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Theses

Title:

Thickness of choroidal layer in diabetics in Khatam eye hospital medical ceneter 2015

Supervisors:

Dr. Mir-Naghi Moosavi

Dr. Naser Shoeibi

Advisers:

Dr. Maryam Salehi

Dr.Zohreh Moosavi

By:

Hamed Torabifard

Abstract

Background: Diabetic retinopathy and its subsequences are of well-known complications of  diabetes. vascular injury involving choroidal vasculature  is the main etiology of diabetic retinopathy  especially in the foveal region. Optical coherence tomography is a noninvasive imaging technology through which we can see cross-sectional images of retinal and subretinal layers(involving choriocapillaris,Sattler and Haller).evaluation of choroidal vasculature layer enhances our understanding of diabetic retinopathy pathophysiology.

Methods: 58 patients with  diabetes and 30 normal individuals similar in age and sex  were involved in the study. Thickness of choroidal vascular layers were measured using optical coherence tomography system.

Results:There were no significant difference in total subfoveal choroidal thickness between diabetic patients and normal individuals. There was increased choriocapillaris layer thickness in type 2 diabetic patients with nonproliferative diabetic retinopathy without diabetic macular edema compared to controls(p=0.013). subfoveal Sattler layer thickness was reduced in type 1 diabetic patients compared to normal individuals(p=0.009).There was no significant difference in Haller layer thickness between diabetics and healthy controls.

Conclusion:Choriocapillaris was thicker in type 2 diabetic patients with nonproliferative diabetic retinopathy without DME. . diabetic choriodopathy may involve mainly the choriocapillaris therefore it is important to evaluate choriocapillaris integrity in diabetic patients.

Keywords:Optical coherence tomography,Sattler layer,Haller layer

 

 

Title:

Developmental status in retinopathy of prematurity cases treated with intravitreal bevacizumab

Supervisors:

Dr. majid abrishami

Advisers:

Dr. naser shoeibi

By:

farid shekarchian

Abstract:

Background: Possible Systemic absorption of bevacizumab can reduce the serum level of VEGF in infants with ROP. The aim of the study was to assess the developmental status in infants who underwent intravitreal bevacizumab injection for treatment of retinopathy of prematurity (ROP).

 

Method: In this cohort retrospective study, ROP cases and age-weight matched controls were followed in ROP clinic of Khatam eye hospital from Jan 2012 to December 2015.

Ophthalmology exams were performed till complete retinal vascularization. Development & growth evaluated by age& stages questionnaire (ASQ) forms were filled by parents in two sessions at the age of 6, 12 & 18 months old with pediatrician supervision. Developmental milestones in five domains (gross motor, fine motor, personal& social status, problem solving, relationship and overall issues) were assessed.

 

Results: 34 cases and 36 controls were included in the study. Mean birth weight and gestational age were 1,281±254 g and 29.5±2.1 weeks, respectively. In a follow-up period of 18 months, bevacizumab was effective in the treatment of severe cases of ROP as a primary treatment.

There was no significant difference between two groups regarding relationship, gross motor, fine motor, personal& social status, problem solving and overall issues in follow up intervals. (p>0.05)

 

Conclusion: This study does not show any systemic side effect of intravitreal bevacizumab in growth and neurodevelopmental status of infants.

 

Keywords: Retinopathy of prematurity (ROP), Vascular endothelial growth factor (VEGF), intravitreal bevacizumab , Ages & Stages Questionnaire(ASQ)

 

 

 

Title: Comparison of ocular anterior segment parameters with Orbscan II and Lenstar biometry

Conductor(s)/Author(s): Dr. Hamid Gharaee &Dr.Ali khodaee

 

Position & Department

Associate Professor, Eye Research Cener, Khatam al Anbia hospital, Mashhad University of Medical Sciences

 

Start date: 2014/5/28

End (Completion) date :2016/4/14

Performing location/Organization

 Dep. Of Ophthalmology, School of Medicine; Mashhad University of Medical Sciences

Keywords : Orbscan II, Lenstar, Ocular anterior segment parameters

 

 

Abstracts (200-250 words)

Introduction : Since there are numerous methods for the assessment of ocular anterior segment parameters, and each one of these methods have strengths and weaknesses, in this study we aimed to evaluate and compare these parameters with Orbscan II and Lenstar

 

Objectives & ( hypothesis  OR questions) : aimed to evaluate and compare these parameters with Orbscan II and Lenstar

 

 

Materials & Methods : In this study, 594 eyes from 297 refractive surgery candidates were evaluated. The anterior chamber depth (ACD), central corneal thickness (CCT), keratometry (Kr), and white-to-white (WTW) corneal diameter of candidates for keratorefractive surgery were measured by using Orbscan II, and Lenstar. Exclusion criteria were history of any intraocular and corneal surgery, contact lens wear and corneal anomalies. The differences between the reported values were compared by the Student paired t-test using SPSS 22.

 

 

Results : The mean CCT measured by Lenstar was smaller than that measured by Orbsacn II (p <0.001). The mean WTW was smaller with Orbscn than Lenstar (p <0.001). The mean ACD was also lower with Lenstar than with Orbscan II (p <0.001). Orbscan II provided significantly (p < 0.0001) different measurements for ACD, CCT, WTW corneal diameter, Kr Max, Min, and Kr Diff compared to Lenstar.

 

Conclusion : The measurement of ACD, CCT, WTW corneal diameter, minimum and maximum keratometry (Kr Max, Min), and difference in keratometry (Kr Diff) by Orbscan II, and Lenstar provided different results, indicating that these systems are not interchangeable. . Moreover, the regression analysis, which was performed to measure the relationship between the reported values for the studied parameters, demonstrated a good linear relationship between the values of all parameters measured by the two methods.

 

 

Title: Comparison of Different Frequencies of Pulse mode Phacoemulsification in Moderate and Severe Cataracts

Conductor(s)/Author(s): Dr. Akbar Derakhshan; Dr. Alireza Eslampoor; Dr. Soheyla Jafarpour

 

Position & Department: associate professor, assistant professor, Ophthalmology Resident, Khatam-al-Anbia Eye Hospital, MUMS

 

Start date : July 5th  2015

End (Completion) date: May 19th  2016

Performing location/Organization: Khatam-al-Anbia Eye Hospital, Cornea Research Center, MUMS

Keywords: cataract, nuclear hardness, phacoemulsification, pulse, ultrasound

Abstracts (200-250 words)

 Introduction: Cataract is the most common cause of blindness worldwide. The surgery is the main proper treatment for cataract-related visual loss. Presently Phacoemulsification is the gold standard way of cataract surgery. The used Ultrasonic energy in Phacoemulsification can carry the risk of ocular tissue damage, especially in cataracts with hard nuclei. To reduce the iatrogenic effects of ultrasound on eye tissues and to increase efficacy of surgery different Phaco modes had been used including pulse, burst and continuous mode. 

 

 Objectives & ( hypothesis  OR questions): The aims of this study were to compare the effects of different frequencies of phacoemulsification with pulse mode on lenses with moderate and severe nuclear hardness and to evaluate post-operative outcomes

 

 Materials & Methods: All the patients with moderate and severe cataract up to 127 who referred to Khatam-al-Anbia eye clinics with any of two types of lens hardness were recruited for the study. One hundred and twenty seven patients (69 with moderate and 58 with severe nuclear hardness) were randomly assigned to one of the frequencies of 10 and 60 PPS (63 with frequency 10 and 64 with frequency 60). The five variables of best corrected visual acuity, endothelial cell count, corneal edema, central corneal thickness and effective phaco time were evaluated in this study.

 

 

 Results: lens hardness had statistically significant effect on best corrected visual acuity; better in nuclei with moderate hardness. Endothelial cell loss and effective phaco time both were less when operating on nuclei with moderate hardness. Frequency had statistically significant effect on best corrected visual acuity; better with frequency 10. Corneal edema and effective phaco time both were less when frequency 10 was applied.  The Central Corneal Thickness was only correlated with time and increased as the time passed from surgery.

 

 Conclusion: The surgery outcome in regard to endothelial cell loss, improvement in visual acuity, and effective phaco time during surgery was better for patients with moderate nuclear hardness. frequency 10 was accompanied with better outcome considering visual acuity improvement, degree of corneal edema after surgery and less effective phaco time during surgery.

 

 

Title: Contrast sensitivity before and after patch therapy in mild and  moderate amblyopic patient between 5-18 year’s old

 

Conductor(s)/Author(s): Dr. Mohamad Etezad Razavi & Dr. Ali Akbar Saber Moghadam & Dr. Mohsen Mohamadzadeh

 

Position & Department : Mashad University of Medical Sciences .School of Medicine

Start date :2015/7/25

End (Completion) date:2016/4/14

Performing location/Organization : Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

 Keywords : amblyopia, contrast  sensitivity, visual acuity, patch therapy

Introduction :

 Amblyopia , the commonest childhood vision disorder, is typically diagnosed by  significantly reduced visual acuity without detectable structural or pathologic causes .deficiencies  other than visual acuity such as  loss of contrast sensitivity has been demonstrated .

A comparison between the normal eyes and the corresponding amblyopic eyes have been shown deficieny of  the contrast sensitivity functions in the amblyopic eyes.

Objectives & ( hypothesis  OR questions):

determine the effect of patching  of the better eye on visual acuity (VA) and contrast sensitivity function in patients with mild to moderate amblyopia.

Materials & Methods:

This prospective study enrolled 25 mild to moderate unilateral   amblyopic subjects aged 5-18 years with BCVA 20/100 or better in the amblyopic eyes

Complete ophthalmic evaluation was done. The Best Corrected VA (BCVA) was measured based on LogMar scale. contarst sensitivity was evaluated with the Vector Vision CSV-1000E.patients regarding age and the severity of amblyopia, underwent daily patching. After that, in follow-up visits at 1, 3 and 6 months, VA and CSF were again evaluated .  The data were analyzed with the SPSS software version 23 . P values of .05 or less were considered as statistically significant.

 

 

Results :

A total number of 25 patients with the mean age of 7/16 years were recruited in this study.

CSF variable was measured at 4 various frequencies at every follow-up time. The CSF was significantly lower in amblyopic eyes in comparison with fellow eyes in all frequencies(p<0.001).  The patching significantly improved  CSF in middle frequencies( B and C), had  nearly significant effect  on improving grade A (p=0.051),  but was not effective in  improving D . Age of start of patching had no significant effect on final CSf. The visual acuity increased to significant level(p=0.023).we did not find reverse amblyopia in the fellow eye after completion of study.

 

Conclusion :

Contrast sensitivity (CS) testing has become an important clinical tool in the battery of tests used to characterize patients’ vision. It is recommended that intermediate frequencies of CSF  test to be applied as a side and complementary test to treat amblyopia.

Address of corresponding author/ conductor : Abutaleb Junction. Shahid Gharani Blvd, Khatam Eye Hospital

E-mail : This email address is being protected from spambots. You need JavaScript enabled to view it.

Tel : 0098 511 7281401-5    

 

 

 

Title:

Comparison of Autologous Platelet-Rich Plasma with Autologous Serum Eye Drop in Corneal Epithelial Disorders

Supervisors:

Dr. Siamak Zarei Ghanavati

Dr. Daryoush Hamidi Alamdari

Advisers:

Dr. Alireza Eslampour

By:

Azadeh Zare Feizabadi

Abstract:

Background: Tear film plays an essential role in maintaining ocular surface epithelium health. It prevents desiccation. Tear film contain nourishing and antibacterial factors such as epidermal growth factor (EGF), fibronectin, vitamin A and neurotrophic growth factor. These factors are necessary for ocular surface epithelium hemostasis, and their lack induce ocular surface damage and lead to persistent epithelial defects. Fox for the first time in 1934 mentioned benefits of using autologous serum in dry eye in Sjogren’s syndrome. After that, ASED (Autologous Serum Eye Drop) has been widely used in treating ocular surface disorders.  ASED acts as a lubricant and also has lots of necessary growth factors (like; vitamin A, EGF, fibronectin and so many cytokines) to heal the damaged epithelium.

PRP (Platelet-Rich Plasma) contains more platelet than plasma. It acquired by centrifuging whole blood added to anticoagulant. Platelets are necessary in wound healing. They come to the wound area and attach to damaged tissue quickly. So that a lot of growth factors and cytokines release leads to liberating PDGF, platelet factor IV and TGF-β from α granules of platelets. Because PRP having high amount of growth factors it may promote effective wound healing.

 

Method: We analyzed 35 eyes from patients at the Khatam hospital of Mashhad between May2012 and September 2014. 19 eyes have been treated by PRP (Platelet Rich Plasma) and the other 16 eyes were treated by ASED 20 %( Autologous Serum Eye Drop). The treatment has been used in patients with chronic ulcer that did not respond to any other conventional therapy. Informed consent for the treatment was obtained from all patients after the possible complications were explained to them. The assessment results contain BCVA, symptoms and slit lamp examinations of the first week and first month of therapy recorded in their check lists. We also took some photos of defect healing process during follow up. Patients’ epithelial disorders divided into three groups; persistent epithelial defect (PED), punctate epithelial erosion (PEE) and filamentary keratitis (FK).

 

Results15 eyes experienced complete healing with no other defect, 16 eyes had partial healing and in 2 other treatment failed. In PRP-treated group 9 patient had complete healing, 6 ones had partial healing and treatment failed in two patients. In ASED group 6 patients healed completely and 10 patients had partial healing.in PRP group 2 patient did not complete the therapy.

 

Conclusion: Autologous Serum and Platelet-Rich Plasma both can be effective in corneal epithelial wound healing. This study showed no significant difference between these two in healing corneal epithelium.

 

Keywords: Platelet Rich Plasma, Autologous Serum Eye Drop, Persistent Epithelial defect, Neurotrophic keratopathy, Filamentary Keratitis, Diffuse Punctate Epithelial Erosion.

 

 

 

Title:

Prevalance and treatment outcome in acute endophthalmitis after intravitreal injection

Supervisors:

Dr. Naser Shoeibi

Dr. S. Maryam Hosseini

Advisers:

Dr. Mir Naghi Mousavi

Dr. Majid Abrishami

Dr. Tooka Banaei

By:

Farzaneh Khosropour

ABSTRACT

INTRODUCTION : Endophthalmitis following intravitreal injection is an intraocular infection due to bacteria or fungi involving the vitreous and / or aqueous. This infection is a rare but dreaded complication and without appropriate treatment causes permanent visual loss. The purpose of this study is to report prevalence and visual outcome in acute endophthalmitis after intravitreal injection.

METHODS :  This single center retrospective non comparative case series study included all patients who underwent intravitreal injection and developed acute endophthalmitis  in Khatam – Al - Anbia eye hospital affiliated to Mashhad University of Medical Sciences from march 2005 to march 2015.  Demographic data and ocular findings of 12 patients with endophthalmitis were reviewed. We converted patients visual acuity to LogMAR for comparation. Recorded data analyzed using SPSS software version 20.

RESULTS : There was 12 cases of acute endophthalmitis  among a total of 23618 injections. The incidence of acute endophthalmitis  was 0.053% ( 1 per 1883 injections). Bevacizumab was the most common drug used (66.7%). Other drugs were triamcinolone (3.4%), Bevacizumab+ triamcinolone (3.4%) and Bevacizumab+ dexamethasone(16.7%). The median age was 61.83 years( range, 51-75 years. The median number of days from injection to presentation was 1.82(1-9) days. The most common symptom was pain(58.3%). Three cases out of 12(25%) were culture-positive.Two cases caused by Staphylococcus epidermidis and other case by  Staphylococcus aureous. The initial treatment in all patients  was intravitreal injection of antibiotics. Vitrectomy was performed  in 4 (33.3%) cases. Comparation between primary visual acuity and final visual acuity was significant ( p = 0.011) but was'nt significant after treatment.(P = 0.686)

CONCLUSIONS : The rate of endophthalmitis was very low ( 0.053% ) but visual devasting. Acute endophthalmitis is a medical emergency. The use of intravitreal injection has greatly increased, therefore prevention, immediately diagnosis and treatment are important.

KEYWORDS : endophthalmitis,  intravitreal injection, Bevacizumab

 

 

 

Title:

Incidence and risk factors of retinopathy of prematurity in Khatam al-anbia eye hospital in mashhad (2010-2013)

Supervisors:

Dr. Naser Shoeibi

Dr. Seyede Maryam Hosseini

Advisers:

Dr. Majid Abrishami

Dr. Touka Banaee

Dr. Mirnaghi Mousavi

By:

Ehsan Abedini


 

Abstract:

Background: Retinopathy of prematurity is a complex disease initiated by abnormal retinal vascularization in premature infants. ROP causes more than 10% of childhood blindness in developed countries. On the other hand ROP is a preventable disease with determining its risk factors and make them least. Incidence rate and risk factors of ROP varies everywhere in the world. Then it's necessary to determine incidence rate and risk factors of ROP in our area.

Method: In a retrospective study, data for premature infants who referred to ROP clinic of Khatam Al-anbia eye hospital (2010-2013) were recorded and analysed using T-test and chi-square test. Patients who have inclusion criteria and have not exclusion criteria were chosen. All patients were examined with fundus photography retcam and indirect ophthalmoscopy.

Results: Among 898 premature infants who referred to Khatam Al-anbia hospital, there were 597 (67.0%) different stages of ROP. Data analysis showed a significant relationship between low birth weight, prematurity, NICU admission, oxygen therapy duration, IVF fertilization, surfactant administration and ROP (P < 0.005). While gender, other systemic disease and type of delivery are irrelevant variables to ROP (P > 0.005).

Conclusion: there is a relatively high incidence of ROP in these area which needs more investigations. low birth weight, prematurity, NICU admission, oxygen therapy duration, IVF fertilization, surfactant administration therapy were independent ROP determinants.

Keywords: Retinopathy of prematurity, Screening, Risk factor


 

Title:

The underlying systemic conditions in uveitis: A study on  cases referred to khatam-Al_anbia eye hospital  (2011- 2014)

Supervisors:

Dr. Naser Shoeibi

Dr. S. Maryam Hosseini

Advisers:

Dr. Majid Abrishami

Dr. Mir naghi Moosavi

Dr.Tooka Banaee

By:

Raheleh Ebrahimi

Abstract

Background: uveitis encompasses a large group of inflammatory diseases. The prevalence varies according to geographic regions, age, gender and systemic factors (For example Behcet's disease is more common in the East and Mediterranean region).This study addresses the associated systemic diseases in uveitis patients.

Methods: in this cross-sectional study 235 patients with uveitis who had been referred to the uveitis clinic in Khatam-Al-Anbia eye Hospital affiliated to Mashhad University of Medical Sciences, classified and analyzed with  respect to age, gender, anatomical location, etiologic and clinical features and  treatment modalities.

Result: At the onest of uveitis, the mean patient age was 35.73 year, and female to male ratio was 1.5/1. In this study the most common anatomic was pan-uveitis (48.9%) followed by anterior uveitis (34.0%), intermediate uveitis (12.8%) and posterior uveitis (4.3%) in descending order. According to this study, both eyes had been involved in 150 cases(63.8%), and in 85 cases(36.2%), patients had unilateral involvement. the left eye was more affected than right eye. 28.5% of patients had no identified etiologies. The most common associated systemic disease were Behcet disease, Vogt-Koyanagi-Harada (VKH), and tuberculosis respectively.

The most common etiology was idiopathic and then Behcet in anterior uveitis, idiopathic in intermediate, toxoplasmosis and serpiginous in posterior uveitis, Behcet and VKH in panuveitis.

Overall noninfectios cases (81.7%) were more frequent etiology of uveitis as compaired to infectios cases (18.3%). Noninfectious uveitis was 85% in anterior uveitis, 79.13 % in panuveitis, 90% in intermediate uveitis, 60% in posterior uveitis.

In final treatment Prednisolone, Methotrexate, Azathioprine were more used than primary treatment, because they are more safe  than other drugs,  have less cost and less systemic complications.

Conclusion: Uveitis clinical pattern is different according to geographic location and study center . The most common associated diseases were Behcet's disease, VKH, herpes simplex, FHI.

Key words: Epidemiology, Etiology, Systemic disease, Uveitis.

 

 

 

Title:

Efficacy of intravitreal bevacizumab monotherapy in retinopathy of prematurity, Khatam al-Anbia eye hospital (2011-14)

Supervisors:

Dr. Naser Shoeibi

Dr. S. Maryam Hosseini

 

Advisers:

Dr. Majid Abrishami

Dr. Mir naghi Moosavi

Dr. Tooka Banaee

By:

Zahra Bakhshi Golestani

February 2016                                        Thesis No: 7249

Abstract:

Background: Retinopathy of prematurity ( ROP) is a disorder of  the developing retina of low birth weight preterm infants that potentially leads to blindness in a small but significant percentage of those infants. Recently there has been interest in off-label use of anti vascular endothelial growth factor agents for ROP. This study aims to evaluate the efficacy of intravitreal bevacizumab monotherapy in retinopathy of prematurity.

Method: the single center retrospective , non comparative case series study included all infants who consecutively underwent intravitreal injection of bevacizumab as monotherapy for stage 3 (plus) of ROP in Khatam-al-Anbia Eye Hospital at Mashhad University of Medical Science. Medical records of 89 infants from October 2011 throughout March 2015 were reviewed. We recorded demographic data and ocular findings at the beginning and follow up visits. Recorded data were analyzed using SPSS software version 20.

Results: This study includes 157 eyes of 89 infants and 168 injection of which 86 (51.2%) had zone 1 disease and 82 (48.8%) had zone 2 disease. 11 eyes (7%) received second injection. Mean Birth weight and gestational age were 1154±265 gr and 28.6±1.5 w respectively. Mean time of Plus disease resolution and start of vascularization was 17.6±22.5 and 44.4±44.4 day after injection respectively. Mean post menstrual age of last follow up was 66.7±14.2 w. No patient showed ocular or short term systemic side effects.

Conclusion: Bevacizumab monotherapy is an effective and safe treatment modality in patients with stage 3 retinopathy of prematurity.

Keywords: bevacizumab, retinopathy of prematurity, efficacy