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Biomedical subjects

Majid Moshirfar

Publications and source records attributed to Majid Moshirfar.

At least 19 recordsLinked to original sources
PubMed2007

Occurrence and prognosis of nonpenetrating injuries in eyes with Verisyse iris-supported phakic intraocular lens.

We report 8 cases of blunt trauma in patients with a Verisyse phakic intraocular lens (pIOL) (AMO). Two cases resulted in dislocation of the pIOL that required repositioning; the other 6 were managed conservatively. In all cases, the outcomes were satisfactory, with no further complications. The cases represent scenarios that patients and physicians might encounter postoperatively and describe ways to manage the complication.

Adult↗
PubMed2006

Endophthalmitis after uncomplicated cataract surgery with the use of fourth-generation fluoroquinolones: a retrospective observational case series.

OBJECTIVE: 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. DESIGN: Retrospective, multicenter, observational case series. PARTICIPANTS: Included in this study were 20,013 patients from 9 cataract surgery centers in 7 states in the United States. METHODS: 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. MAIN OUTCOME MEASURES: Number and rate of endophthalmitis cases after uncomplicated cataract surgery. RESULTS: 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. CONCLUSIONS: 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.

Adult↗
PubMed2006

Fourth-generation fluoroquinolone-resistant bacterial keratitis after refractive surgery.

We report the first 2 cases of bacterial keratitis resistant to fourth-generation fluoroquinolones after laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK). The first patient had Pseudomonas aeruginosa keratitis after PRK despite treatment with moxifloxacin. The second patient was on gatifloxacin post-LASIK when she had methicillin-resistant Staphylococcus aureus (MRSA) keratitis diagnosed. In both cases, culture susceptibilities showed isolates resistant to moxifloxacin and gatifloxacin, and treatment with topical aminoglycosides and surgical intervention was necessary to effect a cure. These cases show the potential limitations in the coverage of these antibiotics.

Adult↗
PubMed2006

Use of Verisyse iris-supported phakic intraocular lens for myopia in keratoconic patients.

We report 2 patients with stable keratoconus and high myopia who benefited from implantation of an iris-supported phakic intraocular lens (Verisyse, AMO) for correction of their refractive error. Both patients had a postoperative uncorrected visual acuity of 20/40. Endothelial cell density showed at most a 4% decrease, and no evidence of keratoconus progression was witnessed. The use of the Verisyse lens may be beneficial for certain keratoconic patients as an alternative step between rigid gas-permeable lenses and penetrating keratoplasty.

Corneal Topography↗
PubMed2006

Toxic anterior segment syndrome after Verisyse iris-supported phakic intraocular lens implantation.

We report a case of toxic anterior segment syndrome (TASS) after implantation of a Verisyse (AMO) iris-supported phakic intraocular lens (IOL). The patient presented the day after surgery with significant decreased visual acuity and severe, persistent, limbus-to-limbus corneal edema. After treatment with topical steroids, oral steroids, nonsteroidal antiinflammatory agents, and hypertonic solution, the edema resolved over the course of 2 months and best corrected visual acuity improved to 20/20. Toxic anterior segment syndrome has been reported after implantation of IOLs previously, but this new case of TASS should alert surgeons to the possibility of the syndrome after phakic IOL placement.

Adult↗
PubMed2006

Implantation of verisyse phakic intraocular lens to correct myopic refractive error after penetrating keratoplasty in pseudophakic eyes.

PURPOSE: We report 2 cases in which a Verisyse phakic intraocular lens (PIOL) was used to successfully treat high myopia after penetrating keratoplasty (PK) in pseudophakic patients. METHODS: Case 1 involved a 69-year-old pseudophakic man with a manifest refraction (MR) of -6.50 + 1.75 x 048 and a best spectacle corrected visual acuity (BSCVA) of 20/40 approximately 16 months after PK in the right eye. Case 2 was a 78-year-old pseudophakic man who had an MR of -9.00 + 5.75 x 132 with a BSCVA of 20/100 approximately 24 months after PK in the left eye. RESULTS: In case 1, 10 months after Verisyse PIOL implantation, the MR was pl +2.00 x 135 with a BSCVA of 20/30. Endothelial cell density (ECD) in this patient decreased from 1926.1 to 815.3 cells/mm over 17 months. In case 2, 24 months after Verisyse PIOL implantation, the MR was -3.25 + 3.50 x 105 with a BSCVA of 20/60. ECD in this patient decreased from 2108.4 to 753.8 cells/mm in 30 months. CONCLUSION: The Verisyse PIOL may provide an alternative method to correct high myopia for anisometropia in pseudophakic patients after PK. In this report, PIOL implantation was associated with a decrease in ECD. Further studies are required to determine the long-term effects and ultimate safety of PIOL placement on the integrity of the cornea endothelium after corneal transplant in pseudophakic patients.

Aged↗
PubMed2005

A retrospective study of endophtalmitis rates comparing quinolone antibiotics.

PURPOSE: To compare endophthalmitis rates between topical quinolone antibiotics over a four-year period in a university setting. DESIGN: Retrospective, cross-sectional (prevalence) study. METHODS STUDY POPULATION: Nine thousand seventy-nine patients who underwent a phacoemulsification procedure at a University Eye Center. INTERVENTIONS: The following interventions were conducted: use of a nosocomial infectious reporting database retrospective analysis of prospectively collected data to establish endophthalmitis rates; prevalence analysis of postoperative quinolone antibiotics; analysis of endophthalmitis rate vs postoperative quinolone prescribed. MAIN OUTCOME MEASURES: Occurrence of endophthalmitis after cataract surgery. RESULTS: During a four-year period involving 9079 phacoemulsification procedures, 26 cases of bacterial postoperative endophthalmitis were reported (rate = 0.286%). Eight of the 26 cases were considered complicated; 18 cases were uncomplicated. Among cases performed during this period, postoperative prescription volumes for ciprofloxacin (Ciloxan, Alcon Laboratories, Inc., Fortworth, Texas) and ofloxacin (Ocuflox, Allergan, Inc., Irvine, California) antibiotic drops were nearly identical, with 4538 patients receiving ciprofloxacin (49.98%) and 4541 patients receiving ofloxacin (50.02%). There were 22 endophthalmitis patients (85%) who had used topical ciprofloxacin and 4 patients (15%) who had used topical ofloxacin postoperatively. The difference in infectious rates between antibiotics was highly significant (P < .00026). For uncomplicated cases, 14 patients received ciprofloxacin and 4 patients received ofloxacin. This difference was also significant (P < .015). CONCLUSIONS: Differences in pharmacokinetic and pharmacodynamic properties exist among quinolone antibiotics, which may affect endophthalmitis incidence following cataract surgery.

Administration, Topical↗
PubMed2005

Laser in situ keratomileusis in patients with corneal guttata and family history of Fuchs' endothelial dystrophy.

PURPOSE: To report 1-year results of laser in situ keratomileusis (LASIK) in 7 eyes with corneal endothelial guttata and a family history of Fuchs' endothelial dystrophy. SETTING: John Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. METHODS: A retrospective chart review was performed of 4 patients (7 eyes) who had trace to 1+endothelial guttata and a family history of Fuchs dystrophy and then had uneventful LASIK for the correction of myopia and myopic astigmatism. Preoperative and postoperative measurements included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, endothelial cell density (ECD), manifest refraction, and spherical equivalent. The changes in ECD, pachymetry, and spherical equivalent after LASIK were subjected to statistical analysis using a paired Student t test to determine significance. RESULTS: Transient corneal edema was noted in the early postoperative period in 3 eyes of 2 patients. At 1 year, 6 of the 7 (86%) eyes had lost > or =2 lines of BSCVA. A statistically significant decrease in ECD of 12.4% +/- 2.7% was observed at 1 year compared with baseline (P < .001). An increase in corneal thickness (P = .006) and a statistically significant myopic shift in spherical equivalent (P = .017) was also noted at 1 year compared with 3 months. CONCLUSIONS: Patients with mild corneal guttata and a family history of Fuchs' dystrophy are prone to transient corneal edema, loss of BSCVA, endothelial cell loss, and myopic regression after uneventful LASIK for correction of myopia and myopic astigmatism.

Adult↗
PubMed2005

Results of late flap removal after complicated laser in situ keratomileusis.

PURPOSE: To evaluate the effect of flap removal on complications after laser in situ keratomileusis (LASIK). SETTING: Three university-based referral centers and 1 private practice. METHODS: This retrospective interventional case series comprised 6 eyes of 6 patients at 4 centers. Flap removal occurred 2 to 41 weeks after the LASIK procedure. The corneal flaps were excised by 2 methods: In 2 eyes, the flap was lifted and excised manually. In 4 eyes, the thin flap was removed by excimer ablation using phototherapeutic keratectomy and/or photorefractive keratectomy. Postoperative measurements included uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, slitlamp evaluation, and computerized videokeratography. All patients had an 8-month or longer convalescence to assess visual recovery. RESULTS: After the initial flap complication, the BSCVA decreased in all 6 eyes (mean loss 3.0 lines +/- 1.5 [SD]). After flap removal, it improved in all eyes (mean gain 2.2 +/- 1.2 lines). All patients reported a reduction in or elimination of visual symptoms. Despite the improvements, a minor loss of BSCVA (mean -0.8 lines [range 0 to 2 lines]) remained in 4 patients. CONCLUSION: In carefully selected patients, flap removal is a viable surgical option to improve visual function.

Adult↗
PubMed2005

Salzmann's-like nodular degeneration following laser in situ keratomileusis.

We report the development of bilateral Salzmann's-like corneal lesions located at the site of laser in situ keratomileusis (LASIK) flap margins in 2 patients. These lesions resulted in ocular surface irritation as well as induction of irregular astigmatism and associated loss of best corrected visual acuity. Both patients had bilateral LASIK before the occurrence of the corneal lesions. A biopsy was performed on 1 nodule. The epithelium overlying this raised bluish-white corneal lesion appeared irregular in thickness, with replacement of Bowman's layer by periodic acid-Schiff positive thickened basement membrane-like material. Underlying this basement membrane was a layer of relatively regular, hypocellular, collagenlike connective tissue, which demonstrated hyalinization on trichrome staining. Based on these 2 cases, it seems possible that the hyposecretion of tears, decreased blink rate, and Dellen effect that often occur following LASIK could produce the corneal irritation needed to induce Salzmann's nodular degeneration.

Adult↗
PubMed2005

Nomogram-based intraocular lens power adjustment after myopic photorefractive keratectomy and LASIK: a new approach.

PURPOSE: (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. DESIGN: Multicenter, retrospective, interventional, noncomparative case series. SUBJECTS: Fourteen patients (19 eyes) after myopic LASIK or PRK with visually significant cataracts. INTERVENTION: 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. MAIN OUTCOME MEASURES: (1) Final refraction and spherical equivalent after cataract surgery and (2) deviation of the final spherical equivalent from the refractive target. RESULTS: 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. CONCLUSIONS: (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.

Adult↗
PubMed2005

Laser in situ keratomileusis in patients with posterior polymorphous dystrophy.

PURPOSE: To report short-term results of LASIK in 4 eyes with the vesicular form of posterior polymorphous dystrophy (PPMD). METHOD: A review was performed of 2 patients with PPMD who underwent bilateral LASIK. Patients were asymptomatic at the time of presentation and had no prior ocular history. Preoperative measurements were made of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal pachymetry, and endothelial cell density (ECD). All 4 eyes underwent uneventful LASIK. Postoperative measurements of UCVA and BSCVA were performed at follow-up visits 1 day, 1 month, 3 months, and 1 year after surgery, along with pachymetry and ECD measurements at the 3-month and 1-year visits. Results were analyzed. RESULTS: At 1 year, all eyes had an UCVA equal to or better than 20/25 and BSCVA equal to or better than 20/20. There was a small mean endothelial cell loss (2.3%) at 1 year. No adverse events were experienced. CONCLUSIONS: Short-term results indicate efficacy and safety of LASIK on eyes with posterior polymorphous dystrophy. Further study is needed to assess long-term outcomes in a larger study population.

Adult↗
PubMed2005

The effect of the fourth-generation fluoroquinolones on corneal reepithelialization after penetrating keratoplasty.

PURPOSE: To compare the effects of topical moxifloxacin and gatifloxacin on corneal reepithelialization after penetrating keratoplasty. METHODS: In this single-center, open-label, prospective study, 46 consecutive patients requiring penetrating keratoplasty were alternately assigned to receive either postoperative moxifloxacin 0.5% ophthalmic solution (n = 23; Vigamox) or gatifloxacin 0.3% ophthalmic solution (n = 23; Zymar). The primary outcome measure was the area of the epithelial defect measured by slit-lamp evaluation during the postoperative period. RESULTS: The mean area of the epithelial defect was similar in both treatment groups at baseline (P = 0.104), but it was significantly larger in the moxifloxacin group than in the gatifloxacin group at day 4 (23.9 mm2 versus 10.6 mm2, respectively; P < .001) and day 7 (3.8 mm2 versus 0.85 mm2, respectively; P = 0.03). At every follow-up visit after day 4, there were more eyes with complete reepithelialization of the corneal graft in the gatifloxacin group than in the moxifloxacin group (statistically significant at days 7 and 14). CONCLUSIONS: The results of this preliminary study suggest that the postoperative use of gatifloxacin in corneal transplant patients may allow the early stages of corneal graft reepithelialization to proceed more quickly than does treatment with moxifloxacin. These findings suggest that a larger, masked, randomized clinical study in a more homogeneous patient population is warranted to further investigate the relative effects of moxifloxacin and gatifloxacin on postoperative corneal wound healing.

Adolescent↗
PubMed2004

Implantation of an Artisan phakic intraocular lens for the correction of high myopia after penetrating keratoplasty.

We report 2 cases in which an Artisan phakic intraocular lens (IOL) (Ophtec) was used to successfully treat high myopia after penetrating keratoplasty (PKP). The first case was a 43-year-old man who had a manifest refraction of -13.75 +3.00 x 50 with a best corrected visual acuity (BCVA) of 20/40(-2) after PKP in the left eye. Approximately 9 months after implantation of the Artisan IOL, the manifest refraction was -2.00 +2.50 x 60 with a BCVA of 20/30(+2). The second case was a 31-year-old man who had a manifest refraction of -10.75 +2.25 x 122 and a BCVA of 20/40 after corneal transplantation in the right eye. Ten months after implantation of the Artisan IOL, the manifest refraction was -2.75 +4.75 x 80 with a BCVA of 20/40. Endothelial cell density did not change significantly in either patient after surgery. The Artisan phakic IOL may provide an alternative method to correct high myopia after PKP.

Adult↗
PubMed2003

Effect of flap hinge placement on post-laser in situ keratomileusis wound healing in the presence of superior corneal vascularization.

We report a case that demonstrates a difference in wound healing after laser in situ keratomileusis using microkeratomes with both superior and nasal hinges in a patient with bilateral superior corneal vascularization. Subsequently, the patient experienced lamellar keratitis, epithelial defects, and peripheral thinning in both eyes. These postoperative conditions were more extensive and required more time to resolve in the eye with a nasal hinge flap. Creating a superiorly hinged flap decreases the likelihood of transecting extensive corneal pannus and may reduce the degree of postoperative complications.

Adult↗
PubMedDate not supplied

Traumatic dislocation of an Ophtec Artisan phakic intraocular lens.

PURPOSE: To report a case of a traumatic dislocation of an Ophtec Artisan phakic anterior chamber intraocular lens. METHODS: Retrospective case review. RESULTS: A 38-year-old female underwent successful implantation of an Ophtec Artisan lens in her left eye as part of the phase III U.S. clinical trials. Approximately 5 months postoperatively, the patient was struck with a roll of packing tape in her left eye and noted immediate decreased vision. Following the blunt trauma, the patient had an uncorrected visual acuity (UCVA) of 20/60 and a best spectacle-corrected visual acuity (BSCVA) of 20/20. The wound was intact, however, the superior claw was no longer enclaved to the iris and the lens had dislocated nasally with the optic of the lens resting in the angle. The patient was taken back to the operating room, the lens was repositioned, and the superior claw was re-enclaved to the iris. One week after repositioning, UCVA was 20/30 and BSCVA was 20/20. CONCLUSION: Despite adequate positioning, significant trauma may result in the iris claw tearing free from the iris with dislocation of the Artisan lens. The lens may be repositioned with good visual outcome, however, the long-term effects on endothelial cell density in this patient remain to be seen.

Adult↗