Zaina al-Mohtaseb - Academia.edu (original) (raw)

Papers by Zaina al-Mohtaseb

Research paper thumbnail of Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia

Ophthalmology, May 1, 2021

PURPOSE To review the literature to evaluate the outcomes of intraocular lens (IOL) power calcula... more PURPOSE To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK). METHODS Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist. RESULTS When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it. CONCLUSIONS Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.

Research paper thumbnail of Amniotic membrane transplantation: an updated clinical review for the ophthalmologist

Annals of Eye Science, Jun 1, 2023

Although amniotic membrane transplantation (AMT) has long been used as an essential surgical tech... more Although amniotic membrane transplantation (AMT) has long been used as an essential surgical technique for ocular surface reconstruction, its role continues to evolve and expand. In the management of numerous ocular surface disorders, ranging from inflammatory to infectious, traumatic to neoplastic, the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist. The purpose of this paper is to provide ophthalmologists with an updated, evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction, reviewing its common and even experimental applications known to date. The methods of amniotic membrane preservation, the available commercial amniotic membrane products to date, and future directions for amniotic membrane use, including amniotic membrane extract eye drops (AMEED), are also discussed. It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice, both in the operating room and in the clinic. By familiarizing the general ophthalmologist with its diverse applications, we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice, or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.

Research paper thumbnail of Repeatability and Reliability of a Combined Dual-Scheimpflug Placido Disc Corneal Topographer in Eyes with Keratoconus

Research paper thumbnail of Repeatability of a Dual-Scheimpflug Placido Disc Corneal Tomographer/Topographer in Eyes with Keratoconus

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings

Current Ophthalmology Reports, Oct 4, 2018

Purpose of Review The aim of this review is to present ophthalmologists with up-to-date literatur... more Purpose of Review The aim of this review is to present ophthalmologists with up-to-date literature and treatment practices in the correction of vision with secondary intraocular lenses (IOLs) in the aphakic setting. Recent Findings Advances in the surgical techniques for the implantation of secondary intraocular lenses have allowed for improved postoperative outcomes. Studies published continue to evaluate the different surgical approaches and provide guidance to surgeons when choosing the optimal treatment plan for their patients. Summary In the absence of adequate capsular support, surgical implantation of intraocular lenses in different positions within the eye can be performed. Anterior chamber, iris-sutured, scleral-fixated, and iris-claw intraocular lenses have been found to be safe and effective treatment modalities in the correction of aphakia in eyes lacking adequate capsular support. Recent studies show that the development of new surgical techniques continue to provide safer and more effective treatment options for these patients.

Research paper thumbnail of Spectral Domain OCT And Autofluorescence In Active Posterior Uveitis

Investigative Ophthalmology & Visual Science, Mar 26, 2012

Research paper thumbnail of Management of Pterygium with Coexisting Cataract

Research paper thumbnail of Application of data mining algorithms to study data trends for corneal transplantation

Journal Francais D Ophtalmologie, Sep 1, 2022

Research paper thumbnail of Evaluation of the Ocular Surface in Patients with Graft-versus-Host Disease at the Bascom Palmer Eye Institute

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Research paper thumbnail of Scleral-Fixated Intraocular Lenses

Current practices in ophthalmology, 2023

Research paper thumbnail of Comparison of Incidence of Cataracts in Pre-menopausal and Post-menopausal Women at a County Hospital

Investigative Ophthalmology & Visual Science, Jul 22, 2019

Research paper thumbnail of Femtosecond Laser-Assisted Cataract Surgery

Ophthalmology, Aug 1, 2022

Purpose of review In 2010, the US Food and Drug Administration (FDA) cleared femtosecond laser sy... more Purpose of review In 2010, the US Food and Drug Administration (FDA) cleared femtosecond laser systems for cataract surgery. Available in 2011, this technology has the potential to significantly impact cataract surgery. Recent findings Femtosecond lasers offer surgeons the ability to make very precise cuts in a targeted area without damaging the surrounding tissues. This technology has already dramatically changed refractive surgery and is poised to do the same for cataract surgery. Three companies, OptiMedica, LenSx (acquired by Alcon in September 2010), and LensAR, in different stages of FDA clearance, are developing femtosecond laser systems for cataract surgery. These systems will create the initial corneal incisions, capsulotomy, and also fragment the lens. Summary This article outlines the advantages of femtosecond laser cataract surgery and provides an initial comparison of the LensAR, LenSx/Alcon, and OptiMedica systems and early clinical results.

Research paper thumbnail of Eyes of a Hurricane: The Effect of Hurricane Harvey on Ophthalmology Consultations at Houston’s County Hospital

Disaster Medicine and Public Health Preparedness

Objective: This study aimed to characterize ophthalmology consultations ordered after Hurricane H... more Objective: This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year. Methods: A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county. Results: Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infecti...

Research paper thumbnail of Pre-Clinical and Clinical Inflammation of Ocular Adnexa in Graft-versus-Host Disease

Investigative Ophthalmology & Visual Science, 2014

Research paper thumbnail of Management of Pterygium with Coexisting Cataract

Textbook of Pterygium Management, 2018

Research paper thumbnail of Toric Intraocular Lenses--The Resident Experience

Investigative Ophthalmology & Visual Science, 2012

Research paper thumbnail of Correction of corneal astigmatism using femtosecond laser intrastromal incisions during cataract surgery

Investigative Ophthalmology & Visual Science, 2015

Research paper thumbnail of Spectral Domain OCT And Autofluorescence In Active Posterior Uveitis

Investigative Ophthalmology & Visual Science, 2012

Research paper thumbnail of Refractive outcomes after multifocal intraocular lens exchange

Journal of cataract and refractive surgery, 2017

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye ... more To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction erro...

Research paper thumbnail of Anterior Segment Manifestations of Microscopic Polyangiitis

Rheumatology: Current Research, 2013

In this retrospective, non-comparative case series, the medical records of three patients diagnos... more In this retrospective, non-comparative case series, the medical records of three patients diagnosed with microscopic polyangiitis (MPA) at the Bascom Palmer Eye Institute, Ocular Surface/Uveitis service were analyzed: an 80-year-old female with episcleritis, peripheral ulcerative keratitis, and lung involvement (patient 1); an 83-yearold female with nodular non-necrotizing scleritis (patient 2); and a 19-year-old female with chronic conjunctivitis and nasal inflammation (patient 3). Patient 1 had a diagnosis of MPA on presentation to our service; despite steroid-sparing therapy, she required steroids to treat the ocular flare-up of MPA. Patient 2 was given an MPA diagnosis with the help of rheumatology, based on clinical signs, symptoms and a positive p-ANCA; she was treated with corticosteroids and methotrexate. Patient 3 was diagnosed with MPA based on a second biopsy performed by ENT and a positive p-ANCA; treatment with corticosteroids and methotrexate was initiated. MPA can have conjunctival, episcleral, scleral, and corneal manifestations. Even if lung or renal involvement is not noted clinically, a patient in whom there is a high suspicion for MPA should undergo a thorough systemic workup, including a biopsy. Furthermore, a multidisciplinary approach should be taken when managing these patients in order to avoid vision and life-threatening complications. Microscopic polyangiitis (MPA) is a necrotizing small-vessel vasculitis. Patients are typically male, middle-aged, and develop nonspecific, constitutional signs and symptoms of inflammation. Characteristic features include glomerulonephritis, pulmonary vasculitis, and circulating perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) with myeloperoxidase specificity (MPO). While MPA can affect various parts of the peripheral and central nervous systems, and ophthalmic involvement has been previously reported in scattered reports, ocular findings have not been well documented. MPA is a severe disease with the mortality as high as 27.5%; thus, treatment with immunosuppressant is generally necessary. In this article, we report our experience with three MPA patients who presented with atypical demographics and various ophthalmic findings.

Research paper thumbnail of Intraocular Lens Power Calculation in Eyes with Previous Excimer Laser Surgery for Myopia

Ophthalmology, May 1, 2021

PURPOSE To review the literature to evaluate the outcomes of intraocular lens (IOL) power calcula... more PURPOSE To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK). METHODS Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist. RESULTS When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72-1.9 diopters [D] and 0.65-1.73 D, respectively), and a low (8%-40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42-0.94 D) and MedAEs (0.30-0.81 D) and higher (30%-68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31-0.35 D) and highest (66%-68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it. CONCLUSIONS Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.

Research paper thumbnail of Amniotic membrane transplantation: an updated clinical review for the ophthalmologist

Annals of Eye Science, Jun 1, 2023

Although amniotic membrane transplantation (AMT) has long been used as an essential surgical tech... more Although amniotic membrane transplantation (AMT) has long been used as an essential surgical technique for ocular surface reconstruction, its role continues to evolve and expand. In the management of numerous ocular surface disorders, ranging from inflammatory to infectious, traumatic to neoplastic, the ability to perform AMT is a valuable addition to the skillset of any ophthalmologist. The purpose of this paper is to provide ophthalmologists with an updated, evidence-based review of the clinical indications for AMT in corneal and conjunctival reconstruction, reviewing its common and even experimental applications known to date. The methods of amniotic membrane preservation, the available commercial amniotic membrane products to date, and future directions for amniotic membrane use, including amniotic membrane extract eye drops (AMEED), are also discussed. It is paramount for ophthalmologists to stay up-to-date on the applications of AMT so as to effectively incorporate this versatile treatment modality into their practice, both in the operating room and in the clinic. By familiarizing the general ophthalmologist with its diverse applications, we hope to motivate general ophthalmologists to incorporate the use of AMT into their clinical practice, or provide guidance on how to recognize when referral to a corneal specialist for amniotic membrane application is prudent.

Research paper thumbnail of Repeatability and Reliability of a Combined Dual-Scheimpflug Placido Disc Corneal Topographer in Eyes with Keratoconus

Research paper thumbnail of Repeatability of a Dual-Scheimpflug Placido Disc Corneal Tomographer/Topographer in Eyes with Keratoconus

doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by pee... more doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Research paper thumbnail of Secondary IOLs: ACIOL vs Iris Sutured vs Scleral Fixated vs Phakic IOL in Aphakic Settings

Current Ophthalmology Reports, Oct 4, 2018

Purpose of Review The aim of this review is to present ophthalmologists with up-to-date literatur... more Purpose of Review The aim of this review is to present ophthalmologists with up-to-date literature and treatment practices in the correction of vision with secondary intraocular lenses (IOLs) in the aphakic setting. Recent Findings Advances in the surgical techniques for the implantation of secondary intraocular lenses have allowed for improved postoperative outcomes. Studies published continue to evaluate the different surgical approaches and provide guidance to surgeons when choosing the optimal treatment plan for their patients. Summary In the absence of adequate capsular support, surgical implantation of intraocular lenses in different positions within the eye can be performed. Anterior chamber, iris-sutured, scleral-fixated, and iris-claw intraocular lenses have been found to be safe and effective treatment modalities in the correction of aphakia in eyes lacking adequate capsular support. Recent studies show that the development of new surgical techniques continue to provide safer and more effective treatment options for these patients.

Research paper thumbnail of Spectral Domain OCT And Autofluorescence In Active Posterior Uveitis

Investigative Ophthalmology & Visual Science, Mar 26, 2012

Research paper thumbnail of Management of Pterygium with Coexisting Cataract

Research paper thumbnail of Application of data mining algorithms to study data trends for corneal transplantation

Journal Francais D Ophtalmologie, Sep 1, 2022

Research paper thumbnail of Evaluation of the Ocular Surface in Patients with Graft-versus-Host Disease at the Bascom Palmer Eye Institute

Investigative Ophthalmology & Visual Science, Apr 30, 2014

Research paper thumbnail of Scleral-Fixated Intraocular Lenses

Current practices in ophthalmology, 2023

Research paper thumbnail of Comparison of Incidence of Cataracts in Pre-menopausal and Post-menopausal Women at a County Hospital

Investigative Ophthalmology & Visual Science, Jul 22, 2019

Research paper thumbnail of Femtosecond Laser-Assisted Cataract Surgery

Ophthalmology, Aug 1, 2022

Purpose of review In 2010, the US Food and Drug Administration (FDA) cleared femtosecond laser sy... more Purpose of review In 2010, the US Food and Drug Administration (FDA) cleared femtosecond laser systems for cataract surgery. Available in 2011, this technology has the potential to significantly impact cataract surgery. Recent findings Femtosecond lasers offer surgeons the ability to make very precise cuts in a targeted area without damaging the surrounding tissues. This technology has already dramatically changed refractive surgery and is poised to do the same for cataract surgery. Three companies, OptiMedica, LenSx (acquired by Alcon in September 2010), and LensAR, in different stages of FDA clearance, are developing femtosecond laser systems for cataract surgery. These systems will create the initial corneal incisions, capsulotomy, and also fragment the lens. Summary This article outlines the advantages of femtosecond laser cataract surgery and provides an initial comparison of the LensAR, LenSx/Alcon, and OptiMedica systems and early clinical results.

Research paper thumbnail of Eyes of a Hurricane: The Effect of Hurricane Harvey on Ophthalmology Consultations at Houston’s County Hospital

Disaster Medicine and Public Health Preparedness

Objective: This study aimed to characterize ophthalmology consultations ordered after Hurricane H... more Objective: This study aimed to characterize ophthalmology consultations ordered after Hurricane Harvey compared to consultations ordered during the same time period of the prior year. Methods: A retrospective chart review was performed at an urban, level 1 trauma center of a county hospital. All patients were included who received an electronic health record, documented ophthalmology consultation order between September 2017 and October 2017 (the time period immediately following Hurricane Harvey) or September 2016 and October 2016. Patient demographic risk factors were collected. Patient ICD10 clinical diagnoses were categorized as extraocular, intraocular, infectious, physiological, or other, and then subcategorized as trauma or non-trauma-related. A geographical heat map was generated to compare the changes in diagnosis volume by zip code to the magnitude of rainfall in the county. Results: Following Hurricane Harvey, ophthalmology consultation volume decreased, number of infecti...

Research paper thumbnail of Pre-Clinical and Clinical Inflammation of Ocular Adnexa in Graft-versus-Host Disease

Investigative Ophthalmology & Visual Science, 2014

Research paper thumbnail of Management of Pterygium with Coexisting Cataract

Textbook of Pterygium Management, 2018

Research paper thumbnail of Toric Intraocular Lenses--The Resident Experience

Investigative Ophthalmology & Visual Science, 2012

Research paper thumbnail of Correction of corneal astigmatism using femtosecond laser intrastromal incisions during cataract surgery

Investigative Ophthalmology & Visual Science, 2015

Research paper thumbnail of Spectral Domain OCT And Autofluorescence In Active Posterior Uveitis

Investigative Ophthalmology & Visual Science, 2012

Research paper thumbnail of Refractive outcomes after multifocal intraocular lens exchange

Journal of cataract and refractive surgery, 2017

To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye ... more To evaluate the refractive outcomes after multifocal intraocular lens (IOL) exchange. Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Retrospective case series. Patients had multifocal IOL explantation followed by IOL implantation. Outcome measures included type of IOL, surgical indication, corrected distance visual acuity (CDVA), and refractive prediction error. The study comprised 29 patients (35 eyes). The types of IOLs implanted after multifocal IOL explantation included in-the-bag IOLs (74%), iris-sutured IOLs (6%), sulcus-fixated IOLs with optic capture (9%), sulcus-fixated IOLs without optic capture (9%), and anterior chamber IOLs (3%). The surgical indication for exchange included blurred vision (60%), photic phenomena (57%), photophobia (9%), loss of contrast sensitivity (3%), and multiple complaints (29%). The CDVA was 20/40 or better in 94% of eyes before the exchange and 100% of eyes after the exchange (P = .12). The mean refractive prediction erro...

Research paper thumbnail of Anterior Segment Manifestations of Microscopic Polyangiitis

Rheumatology: Current Research, 2013

In this retrospective, non-comparative case series, the medical records of three patients diagnos... more In this retrospective, non-comparative case series, the medical records of three patients diagnosed with microscopic polyangiitis (MPA) at the Bascom Palmer Eye Institute, Ocular Surface/Uveitis service were analyzed: an 80-year-old female with episcleritis, peripheral ulcerative keratitis, and lung involvement (patient 1); an 83-yearold female with nodular non-necrotizing scleritis (patient 2); and a 19-year-old female with chronic conjunctivitis and nasal inflammation (patient 3). Patient 1 had a diagnosis of MPA on presentation to our service; despite steroid-sparing therapy, she required steroids to treat the ocular flare-up of MPA. Patient 2 was given an MPA diagnosis with the help of rheumatology, based on clinical signs, symptoms and a positive p-ANCA; she was treated with corticosteroids and methotrexate. Patient 3 was diagnosed with MPA based on a second biopsy performed by ENT and a positive p-ANCA; treatment with corticosteroids and methotrexate was initiated. MPA can have conjunctival, episcleral, scleral, and corneal manifestations. Even if lung or renal involvement is not noted clinically, a patient in whom there is a high suspicion for MPA should undergo a thorough systemic workup, including a biopsy. Furthermore, a multidisciplinary approach should be taken when managing these patients in order to avoid vision and life-threatening complications. Microscopic polyangiitis (MPA) is a necrotizing small-vessel vasculitis. Patients are typically male, middle-aged, and develop nonspecific, constitutional signs and symptoms of inflammation. Characteristic features include glomerulonephritis, pulmonary vasculitis, and circulating perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) with myeloperoxidase specificity (MPO). While MPA can affect various parts of the peripheral and central nervous systems, and ophthalmic involvement has been previously reported in scattered reports, ocular findings have not been well documented. MPA is a severe disease with the mortality as high as 27.5%; thus, treatment with immunosuppressant is generally necessary. In this article, we report our experience with three MPA patients who presented with atypical demographics and various ophthalmic findings.