Papers by Reza Razeghinejad
Journal of Cataract & Refractive Surgery, 2019
PURPOSE To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent ... more PURPOSE To determine the efficacy, safety, and surgical outcomes of trabecular microbypass stent (iStent) surgery performed by resident trainees and attending surgeons. SETTING Wills Eye Hospital, Philadelphia, Pennsylvania, USA. DESIGN Retrospective case series. METHODS Records of all patients who had microbypass stent surgery by a resident at Wills Eye Hospital were retrospectively reviewed. The attending-performed group included any patient who had a microbypass stent implanted by an attending surgeon on the same day a resident case was performed. RESULTS Between 2016 and 2018, 31 microbypass stents were implanted by a resident supervised by an attending and 93 microbypass stents were implanted by an attending surgeon on the day a resident case was performed. The mean follow-up was 16.2 months ± 17.9 (SD). The mean intraocular pressure (IOP) decreased from 16.0 ± 4.6 mm Hg at baseline to 14.0 ± 3.1 mm Hg at most recent follow-up visit in the resident group (P = .02) and from 17.5 ± 4.8 mm Hg to 15.1 ± 4.3 mm Hg, respectively, in the attending group (P < .001). The final mean IOP and mean number of hypotensive medications were similar between the 2 groups (P = .83 and P = .12, respectively). Self-resolving hyphema occurred in 1 resident case and 2 attending cases. The resident group had 1 case of iridodialysis, which did not require additional surgery. One eye in the attending group ultimately required a trabeculectomy. CONCLUSION Microbypass stent implantation by resident trainees with attending supervision had similar efficacy and safety as surgery performed by attending surgeons.
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Eye, 2017
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Survey of Ophthalmology, 2017
Trabeculectomy with antimetabolites is the most commonly performed surgery worldwide for glaucoma... more Trabeculectomy with antimetabolites is the most commonly performed surgery worldwide for glaucoma patients with progressive optic nerve head injury and visual field loss despite maximum pharmacologic intraocular pressure-lowering therapy. Trabeculectomy bleb-associated infections remain one of the most feared early and long-term complications of trabeculectomy surgery because of their poor prognosis and variable response to antimicrobial therapy. Several studies have evaluated how surgical technique, conjunctival incision location, comorbid ocular pathology, concurrent medication use, and bleb morphology affect the risk of bleb-associated infection. New surgical techniques and devices aim to achieve a similar intraocular pressure reduction profile to trabeculectomy while avoiding the presence of a conjunctival bleb. We provide a comprehensive review of studies evaluating risk factors for bleb-associated infection after trabeculectomy and propose a diagnostic and therapeutic approach to bleb-associated infection.
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The Open Ophthalmology Journal, 2016
Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients... more Filtering surgeries are frequently used for controlling intraocular pressure in glaucoma patients. The long-term success of operation is intimately influenced by the process of wound healing at the site of surgery. Indeed, if has not been anticipated and managed accordingly, filtering surgery in high-risk patients could end up in bleb failure. Several strategies have been developed so far to overcome excessive scarring after filtering surgery. The principal step involves meticulous tissue handling and modification of surgical technique, which can minimize the severity of wound healing response at the first place. However, this is usually insufficient, especially in those with high-risk criteria. Thus, several adjuvants have been tried to stifle the exuberant scarring after filtration surgery. Conventionally, corticosteroids and anti-fibrotic agents (including 5-fluorouracil and Mitomycin-C) have been used for over three decades with semi-acceptable outcomes. Blebs and bleb associate...
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Expert Techniques in Ophthalmic Surgery, 2015
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Manual of Glaucoma, 2016
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The Open Ophthalmology Journal, 2015
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Journal of ophthalmic & vision research, 2014
To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium exc... more To evaluate the local safety of bevacizumab and its effect on recurrence of primary pterygium excision. This randomized, placebo-controlled clinical trial was conducted on 44 eyes of 44 patients randomized to Group 1 (bevacizumab) and Group 2 (balanced salt solution). Group 1 underwent pterygium excision with a rotational conjunctival flap and received a total of 7.5 mg subconjunctival bevacizumab (5 mg/0.2 mL on the day of surgery and 2.5 mg/0.1 mL on the fourth day after surgery). Group 2 received balanced salt solution in the same manner. Recurrence, defined as any fibrovascular tissue crossing the limbus, and the number of patients with >1.5 mm fibrovascular overgrowth on the cornea were compared between the study groups. There was no statistically significant difference between the study groups in terms of demographics, pterygium size, daily sun exposure, preoperative visual acuity, keratomeric readings, corneal astigmatism, or IOP (P>0.05). Three and four patients in eac...
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Journal of ophthalmic & vision research, 2014
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Iranian journal of medical sciences, 2011
A number of ocular biometric parameters, iris hiotologic and anatomic characters have been sugges... more A number of ocular biometric parameters, iris hiotologic and anatomic characters have been suggested as inciting factors for converting patients with narrow angle to angle-closure glaucoma. This study was conducted to determine if there was any goniscopic difference between patients with acute angle-closure glaucoma (AACG) and chronic angle-closure glaucoma (CACG). The study is a retrospective analysis of the charts of 97 patients with asymmetric CACG and 15 patients with unilateral AACG. The age, sex, type of glaucoma, gonioscopic findings and optic nerve head cup/disc ratio were recorded for all patients. Dynamic gonioscopy and Spaeth's convention were used to grade the drainage angle. The eyes with AACG or more optic nerve damage in CACG groups were considered as involved eye, and the contralateral eyes in the AACG and CACG groups were considered as noninvolved and less-involved, respectively. There was no significant difference between patients with AACG and CACG in terms of...
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Journal of ophthalmic & vision research, 2012
To report the outcomes of two different surgical techniques for the repair of late onset bleb lea... more To report the outcomes of two different surgical techniques for the repair of late onset bleb leakage following trabeculectomy. This retrospective study includes 21 eyes of 20 patients with prior trabeculectomy and late-onset bleb leaks; 14 eyes underwent excision of the filtering bleb together with conjunctival advancement while in the other 7 eyes the bleb was retained but de-epithelialized before conjunctival advancement. Success was defined as resolution of leakage with no need for additional glaucoma surgery together with intraocular pressure (IOP) of 5-21 mmHg. Complete and qualified success was considered when the above mentioned was achieved without or with glaucoma medications, respectively. Mean duration of follow-up was 20.3±14.4 months. No significant difference was observed between the two groups in terms of complete, qualified and overall success rates (P>0.05), however more antiglaucoma medications were necessary in the bleb excision group (P=0.02). Both surgical t...
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Annals Of Ophthalmology, 2005
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Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus, 2014
To evaluate the outcome of Ahmed glaucoma valve (AGV) implantation in primary congenital glaucoma... more To evaluate the outcome of Ahmed glaucoma valve (AGV) implantation in primary congenital glaucoma (PCG). The medical records of patients with PCG refractory to trabeculotomy and medical therapy who had undergone AGV implantation with a minimum follow-up of 6 months were retrospectively reviewed. The primary outcome measure was cumulative probability of success, defined as intraocular pressure (IOP) of 6-21 mm Hg, with or without medication, and no serious complications, additional glaucoma surgery, or loss of light perception. A total of 33 eyes of 22 children with a mean age (and standard deviation) of 2.7 ± 3.1 years were included. The patients had a mean follow-up time of 32.6 ± 18.3 months. The mean IOP was 32.8 ± 7.3 mm Hg preoperatively and 16.8 ± 4.0 mm Hg postoperatively. The number of glaucoma medications was 2.5 ± 0.7 preoperatively and 2.2 ± 0.7 postoperatively. The cumulative probability of success (and standard error) was 97% ± 3.0% in the 1st year, 85% ± 7.0% in the 2n...
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Journal of glaucoma, Jan 19, 2014
The aim of this study was to compare gonioscopy with Visante and Cirrus optical coherence tomogra... more The aim of this study was to compare gonioscopy with Visante and Cirrus optical coherence tomography (OCT) for identifying angle structures and the presence of angle closure in patients with glaucoma. A secondary objective was to assess interrater agreement for gonioscopy grading among 3 independent examiners. Gonioscopy grading using Spaeth Classification and determination of angle-closure risk was performed on 1 randomly selected eye for 50 phakic patients. Images of the same eye using both Visante and Cirrus OCT were obtained in both light and dark conditions. Agreement of angle closure among 3 devices and interrater agreement for gonioscopy were determined using Cohen's κ (K) or Kendall's coefficient of concordance (W). Of the 50 patients, 60% were female, 64% were white, and the mean age was 62 years. Angle closure was detected in 18%, 16%, and 48% of quadrants with Visante, Cirrus, and gonioscopy, respectively. The scleral spur was identified in 56% and 50% of quadrant...
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Retina, 2012
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Survey of Ophthalmology, 2011
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Survey of Ophthalmology, 2012
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Optometry and Vision Science, 2011
Many new surgeries have been devised since 1856, when von Graefe discovered that iridectomy is an... more Many new surgeries have been devised since 1856, when von Graefe discovered that iridectomy is an effective surgical method for acute glaucoma treatment. Two years later, De Wecker presented sclerotomy as a procedure for chronic glaucoma. In 1900, internal filtration (cyclodialysis) was developed. In 1932, ciliodestruction was suggested. The four approaches, relief of pupillary block, external filtration, internal filtration, and ciliodestruction, are still the basic techniques of glaucoma surgeries over 100 years later. There have been two basic approaches to lowering eye pressure surgically: increase outflow and decrease inflow of aqueous humor. Although the majority of surgeries used nowadays were introduced in the 1960s, their roots can be traced to the work of surgeons in the 19th century. Trabeculectomy, in use since the mid-1960s, is the most effective glaucoma surgery in terms of intraocular pressure reduction but carries its own limitations. Non-penetrating glaucoma surgeries emerged at the same time trabeculectomy was presented, but they are not used as commonly as trabeculectomy. Molteno introduced the first effective shunt and followed by others. Since 1995, the majority of new surgeries have consisted of new implantable devices including SOLX, iStent, and Ex-PRESS shunt. This article will review the history of glaucoma surgery and describe the fundamentals of different glaucoma procedures.
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Ophthalmic Research, 2013
Purpose: It was the aim of this study to determine any possible correlation between the peaks and... more Purpose: It was the aim of this study to determine any possible correlation between the peaks and changes in intraocular pressure (IOP) of a water drinking test and intravenous methylprednisolone pulse therapy (IVMPT) IOP response. Methods: Patients with rheumatic disorders scheduled for IVMPT with normal ocular examination received a WDT before and after 3 days of IVMPT. The maximum value of IOPs detected during the WDT or IVMPT was regarded as peak IOP, and IOP change was defined as the difference between peak IOP and baseline IOP. Results: The mean ± standard deviation (SD) IOPs on the first (21.9 ± 4.6 mm Hg; p = 0.04), second (21.9 ± 4.1 mm Hg; p = 0.03) and third (21.3 ± 4.2 mm Hg; p = 0.01) days of 20 enrolled patients were greater than that at baseline (19.3 ± 2.8 mm Hg). The mean ± SD of peak IVMPT IOP response was 23.9 ± 3.7 mm Hg, and IVMPT IOP change was 4.6 ± 3.7 mm Hg. These values for the first and second WDTs were 22.9 ± 4.9 and 3.9 ± 4.07 as well as 24.1 ± 4.6 and 3...
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Journal of Neurotrauma, 2010
To compare the effect of levodopa-carbidopa on the visual outcome of patients with indirect traum... more To compare the effect of levodopa-carbidopa on the visual outcome of patients with indirect traumatic optic neuropathy (ITON), this randomized, double-blind, placebo-controlled study was conducted on 32 patients with ITON within 6 days after trauma. Patients underwent a complete ocular examination, pattern visual evoked potential (PVEP) testing, and high-resolution orbital computed tomography (CT) scanning. All patients received high-dose intravenous methylprednisolone, and levodopa was also administered to the levodopa group. The main outcome measures were best corrected visual acuity and PVEP results at the last-completed examination. The study was completed on 16 patients in the levodopa group and 10 patients in the placebo group because the others were lost to follow-up. There were no statistically significant differences for age, sex, involved eye, ocular and CT scan findings, pretreatment visual acuity, frequency of recordable PVEPs, and follow-up. In the levodopa group the visual acuity improved significantly after treatment (p = 0.009), but not in the placebo group (p = 0.34). After treatment the visual acuity in the levodopa group was 2.1 ± 2.1, and in the placebo group was 3.9 ± 1.2 (p = 0.008). In those who had visual acuity less than or equal to figure count, significant improvement in visual acuity was observed in the levodopa group (p = 0.03), but not in the placebo group (p = 0.34). However, the final visual acuity in these patients was comparable after treatment (p = 0.21). Nine patients (56.2%) in the levodopa group, and 1 (10%) in the placebo group, experienced improvement in visual acuity (p = 0.02). The frequency of unrecordable PVEPs were comparable in both groups (p = 0.09). Patients treated with levodopa within 6 days of onset of ITON were more likely to experience improvement in visual acuity than those in the placebo group.
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Papers by Reza Razeghinejad