intraocular lens (IOL) power to achieve a desired refractive target after cataract surgery in postmyopic LASIK and photorefractive keratectomy (PRK) eyes and (2) to compare the accuracy of the nomogram-based method with the clinical history method. Multicenter, retrospective, interventional, noncomparative case series. Fourteen patients (19 eyes) after myopic LASIK or PRK with visually significant cataracts. All eyes underwent cataract extraction and posterior chamber intraocular lens implantation. In each case, IOL power was determined with standard keratometry and biometry. Power adjustment was made by use of a theoretical nomogram followed by implantation. (1) Final refraction and spherical equivalent after cataract surgery and (2) deviation of the final spherical equivalent from the refractive target. After cataract extraction, by use of nomogram adjustment, 63.2% of eyes were within 0.5 D of the intended spherical equivalent, 84.2% were within 1.0 diopter of the intended spherical equivalent, and 100% were within 1.5 D of the intended spherical equivalent. The clinical history method was accurate in predicting the correct IOL power in 37.5% of cases, regardless of whether spectacle or corneal plane refraction was used. (1) Given the change in spherical equivalent induced by myopic LASIK/PRK, IOL power can be adjusted accurately to avoid undercorrection without the need for the prerefractive surgery corneal power. (2) The nomogram-based method was more accurate than the clinical history method.

Ophthalmology, 1999

Comparison of clinical results from mechanical and transepithelial debridement during photorefrac... more Comparison of clinical results from mechanical and transepithelial debridement during photorefractive keratectomy. Randomized, prospective study. Two hundred seventy-eight eyes in 173 patients between November 1995 and June 1997. Photorefractive keratectomy treatments with a Summit Omnimed excimer laser (6-mm). Clinical results were measured at 1, 3, and 6 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean spherical equivalent (MSE), astigmatism, corneal haze, and subjective vision (day, night, glare, and halo). At all postoperative intervals, no significant difference was present between mean values of MSE, haze, or any subjective parameters. For mean UCVA, BCVA, and astigmatism values, a significant difference (P < 0.05) was present only at 6 months. At all postoperative intervals, mechanical values tended to be superior to transepithelial valves. Clinical results were not statistically different between the two techniques; however, the mechanical technique tended to have superior values for almost all tested parameters.

Middle East African Journal of Ophthalmology, 2011

To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic kera... more To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic keratoconjunctivitis (SLK). A 62-year-old woman was referred with foreign body sensation, irritation, photophobia and decreased vision in the left eye. She was initially treated for 10 months with intermittent topical corticosteroids for a presumed diagnosis of SLK. She underwent excisional biopsy of the superior conjunctiva and was found, on histopathologic evaluation, to have OSSN with moderate to marked dysplasia. This is the first reported case of OSSN masquerading with signs and symptoms of SLK. Any ocular surface lesion refractory to standard medical treatment should raise suspicion for a malignant process and warrant further cytologic or histopathologic evaluation.

Journal of Refractive Surgery, 2011

To compare differences in visual acuity, contrast sensitivity, higher order ocular aberrations, q... more To compare differences in visual acuity, contrast sensitivity, higher order ocular aberrations, quality of life, and patient-reported outcomes at 3 and 6 months postoperatively in eyes with stable myopia undergoing thin-flap (intended flap thicknesses of 120 or 90 μm) LASIK using the VISX Star S4 CustomVue excimer laser (VISX Inc), with flaps created by the IntraLase FS60 femtosecond laser (Abbott Medical Optics). In this prospective study, thin-flap LASIK was performed contralaterally on 94 eyes: 47 eyes with 120-μm intended flap thickness and 47 eyes with 90-μm intended flap thickness. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and higher order aberrations. At 6 months, mean values for UDVA (logMAR) were -0.064±0.077 and -0.051±0.070 in the 120-μm and 90-μm groups, respectively (n=40, P=.431). Visual acuity of 20/20 was achieved in 98% of eyes with 120-μm flaps and 95% of eyes with 90-μm flaps, whereas 20/15 vision was achieved in 50% of eyes with 120-μm flaps and 45% of eyes with 90-μm flaps (P≥.454). Both groups had significant increases in total higher order aberrations (P≤.003). Significant differences were not found between groups in contrast sensitivity (P≥.258), CDVA (P≥.726), total higher order aberrations (P≥.477), or patient-reported outcomes (P≥.132). Patients in both groups reported increased quality of life postoperatively (P≤.002). Under well-controlled surgical conditions, thin-flap LASIK achieved similar results in visual acuity, contrast sensitivity, and low induction of higher order aberrations in eyes with intended flap thicknesses of either 120 or 90 μm.

Journal of Cataract & Refractive Surgery, 2010

To assess the histopathology of anterior subcapsular cataract associated with a collagen copolyme... more To assess the histopathology of anterior subcapsular cataract associated with a collagen copolymer posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) using light microscopy after pIOL explantation and cataract surgery. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Laboratory investigation. Pathology specimens related to explanted pIOLs were reviewed and preoperative and postoperative patient data collected. The anterior lens capsules and explanted pIOLs were examined. Four eyes (3 patients) had pIOL explantation for low vault and anterior subcapsular cataract. The explanted pIOLs were the shorter length models (3, 12.1 mm; 1, 12.6 mm). Anterior segment optical coherence tomography (AS-OCT) confirmed the low pIOL vault before explantation in 2 eyes. Histopathology of the anterior subcapsular cataract showed fibrous metaplasia with a variable number of lens epithelial cell (LEC) layers attached to the inner surface of the anterior capsulorhexis specimens. Light microscopy of the explanted pIOLs showed no pigment on 1 lens, mild pigment deposition on 1 haptic, and pigment deposition throughout the anterior surface of 2 pIOLs. Anterior subcapsular cataract associated with the pIOLs was caused by low vaulting (confirmed on AS-OCT) and consequent fibrous metaplasia of the anterior LECs. Surgeons should consider the possibility of anterior subcapsular cataract associated with shorter platforms when selecting a pIOL length for appropriate vault.

Journal of Cataract & Refractive Surgery, 1999

To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ kerat... more To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) early in a surgeon's experience. Ophthalmology Department, John A. Moran Eye Center, Salt Lake City, Utah, USA. Between October 1995 and April 1997, a retrospective analysis was performed of 200 eyes in 128 patients who had PRK or LASIK with a follow-up of at least 3 months. The mean age was 38.1 years +/- 10.4 (SD) in the PRK group and 42.3 +/- 10.1 years in the LASIK group. There were 36 women and 30 men in the former and 32 women and 30 men in the latter. Photorefractive keratectomy, PRK/astigmatic keratotomy (AK), LASIK, or LASIK/AK was performed with the Summit Omnimed excimer laser. Preoperative evaluation included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, tonometry, and computerized videokeratography. At 1, 3, and 6 months, UCVA, BSCVA, mean spherical equivalent (SE), astigmatism, corneal haze, subjective vision (day, night, glare, and halo), and complications were measured. Mean SE was 0.16 +/- 0.82 diopter (D) in the PRK group and -0.09 +/- 0.63 D in the LASIK group at 1 month (P < .05), -0.18 +/- 0.66 D and -0.16 +/- 0.58 D, respectively, at 3 months, and -0.33 +/- 0.73 D and -0.09 +/- 0.62 D, respectively, at 6 months. Achieved correction was similar in the 2 groups. Mean BSCVA was 22.8 +/- 6.0 in the PRK group and 22.2 +/- 5.3 in the LASIK group at 1 month, 21.1 +/- 6.0 and 21.1 +/- 3.1, respectively, at 3 months, and 19.8 +/- 3.5 and 22.9 +/- 5.2, respectively, at 6 months (P < .005). Mean surface regularity index was 0.68 +/- 0.40 in the PRK group and 0.86 +/- 0.41 in the LASIK group at 1 month, 0.54 +/- 0.26 and 0.72 +/- 0.37, respectively, at 3 months (P < .05), and 0.49 +/- 0.27 and 0.84 +/- 0.42, respectively, at 6 months. Mean surface asymmetry index was 0.71 +/- 0.43 in the PRK group and 0.55 +/- 0.21 in the LASIK group at 1 month (P < .05), 0.53 +/- 0.24 and 0.51 +/- 0.23, respectively, at 3 months, and 0.46 +/- 0.19 and 0.64 +/- 0.54, respectively, at 6 months. The subjective parameters between the groups were significantly different only at 6 months; patients in the PRK group reported better day and night vision. With careful preparation and proper training, PRK and LASIK appear to be safe and efficacious even during the surgeon's early learning phases.

Journal of Cataract & Refractive Surgery, 2007

To retrospectively review the occurrence, treatment, and visual outcomes associated with various ... more To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis. Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies. Post-LASIK keratitis was diagnosed in 279 eyes. The keratitis was diagnosed as infectious in 33 eyes (12%) and as noninfectious in 246 eyes (88%). Infectious cases included 5 eyes (15%) with herpes simplex keratitis (HSV), 18 (55%) with adenoviral keratitis, and 10 (30%) with nonviral (including bacterial, fungal, and parasitic) keratitis. Of noninfectious cases, 193 (78%) were classified as diffuse lamellar keratitis (DLK), 36 (15%) as staphylococcal marginal hypersensitivity, and 17 (15%) as localized debris-related keratitis. The occurrence of post-LASIK keratitis was 2.66%, with DLK being the most common diagnosis overall. The occurrence of noninfectious keratitis (2.34%) was 7.5 times greater than the occurrence of infectious keratitis (0.31%). Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA. In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA. Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels (P = .0013 and P<.001, respectively).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute anterior uveitis (AAU... more PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute anterior uveitis (AAU) in human leukocyte antigen (HLA)-B27 positive patients who had laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To prospectively study the dependence of visual outcomes and patient satisfaction on cor... more PURPOSE: To prospectively study the dependence of visual outcomes and patient satisfaction on corneal keratometry (K) in hyperopic laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSE... more To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) analysis and to describe its relationship to a dynamic postoperative hyperopic shift. John A. Moran Eye Center, University of Utah, Salt Lake City, USA. In this retrospective observational study, 9 eyes had DSEK and were followed with manifest refractions and AS-OCT analysis. To assess changes in the thickness of the cornea, measurements for each AS-OCT image were taken at the vertex of the cornea, at 1.5 mm on each side of the vertex, and at the distal edges of the graft. Patients were followed for a mean of 134 days (range 46 to 228 days). Monthly Graft thinning rates were 5.2 microm per month at the vertex, 7.9 microm per month 1.5 mm from the vertex, and 26 microm per month at the edges, with the edges thinning significantly faster than the cornea vertex (P = .0024) and the points on either side of the 3.0 mm visual axis (P = .0018). The mean spherical equivalent (SE) showed an initial hyperopic shift that decreased over the ensuing 100 to 200 days postoperatively. The mean monthly postoperative SE change was -0.25 diopter (D) with a mean preoperative to postoperative SE change of +1.26 D. The donor graft underwent changes after DSEK, which may account for the induced hyperopia and its diminishment over time via changes in the posterior corneal curvature. Results suggest that intraocular lenses be targeted to -1.00 to -1.25 D of myopia for combined DSEK and cataract procedures.

Journal of Cataract & Refractive Surgery, 2007

To evaluate the implantation of Artisan/Verisyse phakic intraocular lenses (pIOLs) (Advanced Medi... more To evaluate the implantation of Artisan/Verisyse phakic intraocular lenses (pIOLs) (Advanced Medical Optics) as an effective and safe method for the correction of high myopia. Department of Ophthalmology, John A. Moran Eye Center, University of Utah Medical Center, Salt Lake City, Utah, USA. This retrospective outcomes trial examined the implantation of Artisan/Verisyse pIOLs in 85 highly myopic eyes (mean spherical equivalent -12.2 diopters). Patients were followed for 2 years and examined postoperatively at 1,6,12, and 24 months. Data collected included best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), corneal endothelial cell density, and adverse events. Six months postoperatively, 5 (7%) eyes lost 1 line of the BSCVA; no eye lost 2 or more lines. The UCVA was better than 20/40 in 83% of eyes and better than 20/25 in 32%. Endothelial cell density decreased by 3.3% and 6.5% over the 1-year and 2-year intervals, respectively. Glare and halos, the most common complications of surgery, were reported by 6% of patients at 1 month and by 3% at 2 years. Implantation of the Verisyse/Artisan pIOL yielded accurate refractive results with acceptable safety in highly myopic eyes.

Journal of Cataract & Refractive Surgery, 2005

Purpose: To evaluate the effect of flap removal on complications after laser in situ keratomileus... more Purpose: To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To determine differences in endophthalmitis rates with prophylactic use of third-versus ... more PURPOSE: To determine differences in endophthalmitis rates with prophylactic use of third-versus fourth-generation fluoroquinolones in cataract surgery.

Journal of Cataract & Refractive Surgery, 2007

Corneal scrapings were collected from a case of keratitis and microbiological investigations done... more Corneal scrapings were collected from a case of keratitis and microbiological investigations done. Coagulase-negative Staphylococcus (Staphylococcus epidermidis) was identified on culture, and antibiotic susceptibility tests were performed. Treatment was started with topical cefazolin sulfate 5% and gatifloxacin 0.3%; this was subsequently changed to vancomycin 5% and tobramycin sulfate 1.3% based on the sensitivity pattern. The isolates of this bacterium were susceptible to vancomycin, tobramycin, and gentamicin, and resistance was present against moxifloxacin, gatifloxacin, ciprofloxacin, and cefazolin. The case highlights the occurrence of keratitis caused by coagulase-negative Staphylococcus that is resistant to treatment with moxifloxacin.

American Journal of Ophthalmology, 2011

Ophthalmology, 2007

To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery ... more To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. Retrospective, multicenter, observational case series. Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. Number and rate of endophthalmitis cases after uncomplicated cataract surgery. During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were tre...

The Open Ophthalmology Journal, 2014

Purpose: Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after bl... more Purpose: Present a case of dislocation of an Implantable Collamer Lens (ICL) that occurs after blunt trauma and review the published literature on this topic.

Journal of Ophthalmology, 2012

properly cited.

Ophthalmology, 2007

To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery ... more To estimate the rate of acute postoperative endophthalmitis after uncomplicated cataract surgery in patients treated before and after surgery with 1 of 2 different fourth-generation fluoroquinolone ophthalmic drops for surgical prophylaxis. Retrospective, multicenter, observational case series. Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. Patients who had undergone uncomplicated phacoemulsification who received preoperative and postoperative topical fourth-generation fluoroquinolones for surgical prophylaxis between March 2003 and July 2005 were included in the study. The files of patients in whom acute endophthalmitis developed were reviewed and analyzed. Number and rate of endophthalmitis cases after uncomplicated cataract surgery. During the study period, the participating surgeons performed 20,013 uncomplicated surgeries. Of these, 16,209 patients (81%) received topical gatifloxacin and 3804 patients (19%) were treated with topical moxifloxacin as antiinfective prophylaxis. A total of 14 patients experienced endophthalmitis. The overall rate of endophthalmitis was 0.07%. There were 9 endophthalmitis patients in the gatifloxacin group and 5 endophthalmitis patients in the moxifloxacin group. The rate of endophthalmitis in the gatifloxacin group was 0.06% and the rate in the moxifloxacin group was 0.1%. The difference in the rate of endophthalmitis between the 2 groups was not statistically significant. In 10 of the patients, vitreous culture results were positive. Coagulase-negative staphylococci, followed by streptococci, species were the most commonly isolated organisms in the culture-positive patients. The overall rate of endophthalmitis after uncomplicated cataract surgery in patients treated with topical fourth-generation fluoroquinolones as antiinfective prophylaxis was 0.07%. This rate was within the range of previously reported rates of endophthalmitis in the literature. The difference in the observed rate of postoperative endophthalmitis in patients treated with moxifloxacin versus gatifloxacin was not statistically significant.

Clinical Ophthalmology, 2014

Numerous brands and types of artificial tears are available on the market for the treatment of dy... more Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient's clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived.

Ophthalmology, 2005

(1) To evaluate the accuracy of nomogram-based adjustment of intraocular lens (IOL) power to achi... more (1) To evaluate the accuracy of nomogram-based adjustment of intraocular lens (IOL) power to achieve a desired refractive target after cataract surgery in postmyopic LASIK and photorefractive keratectomy (PRK) eyes and (2) to compare the accuracy of the nomogram-based method with the clinical history method. Multicenter, retrospective, interventional, noncomparative case series. Fourteen patients (19 eyes) after myopic LASIK or PRK with visually significant cataracts. All eyes underwent cataract extraction and posterior chamber intraocular lens implantation. In each case, IOL power was determined with standard keratometry and biometry. Power adjustment was made by use of a theoretical nomogram followed by implantation. (1) Final refraction and spherical equivalent after cataract surgery and (2) deviation of the final spherical equivalent from the refractive target. After cataract extraction, by use of nomogram adjustment, 63.2% of eyes were within 0.5 D of the intended spherical equivalent, 84.2% were within 1.0 diopter of the intended spherical equivalent, and 100% were within 1.5 D of the intended spherical equivalent. The clinical history method was accurate in predicting the correct IOL power in 37.5% of cases, regardless of whether spectacle or corneal plane refraction was used. (1) Given the change in spherical equivalent induced by myopic LASIK/PRK, IOL power can be adjusted accurately to avoid undercorrection without the need for the prerefractive surgery corneal power. (2) The nomogram-based method was more accurate than the clinical history method.

Ophthalmology, 1999

Comparison of clinical results from mechanical and transepithelial debridement during photorefrac... more Comparison of clinical results from mechanical and transepithelial debridement during photorefractive keratectomy. Randomized, prospective study. Two hundred seventy-eight eyes in 173 patients between November 1995 and June 1997. Photorefractive keratectomy treatments with a Summit Omnimed excimer laser (6-mm). Clinical results were measured at 1, 3, and 6 months. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA), mean spherical equivalent (MSE), astigmatism, corneal haze, and subjective vision (day, night, glare, and halo). At all postoperative intervals, no significant difference was present between mean values of MSE, haze, or any subjective parameters. For mean UCVA, BCVA, and astigmatism values, a significant difference (P < 0.05) was present only at 6 months. At all postoperative intervals, mechanical values tended to be superior to transepithelial valves. Clinical results were not statistically different between the two techniques; however, the mechanical technique tended to have superior values for almost all tested parameters.

Middle East African Journal of Ophthalmology, 2011

To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic kera... more To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic keratoconjunctivitis (SLK). A 62-year-old woman was referred with foreign body sensation, irritation, photophobia and decreased vision in the left eye. She was initially treated for 10 months with intermittent topical corticosteroids for a presumed diagnosis of SLK. She underwent excisional biopsy of the superior conjunctiva and was found, on histopathologic evaluation, to have OSSN with moderate to marked dysplasia. This is the first reported case of OSSN masquerading with signs and symptoms of SLK. Any ocular surface lesion refractory to standard medical treatment should raise suspicion for a malignant process and warrant further cytologic or histopathologic evaluation.

Journal of Refractive Surgery, 2011

To compare differences in visual acuity, contrast sensitivity, higher order ocular aberrations, q... more To compare differences in visual acuity, contrast sensitivity, higher order ocular aberrations, quality of life, and patient-reported outcomes at 3 and 6 months postoperatively in eyes with stable myopia undergoing thin-flap (intended flap thicknesses of 120 or 90 μm) LASIK using the VISX Star S4 CustomVue excimer laser (VISX Inc), with flaps created by the IntraLase FS60 femtosecond laser (Abbott Medical Optics). In this prospective study, thin-flap LASIK was performed contralaterally on 94 eyes: 47 eyes with 120-μm intended flap thickness and 47 eyes with 90-μm intended flap thickness. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and higher order aberrations. At 6 months, mean values for UDVA (logMAR) were -0.064±0.077 and -0.051±0.070 in the 120-μm and 90-μm groups, respectively (n=40, P=.431). Visual acuity of 20/20 was achieved in 98% of eyes with 120-μm flaps and 95% of eyes with 90-μm flaps, whereas 20/15 vision was achieved in 50% of eyes with 120-μm flaps and 45% of eyes with 90-μm flaps (P≥.454). Both groups had significant increases in total higher order aberrations (P≤.003). Significant differences were not found between groups in contrast sensitivity (P≥.258), CDVA (P≥.726), total higher order aberrations (P≥.477), or patient-reported outcomes (P≥.132). Patients in both groups reported increased quality of life postoperatively (P≤.002). Under well-controlled surgical conditions, thin-flap LASIK achieved similar results in visual acuity, contrast sensitivity, and low induction of higher order aberrations in eyes with intended flap thicknesses of either 120 or 90 μm.

Journal of Cataract & Refractive Surgery, 2010

To assess the histopathology of anterior subcapsular cataract associated with a collagen copolyme... more To assess the histopathology of anterior subcapsular cataract associated with a collagen copolymer posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) using light microscopy after pIOL explantation and cataract surgery. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. Laboratory investigation. Pathology specimens related to explanted pIOLs were reviewed and preoperative and postoperative patient data collected. The anterior lens capsules and explanted pIOLs were examined. Four eyes (3 patients) had pIOL explantation for low vault and anterior subcapsular cataract. The explanted pIOLs were the shorter length models (3, 12.1 mm; 1, 12.6 mm). Anterior segment optical coherence tomography (AS-OCT) confirmed the low pIOL vault before explantation in 2 eyes. Histopathology of the anterior subcapsular cataract showed fibrous metaplasia with a variable number of lens epithelial cell (LEC) layers attached to the inner surface of the anterior capsulorhexis specimens. Light microscopy of the explanted pIOLs showed no pigment on 1 lens, mild pigment deposition on 1 haptic, and pigment deposition throughout the anterior surface of 2 pIOLs. Anterior subcapsular cataract associated with the pIOLs was caused by low vaulting (confirmed on AS-OCT) and consequent fibrous metaplasia of the anterior LECs. Surgeons should consider the possibility of anterior subcapsular cataract associated with shorter platforms when selecting a pIOL length for appropriate vault.

Journal of Cataract & Refractive Surgery, 1999

To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ kerat... more To determine the safety and efficacy of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) early in a surgeon's experience. Ophthalmology Department, John A. Moran Eye Center, Salt Lake City, Utah, USA. Between October 1995 and April 1997, a retrospective analysis was performed of 200 eyes in 128 patients who had PRK or LASIK with a follow-up of at least 3 months. The mean age was 38.1 years +/- 10.4 (SD) in the PRK group and 42.3 +/- 10.1 years in the LASIK group. There were 36 women and 30 men in the former and 32 women and 30 men in the latter. Photorefractive keratectomy, PRK/astigmatic keratotomy (AK), LASIK, or LASIK/AK was performed with the Summit Omnimed excimer laser. Preoperative evaluation included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cycloplegic refraction, tonometry, and computerized videokeratography. At 1, 3, and 6 months, UCVA, BSCVA, mean spherical equivalent (SE), astigmatism, corneal haze, subjective vision (day, night, glare, and halo), and complications were measured. Mean SE was 0.16 +/- 0.82 diopter (D) in the PRK group and -0.09 +/- 0.63 D in the LASIK group at 1 month (P < .05), -0.18 +/- 0.66 D and -0.16 +/- 0.58 D, respectively, at 3 months, and -0.33 +/- 0.73 D and -0.09 +/- 0.62 D, respectively, at 6 months. Achieved correction was similar in the 2 groups. Mean BSCVA was 22.8 +/- 6.0 in the PRK group and 22.2 +/- 5.3 in the LASIK group at 1 month, 21.1 +/- 6.0 and 21.1 +/- 3.1, respectively, at 3 months, and 19.8 +/- 3.5 and 22.9 +/- 5.2, respectively, at 6 months (P < .005). Mean surface regularity index was 0.68 +/- 0.40 in the PRK group and 0.86 +/- 0.41 in the LASIK group at 1 month, 0.54 +/- 0.26 and 0.72 +/- 0.37, respectively, at 3 months (P < .05), and 0.49 +/- 0.27 and 0.84 +/- 0.42, respectively, at 6 months. Mean surface asymmetry index was 0.71 +/- 0.43 in the PRK group and 0.55 +/- 0.21 in the LASIK group at 1 month (P < .05), 0.53 +/- 0.24 and 0.51 +/- 0.23, respectively, at 3 months, and 0.46 +/- 0.19 and 0.64 +/- 0.54, respectively, at 6 months. The subjective parameters between the groups were significantly different only at 6 months; patients in the PRK group reported better day and night vision. With careful preparation and proper training, PRK and LASIK appear to be safe and efficacious even during the surgeon's early learning phases.

Journal of Cataract & Refractive Surgery, 2007

To retrospectively review the occurrence, treatment, and visual outcomes associated with various ... more To retrospectively review the occurrence, treatment, and visual outcomes associated with various etiologies of keratitis as a postoperative complication of laser in situ keratomileusis (LASIK) at an academic surgical center. John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. The charts of 5618 post-LASIK patients (10 477 eyes) were reviewed for the development of keratitis. Occurrence rates, management regimens, and final best spectacle-corrected visual acuity (BSCVA) were reported for infectious and noninfectious keratitis etiologies. Post-LASIK keratitis was diagnosed in 279 eyes. The keratitis was diagnosed as infectious in 33 eyes (12%) and as noninfectious in 246 eyes (88%). Infectious cases included 5 eyes (15%) with herpes simplex keratitis (HSV), 18 (55%) with adenoviral keratitis, and 10 (30%) with nonviral (including bacterial, fungal, and parasitic) keratitis. Of noninfectious cases, 193 (78%) were classified as diffuse lamellar keratitis (DLK), 36 (15%) as staphylococcal marginal hypersensitivity, and 17 (15%) as localized debris-related keratitis. The occurrence of post-LASIK keratitis was 2.66%, with DLK being the most common diagnosis overall. The occurrence of noninfectious keratitis (2.34%) was 7.5 times greater than the occurrence of infectious keratitis (0.31%). Adenoviral keratitis had the best visual outcomes overall, with all 18 patients achieving 20/20 BSCVA. In contrast, all 5 eyes with HSV keratitis lost 1 or 2 lines of BSCVA. Excluding adenoviral keratitis, infectious etiologies had significantly worse visual outcomes than noninfectious etiologies at the 20/40 and 20/20 levels (P = .0013 and P<.001, respectively).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute anterior uveitis (AAU... more PURPOSE: To assess the incidence of, risk for, and visual outcomes of acute anterior uveitis (AAU) in human leukocyte antigen (HLA)-B27 positive patients who had laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To prospectively study the dependence of visual outcomes and patient satisfaction on cor... more PURPOSE: To prospectively study the dependence of visual outcomes and patient satisfaction on corneal keratometry (K) in hyperopic laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSE... more To evaluate changes in the corneal profile after Descemet stripping endothelial keratoplasty (DSEK) using anterior segment optical coherence tomography (AS-OCT) analysis and to describe its relationship to a dynamic postoperative hyperopic shift. John A. Moran Eye Center, University of Utah, Salt Lake City, USA. In this retrospective observational study, 9 eyes had DSEK and were followed with manifest refractions and AS-OCT analysis. To assess changes in the thickness of the cornea, measurements for each AS-OCT image were taken at the vertex of the cornea, at 1.5 mm on each side of the vertex, and at the distal edges of the graft. Patients were followed for a mean of 134 days (range 46 to 228 days). Monthly Graft thinning rates were 5.2 microm per month at the vertex, 7.9 microm per month 1.5 mm from the vertex, and 26 microm per month at the edges, with the edges thinning significantly faster than the cornea vertex (P = .0024) and the points on either side of the 3.0 mm visual axis (P = .0018). The mean spherical equivalent (SE) showed an initial hyperopic shift that decreased over the ensuing 100 to 200 days postoperatively. The mean monthly postoperative SE change was -0.25 diopter (D) with a mean preoperative to postoperative SE change of +1.26 D. The donor graft underwent changes after DSEK, which may account for the induced hyperopia and its diminishment over time via changes in the posterior corneal curvature. Results suggest that intraocular lenses be targeted to -1.00 to -1.25 D of myopia for combined DSEK and cataract procedures.

Journal of Cataract & Refractive Surgery, 2007

To evaluate the implantation of Artisan/Verisyse phakic intraocular lenses (pIOLs) (Advanced Medi... more To evaluate the implantation of Artisan/Verisyse phakic intraocular lenses (pIOLs) (Advanced Medical Optics) as an effective and safe method for the correction of high myopia. Department of Ophthalmology, John A. Moran Eye Center, University of Utah Medical Center, Salt Lake City, Utah, USA. This retrospective outcomes trial examined the implantation of Artisan/Verisyse pIOLs in 85 highly myopic eyes (mean spherical equivalent -12.2 diopters). Patients were followed for 2 years and examined postoperatively at 1,6,12, and 24 months. Data collected included best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), corneal endothelial cell density, and adverse events. Six months postoperatively, 5 (7%) eyes lost 1 line of the BSCVA; no eye lost 2 or more lines. The UCVA was better than 20/40 in 83% of eyes and better than 20/25 in 32%. Endothelial cell density decreased by 3.3% and 6.5% over the 1-year and 2-year intervals, respectively. Glare and halos, the most common complications of surgery, were reported by 6% of patients at 1 month and by 3% at 2 years. Implantation of the Verisyse/Artisan pIOL yielded accurate refractive results with acceptable safety in highly myopic eyes.

Journal of Cataract & Refractive Surgery, 2005

Purpose: To evaluate the effect of flap removal on complications after laser in situ keratomileus... more Purpose: To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK).

Journal of Cataract & Refractive Surgery, 2008

PURPOSE: To determine differences in endophthalmitis rates with prophylactic use of third-versus ... more PURPOSE: To determine differences in endophthalmitis rates with prophylactic use of third-versus fourth-generation fluoroquinolones in cataract surgery.

Journal of Cataract & Refractive Surgery, 2007

Corneal scrapings were collected from a case of keratitis and microbiological investigations done... more Corneal scrapings were collected from a case of keratitis and microbiological investigations done. Coagulase-negative Staphylococcus (Staphylococcus epidermidis) was identified on culture, and antibiotic susceptibility tests were performed. Treatment was started with topical cefazolin sulfate 5% and gatifloxacin 0.3%; this was subsequently changed to vancomycin 5% and tobramycin sulfate 1.3% based on the sensitivity pattern. The isolates of this bacterium were susceptible to vancomycin, tobramycin, and gentamicin, and resistance was present against moxifloxacin, gatifloxacin, ciprofloxacin, and cefazolin. The case highlights the occurrence of keratitis caused by coagulase-negative Staphylococcus that is resistant to treatment with moxifloxacin.