Sepehr Feizi

To develop clinical practice guidelines (CPGs) for prevention, diagnosis, treatment and follow-up of ocular injuries caused by exposure to mustard gas. The clinical questions were designed by the guideline team. Websites and databases including National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane, and PubMed were searched to find related CPGs and explore possible answers to the clinical questions. Since there were no relevant CPGs in the literature, related articles in Persian and English languages were extracted. Each article along with its level of evidence was summarized. Additionally, hand search was performed by looking the reference list of each article. Consequently, recommendations were developed considering the clinical benefits and side effects of each therapeutic modality. The recommendations were re-evaluated in terms of customization criteria. All recommendations along with the related evidence were scored from 1 to 9 by experts from a...

To report the clinical, confocal scan, and histopathologic features of nocardia keratitis in a patient who developed bilateral infection following photorefractive keratectomy (PRK). A 23-year-old woman underwent bilateral PRK for low myopia. On postoperative day 3, dense central stromal infiltrates were noticed in both eyes. Empirical antibiotic therapy was initiated which was converted into specific therapy after a definite diagnosis was made based on clinical features and confirmed by confocal scan and histopathologic findings. Clinical and confocal scan features were consistent with the diagnosis of Nocardia keratitis, and topical 2% amikacin eye drops were started. Because of poor response to medical therapy, lamellar keratectomy was performed in both eyes which shortened the treatment course. Histopathologic examination reconfirmed the initial diagnosis. Familiarity with clinical and confocal scan features facilitates early diagnosis of Nocardia keratitis leading to proper mana...

To determine the rate and risk factors of vitreous loss during phacoemulsification in patients with cataracts operated by ophthalmology residents and fellows at Labbafinejad Medical Center. This prospective descriptive study included consecutive patients with cataracts undergoing phacoemulsification over a one year period. All patients were operated under local or general anesthesia using the divide and conquer technique. Preoperatively, all patients underwent a complete ocular examination including measurement of visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, and dilated funduscopy. Main outcome measures included the rate of posterior capsular rupture and vitreous loss as well as associated risk factors such as surgical experience, ocular and systemic conditions, and type and severity of the cataract. Overall, 767 eyes of 767 patients with mean age of 63.7±10.3 (range, 25-91) years were operated. The overall rate of vitreous loss was 7.9% which was 5-fold ...

To describe a sign that can confirm the correct position of donor lenticules during Descemet stripping automated endothelial keratoplasty (DSAEK). In this clinical and laboratory study, DSAEK was performed in 3 eyes with a diagnosis of pseudophakic bullous keratopathy. Additionally, 2 whole globes and 2 precut corneoscleral buttons were procured for the purpose of the laboratory part of the study. After removal of recipient Descemet membrane, the donor graft was inserted into the anterior chamber, unfolded, and attached to the posterior corneal stroma with an air bubble. A similar procedure was performed in the eye-bank eyes with lenticules attached in both correct and upside-down orientations. After the anterior chamber was completely filled with air, 2 or more concentric shiny rings were formed at the border of the donor lenticule because of total internal reflection in the graft. In the live and eye-bank eyes with a donor graft attached in the correct orientation, the innermost shiny ring, indicating the stromal side of the graft, was observed under the recipient cornea, whereas the outermost ring, indicating the endothelial side, was formed deeper. When the donor lenticule was intentionally implanted upside down in the eye-bank eyes, the reverse situation occurred, and the largest ring was observed just beneath the recipient cornea. The correct anterior-posterior orientation of the donor lenticule during DSAEK could be identified by the shiny rings formed at the border of the graft after the anterior chamber was completely filled with air.

To investigate the efficacy of normobaric oxygen (NBO) therapy for treatment of scleral ischemia or melt. This prospective interventional case series includes 9 eyes of 8 patients with scleral ischemia or melt of diverse etiologies. Following the failure of conventional medical and/or surgical therapy to improve ischemia or upon clinical deterioration, NBO was initiated. All patients received 100% NBO at flow rate of 10 liters/minute by face mask for 1 hour, twice daily until complete vascularization of ischemic areas. Main outcome measures were improvement of scleral ischemia and healing of conjunctival epithelial defects. NBO therapy led to epithelialization and vascularization of the ischemic sclera in all eyes; the repair process began 3-4 days after NBO had been initiated and was completed in 18.1±4.7 (range, 10-25) days. All patients remained stable over a 9-month follow-up period. NBO therapy seems effective for treatment of scleral ischemia or melt, and hence can be consider...

To investigate the incidence, mechanisms, characteristics, and visual outcomes of traumatic wound dehiscence following keratoplasty. Medical records of 32 consecutive patients with traumatic globe rupture following keratoplasty who had been treated at our center from 2001 to 2009 were retrospectively reviewed. The study population consisted of 32 eyes of 32 patients including 25 men and 7 women with history of corneal transplantation who had sustained eye trauma leading to globe rupture. Mean patient age was 38.1 (range, 8 to 87) years and median interval between keratoplasty and the traumatic event was 9 months (range, 30 days to 20 years). Associated anterior segment findings included iris prolapse in 71.9%, lens extrusion in 34.4%, and hyphema in 40.6% of eyes. Posterior segment complications included vitreous prolapse (56%), vitreous hemorrhage (28%) and retinal detachment (18%). Eyes which had undergone deep anterior lamellar keratoplasty (DALK; 5 cases, 15.6%) tended to have l...

To evaluate the correlation between refractive error and higher-order aberrations (HOAs) in patients with myopic astigmatism. HOAs were measured using the Zywave II aberrometer over a 6 mm pupil. Correlations between HOAs and myopia, astigmatism, and age were analyzed. One hundred and twenty-six eyes of 63 subjects with mean age of 26.4±5.9 years were studied. Mean spherical equivalent refractive error and refractive astigmatism were -4.94±1.63 D and 0.96±1.06 D, respectively. The most common higher-order aberration was primary horizontal trefoil with mean value of 0.069±0.152 μm followed by spherical aberration (-0.064±0.130 μm) and primary vertical coma (-0.038±0.148 μm). As the order of aberration increased from third to fifth, its contribution to total HOA decreased: 53.9% for third order, 31.9% for fourth order, and 14.2% for fifth order aberrations. Significant correlations were observed between spherical equivalent refractive error and primary horizontal coma (R=0.231, P=0.02...

The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to conventional PK. This review article describes the indications, different techniques, clinical outcomes and complications of deep anterior LK.

To report the outcomes of penetrating keratoplasty (PKP) in patients with macular corneal dystrophy (MCD). This retrospective case series includes consecutive patients with MCD who underwent PKP from 1986 to 2006 with at least 6 months' follow-up. Main outcome measures included best spectacle-corrected visual acuity (BSCVA), postoperative astigmatism and graft survival. Sixty-two eyes of 39 patients with mean age of 34.0±10.5 (range 13-58) years at the time of keratoplasty were included for analysis. After a mean follow-up period of 52.0±47.3 (range 6-190) months, BSCVA improved from 1.4±0.4 logMAR (4/100) preoperatively to 0.2±0.3 logMAR (20/32) at final follow-up (P<0.001).Mean postoperative BSCVA was 0.15±0.40 logMAR in patients (36 eyes) aged less than 35 years at the time of surgery as compared to 0.26±0.25 logMAR in subjects (26 eyes) older than 35 years (P=0.005). Final astigmatism was comparable with different suturing techniques including separate, continuous, and co...

To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period. Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation. During this period, 776 eyes of 756 patients (including 504 male subjects) with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8%) followed by bullous keratopathy (n=90, 11.6%), non-herpetic corneal scars (n=62, 8.0%), infectious corneal ulcers (n=61, 7.9%), previously failed grafts (n=61, 7.9%), endothelial and stromal corneal dystrophies (n=28, 3.6%), and trachoma keratopathy (n=26, 3.3%). Other indications including Terrien's marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest o...

To evaluate agreement in keratometry readings and anterior and posterior elevation map measurements among the Galilei V4.01 (Ziemer), Orbscan IIz (Bausch & Lomb), and Corneal Map topographer (Costruzione Strumenti Oftalmici) systems. This prospective comparative study comprised 184 eyes of 92 consecutive refractive surgery candidates who were simultaneously examined with the Galilei (dual Scheimpflug), Orbscan II (scanning-slit), and Corneal Map topographer (Placido disk-based) systems. Keratometry readings and anterior and posterior elevation map measurements were compared using analysis of variance and paired t test, respectively. Mean keratometry reading was 44.30 ± 1.49 diopters (D), 44.11 ± 1.47 D, and 44.60 ± 1.56 D with the Galilei, Orbscan, and Corneal Map topographer, respectively. Despite a significant difference in mean keratometry (P<.001), the correlation among these three systems was strong. The maximum mean difference between two sets in simulated keratometry and astigmatism was <0.50 D. In the evaluation of anterior best-fit-sphere (BFS) and posterior BFS, the correlation between Galilei and Orbscan II was found to be 0.960 and 0.947, respectively. Maximum anterior central elevation measured by Orbscan II and Galilei was 9.2 ± 5.1 μm and 3.2 ± 1.8 μm, respectively. Maximum posterior central elevation by Orbscan II and Galilei was 33.8 ± 9.3 μm and 6.8 ± 3.8 μm, respectively. Despite significant differences in mean keratometry readings and anterior and posterior elevation measurements among the three systems, the keratometry readings can be used interchangeably, as this difference is not clinically significant.

To measure corneal elevations in eyes with subclinical keratoconus and those with keratoconus using the Galilei Scheimpflug analyzer and to determine the optimal corneal elevation cutoff points to maximize sensitivity and specificity in discriminating keratoconus and subclinical keratoconus from normal corneas. 
 A total of 136 normal eyes, 23 eyes with subclinical keratoconus, and 51 eyes with keratoconus were enrolled. Maximum anterior and posterior corneal elevation was measured in the central 3-, 5-, and 7-mm zones using the Galilei double Scheimpflug camera. Receiver operating characteristic curves were used to compare the sensitivity and specificity of the measured parameters and to identify optimal cutoff points for discriminating keratoconus and subclinical keratoconus from normal corneas. 
 Mean anterior and posterior corneal elevations in all zones were statistically higher in keratoconus and subclinical keratoconus versus normal corneas. The posterior elevation measurement in the 3-mm zone had the strongest power to distinguish keratoconus from normal. The corresponding figure for the 7-mm zone, however, had the strongest power to distinguish eyes with subclinical keratoconus (area under the curve, 0.98 and 0.92, respectively). Optimal cutoff point for posterior elevation in the 3-mm zone was 18.5 µm for keratoconus (sensitivity, 92%; specificity, 95%). The corresponding figure in the 7-mm zone was 50.5 µm for subclinical keratoconus (sensitivity, 79.9%; specificity, 94.0%). 
 Anterior and posterior elevations measured by the Galilei analyzer in the 3-mm zone can effectively discriminate keratoconus from normal corneas. These measurements in the 7-mm zone can be considered to distinguish subclinical keratoconus.

To compare biomechanical properties of transplanted corneas after penetrating keratoplasty (PK) with those after deep anterior lamellar keratoplasty (DALK) using Anwar's big-bubble technique. This cross-sectional comparative study consisted of 45 PK eyes (group 1) and 23 DALK eyes (group 2) with the underlying pathology of keratoconus. The Ocular Response Analyzer was used to measure Goldmann-correlated intraocular pressure (IOPg) and cornea-compensated IOP (IOPcc), as well as graft biomechanical properties, namely corneal hysteresis (CH) and corneal resistance factor (CRF). The results were compared between the study groups using independent t-test. Mean patient age was 29.8 ± 6.1 years in group 1 and 27.2 ± 6.5 years in group 2 (P = 0.11) and they were followed up for 31.4 ± 19.0 months and 29.2 ± 17.3 months after corneal transplantation, respectively (P = 0.27). There was no significant difference between the study groups in terms of recipient (P = 0.21) and donor (P = 0.57) trephine sizes or BSCVA (P = 0.77). CH was measured 10.09 ± 2.5 mmHg in group 1 and 9.64 ± 2.1 mmHg in group 2 (P = 0.36). CRF was 10.13 ± 2.2 and 9.36 ± 2.1 mmHg, respectively (P = 0.17). Similarly, no significant difference was found between group 1 and group 2 in terms of IOPg (P = 0.25) and IOPcc (P = 0.80). DALK using the big-bubble technique for keratoconic eyes provides corneal biomechanics comparable to PK.