Darius M. Moshfeghi, MD

All Publications

• Chronic Vascular Arrest as a Predictor of Bevacizumab Treatment Failure in Retinopathy of Prematurity. Ophthalmology Toy, B. C., Schachar, I. H., Tan, G. S., Moshfeghi, D. M. 2016; 123 (10): 2166-2175

  Abstract

  To describe a pattern of retinopathy of prematurity (ROP) disease regression and chronic vascular arrest after intravitreal bevacizumab treatment that is not observed after peripheral laser ablation.Single-institution retrospective cohort study.Consecutive sample of 58 eyes in 30 patients treated for type 1 ROP.Initial treatment with either a single intravitreal injection of bevacizumab in off-label use (n = 33 eyes) or peripheral laser ablation (n = 25 eyes) as part of standard clinical care. There was bias in recommending off-label bevacizumab for smaller infants with type 1 ROP.Reactivation or persistence of ROP, as determined by clinical examination, fundus photography, and fluorescein angiography.All eyes treated initially with bevacizumab demonstrated irregular progression of the leading vascular edge in a stereotyped pattern, suggestive of scalloped regression. Recurrence, based on angiographic demonstration of leakage, or chronic vascular arrest, confirmed based on angiographic demonstration of peripheral ischemia, was noted in 30 eyes (91%) in the bevacizumab group, at a median interval of 14.9 weeks after injection (corrected gestational age, 49.3 weeks). Univariate logistic regression indicated that the need for rescue treatment was associated with decreased birth weight (odds ratio [OR], -0.007; P = 0.04) and age of initial treatment (OR, -0.35; P = 0.05), but not gender, race, or gestational age. Multivariate logistic regression indicated that only decreased birth weight (OR, -0.018; P = 0.04) was associated with need for rescue treatment.Treating ROP with intravitreal bevacizumab results in a characteristic scalloped regression pattern that is highly associated with treatment using biologic anti-vascular endothelial growth factor agents. The presence of this pattern in conjunction with chronic vascular arrest and peripheral retinal ischemia persisting beyond standard screening timelines has significant implications for the management of ROP. Fluorescein angiography is important in assessing vascular maturation in these infants.

  View details for DOI 10.1016/j.ophtha.2016.06.055

  View details for PubMedID 27506484

• Expanded Spectrum of Congenital Ocular Findings in Microcephaly with Presumed Zika Infection OPHTHALMOLOGY de Miranda, H. A., Costa, M. C., Monteiro Frazao, M. A., Simao, N., Franchischini, S., Moshfeghi, D. M. 2016; 123 (8): 1788-1794

  Abstract

  To describe the ocular findings of 3 cases of suspected congenital Zika viral infection with microcephaly and maculopathy.Retrospective, consecutive case series.Three male infants born in northern Brazil whose mothers demonstrated a viral syndrome during the first trimester and who subsequently were born with microcephaly.Observational report of macular findings.Continued observation.Three male infants were born with microcephaly to mothers who had a viral syndrome during the first trimester of gestation in an area that subsequently has demonstrated epidemic Zika infection, a flavivirus related to Dengue. Ocular examination was performed. All 6 eyes demonstrated a pigmentary maculopathy ranging from mild to pronounced. In 4 eyes, well-delineated macular chorioretinal atrophy with a hyperpigmented ring developed. Three eyes demonstrated vascular tortuosity and 2 eyes demonstrated a pronounced early termination of the retinal vasculature on photographic evaluation. Two eyes demonstrated a washed out peripheral retina with a hypolucent spot. One eye had scattered subretinal hemorrhages external to the macula. Finally, 1 eye demonstrated peripheral pigmentary changes and clustered atrophic lesions resembling grouped congenital albinotic spots (polar bear tracks).Zika virus has been linked to microcephaly in children of mothers with a viral syndrome during the first trimester of pregnancy. Ocular findings previously described a pigmentary retinopathy and atrophy that now can be expanded to include torpedo maculopathy, vascular changes, and hemorrhagic retinopathy. Ophthalmologic screening guidelines need to be defined to determine which children would benefit from newborn screening in affected regions.

  View details for DOI 10.1016/j.ophtha.2016.05.001

  View details for Web of Science ID 000380754200038

  View details for PubMedID 27236271

• Retinal and Optic Nerve Hemorrhages in the Newborn Infant OPHTHALMOLOGY Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

  Abstract

  To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

  View details for DOI 10.1016/j.ophtha.2016.01.004

  View details for Web of Science ID 000375942300026

• 16 and 24 Gy low-voltage X-ray irradiation with ranibizumab therapy for neovascular age-related macular degeneration: 12-month outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

  Abstract

  To describe the 12-month safety and efficacy outcomes of 16 or 24 Gy radiation using low-voltage x-ray irradiation in conjunction with intravitreal ranibizumab for neovascular age-related macular degeneration (AMD).Prospective, phase I, open-label, nonrandomized uncontrolled safety study.setting: Institutional. study population: Neovascular AMD patients. intervention: One x-ray irradiation treatment at 16 or 24 Gy was administered externally through 3 locations in the inferior pars plana. After 2 initial monthly loading doses of ranibizumab, subsequent ranibizumab was administered according to predetermined criteria. main outcome measures: Visual acuity, number of ranibizumab injections, safety and efficacy metrics at 12 months.Forty-seven eyes of 47 patients were enrolled and completed 12 months of follow-up: 16 Gy (n = 28) and 24 Gy (n = 19). There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean visual acuity improved in both groups: +8.4 ± 11.9 letters and +7.8 ± 12 letters for 16 and 24 Gy, respectively. In both groups, 100% of subjects lost <15 letters, with 76% and 79% gaining ≥0 letters in the 16 Gy and 24 Gy groups, respectively. Patients received a mean of 1.0 additional injection over 12 months. The mean change in optical coherence tomography central subfield thickness from baseline to month 12 was -107 and -87 μm for the 16 Gy and 24 Gy groups, respectively.One treatment of 16 or 24 Gy low-voltage x-ray therapy with as-needed ranibizumab appears safe in subjects with neovascular AMD at 12 months. An overall improvement in visual acuity was observed. No radiation-related adverse effects were reported.

  View details for DOI 10.1016/j.ajo.2013.01.015

  View details for PubMedID 23497847

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine CURRENT EYE RESEARCH Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2013; 38 (2): 283-291

  Abstract

  To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP).A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes.The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome.The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.

  View details for DOI 10.3109/02713683.2012.754902

  View details for Web of Science ID 000314900400008

  View details for PubMedID 23330739

• What colour are newborns' eyes? Prevalence of iris colour in the Newborn Eye Screening Test (NEST) study. Acta ophthalmologica Ludwig, C. A., Callaway, N. F., Fredrick, D. R., Blumenkranz, M. S., Moshfeghi, D. M. 2016; 94 (5): 485-488

  Abstract

  This study aims to assess the birth prevalence of iris colour among newborns in a prospective, healthy, full-term newborn cohort.The Newborn Eye Screening Test (NEST) study is a prospective cohort study conducted at Lucile Packard Children's Hospital at Stanford University School of Medicine. A paediatric vitreoretinal specialist (DMM) reviewed images sent to the Byers Eye Institute telemedicine reading centre and recorded eye colour for every infant screened. Variables were graphed to assess for normality, and frequencies per subject were reported for eye colour, sex, ethnicity and race.Among 192 subjects screened in the first year of the NEST study with external images of appropriate quality for visualization of the irides, the birth prevalence of iris colour was 63.0% brown, 20.8% blue, 5.7% green/hazel, 9.9% indeterminate and 0.5% partial heterochromia. The study population was derived from a quaternary care children's hospital. We report the birth prevalence of iris colour among full-term newborns in a diverse prospective cohort.The study demonstrates a broad range of iris colour prevalence at birth with a predominance of brown iris coloration. Future studies with the NEST cohort will assess the change in iris colour over time and whether the frequencies of eye colour change as the child ages.

  View details for DOI 10.1111/aos.13006

  View details for PubMedID 27061128

• Evaluation of Visunex Medical's PanoCam(TM) LT and PanoCam(TM) Pro wide-field imaging systems for the screening of ROP in newborn infants. Expert review of medical devices Wood, E. H., Moshfeghi, A. A., Nudleman, E. D., Moshfeghi, D. M. 2016; 13 (8): 705-712

  Abstract

  Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness. The incidence of ROP is rising, placing greater demands on the healthcare providers that serve these patients and their families. Telemedicine remote digital fundus imaging (TM-RDFI) plays a pivotal role in ROP management, and has allowed for the expansion of ROP care into previously underserved areas.A broad literature review through the pubmed index was undertaken with the goal of summarizing the current state of ROP and guidelines for its screening . Furthermore, all currently used telemedicine remote digital fundus imaging devices were analyzed both via the literature and the companies' websites/brochures. Finally, the PanoCam LT™ and PanoCam™ Pro created by Visunex Medical were analyzed via the company website/brochures. Expert commentary: The PanoCam LT™ and PanoCam™ Pro have recently been approved for use within the USA and CE marked for international commercialization in European Union and other countries requiring CE mark. These wide-field imaging systems have the intended use of ophthalmic imaging of all newborn babies and meet the requirements for ROP screening, thereby serving as competition within the ROP screening market previously dominated by one camera imaging system.

  View details for DOI 10.1080/17434440.2016.1208560

  View details for PubMedID 27424884

• High-resolution contrast-enhanced optical coherence tomography in mice retinae. Journal of biomedical optics Sen, D., SoRelle, E. D., Liba, O., Dalal, R., Paulus, Y. M., Kim, T., Moshfeghi, D. M., de la Zerda, A. 2016; 21 (6): 66002-?

  View details for DOI 10.1117/1.JBO.21.6.066002

  View details for PubMedID 27264492

  View details for PubMedCentralID PMC4893203

• Visual acuity measured with a smartphone app is more accurate than Snellen testing by emergency department providers GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Pathipati, A. S., Wood, E. H., Lam, C. K., Sales, C. S., Moshfeghi, D. M. 2016; 254 (6): 1175-1180

  Abstract

  To assess the accuracy of best-corrected visual acuity (BCVA) measured by non-ophthalmic emergency department (ED) staff with a standard Snellen chart versus an automated application (app) on a handheld smartphone (Paxos Checkup, San Francisco, CA, USA).The study included 128 subjects who presented to the Stanford Hospital ED for whom the ED requested an ophthalmology consultation. We conducted the study in two phases. During phase 1 of the study, ED staff tested patient BCVA using a standard Snellen test at 20 feet. During phase 2 of the study, ED staff tested patient near BCVA using the app. During both phases, ophthalmologists measured BCVA with a Rosenbaum near chart, which was treated as the gold standard. ED BCVA measurements were benchmarked prospectively against ophthalmologists' measurements and converted to logMAR.ED logMAR BCVA was 0.21 ± 0.35 (approximately 2 Snellen lines difference ± 3 Snellen lines) higher than that of ophthalmologists when ED staff used a Snellen chart (p = .0.00003). ED BCVA was 0.06 ± 0.40 (less than 1 Snellen line ± 4 Snellen lines) higher when ED staff used the app (p = 0.246). Inter-observer difference was therefore smaller by more than 1 line (0.15 logMAR) with the app (p = 0.046).BCVA measured by non-ophthalmic ED staff with an app was more accurate than with a Snellen chart. Automated apps may provide a means to standardize and improve the efficiency of ED ophthalmologic care.

  View details for DOI 10.1007/s00417-016-3291-4

  View details for Web of Science ID 000377022400019

  View details for PubMedID 26931323

• Retinal and Optic Nerve Hemorrhages in the Newborn Infant: One-Year Results of the Newborn Eye Screen Test Study. Ophthalmology Callaway, N. F., Ludwig, C. A., Blumenkranz, M. S., Jones, J. M., Fredrick, D. R., Moshfeghi, D. M. 2016; 123 (5): 1043-1052

  Abstract

  To report the birth prevalence, risk factors, characteristics, and location of fundus hemorrhages (FHs) of the retina and optic nerve present in newborns at birth.Prospective cohort study at Stanford University School of Medicine.All infants who were 37 weeks postmenstrual age or older and stable were eligible for screening. Infants with known or suspected infectious conjunctivitis were excluded.Infants born at Lucile Packard Children's Hospital (LPCH) from July 25, 2013, through July 25, 2014, were offered universal newborn screening via wide-angle digital retinal photography in the Newborn Eye Screen Test study. Maternal, obstetric, and neonatal factors were obtained from hospital records. The location, retinal layer, and laterality of FH were recorded by 1 pediatric vitreoretinal specialist.Birth prevalence of FH. Secondary outcomes included rate of adverse events, risk factors for FH, hemorrhage characteristics, and adverse events.The birth prevalence of FH in this study was 20.3% (41/202 infants). Ninety-five percent of FHs involved the periphery, 83% involved the macula, and 71% involved multiple layers of the retina. The fovea was involved in 15% of FH cases (birth prevalence, 3.0%). No cases of bilateral foveal hemorrhage were found. Fundus hemorrhages were more common in the left eye than the right. Fundus hemorrhages were most commonly optic nerve flame hemorrhages (48%) and white-centered retinal hemorrhages (30%). Retinal hemorrhages were found most frequently in all 4 quadrants (35%) and more often were multiple than solitary. Macular hemorrhages most often were intraretinal (40%). Among the risk factors examined in this study, vaginal delivery compared with cesarean section (odds ratio [OR], 9.34; 95% confidence interval [CI], 2.57-33.97) showed the greatest level of association with FH. Self-identified ethnicity as Hispanic or Latino showed a protective effect (OR, 0.43; 95% CI, 0.20-0.94). Other study factors were not significant.Fundus hemorrhages are common among newborns. They often involve multiple areas and layers of the retina. Vaginal delivery was associated with a significantly increased risk of FH, whereas self-identified Hispanic or Latino ethnicity was protective against FH in this study. The long-term consequences of FH on visual development remain unknown.

  View details for DOI 10.1016/j.ophtha.2016.01.004

  View details for PubMedID 26875004

• Mining Retrospective Data for Virtual Prospective Drug Repurposing: L-DOPA and Age-related Macular Degeneration AMERICAN JOURNAL OF MEDICINE Brilliant, M. H., Vaziri, K., Connor, T. B., Schwartz, S. G., Carroll, J. J., McCarty, C. A., Schrodi, S. J., Hebbring, S. J., Kishor, K. S., Flynn, H. W., Moshfeghi, A. A., Moshfeghi, D. M., Fini, M. E., McKay, B. S. 2016; 129 (3): 292-298

  Abstract

  Age-related macular degeneration (AMD) is a leading cause of visual loss among the elderly. A key cell type involved in AMD, the retinal pigment epithelium, expresses a G protein-coupled receptor that, in response to its ligand, L-DOPA, up-regulates pigment epithelia-derived factor, while down-regulating vascular endothelial growth factor. In this study we investigated the potential relationship between L-DOPA and AMD.We used retrospective analysis to compare the incidence of AMD between patients taking vs not taking L-DOPA. We analyzed 2 separate cohorts of patients with extensive medical records from the Marshfield Clinic (approximately 17,000 and approximately 20,000) and the Truven MarketScan outpatient and databases (approximately 87 million) patients. We used International Classification of Diseases, 9th Revision codes to identify AMD diagnoses and L-DOPA prescriptions to determine the relative risk of developing AMD and age of onset with or without an L-DOPA prescription.In the retrospective analysis of patients without an L-DOPA prescription, AMD age of onset was 71.2, 71.3, and 71.3 in 3 independent retrospective cohorts. Age-related macular degeneration occurred significantly later in patients with an L-DOPA prescription, 79.4 in all cohorts. The odds ratio of developing AMD was also significantly negatively correlated by L-DOPA (odds ratio 0.78; confidence interval, 0.76-0.80; P <.001). Similar results were observed for neovascular AMD (P <.001).Exogenous L-DOPA was protective against AMD. L-DOPA is normally produced in pigmented tissues, such as the retinal pigment epithelium, as a byproduct of melanin synthesis by tyrosinase. GPR143 is the only known L-DOPA receptor; it is therefore plausible that GPR143 may be a fruitful target to combat this devastating disease.

  View details for DOI 10.1016/j.amjmed.2015.10.015

  View details for Web of Science ID 000369947300023

  View details for PubMedID 26524704

• Effect of Fluid Status at Week 12 on Visual and Anatomic Outcomes at Week 52 in the VIEW 1 and 2 Trials OPHTHALMIC SURGERY LASERS & IMAGING RETINA Moshfeghi, D. M., Hariprasad, S. M., Marx, J. L., Thompson, D., Soo, Y., Gibson, A., Saroj, N., Vitti, R., Heier, J. S. 2016; 47 (3): 238-244

  Abstract

  To evaluate effect of retinal fluid status at week 12 on visual and anatomic outcomes at week 52 in patients with neovascular age-related macular degeneration from the VIEW studies.Post-hoc analysis included 1,465 eyes treated with intravitreal aflibercept (Eylea; Regeneron, Tarrytown, NY) 2 mg every 4 weeks (2q4) or every 8 weeks following three initial monthly injections (2q8) or ranibizumab (Lucentis; Genentech, South San Francisco, CA) 0.5 mg every 4 weeks (Rq4), which had known retinal fluid status at weeks 12 and 52.At 12 weeks, 512 (35%) eyes had fluid and 953 (65%) were fluid-free. Two hundred three (41.5%), 148 (29.8%), and 161 (33.5%) eyes had fluid in Rq4, 2q4, and 2q8, respectively. Best-corrected visual acuity (BCVA) change at week 52 from baseline was independent of retinal fluid status at week 12 or treatment assignment. Eyes were more likely to remain fluid-free at week 52 if absent of fluid at week 12.At week 52, 2q4, 2q8, and Rq4 improved BCVA independent of fluid status at week 12.

  View details for DOI 10.3928/23258160-20160229-06

  View details for Web of Science ID 000378844900007

  View details for PubMedID 26985797

• AFLIBERCEPT FOR THE TREATMENT OF RETINAL PIGMENT EPITHELIAL DETACHMENTS. Retina (Philadelphia, Pa.) He, L., Silva, R. A., Moshfeghi, D. M., Blumenkranz, M. S., Leng, T. 2016; 36 (3): 492-498

  Abstract

  To compare anatomical and visual acuity outcomes of eyes with persistent pigment epithelial detachments (PEDs) secondary to exudative age-related macular degeneration despite ranibizumab or bevacizumab treatment.After institutional review board approval, 40 eyes with PEDs switched from ranibizumab or bevacizumab to intravitreal aflibercept were compared for logMAR visual acuity, central subfield thickness on spectral domain optical coherence tomography, and PED height. Using paired t-tests, these parameters at baseline, after 3 consecutive injections, and 1 year after the switch were compared.Baseline visions of 20/61 ± 3.99 lines declined after 3 injections with aflibercept by 0.39 ± 2.43 lines (P = 0.32) and continued to fall after 1 year by 1.27 ± 3.48 lines (P = 0.03). Central subfield thickness was reduced after 3 injections (9.1 ± 52.0 μm, P = 0.27) and after 1 year (24.4 ± 55.3 μm, P = 0.01). The height of PEDs decreased by 31.7 ± 71.53 μm (P = 0.008) after 3 injections and by 47.81 ± 77.94 μm (P < 0.001) after 1 year.Switching to aflibercept from ranibizumab or bevacizumab resulted in a reduction in the height of PED and central subfield thickness, but a trend toward worse visual acuity 1 year after the switch.

  View details for DOI 10.1097/IAE.0000000000000749

  View details for PubMedID 26398694

• Intraocular Nematode Affixed to Posterior Lens Capsule. Ophthalmic surgery, lasers & imaging retina Karth, P. A., Swinney, C. C., Moshfeghi, D. M., Yannuzzi, L. A., Pang, C. E., Leng, T. 2015; 46 (10): 1066-1067

  Abstract

  The clinical presentation of an intraocular nematode unusually affixed to the posterior lens capsule is described. A 64-year-old female patient presented with a 7-year history of gradually declining vision and enlarging central scotoma, but no inflammation. On follow-up 2 years later, vision had further declined and a non-motile, 8-mm nematode was seen affixed to the posterior lens capsule that remained unchanged through final follow-up. The patient disclosed having resided in Africa as a child. Systemic review revealed no evidence of extraocular involvement. Nematode carcasses may remain preserved in the human eye for extended periods without ongoing inflammation.

  View details for DOI 10.3928/23258160-20151027-16

  View details for PubMedID 26599254

• Short-Term Outcomes of Aflibercept Therapy for Diabetic Macular Edema in Patients With Incomplete Response to Ranibizumab and/or Bevacizumab. Ophthalmic surgery, lasers & imaging retina Wood, E. H., Karth, P. A., Moshfeghi, D. M., Leng, T. 2015; 46 (9): 950-954

  Abstract

  Aflibercept is a vascular endothelial growth factor (VEGF) inhibitor recently approved by the U.S. Food and Drug Administration for the treatment of diabetic macular edema (DME). Currently, the effect of switching to aflibercept from other anti-VEGF agents for DME is unknown.In this prospective, interventional case series, DME patients with persistent retinal fluid despite regular (every 4 to 6 weeks) intravitreal injection (IVI) with ranibizumab 0.3 mg, and/or bevacizumab 1.25 mg were switched to IVI aflibercept 2 mg. Collected data included visual acuity, central subfield foveal thickness (CSFT), and the area of thickest edema on registered spectral-domain optical coherence tomography (SD-OCT).At 1 month after the first aflibercept IVI, 79% (11 of 14 eyes) showed anatomic improvement with a 23% decrease in average CSFT from 421 µm to 325 µm (P < .0132).A majority of patients with DME with persistent fluid on SD-OCT despite regular ranibizumab 0.3 mg and/or bevacizumab 1.25 mg IVIs showed a positive anatomic response to IVI aflibercept 2 mg. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:950-954.].

  View details for DOI 10.3928/23258160-20151008-08

  View details for PubMedID 26469235

• Reply: To PMID 25486541. American journal of ophthalmology Pershing, S., Vaziri, K., Albini, T. A., Moshfeghi, D. M., Moshfeghi, A. A. 2015; 160 (2): 392-?

  View details for DOI 10.1016/j.ajo.2015.04.037

  View details for PubMedID 26187878

• Barriers to Follow-Up and Strategies to Improve Adherence to Appointments for Care of Chronic Eye Diseases. Investigative ophthalmology & visual science Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., Singh, K. 2015; 56 (8): 4324-4331

  Abstract

  To understand factors associated with poor attendance of follow-up appointments for care of glaucoma (GL), AMD, and diabetic retinopathy (DR) in a tertiary referral center, and to identify strategies to improve adherence.Cross-sectional study of 240 adults attending follow-up appointments for GL, AMD, or DR. Cases (N = 102) were patients with poor follow-up who missed and failed to reschedule an appointment within 1 month of the recommended follow-up date during the preceding year. Controls (N = 138) were patients who completed the assigned follow-up. Data regarding the factors impacting adherence to appointments were collected via an orally administered questionnaire. Multivariate logistic regression was performed to determine factors associated with poor follow-up.In a multivariate logistic regression model, independent factors significantly associated with poor follow-up included incorrectly answering more than 50% of questions about eye disease (adjusted odds ratio [OR] = 3.24, P = 0.001), legal blindness (adjusted OR 2.64, P = 0.013), the presence of glaucomatous versus retinal disease (adjusted OR 2.06, P = 0.013), and difficulty for the study subject and/or escort taking time away from work for the appointments (adjusted OR 1.80, P = 0.049). Subjects identified the following strategies to improve follow-up: contact with others having the same eye condition (41.3%), greater education regarding eye disease (40.8%), and improved transportation services to the clinic (44.6%).Low disease knowledge scores, legal blindness, and difficulty getting time away from work for appointments adversely impacted follow-up independent of eye disease diagnosis. Improvements in patient education, transportation services, and clinic efficiency may increase adherence to recommended appointment intervals.

  View details for DOI 10.1167/iovs.15-16444

  View details for PubMedID 26176869

• Peripheral Avascular Retina in a Term Male Neonate With Microvillus Inclusion Disease and Pancreatic Insufficiency OPHTHALMIC SURGERY LASERS & IMAGING RETINA Paulus, Y. M., Alcorn, D. M., Gaynon, M., Moshfeghi, D. M. 2015; 46 (5): 589-591

  Abstract

  The authors present the first case of peripheral avascular retina in a term male neonate with pancreatic exocrine insufficiency, atypical microvillus inclusion disease, flat tympanograms, and recurrent urinary tract infections. Clinical examination showed avascular peripheral retina to posterior zone II temporally, with a flat stage 1-like demarcation line, and no plus disease. Genetic testing results were normal. The patient developed peripheral neovascularization and underwent panretinal photocoagulation. This case likely represents mild Norrie disease, familial exudative vitreoretinopathy, or incontinentia pigmenti due to a Wnt signaling abnormality. While these conditions are usually more severe, a variable spectrum of Wnt abnormalities exists throughout the body.

  View details for DOI 10.3928/23258160-20150521-14

  View details for Web of Science ID 000359292500014

  View details for PubMedID 26057766

• Experience With Aflibercept for the Treatment of Neovascular Age-Related Macular Degeneration. Ophthalmic surgery, lasers & imaging retina He, L., Silva, R. A., Ayoub, N., Moshfeghi, D. M., Leng, T. 2015; 46 (5): 542-549

  Abstract

  Describe visual and anatomic outcomes of eyes with exudative age- related macular degeneration (AMD) after treatment with aflibercept.Eyes treated with intravitreal injections of aflibercept for exudative AMD were retrospectively reviewed to compare visual acuity and central subfield thickness (CST) on optical coherence tomography.A total of 142 eyes receiving aflibercept were previously treated with bevacizumab or ranibizumab intravitreal injections. Baseline vision was 20/73 ± 5.18 lines when switched to aflibercept. It improved by 0.2 ± 1.91 lines (P =.14) after three injections but decreased by 0.45 ± 2.9 lines (P = .06) after 1 year of follow-up. The reduction in CST was 9.9 ± 46.5 µm (P = .06) after three injections and grew to 19.3 ± 50.6 µm (P = .002), a statistically significant amount, after 1 year.Switching to aflibercept resulted in no clinically significant differences in visual acuity after 1 year. There was a significant reduction in CST, but this may not be clinically significant.

  View details for DOI 10.3928/23258160-20150521-05

  View details for PubMedID 26057757

• Experience With Aflibercept for the Treatment of Neovascular Age-Related Macular Degeneration. Ophthalmic surgery, lasers & imaging retina He, L., Silva, R. A., Ayoub, N., Moshfeghi, D. M., Leng, T. 2015; 46 (5): 542-549

  View details for DOI 10.3928/23258160-20150521-05

  View details for PubMedID 26057757

• SUNDROP: six years of screening for retinopathy of prematurity with telemedicine. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Wang, S. K., Callaway, N. F., Wallenstein, M. B., Henderson, M. T., Leng, T., Moshfeghi, D. M. 2015; 50 (2): 101-106

  Abstract

  To report the 6-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) initiative in the context of telemedicine screening initiatives for retinopathy of prematurity (ROP).A retrospective analysis.Premature newborns requiring ROP screening at 6 neonatal intensive care units from December 1, 2005, to November 30, 2011.Infants were evaluated via remote retinal photography by an ROP specialist. A total of 608 preterm infants meeting ROP examination criteria were screened with the RetCam II/III (Clarity Medical Systems, Pleasanton, Calif.). Primary outcomes were treatment-warranted ROP (TW-ROP) and adverse anatomical events.During the 6 years, 1216 total eyes were screened during 2169 examinations, generating 26 970 retinal images, an average of 3.56 examinations and 44.28 images per patient. Twenty-two (3.6%) of the infants screened met criteria for TW-ROP. Compared with bedside binocular ophthalmoscopy, remote interpretation of RetCam II/III images had a sensitivity of 100%, specificity of 99.8%, positive predicative value of 95.5%, and negative predicative value of 100% for the detection of TW-ROP. No adverse anatomical outcomes were observed for any enrolled patient.The 6-year results for the SUNDROP telemedicine initiative were highly favourable with respect to diagnostic accuracy. Telemedicine appears to be a safe, reliable, and cost-effective complement to the efforts of ROP specialists, capable of increasing patient access to screening and focusing the resources of the current ophthalmic community on infants with potentially vision-threatening disease.

  View details for DOI 10.1016/j.jcjo.2014.11.005

  View details for PubMedID 25863848

• Multimodal Imaging of Posterior Dislocation of Crystalline Lens Nucleus following Vitrectomy. Journal of ophthalmic & vision research Karth, P. A., Swinney, C. C., Montague, A. A., Moshfeghi, D. M. 2015; 10 (2): 197-199

  View details for DOI 10.4103/2008-322X.163785

  View details for PubMedID 26425326

• Feasibility of Telemedicine in Detecting Diabetic Retinopathy and Age-Related Macular Degeneration SEMINARS IN OPHTHALMOLOGY Vaziri, K., Moshfeghi, D. M., Moshfeghi, A. A. 2015; 30 (2): 81-95

  Abstract

  Age-related macular degeneration and diabetic retinopathy are important causes of visual impairment and blindness in the world. Because of recent advances and newly available treatment modalities along with the devastating consequences associated with late stages of these diseases, much attention has been paid to the importance of early detection and improving patient access to specialist care. Telemedicine or, more specifically, digital retinal imaging utilizing telemedical technology has been proposed as an important alternative screening and management strategy to help meet this demand. In this paper, we perform a literature review and analysis that evaluates the validity and feasibility of telemedicine in detecting diabetic retinopathy and age-related macular degeneration. Understanding both the progress and barriers to progress that have been demonstrated in these two areas is important for future telemedicine research projects and innovations in telemedicine technology.

  View details for DOI 10.3109/08820538.2013.825727

  View details for Web of Science ID 000350451500001

  View details for PubMedID 24171781

• Ambulatory surgery center utilization by vitreoretinal surgeons: 1999-2011. Ophthalmic surgery, lasers & imaging retina Vaziri, K., Moshfeghi, D. M., Hernandez-Boussard, T., Callaway, N. F., Moshfeghi, A. A. 2015; 46 (3): 355-361

  View details for DOI 10.3928/23258160-20150323-10

  View details for PubMedID 25856823

• Author reply: To PMID 24393349. Ophthalmology Bakri, S. J., Moshfeghi, D. M., Francom, S., Rundle, A. C., Reshef, D. S., Lee, P. P., Schaeffer, C., Rubio, R. G., Lai, P. 2015; 122 (3)

  View details for DOI 10.1016/j.ophtha.2014.08.010

  View details for PubMedID 25703472

• Ambulatory surgery center utilization by vitreoretinal surgeons: 1999-2011. Ophthalmic surgery, lasers & imaging retina Vaziri, K., Moshfeghi, D. M., Hernandez-Boussard, T., Callaway, N. F., Moshfeghi, A. A. 2015; 46 (3): 355-361

  Abstract

  To evaluate the utilization rates of ambulatory surgery centers (ASCs) in the state of Florida for vitreoretinal, cataract, and glaucoma surgical procedures over a 13-year period from 1999 through 2011.Retrospective analysis utilizing the State Ambulatory Surgery Databases (SASD) for Florida from 1999 through 2011. ICD-9 codes for vitreoretinal, cataract, and glaucoma procedures were queried. Joinpoint regression was used to calculate average annual percent change (APC) in ASC utilization by these procedures over the 13-year study period and also separately for the years 2007 to 2011.From 1999 through 2011, APC in ambulatory surgery center utilization was +26.4% (P = .0039) for vitreoretinal, +21.3% (P = .012) for cataract, and +20.9% (P = .0063) for glaucoma surgery. The APC from 2007 through 2011 was -1.2% for vitreoretinal (P = .47), -9.2% for cataract (P = .0039), and -17.3% for glaucoma surgery (P = .008).A significant overall increase in ASC utilization by vitreoretinal, cataract, and glaucoma surgeons over the study period was seen; however, the most recent 5-year data show that these trends may have begun to reverse. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:355-361.].

  View details for DOI 10.3928/23258160-20150323-10

  View details for PubMedID 25856823

• Risk factors predictive of endogenous endophthalmitis among hospitalized patients with hematogenous infections in the united states. American journal of ophthalmology Vaziri, K., Pershing, S., Albini, T. A., Moshfeghi, D. M., Moshfeghi, A. A. 2015; 159 (3): 498-504

  Abstract

  To identify potential risk factors associated with endogenous endophthalmitis among hospitalized patients with hematogenous infections.Retrospective cross-sectional study.MarketScan Commercial Claims and Encounters, and Medicare Supplemental and Coordination of Benefit inpatient databases from the years 2007-2011 were obtained. Utilizing ICD-9 codes, logistic regression was used to identify potential predictors/comorbidities for developing endophthalmitis in patients with hematogenous infections.Among inpatients with hematogenous infections, the overall incidence rate of presumed endogenous endophthalmitis was 0.05%-0.4% among patients with fungemia and 0.04% among patients with bacteremia. Comorbid human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) (OR = 4.27; CI, 1.55-11.8; P = .005), tuberculosis (OR = 8.5; CI, 1.2-61.5; P = .03), endocarditis (OR = 8.3; CI, 4.9-13.9; P < .0001), bacterial meningitis (OR = 3.8; CI, 1.2-12.0; P = .023), fungal meningitis (OR = 59.1; CI, 14.1-247.8; P < .0001), internal organ abscess (OR = 2.9; CI, 1.2-6.4; P = .02), lymphoma/leukemia (OR = 2.9; CI, 1.6-5.3; P < .0001), skin abscess/cellulitis (OR = 1.75; CI, 1.1-2.8; P = .02), pyogenic arthritis (OR = 4.2; CI, 1.8-9.6; P = .001), diabetes with ophthalmic manifestations (OR = 7.0; CI, 1.7-28.3; P = .006), and urinary tract infection (OR = 0.04; CI, 0.3-0.9; P = .023) were each significantly associated with a diagnosis of endogenous endophthalmitis. Patients aged 0-17 years (OR = 2.61; CI, 1.2-5.7; P = .02), 45-54 years (OR = 3.4; CI, 2.0-5.4; P < .0001), and 55-64 years (OR = 2.9; CI, 1.8-4.8; P < .0001); those having length of stay of 3-10 days (OR = 1.9; CI, 1.1-3.3; P = .01), 11-30 days (OR = 3.1; CI, 1.8-5.5; P < .0001), and 31+ days (OR = 5.3; CI, 2.7-10.4; P < .0001); and those with intensive care unit/neonatal intensive care unit (ICU/NICU) admissions (OR = 1.5; CI, 1.4-1.6; P < .0001) were all more likely to be diagnosed with endogenous endophthalmitis.Endogenous endophthalmitis is rare among hospitalized patients in the United States. Among patients with hematogenous infections, odds of endogenous endophthalmitis were higher for children and middle-aged patients, and for patients with endocarditis, bacterial meningitis, lymphoma/leukemia, HIV/AIDS, internal organ abscess, diabetes with ophthalmic manifestations, skin cellulitis/abscess, pyogenic arthritis, tuberculosis, longer hospital stays, and/or ICU/NICU admission.

  View details for DOI 10.1016/j.ajo.2014.11.032

  View details for PubMedID 25486541

• STEREOTACTIC RADIOTHERAPY FOR WET AGE-RELATED MACULAR DEGENERATION (INTREPID) Influence of Baseline Characteristics on Clinical Response RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Jackson, T. L., Shusterman, E. M., Arnoldussen, M., Chell, E., Wang, K., Moshfeghi, D. M. 2015; 35 (2): 194-204

  Abstract

  To determine which patients respond best to stereotactic radiotherapy (SRT) for neovascular age-related macular degeneration.Participants (n = 230) receiving intravitreal anti-vascular endothelial growth factor injections for neovascular age-related macular degeneration enrolled in a randomized, double-masked sham-controlled trial comparing 16 Gray, 24 Gray, or Sham SRT. In a post hoc analysis, participants were grouped according to their baseline characteristics, to determine if these influenced SRT efficacy.At 52 weeks, SRT was most effective for lesions ≤4 mm in greatest linear dimension and with a macular volume greater than the median value of 7.4 mm. For 26% of the participants with both these characteristics, SRT resulted in 55% fewer ranibizumab injections (2.08 vs. 4.60; P = 0.0002), a mean visual acuity change that was 5.33 letters superior to sham (+2.18 vs. -3.15 letters; P = 0.0284), and a 71.1-μm greater reduction in mean central subfield thickness (-122.6 vs. -51.5 μm; P = 0.027). Other features associated with a positive response to SRT included pigment epithelial detachment and the absence of fibrosis.Stereotactic radiotherapy is most effective for neovascular age-related macular degeneration lesions that are actively leaking at the time of treatment, and no larger than the 4-mm treatment zone.

  View details for Web of Science ID 000348764200006

  View details for PubMedID 25102198

• Stereotactic Radiotherapy for Neovascular Age-Related Macular Degeneration OPHTHALMOLOGY Jackson, T. L., Chakravarthy, U., Slakter, J. S., Muldrew, A., Shusterman, E. M., O'Shaughnessy, D., Arnoldussen, M., Gertner, M. E., Danielson, L., Moshfeghi, D. M. 2015; 122 (1): 138-145

  View details for DOI 10.1016/j.ophtha.2014.07.043

  View details for Web of Science ID 000346737000030

• Stereotactic radiotherapy for neovascular age-related macular degeneration: year 2 results of the INTREPID study. Ophthalmology Jackson, T. L., Chakravarthy, U., Slakter, J. S., Muldrew, A., Shusterman, E. M., O'Shaughnessy, D., Arnoldussen, M., Gertner, M. E., Danielson, L., Moshfeghi, D. M. 2015; 122 (1): 138-145

  Abstract

  To determine the safety and efficacy of low-voltage, external-beam, stereotactic radiotherapy (SRT) for patients with neovascular age-related macular degeneration (AMD).Randomized, double-masked, sham-controlled, multicenter, clinical trial.A total of 230 participants with neovascular AMD who received ≥ 3 ranibizumab or bevacizumab injections within the preceding year and requiring treatment at enrollment.Participants received 16 Gray, 24 Gray, or sham SRT. All arms received pro re nata (PRN) ranibizumab for 12 months, with PRN bevacizumab or ranibizumab thereafter.Mean number of PRN injections; best-corrected visual acuity (BCVA); loss of <15 Early Treatment of Diabetic Retinopathy Study letters; change in optical coherence tomography central subfield thickness; and change in angiographic total lesion area and choroidal neovascularization (CNV) area.At year 2, the 16 and 24 Gray arms received fewer PRN treatments compared with sham (mean 4.5, P = 0.008; mean 5.4, P = 0.09; and mean 6.6, respectively). Change in mean BCVA was -10.0, -7.5, and -6.7 letters for the 16 Gray, 24 Gray, and sham arms, respectively, with 46 (68%), 51 (75%), and 58 participants (79%), respectively, losing <15 letters. Mean central subfield thickness decreased by 67.0 μm, 55.4 μm, and 33.3 μm, respectively. Mean total active lesion area increased by 1.0, 4.2, and 2.7 mm(2), respectively. Mean CNV area decreased by 0.1 mm(2) in all groups. An independent reading center detected microvascular abnormalities in 6 control eyes and 29 SRT eyes, of which 18 were attributed to radiation; however, only 2 of these possibly affected vision. An exploratory subgroup analysis found that lesions with a greatest linear dimension ≤ 4 mm (the size of the treatment zone) and a macular volume greater than the median (7.4 mm(3)) were more responsive to SRT, with 3.9 PRN injections versus 7.1 in comparable sham-treated participants (P = 0.001) and mean BCVA 4.4 letters superior to sham (P = 0.24).A single dose of SRT significantly reduces intravitreal injections over 2 years. Radiation can induce microvascular change, but in only 1% of eyes does this possibly affect vision. The best response occurs when AMD lesions fit within the treatment zone and they are actively leaking.

  View details for DOI 10.1016/j.ophtha.2014.07.043

  View details for PubMedID 25208859

• Incidence of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries in the United States. Clinical ophthalmology (Auckland, N.Z.) Vaziri, K., Schwartz, S. G., Kishor, K. S., Fortun, J. A., Moshfeghi, D. M., Moshfeghi, A. A., Flynn, H. W. 2015; 9: 579-584

  Abstract

  To report the 3-month incidence rates of postoperative suprachoroidal hemorrhage after glaucoma filtration surgeries and to examine the subsequent surgical treatments in these eyes.This is a retrospective study using the nationally pooled, insurance claim-based MarketScan databases from the years 2007-2011. Patients with records of trabeculectomy and/or tube shunt procedures were identified, and all cases of "definite" (ie, properly coded) and "suspected" (possibly miscoded) postoperative suprachoroidal hemorrhage occurring within 3 months of their glaucoma filtration procedures were captured along with the surgical interventions used for this condition. Kaplan-Meier survival analysis was used to evaluate the 3-month incidence rates of suprachoroidal hemorrhage, and regression analysis was applied to calculate the odds ratios, confidence intervals, and P-values.There were 17,843 trabeculectomies and 9,597 tube shunt surgeries identified. Among these, there were 107 cases (247 including "suspected" cases) of postoperative suprachoroidal hemorrhage within 3 months of trabeculectomy and 113 cases (255 including "suspected" cases) within 3 months of tube shunt procedures. The 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage ranged from 0.6%±0.06% to 1.4%±0.09% after trabeculectomy and 1.2%±0.11% to 2.7%±0.16% after tube shunt surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries than after trabeculectomies for both "definite" and "definite" plus "suspected" cases (odds ratio, 1.98; 95% confidence interval, 1.51-2.58; P<0.001; and odds ratio, 1.95; 95% confidence interval, 1.63-2.32; P<0.001, respectively). Among the 502 "definite" and "suspected" cases of postoperative suprachoroidal hemorrhage, 32.9% (165 cases) had a treatment record of choroidal tap and 8.8% (44 cases) had a treatment record of pars plana vitrectomy.In this sample, the 3-month cumulative incidence rate of postoperative suprachoroidal hemorrhage was 0.6%-1.4% after trabeculectomy and 1.2%-2.7% after tube shunt procedures, and the majority of the cases appeared to be managed without further surgery. Postoperative suprachoroidal hemorrhage was almost twice as likely to occur after tube shunt surgeries as after trabeculectomies.

  View details for DOI 10.2147/OPTH.S78359

  View details for PubMedID 25897196

• Incidence of bleb-associated endophthalmitis in the United States. Clinical ophthalmology (Auckland, N.Z.) Vaziri, K., Kishor, K., Schwartz, S. G., Maharaj, A. S., Moshfeghi, D. M., Moshfeghi, A. A., Flynn, H. W. 2015; 9: 317-322

  Abstract

  To evaluate the 5-year incidence rate of blebitis and bleb-associated endophthalmitis in the United States.In this retrospective cross-sectional study, we utilized a large commercial health insurance claim-based database during 2007-2011 and identified all patients who had a record of trabeculectomy in 2007. These patients were followed until the end of 2011. During the follow-up period, all incidences of blebitis, confirmed bleb-associated endophthalmitis, and presumed bleb-associated endophthalmitis were recorded. Kaplan-Meier survival analysis was utilized to calculate 5-year cumulative incidence rates of blebitis and bleb-associated endophthalmitis following trabeculectomy procedures.Among the 1,461 trabeculectomies included in our analysis, eight cases of blebitis, five cases of confirmed bleb-associated endophthalmitis, and eight cases of presumed bleb-associated endophthalmitis were identified. We found that the 5-year cumulative incidence of blebitis was 0.55%±0.19%. The 5-year cumulative incidence of bleb-associated endophthalmitis was 0.45%±0.2% when only confirmed cases were included and 1.3%±0.34% when presumed cases were also added to the analysis. The mean time from procedure to diagnosis was 45 months for blebitis and 33 months for bleb-associated endophthalmitis.Blebitis and bleb-related endophthalmitis are uncommon in the United States. The 5-year cumulative incidence was 0.55% for blebitis and 0.45%-1.3% for bleb-associated endophthalmitis.

  View details for DOI 10.2147/OPTH.S75286

  View details for PubMedID 25709395

• Reply. Retina (Philadelphia, Pa.) Moshfeghi, D. M., Silva, R. A., Berrocal, A. M. 2014; 34 (11)

  View details for DOI 10.1097/IAE.0000000000000352

  View details for PubMedID 25333627

• Spectral-domain optical coherence tomography of emulsified subretinal silicone oil presenting as a macular inverted pseudohypopyon. Ophthalmic surgery, lasers & imaging retina Karth, P. A., Moshfeghi, D. M. 2014; 45 (5): 437-439

  Abstract

  The authors present a rare case of an inverted pseudohypopyon due to subretinal emulsified silicone oil in the macula of a patient who underwent pars plana vitrectomy surgery for repair of retinal detachment with proliferative vitreoretinopathy 1 year prior to presentation of this finding. The patient’s predisposing diagnosis is pathologic myopia.

  View details for PubMedID 25215873

• Perivascular Exudates in Frosted Branch Angiitis OPHTHALMIC SURGERY LASERS & IMAGING RETINA He, L., Moshfeghi, D. M., Wong, I. G. 2014; 45 (5): 443-446

  View details for DOI 10.3928/23258160-20140908-04

  View details for Web of Science ID 000347297300013

  View details for PubMedID 25215872

• Prefoveal Vitreous Condensation in Chronic Inflammation OPHTHALMIC SURGERY LASERS & IMAGING RETINA Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

  View details for DOI 10.3928/23258160-20140806-03

  View details for Web of Science ID 000347297300014

  View details for PubMedID 25153658

• Perivascular exudates in frosted branch angiitis. Ophthalmic surgery, lasers & imaging retina He, L., Moshfeghi, D. M., Wong, I. G. 2014; 45 (5): 443-446

  Abstract

  Three cases of young, minimally symptomatic patients found to have vitritis and extensive perivenous vitreous exudates resembling frosted branch angiitis are presented. Optical coherence tomography showed that these exudates appear to be extravascated from the vasculature. The material persisted over 1 year on immunosuppressive therapy, suggesting that its resolution should not be a treatment end point. These cases add to our understanding of the spectrum of clinical findings in frosted branch angiitis.

  View details for PubMedID 25215872

• Prefoveal vitreous condensation in chronic inflammation. Ophthalmic surgery, lasers & imaging retina Paulus, Y. M., Wong, I. G., Sanislo, S., Moshfeghi, D. M. 2014; 45 (5): 447-450

  Abstract

  Uveitis can produce a host of signs throughout the eye. Cylinders, snowballs, condensations, and snowbanks in the vitreous have been described. The authors report two cases of chronic ocular inflammation with a novel sign of a prefoveal white vitreous condensation. One patient is a 6-year-old child with intermediate uveitis and positive results for PPD, and the second is a 65-year-old woman with bilateral recurrent intraocular lymphoma. Both cases responded well to vitrectomy and treatment of the inflammation.

  View details for DOI 10.3928/23258160-20140806-03

  View details for PubMedID 25153658

• Reply. Retina (Philadelphia, Pa.) Moshfeghi, D. M., Silva, R. A., Berrocal, A. M. 2014; 34 (8): e23-4

  View details for DOI 10.1097/IAE.0000000000000305

  View details for PubMedID 25054346

• Gender differences in compensation in academic medicine: the results from four neurological specialties within the University of California Healthcare System SCIENTOMETRICS Henderson, M. T., Fijalkowski, N., Wang, S. K., Maltenfort, M., Zheng, L. L., Ratliff, J., Moshfeghi, A. A., Moshfeghi, D. M. 2014; 100 (1): 297-306

  View details for DOI 10.1007/s11192-014-1266-y

  View details for Web of Science ID 000337171300017

• Clinical-pathologic correlation: vitrectomy with epiretinal and internal limiting membrane peel. Ophthalmic surgery, lasers & imaging retina Demarchis, E. H., Pershing, S., Moshfeghi, D. M. 2014; 45 (3): 218-221

  Abstract

  To correlate clinical and pathologic findings in vitreoretinal surgeries with epiretinal membrane (ERM) and internal limiting membrane (ILM) peels.A retrospective review of the clinical and pathologic reports for 698 vitrectomy specimens involving ERM and/or ILM peels from 2008 to 2012.Labeling with clear operative clinical diagnoses - ERM, ILM or both - was available for 520 of 698 cases; 492 cases had a corresponding pathology result. Combined ERM-ILM specimens were the dominant clinical and pathologic diagnosis. Over 43% had differing operative and pathologic diagnoses, with 79.6% of cases labeled as ERMs, 75.0% of cases labeled as ILMs, and 22.1% cases labeled as ERM-ILM demonstrating incongruous specimens on pathology.It can be difficult to determine the nature of membranes pre- or intraoperatively. Combined ERM-ILM specimens may be more common than previously recognized, implying that the two membranes are not always distinct and surgically separable. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:218-221.].

  View details for DOI 10.3928/23258160-20140411-01

  View details for PubMedID 24766198

• Multiple myeloma recurrence with optic nerve infiltration diagnosed by vitrectomy, immunohistochemistry, and in situ hybridization. European journal of ophthalmology Nugent, A. K., Paulus, Y. M., Chan, A., Kim, J. W., Schwartz, E. J., Moshfeghi, D. M. 2014; 24 (3): 446-448

  Abstract

  We present a case of multiple myeloma recurrence diagnosed by optic nerve infiltration.Interventional case report with clinical, surgical, immunohistochemical, and fluorescence in situ hybridization correlation.A 51-year-old woman with a history of bilateral invasive ductal breast carcinoma and multiple myeloma, both in remission on maintenance bortezomib, was referred for sudden, painless loss of vision OS. Examination demonstrated anterior vitritis with severe optic disc elevation, with yellow-white thickening, peripapillary hemorrhages, and a retinal detachment inferiorly. Diagnostic vitrectomy showed CD138-positive and BRST2-negative cells. Fluorescence in situ hybridization was positive for del(13q) and p53 deletion and negative for CCND1/IGH.This is the first report of optic nerve infiltration of multiple myeloma as evidence of recurrence while on maintenance chemotherapy. We demonstrate that diagnostic vitrectomy and immunohistochemistry of vitreous fluid is feasible for the diagnosis of recurrent multiple myeloma.

  View details for DOI 10.5301/ejo.5000392

  View details for PubMedID 24242215

• Multiple myeloma recurrence with optic nerve infiltration diagnosed by vitrectomy, immunohistochemistry, and in situ hybridization EUROPEAN JOURNAL OF OPHTHALMOLOGY Nugent, A. K., Paulus, Y. M., Chan, A., Kim, J. W., Schwartz, E. J., Moshfeghi, D. M. 2014; 24 (3): 446-448

  View details for DOI 10.5301/ejo.5000392

  View details for Web of Science ID 000337652600025

• Intraocular Pressure in Eyes Receiving Monthly Ranibizumab in 2 Pivotal Age-Related Macular Degeneration Clinical Trials OPHTHALMOLOGY Bakri, S. J., Moshfeghi, D. M., Francom, S., Rundle, A. C., Reshef, D. S., Lee, P. P., Schaeffer, C., Rubio, R. G., Lai, P. 2014; 121 (5): 1102-1108

  Abstract

  To characterize preinjection intraocular pressure (IOP) in eyes receiving monthly ranibizumab versus sham or verteporfin photodynamic therapy (PDT) for age-related macular degeneration (AMD).Post hoc analysis of IOP data from 2 phase 3 clinical trials, the Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD (MARINA) and the Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD (ANCHOR) trial.All safety-evaluable patients who received 1 or more injections of sham or PDT or of ranibizumab and had 1 or more postbaseline IOP measurements recorded for the study eye.Preinjection IOP measurements for study eyes (n = 1125) and fellow eyes in MARINA and ANCHOR at baseline and at each monthly visit through month 24 were analyzed.End points evaluated were maximum preinjection IOP during the 24-month treatment period; any occurrence of absolute preinjection IOP of 21 mmHg or more, 25 mmHg or more, or 30 mmHg or more; any occurrence of IOP increase of 6 mmHg or more, 8 mmHg or more, or 10 mmHg or more from baseline; any combination of IOP increase of 6 mmHg or more or 8 mmHg or more from baseline with concurrent absolute preinjection IOP of 21 mmHg or more or 25 mmHg or more; glaucoma-related adverse events; new glaucoma medications used for 45 days or more; and glaucoma filtration or laser surgeries.Across treatment groups, 60.1% to 70.9% of study eyes had a maximum preinjection IOP of less than 21 mmHg. Comparing ranibizumab 0.5 mg versus sham or PTD treatment, respectively: 39.9% versus 29.1% and 10.9% versus 5.1% had maximum preinjection IOPs of 21 mmHg or more or 25 mmHg or more, respectively; 44.1% versus 29.9% and 24.2% versus 13.6% had IOP increases from baseline of 6 mmHg or more or 8 mmHg or more, respectively; 26.1% versus 13.6% and 16.8% versus 9.0% had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, respectively, with a concurrent IOP of 21 mmHg or more; 9.6% versus 3.7% and 7.5% versus 2.4% had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, respectively, with a concurrent IOP of 25 mmHg or more. No differences were observed in fellow eyes.Most ranibizumab-treated eyes did not experience sustained preinjection IOP of 21 mmHg or more (>2 consecutive visits) over 24 months. When evaluating the combined IOP end point, more ranibizumab-treated eyes had 1 or more IOP increase from baseline of 6 mmHg or more or 8 mmHg or more, with concurrent highest IOPs of 21 mmHg or more and 25 mmHg or more versus sham or PDT. Intraocular pressure should be monitored in eyes receiving ranibizumab.

  View details for DOI 10.1016/j.ophtha.2013.11.029

  View details for Web of Science ID 000335504200024

  View details for PubMedID 24393349

• Clinical-Pathologic Correlation: Vitrectomy With Epiretinal and Internal Limiting Membrane Peel OPHTHALMIC SURGERY LASERS & IMAGING RETINA Demarchis, E. H., Pershing, S., Moshfeghi, D. M. 2014; 45 (3): 218-221

  View details for DOI 10.3928/23258160-20140411-01

  View details for Web of Science ID 000338322300006

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): five years of screening with telemedicine. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wang, S. K., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2014; 45 (2): 106-113

  Abstract

  To report the 5-year results of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Infants requiring retinopathy of prematurity (ROP) screening at six neonatal intensive care units from December 1, 2005, to November 30, 2010, were evaluated with remote retinal photography by an ROP specialist. Every infant received outpatient binocular indirect ophthalmoscope examinations until termination criteria were achieved or until treatment. Outcomes were treatment-warranted ROP (TW-ROP, ETROP type 1) and adverse anatomical events.Five hundred eleven infants (1,022 eyes) were screened. Fifteen infants had TW-ROP and underwent laser photocoagulation. The TW-ROP cohort had significantly lower birth weight and gestational age (both P < .001). No patient progressed to adverse anatomical outcomes and no case of TW-ROP was missed. Tele-medicine had 100% sensitivity, 99.8% specificity, 93.8% positive predictive value, and 100% negative predictive value for detection of TW-ROP.Telemedicine demonstrates high diagnostic accuracy for detection of TW-ROP and can complement ROP screening. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:106-113.].

  View details for DOI 10.3928/23258160-20140122-01

  View details for PubMedID 24444469

• RETINAL VASCULAR ABNORMALITIES IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Jackson, T. L., Danis, R. P., Goldbaum, M., Slakter, J. S., Shusterman, E. M., O'shaughnessy, D. J., Moshfeghi, D. M. 2014; 34 (3): 568-575

  Abstract

  To determine the prevalence of retinal vascular abnormalities (RVA) in neovascular age-related macular degeneration (AMD).A post hoc subanalysis of images acquired during a Phase III randomized controlled trial was undertaken, selecting images from participants with untreated, neovascular AMD in at least one eye. Protocol mandated fundus photographs and fluorescein angiograms were acquired at baseline and Year 2, from 107 sham-treated study eyes with neovascular AMD and 107 untreated fellow eyes. Images were reanalyzed by an independent reading center for the presence of RVA, defined as at least one of the following: microaneurysms, vessel staining or leakage, dilated or tortuous vessels, intraretinal hemorrhage, vessel sheathing or narrowing, capillary nonperfusion, or capillary infarcts.The baseline prevalence of RVA in the sham-treated study eyes was 14.4% (15 of 104 gradable images) versus 8.3% (5 of 60) in the fellow eyes with dry AMD. The baseline prevalence of individual RVAs in study eyes was: microaneurysms (6.7%), vessel staining or leakage (6.7%), dilated or tortuous vessels (4.8%), intraretinal hemorrhage (4.8%), vessel sheathing or narrowing (2.9%), capillary nonperfusion (0%), and capillary infarcts (0%). Results were similar at 24 months.Compared with several studies that relied solely on fundus photographs, this study included fluorescein angiography and found a higher prevalence of RVAs occurring in eyes with neovascular AMD.

  View details for Web of Science ID 000336960100024

  View details for PubMedID 24045343

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Five Years of Screening With Telemedicine. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Zheng, L. L., Henderson, M. T., Wang, S. K., Wallenstein, M. B., Leng, T., Moshfeghi, D. M. 2014; 45 (2): 106-113

  View details for DOI 10.3928/23258160-20140122-01

  View details for PubMedID 24444469

• Active aspiration of suprachoroidal hemorrhage using a guarded needle. Ophthalmic surgery, lasers & imaging retina Mandelcorn, E. D., Kitchens, J. W., Fijalkowski, N., Moshfeghi, D. M. 2014; 45 (2): 150-152

  Abstract

  To describe a novel technique using a guarded needle to drain suprachoroidal hemorrhage.A guarded needle is used to drain suprachoroidal hemorrhage under direct microscope visualization. A scleral buckling sleeve is used to create a guarded 26-gauge needle to avoid over-penetration of the needle beyond the suprachoroidal space. Active extrusion can be used to drain suprachoroidal blood.The authors report two cases in which active aspiration using a guarded needle was successful in draining suprachoroidal hemorrhage without complications. In both cases, the vitreous cavity could be restored, allowing for subsequent pars plana vitrectomy.The technique of active aspiration using a guarded needle optimizes surgeon control of suprachoroidal hemorrhage drainage and also has the added benefit of easy transition to secondary vitrectomy after drainage has been completed. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:150-152.].

  View details for DOI 10.3928/23258160-20140306-09

  View details for PubMedID 24635157

• Exudative retinal detachment following photocoagulation in older premature infants for retinopathy of prematurity: description and management. Retina (Philadelphia, Pa.) Moshfeghi, D. M., Silva, R. A., Berrocal, A. M. 2014; 34 (1): 83-86

  Abstract

  To describe exudative retinal detachment following laser photocoagulation after 40 weeks of postmenstrual age (PMA) for retinopathy of prematurity in premature infants, its medical management, and outcomes.Two pediatric vitreoretinal surgeons at 2 different quaternary care institutions retrospectively identified children who received laser photocoagulation after 40 weeks of PMA and subsequently developed exudative detachment. Hospital course, management, and outcomes were identified.Three infants were identified that developed exudative retinal detachments following laser photocoagulation for retinopathy of prematurity after 40 weeks of PMA. The average gestational age was 25 weeks with an average birth weight of 650 g. All babies were Zone II at initial examination and developed Stage 3 with pre-plus or plus disease after 40 weeks of PMA (average 42 weeks of PMA). Therapy consisted of topical cyclogyl (0.5%) and topical prednisolone acetate (1%) to the affected eyes and intravenous dexamethasone in all cases. The exudative retinal detachments resolved by 50 weeks of PMA in all infants. Hard exudates following resolution were found in all eyes. Two eyes demonstrated temporal macular dragging.Premature infants who require laser photocoagulation for retinopathy of prematurity at >40 weeks of PMA may be predisposed to develop exudative retinal detachments. In the absence of identifiable traction, systemic corticosteroid use can be considered to achieve favorable anatomic outcomes.

  View details for DOI 10.1097/IAE.0b013e3182993d5f

  View details for PubMedID 23881225

• Retinal breaks due to intravitreal ocriplasmin. Clinical ophthalmology (Auckland, N.Z.) Silva, R. A., Moshfeghi, D. M., Leng, T. 2014; 8: 1591-1594

  Abstract

  Ocriplasmin represents a new treatment option for numerous vitreoretinopathies involving an abnormal vitreomacular interface. While the drug may circumvent the traditional risks of surgical treatment, pharmacologic vitreolysis is not devoid of risk itself. This report presents two cases, one of vitreomacular traction syndrome and the other of a full-thickness macular hole, both of which were treated with an intravitreal injection of ocriplasmin. Notably, in both cases, vitreomacular traction of the macula appears to have been alleviated; however, failure to completely relieve vitreoretinal traction from the peripheral retina generated retinal breaks with one patient eventually developing a macula-involving retinal detachment. Thus, even in instances of 'successful' pharmacologic treatment of vitreomacular traction, continued follow-up evaluation is essential.

  View details for DOI 10.2147/OPTH.S68037

  View details for PubMedID 25210426

• Stereotactic Radiotherapy for Neovascular Age-related Macular Degeneration 52-Week Safety and Efficacy Results of the INTREPID Study OPHTHALMOLOGY Jackson, T. L., Chakravarthy, U., Kaiser, P. K., Slakter, J. S., Jan, E., Bandello, F., O'Shaughnessy, D., Gertner, M. E., Danielson, L., Moshfeghi, D. M. 2013; 120 (9): 1893-1900

  Abstract

  PURPOSE: To determine the safety and efficacy of low-voltage, external-beam, stereotactic radiotherapy (SRT) for patients with neovascular age-related macular degeneration (nvAMD). DESIGN: Randomized, double-masked, sham-controlled, multicenter, clinical trial. PARTICIPANTS: Two hundred thirty patients with onset of nvAMD within 3 years who received 3 or more injections of ranibizumab or bevacizumab within the preceding year and who needed continuing ranibizumab or bevacizumab treatment. INTERVENTIONS: Participants were randomized 2:1:2:1 to 16 Gy plus pro re nata (PRN) ranibizumab, sham 16 Gy plus PRN ranibizumab, 24 Gy plus PRN ranibizumab, or sham 24 Gy plus PRN ranibizumab, respectively. MAIN OUTCOME MEASURES: The primary efficacy end point was the mean number of ranibizumab injections at 52 weeks. Secondary end points were change in mean best-corrected visual acuity (VA), loss of fewer than 15 Early Treatment Diabetic Retinopathy Study letters, gain of 0 or more and 15 or more letters, and change in angiographic total lesion size and choroidal neovascularization (CNV) lesion size. RESULTS: Both the 16-Gy and 24-Gy SRT arms received significantly fewer ranibizumab treatments compared with the sham arms: mean number of treatments, 2.64 (median, 2), 2.43 (median, 2), and 3.74 (median, 3.5), respectively (P = 0.013 and P = 0.004, respectively, vs. sham). Change in mean VA was -0.28, +0.40, and -1.57 letters for the 16-Gy, 24-Gy, and sham arms, respectively. The 16-Gy, 24-Gy, and sham arms lost fewer than 15 letters in 93%, 89%, and 91% of eyes, respectively, with 53%, 57%, and 56% gaining 0 or more letters, respectively, and 4% gaining 15 letters or more in all arms. Mean total angiographic lesion area changed by -1.15 mm(2), +0.49 mm(2), and +0.75 mm(2), respectively; mean CNV lesion area decreased by 0.16 mm(2), 0.18 mm(2), and 0.10 mm(2), respectively. Optical coherence tomography central subfield thickness decreased by 85.90 μm, 70.39 μm, and 33.51 μm, respectively. The number of adverse events (AEs) and number of serious AEs (SAEs) were similar across arms. No AEs were attributed to radiation. No SAEs occurred in the study eye. CONCLUSIONS: A single dose of SRT significantly reduces ranibizumab retreatment for patients with nvAMD, with a favorable safety profile at 1 year. Whereas chronic nvAMD typically results in loss of VA over time, SRT is associated with relatively well-preserved VA over 1 year. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

  View details for DOI 10.1016/j.ophtha.2013.02.016

  View details for Web of Science ID 000324045800044

  View details for PubMedID 23490327

• A new paradigm for incorporating the joint statement screening guidelines for retinopathy of prematurity into clinical practice: outcomes from a quaternary referral program. Ophthalmic surgery, lasers & imaging retina Henderson, M. T., Wang, S. K., Moshfeghi, D. M. 2013; 44 (5): 442-447

  Abstract

  This study examines patient experience at a quaternary referral pediatric clinic with a retinopathy of prematurity (ROP) screening program that monitors infants at least on a weekly basis for any stage of ROP.Admission records of 399 prematurely born patients treated at the Byers Eye Institute outpatient ROP clinic were retrospectively reviewed. Patients were categorized according to ROP status and whether they completed, canceled, or failed to show up for scheduled examinations. Demographic information was collected from medical records.Of 1,823 scheduled ROP-related visits, 327 (17.9%) resulted in cancellations and 90 (4.9%) in no-shows, with 238 missed visits due to caregiver-related and 149 due to caregiver-unrelated reasons. Of 399 total patients, 142 (35.6%) canceled or failed to show up for at least one appointment because of caregiver-related reasons.More than one-third of patients with ROP canceled or missed appointments. The true risk of delay is difficult to assess because all patients requiring treatment received it prior to discharge from the hospital. To achieve maximal compliance with joint statement guidelines on ROP screening, patients should be scheduled for examination earlier than recommended. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:442-447.].

  View details for DOI 10.3928/23258160-20130909-04

  View details for PubMedID 24044706

• Ocular hypertension and intraocular pressure asymmetry after intravitreal injection of anti-vascular endothelial growth factor agents. Ophthalmic surgery, lasers & imaging retina Pershing, S., Bakri, S. J., Moshfeghi, D. M. 2013; 44 (5): 460-464

  Abstract

  To evaluate elevated intraocular pressure (IOP) after intravitreal injections of vascular endothelial growth factor (VEGF) inhibitors and contribute toward the recognition and understanding of its mechanisms, pattern, and treatment.Retrospective case series of VEGF-inhibitor injections at two academic centers (Stanford University and Mayo Clinic) over 4 years. Cases were evaluated for IOP elevation (≥ 24 mm Hg) or asymmetry (≥ 3 mm Hg IOP difference between eyes on three visits).Twenty-one eyes were identified with pathologically elevated IOP after treatment. Most had delayed-onset (average: 15 months after treatment, after 10 injections) elevation. IOP-lowering therapy was required in 81%. More consecutive visits with IOP asymmetry occurred in patients developing ocular hypertension (11.1% pre-diagnosis vs 66.7% post-diagnosis; OR = 9.00, P = .003).Elevated IOP may occur after ranibizumab or bevacizumab injections, often exhibiting a delayed and perhaps cumulative effect. The authors found significant bilateral IOP asymmetry in patients developing unilateral glaucoma after VEGF-inhibitor injections, a potential early indicator or proxy for pathologic IOP elevation. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:460-464.].

  View details for DOI 10.3928/23258160-20130909-07

  View details for PubMedID 24044708

• Persistent plus disease after laser in retinopathy of prematurity with tetralogy of Fallot EUROPEAN JOURNAL OF OPHTHALMOLOGY Paulus, Y. M., Moshfeghi, D. M. 2013; 23 (5): 764-766

  Abstract

  Introduction: We present a patient with retinopathy of prematurity (ROP) who received panretinal photocoagulation (PRP), but in whom plus disease developed, likely secondary to a complicated cardiovascular history, including DiGeorge syndrome and tetralogy of Fallot.Method: Interventional case report with clinical and angiographic correlation. Results: Our patient had been born at 29 weeks and 2 days gestational age with a birthweight of 940 grams, tetralogy of Fallot, DiGeorge syndrome, and major aortopulmonary collaterals. Type 1 Early Treatment for Retinopathy of Prematurity ROP (zone 2, stage 2 with plus) developed, requiring PRP. Worsening plus disease developed and mild further PRP was performed. Despite this, plus disease persisted.Conclusions: We report plus disease even after appropriate PRP therapy for ROP. In this case, it is likely the patient's cardiovascular diseases that caused the persistent plus disease. Vascular tortuosity can be due to a number of different systemic disorders, so it is important to consider an infant's systemic conditions in the evaluation of ROP.

  View details for DOI 10.5301/ejo.5000295

  View details for Web of Science ID 000326767600024

  View details for PubMedID 23640514

• Academic productivity and its relationship to physician salaries in the University of California Healthcare System. Southern medical journal Fijalkowski, N., Zheng, L. L., Henderson, M. T., Moshfeghi, A. A., Maltenfort, M., Moshfeghi, D. M. 2013; 106 (7): 415-421

  Abstract

  To evaluate whether physicians with higher academic productivity, as measured by the number of publications in Scopus and the Scopus Hirsch index (h-index), earn higher salaries.This was a cross-sectional study. Participants were ophthalmologists, otolaryngologists, neurosurgeons, and neurologists classified as "top earners" (>$100,000 annually) within the University of California (UC) healthcare system in 2008. Bibliometric searches on Scopus were conducted to retrieve the total number of publications and Hirsch indices (h-index), a measure of academic productivity. The association between the number of publications and h-index on physicians' total compensation was determined with multivariate regression models after controlling for the four specialties (ophthalmology, otolaryngology, neurosurgery, and neurology), the five institutions (UC San Francisco, UC Los Angeles, UC San Diego, UC Irvine, and UC Davis), and academic rank (assistant professor, associate professor, and professor).The UC healthcare system departments reported 433 faculty physicians among the four specialties, with 71.6% (n = 310) earning more than $100,000 in 2008 and classifying as top earners. After controlling for the specialty, institution, and ranking, there was a significant association between the number of publications on salary (P < 0.000001). Scopus number of publications and h-index were correlated (P < 0.001). Scopus h-index was of borderline significance in predicting physician salary (P = 0.12). Physicians with higher Scopus publications had higher total salaries across all four specialties. Every 10 publications were associated with a 2.40% increase in total salary after controlling for specialty, institution, rank, and chair.Ophthalmologists, otolaryngologists, neurosurgeons, and neurologists in the UC healthcare system who are more academically productive receive greater remuneration.

  View details for DOI 10.1097/SMJ.0b013e31829b9dae

  View details for PubMedID 23820322

• Fundus Findings in Chronic Granulomatous Disease OPHTHALMIC SURGERY LASERS & IMAGING Vaziri, K., Moshfeghi, A. A., Moshfeghi, D. M. 2013; 44 (4): 390-392

  Abstract

  Chronic granulomatous disease (CGD) is a rare primary immunodeficiency disease that has been reported to present with various chorioretinal findings, predominantly in men. We report a case of a 17-year-old girl with a known diagnosis of CGD referred to the ophthalmology clinic for evaluation of an inflamed pingueculum. Upon clinical examination and ophthalmic imaging, high-quality montage fundus photographs demonstrated a wide array of bilaterally asymmetric chorioretinal findings known to be characteristic of the ophthalmic manifestations of CGD, including chorioretinitis and focal subretinal granuloma. This report also adds to the body of evidence that the chorioretinal findings associated with this disease have the potential to worsen over time. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:390-392.].

  View details for DOI 10.3928/23258160-20130601-01

  View details for Web of Science ID 000324534900013

  View details for PubMedID 23799791

• 16 and 24 Gy Low-voltage X-ray Irradiation With Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 12-Month Outcomes. American journal of ophthalmology Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2013; 155 (6): 1000-1008 e2

  View details for DOI 10.1016/j.ajo.2013.01.015

  View details for PubMedID 23497847

• The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting. Ophthalmic surgery, lasers & imaging retina Fijalkowski, N., Pershing, S., Moshfeghi, D. M. 2013; 44 (2): 133-139

  Abstract

  To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States.Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011.Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%).Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.

  View details for DOI 10.3928/23258160-20130313-06

  View details for PubMedID 23510039

• Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Silva, R. A., Berrocal, A. M., Moshfeghi, D. M., Blumenkranz, M. S., Sanislo, S., Davis, J. L. 2013; 251 (2): 559-566

  Abstract

  We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease.Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof.Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance.In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.

  View details for DOI 10.1007/s00417-012-2164-8

  View details for Web of Science ID 000314683200020

  View details for PubMedID 23052715

• Human histopathology of PASCAL laser burns. Eye (London, England) Paulus, Y. M., Kaur, K., Egbert, P. R., Blumenkranz, M. S., Moshfeghi, D. M. 2013

  View details for DOI 10.1038/eye.2013.100

  View details for PubMedID 23722723

• Retinal Glioneuronal Hamartoma in Neurofibromatosis Type 1 ARCHIVES OF OPHTHALMOLOGY Lad, E. M., Karamchandani, J. R., Alcorn, D. M., Moshfeghi, D. M., Egbert, P. R. 2012; 130 (10): 1335-1337

  View details for Web of Science ID 000309543500017

  View details for PubMedID 23044954

• 16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a 'radiation-first' strategy BRITISH JOURNAL OF OPHTHALMOLOGY Moshfeghi, A. A., Morales-Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Zavala-Ayala, A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 96 (10): 1320-1324

  Abstract

  To describe 'radiation-first' combination treatment with a non-invasive, low-voltage x-ray irradiation system followed by as needed ranibizumab for neovascular age-related macular degeneration (AMD).Phase I study of non-invasive, low-voltage 16 Gy x-ray irradiation delivered in three beams via the inferior pars plana in patients with active neovascular AMD. Ranibizumab was administered as needed per protocol. Patients were followed monthly for safety and efficacy over 12 months.13 patients were enrolled and completed 12 months follow-up. Safety was good with no serious ocular/non-ocular adverse events or radiation-related ocular complications. 11 patients lost <15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, seven gained ≥0 ETDRS letters and 0 gained ≥15 ETDRS letters. Patients received a total of 31 subsequent ranibizumab injections (of possible 156) over the 12 months following x-ray irradiation. Mean time to first injection was 3.9 months. One patient received no ranibizumab injections, three patients received one injection, four patients received two injections, and five patients received three or more injections.After 12 months, non-invasive, low-voltage x-ray irradiation with as needed ranibizumab rescue therapy demonstrated good safety with a visual acuity stabilising effect and reduction in retinal thickness in patients with neovascular AMD.

  View details for DOI 10.1136/bjophthalmol-2011-301222

  View details for Web of Science ID 000309215500010

  View details for PubMedID 22895887

• Cannula-Based 25-Gauge Vitreous Tap And Injection: A New Surgical Technique RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Chan, A., Leng, T., Moshfeghi, D. M. 2012; 32 (5): 1021-1022

  View details for DOI 10.1097/IAE.0b013e318248e6ba

  View details for Web of Science ID 000303502200022

  View details for PubMedID 22311272

• The influence of medical school and residency training program upon choice of an academic career and academic productivity among otolaryngology faculty in the United States of America: Our experience of 1433 academic otolaryngologists CLINICAL OTOLARYNGOLOGY Leng, T., Jaben, K. A., Zheng, L., Yang, J., Paulus, Y. M., Moshfeghi, A. A., Maltenfort, M. G., Campbell, P. G., Ratliff, J. K., Moshfeghi, D. M. 2012; 37 (1): 58-62

  View details for DOI 10.1111/j.1749-4486.2011.02402.x

  View details for Web of Science ID 000301779300008

  View details for PubMedID 22433138

• Pilot Study of the Delivery of Microcollimated Pars Plana External Beam Radiation in Porcine Eyes: 270-Day Analysis JOURNAL OF OPHTHALMOLOGY Singh, R. P., Shusterman, E. M., Moshfeghi, D., Danis, R., Gertner, M. 2012

  Abstract

  Objective. To determine the dose response and toxicity threshold of micro-collimated X-rays delivered to porcine maculae by a stereotactic radiosurgical system after 270 days. Methods. Twelve eyes of six Yucatan mini-swine were randomized to receive up to 90 Gy to the retina, using an office-based trans-pars plana delivery system. To determine the safety profile of this radiation delivery, ophthalmic examination, fundus photography, fluorescein angiography (FA), and spectral domain optical coherence tomography (SD-OCT) were obtained at multiple time points up to 270 days post treatment. Results. No abnormalities were noted on external examination. Cataracts were noted in 4 of 12 eyes. Dose and time-dependent changes were noted on fundus examination, FA, ICG and SD-OCT. No significant abnormalities were seen in the control, 16 Gy or 24 Gy groups using any modality. Histopathology revealed a dose response effect with no discernable lesions in the 16 Gy group. Conclusion. The X-ray delivery system precisely targets the porcine retina in vivo with little effect on surrounding structures. No ophthalmic or intracranial adverse effects were noted at clinically relevant doses at 270 days following radiation delivery.

  View details for DOI 10.1155/2012/615214

  View details for Web of Science ID 000306800200001

  View details for PubMedID 22848793

• 24-Gy Low-Voltage X-Ray Irradiation With Ranibizumab Therapy for Neovascular AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Morales Canton, V., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2012; 43 (1): 20-24

  Abstract

  To describe the 6-month safety and preliminary efficacy outcomes of the use of 24-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 24 Gy was administered in one session through three locations in the inferior pars plana in a consecutive series of patients with neo-vascular AMD (treatment naïve and previously treated). Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity examinations were performed at 1 week, 1 month, and monthly thereafter with quarterly fluorescein angiography.Nineteen patients completed 6 months of follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 38.3 ± 19.5 letters. At 6 months, the corresponding ETDRS score was 44.7 ± 16.8 letters. At 6 months, the mean change in visual acuity was 6.4 ± 9.8 ETDRS letters. Patients received an average of 0.4 additional ranibizumab injections following the initial two mandated injections.A single treatment of external 24-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement in visual acuity in patients with neovascular AMD at 6 months, with no radiation-related adverse effects.

  View details for DOI 10.3928/15428877-20111129-01

  View details for Web of Science ID 000305342600003

  View details for PubMedID 22251841

• 16-Gy Low-Voltage X-ray Irradiation With Ranibizumab Therapy for AMD: 6-Month Safety and Functional Outcomes OPHTHALMIC SURGERY LASERS & IMAGING Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Moshfeghi, A. A., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 468-473

  Abstract

  To describe the 6-month safety and preliminary efficacy outcomes of the use of 16-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD).A single treatment of a non-invasive, externally delivered low-voltage 16-Gy x-ray irradiation was administered in one session through three locations in the inferior pars plana. Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) examinations were performed at 1 week, 1 month, and monthly thereafter, with quarterly fluorescein angiography (FA). After the two initial ranibizumab injections, subsequent injections were administered according to the following criteria: VA decline of 10 ETDRS letters compared with baseline, increase of 100-μm central foveal thickness on OCT compared with baseline, the development of new submacular hemorrhage, and the development of a new area of classic choroidal neovascularization on FA.Twenty-six patients completed a 6-month follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 46.6 letters (range: 5 to 80; standard deviation [SD]: 21.5). At 6 months, the corresponding ETDRS score was 55.6 letters (range: 25 to 80; SD: 18.9) and the mean change in VA was 9.5 ETDRS letters (SD: 10.3). On responder analysis, 96% lost 15 or fewer ETDRS letters, 81% gained 0 or more ETDRS letters, and 50% gained 15 or more ETDRS letters. Patients received a total of 13 ranibizumab injections following two initial injections. At 6 months, patients received an average of 0.5 additional injections following the initial two mandated injections.A single treatment of externally applied, non-invasive 16-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement of VA in patients with neovascular AMD at 6 months with no radiation-related adverse effects.

  View details for DOI 10.3928/15428877-20110804-01

  View details for Web of Science ID 000305342500004

  View details for PubMedID 21830747

• 16-Gy Low-Voltage X-ray Irradiation Followed by As-Needed Ranibizumab Therapy for AMD: 6-Month Outcomes of a "Radiation-First" Strategy OPHTHALMIC SURGERY LASERS & IMAGING Moshfeghi, A. A., Canton, V. M., Quiroz-Mercado, H., Velez-Montoya, R., Lopez-Miranda, M. J., Shusterman, E. M., Kaiser, P. K., Sanislo, S. R., Gertner, M., Moshfeghi, D. M. 2011; 42 (6): 460-467

  Abstract

  To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy.Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria.Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections.Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.

  View details for DOI 10.3928/15428877-20110804-03

  View details for Web of Science ID 000305342500003

  View details for PubMedID 21830745

• Medical School and Residency Influence on Choice of an Academic Career and Academic Productivity Among US Neurology Faculty ARCHIVES OF NEUROLOGY Campbell, P. G., Lee, Y. H., Bell, R. D., Maltenfort, M. G., Moshfeghi, D. M., Leng, T., Moshfeghi, A. A., Ratliff, J. K. 2011; 68 (8): 999-1004

  Abstract

  To evaluate the effectiveness of medical schools and neurology training programs in the United States by determining their contribution to academic neurology in terms of how many graduates choose academic careers and their respective influence on current medical knowledge through bibliometric analysis.Biographical information from current faculty members of neurology training programs in the United States was obtained through an Internet-based search of departmental Web sites. Collected variables included medical school attended, residency program completed, and current academic rank. For each faculty member, ISI Web of Science and Scopus h -indices were also collected.Data from academic neurologists from 120 training programs with 3249 faculty members were collected. All data regarding training program and medical school education were compiled and analyzed by the institution from which each individual graduated. The 20 medical schools and neurology residency training programs producing the greatest number of graduates remaining in academic practice and the mean h -indices are reported. More medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academic neurology practice than the graduates of any other institution. Analyzed by residency training program attended, New York Presbyterian Hospital (Columbia University), Mayo Clinic (Rochester, Minnesota), and Mount Sinai Medical Center (New York, New York) produced the most graduates remaining in academics.This retrospective, longitudinal cohort study examines through quantitative measures the academic productivity and rank of academic neurologists. The results demonstrate that several training programs excel in producing a significantly higher proportion of academically active neurologists.

  View details for DOI 10.1001/archneurol.2011.67

  View details for Web of Science ID 000293647500005

  View details for PubMedID 21482917

• Medical school and residency influence on choice of an academic career and academic productivity among neurosurgery faculty in the United States Clinical article JOURNAL OF NEUROSURGERY Campbell, P. G., Awe, O. O., Maltenfort, M. G., Moshfeghi, D. M., Leng, T., Moshfeghi, A. A., Ratliff, J. K. 2011; 115 (2): 380-386

  Abstract

  Factors determining choice of an academic career in neurological surgery are unclear. This study seeks to evaluate the graduates of medical schools and US residency programs to determine those programs that produce a high number of graduates remaining within academic programs and the contribution of these graduates to academic neurosurgery as determined by h-index valuation.Biographical information from current faculty members of all accredited neurosurgery training programs in the US with departmental websites was obtained. Any individual who did not have an American Board of Neurological Surgery certificate (or was not board eligible) was excluded. The variables collected included medical school attended, residency program completed, and current academic rank. For each faculty member, Web of Science and Scopus h-indices were also collected.Ninety-seven academic neurosurgery departments with 986 faculty members were analyzed. All data regarding training program and medical school education were compiled and analyzed by center from which each faculty member graduated. The 20 medical schools and neurosurgical residency training programs producing the greatest number of graduates remaining in academic practice, and the respective individuals' h-indices, are reported. Medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academics the most frequently. The neurosurgery training program at the University of Pittsburgh produced the highest number of academic neurosurgeons in this sample.The use of quantitative measures to evaluate the academic productivity of medical school and residency graduates may provide objective measurements by which the subjective influence of training experiences on choice of an academic career may be inferred. The top 3 residency training programs were responsible for 10% of all academic neurosurgeons. The influence of medical school and residency experiences on choice of an academic career may be significant.

  View details for DOI 10.3171/2011.3.JNS101176

  View details for Web of Science ID 000293145100037

  View details for PubMedID 21495810

• Retinopathy of Prematurity in the Time of Bevacizumab: Incorporating the BEAT-ROP Results into Clinical Practice OPHTHALMOLOGY Moshfeghi, D. M., Berrocal, A. M. 2011; 118 (7): 1227-1228

  View details for DOI 10.1016/j.ophtha.2011.04.028

  View details for Web of Science ID 000292303000001

  View details for PubMedID 21724044

• Radiation Treatment for Age-Related Macular Degeneration SEMINARS IN OPHTHALMOLOGY Silva, R. A., Moshfeghi, A. A., Kaiser, P. K., Singh, R. P., Moshfeghi, D. M. 2011; 26 (3): 121-130

  Abstract

  Age-related macular degeneration (AMD) remains a devastating cause of visual loss among elderly individuals. While considerable progress has been made towards combating the disease, most recently with intravitreal anti-VEGF agents, visual outcomes are still limited by continued retinal pigment epithelium (RPE) degeneration and subsequent neurosensory retinal atrophy. Among the promising new treatment options being explored, radiotherapy appears apt to address the multifactorial etiology of AMD. Current investigative studies underway will hopefully yield clinical efficacy to complement this theoretical suitability for arresting visual loss.

  View details for DOI 10.3109/08820538.2011.554486

  View details for Web of Science ID 000293502200007

  View details for PubMedID 21609224

• Pilot Study of the Delivery of Microcollimated Pars Plana External Beam Radiation in Porcine Eyes ARCHIVES OF OPHTHALMOLOGY Barakat, M. R., Shusterman, M., Moshfeghi, D., Danis, R., Gertner, M., Singh, R. P. 2011; 129 (5): 628-632

  Abstract

  To investigate the effects of a novel stereotactic radiosurgical system for pars plana delivery of microcollimated x-rays to the retina and determine the retinal radiological dose response and toxicity threshold in a pig model.The x-rays were delivered through the pars plana to the maculae of Yucatan miniswine to verify the targeting and safety of a cornea-scleral, stabilized, office-based delivery system. Twelve eyes were randomized to receive 0, 16, 24, 42, 60, or 90 Gy in a single dose to the retina. Eye examinations, fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography were obtained at days 7, 30, 60, and 90. Indocyanine green angiography was done at day 90.Through day 90 interim analysis, no abnormalities of external structures were noted. A small cortical lens opacity was noted in the 60-Gy group. Fundus evaluation revealed no abnormalities at 16 or 24 Gy. Beginning at day 30, circular pale retinal lesions with sharp margins were noted in the maculae of the eyes that received 42, 60, and 90 Gy. Higher-dose lesions showed late staining on fluorescein angiography, choroidal hypoperfusion on indocyanine green angiography, and defined photoreceptor loss and retinal thinning on spectral-domain optical coherence tomography.Transscleral stereotactic radiation dosing of porcine eyes demonstrates no apparent clinical abnormalities in doses less than 24 Gy. Doses of 42 Gy or higher led to focal choroidal and retinal damage within the target area.Radiation can induce small-blood vessel closure and thereby has therapeutic potential in neovascular diseases such as age-related macular degeneration.

  View details for Web of Science ID 000290437100013

  View details for PubMedID 21555617

• Stereotactic Radiosurgery for AMD: A Monte Carlo-Based Assessment of Patient-Specific Tissue Doses INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE Hanlon, J., Firpo, M., Chell, E., Moshfeghi, D. M., Bolch, W. E. 2011; 52 (5): 2334-2342

  Abstract

  To define the radiation doses to nontargeted ocular and adnexal tissues with Monte-Carlo simulation using a stereotactic low-voltage x-ray irradiation system for the treatment of wet age-related macular degeneration.Thirty-two right/left eye models were created from three-dimensional reconstructions of 1-mm computed tomography images of the head and orbital region. The resultant geometric models were voxelized and imported to the MCNPX 2.5.0 radiation transport code for Monte Carlo-based simulations of AMD treatment. Clinically, treatment is delivered noninvasively by three divergent 100-kVp photon beams entering through the sclera and overlapping on the macula cumulating in a therapeutic dose. Tissue-averaged doses, localized point doses, and color-coded dose contour maps are reported from Monte Carlo simulations of x-ray energy deposition for several tissues of interest, including the lens, optic nerve, macula, brain, and orbital bone.For all eye models in this study (n = 32), tissues at risk did not receive tissue-averaged doses over the generally accepted thresholds for serious complication, specifically the formation of cataracts or radiation-induced optic neuropathy. Dose contour maps are included for three patients, each from separate groups defined by coherence to clinically realistic treatment setups. Doses to the brain and orbital bone were found to be insignificant.The computational assessment performed indicates that a previously established therapeutic dose can be delivered effectively to the macula with the scheme described so that the potential for complications to nontargeted radiosensitive tissues might be reduced.

  View details for DOI 10.1167/iovs.10-6421

  View details for Web of Science ID 000289282600034

  View details for PubMedID 21087954

• Stereotactic low-voltage x-ray irradiation for age-related macular degeneration BRITISH JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Kaiser, P. K., Gertner, M. 2011; 95 (2): 185-188

  Abstract

  The IRay stereotactic low-voltage x-ray irradiation treatment system for age-related macular degeneration consists of a low voltage x-ray tube, an eye tracking system, a robotically controlled delivery system, a coupling device to facilitate tracking and stabilisation, a graphical user interface and gating software. Low-voltage x-rays are delivered in a series of three spots to the macula in a non-invasive manner through the inferior pars plana. These beams are designed to overlap on the centre of the macula. Each beam delivers one-third of the total dose, such that the total macula dose is three times an individual beam's dose. The device is designed to run off standard domestic electrical power, and no special shielding is necessary for the room. This system has been validated in Monte Carlo simulations, human cadaver eye studies, pre-clinical animal studies and in a phase I clinical trial.

  View details for DOI 10.1136/bjo.2009.163907

  View details for Web of Science ID 000286458700008

  View details for PubMedID 20852318

• Retinopathy of prematurity in an infant with Aicardi's syndrome EYE Leng, T., Moshfeghi, D. M. 2011; 25 (2): 257-258

  View details for DOI 10.1038/eye.2010.189

  View details for Web of Science ID 000287187300025

  View details for PubMedID 21151036

• The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy. Retina (Philadelphia, Pa.) Moshfeghi, A. A., Albini, T. A., Kitchens, J. W., Leng, T., Moshfeghi, D. M. 2011; 31 (2): 426-427

  View details for DOI 10.1097/IAE.0b013e318200c125

  View details for PubMedID 21233788

• Telemedicine as a tool for evaluation of retinopathy of prematurity. International ophthalmology clinics Silva, R. A., Moshfeghi, D. M. 2011; 51 (1): 33-48

  View details for DOI 10.1097/IIO.0b013e3182009a91

  View details for PubMedID 21139476

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 36-Month Experience With Telemedicine Screening OPHTHALMIC SURGERY LASERS & IMAGING Silva, R. A., Murakami, Y., Lad, E. M., Moshfeghi, D. M. 2011; 42 (1): 1-8

  View details for DOI 10.3928/15428877-20100929-08

  View details for Web of Science ID 000305325700002

• Declining Incidence of Neonatal Endophthalmitis in the United States AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, A. A., Charalel, R. A., Hernandez-Boussard, T., Morton, J. M., Moshfeghi, D. M. 2011; 151 (1): 59-65

  Abstract

  To determine the incidence of neonatal endogenous endophthalmitis in the United States between 1998 and 2006 and to identify associated risk factors.Retrospective cohort study.We used the Nationwide Inpatient Sample database, a 20% representative sample of all hospital discharges in the United States, to help refine our understanding of this condition. International Classification of Diseases, ninth edition, codes for endophthalmitis, sepsis, and suspected endophthalmitis risk factors in hospitalized infants and neonates were searched in the database and were tracked over time. The main outcome measure was incidence of neonatal endophthalmitis over the study period.Of 3.64 million live births in 1998, 317 newborns were identified with endophthalmitis (8.71 cases per 100 000 live births). Of 4.14 million live births in 2006, only 183 newborns were identified with endophthalmitis (4.42 cases per 100 000 live births) by comparison. The incidence of endophthalmitis decreased at a rate of 6% per year (P = .01130) between 1998 and 2006. Neonates with endophthalmitis were more likely to have systemic bacteremia (odds ratio, 21.114; P < .0001), Candidemia (odds ratio, 2.356; P < .0001), a birth weight of less than 1500 g (odds ratio, 1.215; P < .0001), and retinopathy of prematurity (odds ratio, 2.052; P < .0001).We objectively validated the commonly held belief that Candidemia, bacteremia, retinopathy of prematurity, and low birth weight are significant risk factors for endophthalmitis development in infants, which seems to have had a decreasing incidence in recent years.

  View details for DOI 10.1016/j.ajo.2010.07.008

  View details for Web of Science ID 000286081200011

  View details for PubMedID 20970776

• Stanford University network for diagnosis of retinopathy of prematurity (SUNDROP): 36-month experience with telemedicine screening. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Silva, R. A., Murakami, Y., Lad, E. M., Moshfeghi, D. M. 2011; 42 (1): 12-19

  Abstract

  to report the 36-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.retrospective analysis of the SUNDROP archival data between December 1, 2005, and November 30, 2008, to evaluate this diagnostic technology for retinopathy of prematurity (ROP) screening. A total of 230 consecutively enrolled infants meeting ROP examination criteria were screened with the Ret-Cam II (Clarity Medical Systems, Pleasanton, CA) and evaluated by the SUNDROP reading center at Stanford University. Outcomes included referral-warranted ROP, treatment-warranted ROP, and anatomic outcomes.in the initial 36-month period, the SUNDROP telemedicine initiative did not miss any treatment-warranted ROP. A total of 230 infants (460 eyes) were imaged, resulting in 1,059 examinations and 10,921 unique images. Ten infants were identified with referral-warranted ROP: nine underwent laser photocoagulation and one regressed spontaneously. The sensitivity was 100% with a specificity of 99.5%. No patient progressed to retinal detachment or other adverse outcomes.the SUNDROP telemedicine screening initiative for ROP has demonstrated high reliability for identification of treatment-warranted disease. All cases of treatment-warranted disease were captured. There were no adverse outcomes.

  View details for DOI 10.3928/15428877-20100929-08

  View details for PubMedID 20954641

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 24-month experience with telemedicine screening ACTA OPHTHALMOLOGICA Murakami, Y., Silva, R. A., Jain, A., Lad, E. M., Gandhi, J., Moshfeghi, D. M. 2010; 88 (3): 317-322

  Abstract

  To report the 24-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Retrospective analysis of the SUNDROP archival data gathered between 1 December 2005 and 30 November 2007 to evaluate this diagnostic technology for ROP screening. One hundred and sixty consecutively enrolled infants meeting ROP examination criteria were screened with the RetCam II and evaluated by the SUNDROP reading centre at Stanford University. Nurses obtained five or six images in each eye. All patients also received a dilated examination within 1 week of discharge. Outcomes included treatment-warranted retinopathy of prematurity (TW-ROP) and anatomical outcomes.In the initial 24-month period, the SUNDROP telemedicine initiative has not missed any TW-ROP. A total of 160 infants (320 eyes) were imaged, resulting in 669 exams and 7556 images. Seven infants were identified with TW-ROP; six underwent laser photocoagulation and one regressed spontaneously. The sensitivity was 100%, with specificity of 99.4%. No patient progressed to retinal detachment or other adverse outcomes.The SUNDROP telemedicine screening initiative for ROP has been proven to have a high degree of sensitivity and specificity for the identification of treatment-warranted disease. All cases of treatment-warranted disease were captured. There were no adverse outcomes.

  View details for DOI 10.1111/j.1755-3768.2009.01715.x

  View details for Web of Science ID 000277122600018

  View details for PubMedID 19930212

• Stereotactic targeting and dose verification for age-related macular degeneration MEDICAL PHYSICS Gertner, M., Chell, E., Pan, K., Hansen, S., Kaiser, P. K., Moshfeghi, D. M. 2010; 37 (2): 600-606

  Abstract

  Validation of the targeting and dose delivery of the IRay low voltage age-related macular degeneration treatment system.Ten human cadaver eyes were obtained for this study and mounted in the IRay system. Using gel and vacuum, an I-Guide immobilization device was coupled to the eyes and radiochromic film was affixed to the posterior aspect of the globes. Three narrow x-ray beams were delivered through the pars plana to overlap on the predicted nominal fovea. A needle was placed through the center of the film's beam spot and into the eye to register the film and the inner retina. The process was performed three times for each of the ten eyes (30 simulated treatments; 90 individual beams). The globes were dissected to assess the targeting accuracy by measuring the distances from the needles to the fovea. The dose to the fovea was calculated from the radiochromic film.X-ray targeting on the retina averaged 0.6 +/- 0.4 mm from the fovea. Repeated treatments on the same eye showed a reproducibility of 0.4 +/- 0.4 mm. The optic nerve was safely avoided, with the 90% isodose edge of the beam spot between 0.4 and 2.6 mm from the edge of the optic disk. Measured dose matched that prescribed.This study provides confidence that the IRay, with an average accuracy of 0.6 mm and a precision of 0.4 mm, can reliably treat most AMD lesions centered on the fovea. With the exception of motion, all sources of error are included.

  View details for DOI 10.1118/1.3291648

  View details for Web of Science ID 000274075600020

  View details for PubMedID 20229868

• Photoacoustic ocular imaging OPTICS LETTERS de la Zerda, A., Paulus, Y. M., Teed, R., Bodapati, S., Dollberg, Y., Khuri-Yakub, B. T., Blumenkranz, M. S., Moshfeghi, D. M., Gambhir, S. S. 2010; 35 (3): 270-272

  Abstract

  We developed a photoacoustic ocular imaging device and demonstrated its utility in imaging the deeper layers of the eye including the retina, choroid, and optic nerve. Using safe laser intensity, the photoacoustic system was able to visualize the blood distribution of an enucleated pig's eye and an eye of a living rabbit. Ultrasound images, which were simultaneously acquired, were overlaid on the photoacoustic images to visualize the eye's anatomy. Such a system may be used in the future for early detection and improved management of neovascular ocular diseases, including wet age-related macular degeneration and proliferative diabetic retinopathy.

  View details for Web of Science ID 000274196100001

  View details for PubMedID 20125691

  View details for PubMedCentralID PMC2886805

• Simethicone retinopathy in an immature infant. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Chan, A., Tsai, T., O'Brien, J., Moshfeghi, D. M. 2010; 41 Online: e1-2

  Abstract

  The authors describe retinal findings in an immature infant consuming simethicone, a common over-the-counter drug used in the treatment of colic. The lesions are most consistent with an embolic phenomenon possibly from systemic absorption of a medication such as simethicone.

  View details for DOI 10.3928/15428877-20101025-04

  View details for PubMedID 21053868

• Branch retinal artery occlusion after septoplasty. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Leng, T., Moshfeghi, D. M. 2010; 41 Online: e1-2

  Abstract

  Loss of vision after uncomplicated rhinosurgery is a rare and uncommon complication. The authors describe a case of branch retinal artery occlusion after septoplasty in a 40-year-old otherwise healthy man. The likely etiology was injection of local anesthetics into the nasal mucosa during surgery. Vision loss could potentially have been prevented through the application of topical vasoconstrictive agents prior to anesthetic injection. Furthermore, slow injection and aspiration prior to injection could also help prevent inadvertent intraarterial injection.

  View details for DOI 10.3928/15428877-20101124-13

  View details for PubMedID 22785539

• Orbital fibrosis and intraocular recurrence of retinoblastoma following periocular carboplatin. Journal of pediatric ophthalmology & strabismus Kim, J. W., Yau, J. W., Moshfeghi, D., Fishman, M. 2010; 47 Online: e1-4

  Abstract

  A 5-month-old infant with bilateral advanced retinoblastoma underwent six cycles of systemic chemotherapy. In an attempt to salvage the second eye, three serial injections of periocular carboplatin were given for persistent vitreous seeding. Following the third injection, the patient developed periocular ecchymosis and magnetic resonance imaging demonstrated abnormal signal characteristics at the site of injection. An orbital biopsy did not demonstrate extraocular tumor extension, but histopathologic examination revealed severe orbital fibrosis and fat necrosis. Following the biopsy, the patient developed an intraocular tumor recurrence at the same location where the carboplatin injections had been given and enucleation was performed to prevent tumor spread. In this case, a child developed orbital scarring and intraocular tumor recurrence at the site of injection following treatment with periocular carboplatin.

  View details for DOI 10.3928/01913913-20100510-03

  View details for PubMedID 21214147

• Acute Phthisis Bulbi in a Premature Infant. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Moss, J., Jain, A., Doshi, A., Moshfeghi, D. M. 2010: 1–3

  Abstract

  A neonate with an estimated gestational age of 32 weeks who had post-partum sepsis (methicillin-resistant Staphylococcus aureus [MRSA] and Pseudomonas aeruginosa) and MRSA meningitis was found to have blunted light reflexes and microphthalmia in both eyes on routine screening for retinopathy of prematurity. Retrolenticular membranes precluded visualization of the fundi. Computed tomography confirmed the presence of intraocular calcifications, an interval development over 6 weeks from previously normal scans. Referral was made and diagnostic enucleation of the right eye was performed, revealing intraocular disorganization and metaplasia consistent with phthisis following intraocular inflammation. The patient's contralateral eye achieved visual acuity of light perception after lensectomy and vitrectomy. Vitreous cultures from the enucleation specimen and from the fellow eye at the time of vitrectomy were negative. Unsuspected, untreated endogenous endophthalmitis can result in dramatic and rapid metaplastic response in the developing eye and result in acute phthisis.

  View details for DOI 10.3928/15428877-20100216-11

  View details for PubMedID 20337263

• Branch retinal artery occlusion after septoplasty. Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye Leng, T., Moshfeghi, D. M. 2010; 41 Online: e1-2

  Abstract

  Loss of vision after uncomplicated rhinosurgery is a rare and uncommon complication. The authors describe a case of branch retinal artery occlusion after septoplasty in a 40-year-old otherwise healthy man. The likely etiology was injection of local anesthetics into the nasal mucosa during surgery. Vision loss could potentially have been prevented through the application of topical vasoconstrictive agents prior to anesthetic injection. Furthermore, slow injection and aspiration prior to injection could also help prevent inadvertent intraarterial injection.

  View details for DOI 10.3928/15428877-20101124-13

  View details for PubMedID 21117572

• Orbital Recurrence of B-Progenitor Acute Lymphoblastic Leukemia in a Child JOURNAL OF PEDIATRIC OPHTHALMOLOGY & STRABISMUS Lad, E. M., Jain, A., Lad, S. P., Lin, R. C., Alcorn, D. M., Moshfeghi, D. M. 2010; 47 (1): 46-50

  Abstract

  Orbital mass is an exceedingly rare presentation of acute lymphoblastic leukemia. This report describes a 12-year-old boy with recurrent orbital pre-B-cell acute lymphoblastic leukemia and reviews the literature on the incidence, presentation, prognosis, and management of orbital tumors in acute lymphoblastic leukemia. Early diagnosis and treatment of orbital acute lymphoblastic leukemia with a multidisciplinary approach is essential to minimize or prevent deterioration of vision and optimize clinical outcomes.

  View details for DOI 10.3928/01913913-20100106-11

  View details for Web of Science ID 000273750300010

  View details for PubMedID 20128555

• Incidence of Retinopathy of Prematurity in the United States: 1997 through 2005 AMERICAN JOURNAL OF OPHTHALMOLOGY Lad, E. M., Hernandez-Boussard, T., Morton, J. M., Moshfeghi, D. M. 2009; 148 (3): 451-458

  Abstract

  To determine the incidence of retinopathy of prematurity (ROP) based on a national database and to identify baseline characteristics, demographic information, comorbidities, and surgical interventions.Retrospective study based on the National Inpatient Sample from 1997 through 2005.The National Inpatient Sample was queried for all newborn infants with and without ROP. Multivariate logistic regression was used to predict risk factors for ROP.Thirty-four million live births were recorded during the study period. The total ROP incidence was 0.17% overall and 15.58% for premature infants with length of stay of more than 28 days. Our results conclusively demonstrated the importance of low birth weight as a risk for ROP development in infants with length of stay of more than 28 days, as well as association with respiratory conditions, fetal hemorrhage, intraventricular hemorrhage, and blood transfer. An interesting finding was the protective effect conferred by hypoxia, necrotizing enterocolitis, and hemolytic disease of the newborn. Infants with ROP had a higher incidence of undergoing laser photocoagulation therapy, pars plana vitrectomy, and scleral buckle surgery.The current study represents a large, retrospective analysis of newborns with ROP. The multivariate analysis emphasizes the role of birth weight in extended-stay infants, as well as respiratory conditions, fetal hemorrhage, intraventricular hemorrhage, and blood transfer.

  View details for DOI 10.1016/j.ajo.2009.04.018

  View details for Web of Science ID 000269755400020

  View details for PubMedID 19541285

• INTRAVITREAL INJECTION OF THERAPEUTIC AGENTS RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Peyman, G. A., Lad, E. M., Moshfeghi, D. M. 2009; 29 (7): 875-912

  Abstract

  Intravitreal injection (IVI) with administration of various pharmacological agents is a mainstay of treatment in ophthalmology for endopthalmitis, viral retinitis, age-related macular degeneration, cystoid macular edema, diabetic retinopathy, uveitis, vascular occlusions, and retinal detachment. The indications and therapeutic agents are reviewed in this study.A search of the English, German, and Spanish language MEDLINE database was conducted. A total of 654 references spanning the period through early 2008 were individually evaluated.The advantage of the IVI technique is the ability to maximize intraocular levels of medications and to avoid the toxicities associated with systemic treatment. Intravitreal injection has been used to deliver several types of pharmacological agents into the vitreous cavity: antiinfective and antiinflammatory medications, immunomodulators, anticancer agents, gas, antivascular endothelial growth factor, and several others. The goal of this review is to provide a detailed description of the properties of numerous therapeutic agents that can be delivered through IVI, potential complications of the technique, and recommendations to avoid side effects.The IVI technique is a valuable tool that can be tailored to the disease process of interest based on the pharmacological agent selected. This review provides the reader with a comprehensive summary of the IVI technique and its multitude of uses.

  View details for Web of Science ID 000267955400002

  View details for PubMedID 19584648

• TRIAMCINOLONE ACETONIDE PREPARATIONS Impact of Crystal Size on In Vitro Behavior RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Moshfeghi, A. A., Nugent, A. K., Nomoto, H., Sanislo, S. R., Kitchens, J. W., Moshfeghi, D. M. 2009; 29 (5): 689-698

  Abstract

  To characterize the in vitro behavior of three preparations of triamcinolone acetonide (TA).Three preparations of TA were mixed with Balanced Salt Solution Plus: commercially available TA (Kenalog 40, Bristol-Myers Squibb, Princeton, NJ), compounded preservative-free triamcinolone acetonide (PFTA, New England Compounding Center, Framingham, MA), and triamcinolone acetonide injectable suspension (TAIS, TRIESENCE, Alcon, Inc., Fort Worth, TX). We determined the mean number of crystalline aggregates per high-power deconvolution microscopy field, largest aggregate area, and spectroscopic photometric absorption.Preservative-free triamcinolone acetonide had larger mean number of aggregates compared with TA (time 0 P = 0.002, 10 minutes P < 0.001) and TAIS (time 0 P < 0.001, 10 minutes P = 0.003). Aggregate size varied at both 0 and 10 minutes: TAIS > TA > PFTA. Spectroscopic photometric absorption decreased in direct correlation to aggregate size over time for all three preparations.In vitro, PFTA in Balanced Salt Solution Plus had more aggregates of smaller size than either TA or TAIS. By contrast, TAIS had much larger aggregate size than both PFTA and TA, and this increased over time. These findings correlate with the clinical observations that PFTA and TA tend to disperse throughout the vitreous, whereas TAIS tends to conglomerate and gravitate toward the most dependent portion of the eye in a globular fashion.

  View details for Web of Science ID 000266059000019

  View details for PubMedID 19373129

• Resolution of Persistent Exudative Retinal Detachment in a Case of Sturge-Weber Syndrome with Anti-VEGF Administration OCULAR IMMUNOLOGY AND INFLAMMATION Paulus, Y. M., Jain, A., Moshfeghi, D. M. 2009; 17 (4): 292-294

  Abstract

  Report the resolution of a persistent exudative retinal detachment in a patient with Sturge-Weber syndrome following intravitreal pegaptanib injection.Case report.A 13-year-old male with Sturge-Weber syndrome presented with a choroidal hemangioma associated with an exudative retinal detachment that failed to resolve 6 months after external beam radiation therapy.A single intravitreal pegaptanib injection resulted in 50% resolution of the detachment within 1 week and complete resolution within a month. Despite anatomic success, vision remained poor.VEGF likely plays a role in the pathogenesis of Sturge-Weber choroidal hemangioma-associated exudative retinal detachment and offers potential treatment.

  View details for DOI 10.1080/09273940902989357

  View details for Web of Science ID 000268717000012

  View details for PubMedID 19657986

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 18-month experience with telemedicine screening GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Silva, R. A., Murakami, Y., Jain, A., Gandhi, J., Lad, E. M., Moshfeghi, D. M. 2009; 247 (1): 129-136

  Abstract

  To report the 18-month experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Retrospective analysis of the SUNDROP archival data between 1 December 2005 and 30 May 2007, evaluating this new diagnostic technology for ROP screening.All 97 consecutively enrolled infants in the SUNDROP network.All patients were screened using the RetCam II, and evaluated by the SUNDROP reading center at Stanford University. Nurses were trained to obtain five images in each eye. All patients were screened by an ophthalmologist trained in diagnosing ROP within 1 week of discharge from the hospital.Outcomes included referral-warranted disease, need for treatment, and anatomic outcomes. Referral-warranted disease was defined as any Early Treatment Retinopathy of Prematurity Disease Type 2 or greater, threshold disease, any plus disease, and any stage 4 or higher disease.In the initial 18-month period, the SUNDROP telemedicine screening initiative has not missed any referral-warranted disease for ROP. A total of 97 infants (194 eyes) were enrolled, resulting in 443 unique examinations and 4,929 unique images. The mean birth weight of the infants was 1,186.9 grams, with a mean gestational age at birth of 28.9 weeks. Seven infants were identified with referral-warranted disease; six patients underwent laser photocoagulation and completely regressed. The one remaining patient regressed spontaneously, and did not require intervention. Calculated sensitivity and specificity was 100% and 98.9% respectively. No patient progressed to retinal detachment or other adverse outcome. Inadequate exposure, artifact, poor visualization of the periphery, and lack of a complete standardized image set in some patients were identified as areas requiring further assessment.The SUNDROP telemedicine screening initiative for ROP has proven to have a high degree of sensitivity and specificity for identification of referral-warranted disease. Training was easily implemented. All cases of referral-warranted disease were captured. There were no adverse outcomes.

  View details for DOI 10.1007/s00417-008-0943-z

  View details for Web of Science ID 000261750600017

  View details for PubMedID 18784936

• Total rod ERG suppression with high dose compassionate Fenretinide usage DOCUMENTA OPHTHALMOLOGICA Marmor, M. F., Jain, A., Moshfeghi, D. 2008; 117 (3): 257-261

  Abstract

  Fenretinide is a synthetic retinoid that interferes with the attachment of retinol to retinol binding protein. It may inhibit accumulation of A2E and lipofuscin, and is proposed as therapy for Stargardt disease. It is currently used for cancer therapy, and mild depression of rod function and dark adaptation is a side effect at standard dosage. We studied two youngsters (aged between 12 and 13) receiving high doses as compassionate treatment for neuroblastoma: 800 mg daily for 1 out of every 3 weeks, for roughly 2 years. Goldmann-Weekers dark adaptometry, ISCEV standard ERG and mfERG were performed, and blood was analyzed for vitamin A. Neither child complained of night blindness or showed retinal fundus abnormalities. On initial exam, dark adaptation thresholds were elevated by 3 log units, and there were no detectable rod ERG responses. However, cone responses and mfERG were normal. Retesting one subject 3 months after stopping the drug revealed normal rod thresholds (slightly delayed) and low normal rod ERG responses. Serum vitamin A levels were normal from both subjects, but there is no record of whether the samples were drawn during cycles on or off drug. Our study demonstrates that high dose Fenretinide can suppress rod function quite completely, although serum vitamin A and rod function apparently return to normal or near normal levels rapidly once the drug is stopped. It is intriguing that cone function and access to vitamin A seems largely independent of Fenretinide effects on retinol availability.

  View details for DOI 10.1007/s10633-008-9132-y

  View details for Web of Science ID 000260262200010

  View details for PubMedID 18523815

• Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 12-month experience with telemedicine screening BRITISH JOURNAL OF OPHTHALMOLOGY Murakami, Y., Jain, A., Silva, R. A., Lad, E. M., Gandhi, J., Moshfeghi, D. M. 2008; 92 (11): 1456-1460

  Abstract

  To report the 1-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative.Forty-two consecutively enrolled infants who met ROP examination criteria were screened between 1 December 2005 through 30 November 2006 with the RetCam II and evaluated by the SUNDROP reading centre at Stanford University. Nurses obtained five images in each eye. All patients also received a dilated examination by the author within 1 week of discharge from the hospital. Outcomes included referral-warranted disease, need for treatment and anatomical outcomes. Referral-warranted disease was defined as any Early Treatment Retinopathy of Prematurity (ROP) Disease Type 2 or greater, or any plus disease. A retrospective analysis of 84 eyes, 131 unique examinations and 1315 unique images from the SUNDROP archival data is reported here.In the initial 12-month period, the SUNDROP telemedicine screening initiative had not missed any referral warranted ROP. Calculated sensitivity and specificity was 100% and 95%, respectively. No patient progressed to retinal detachment or other adverse outcomes.The SUNDROP telemedicine screening initiative for ROP has proven to have a high degree of sensitivity and specificity for identification of referral warranted disease. These results indicate that telemedicine may improve accessibility of ROP screening.

  View details for DOI 10.1136/bjo.2008.138867

  View details for Web of Science ID 000260341100006

  View details for PubMedID 18703553

• Severe surfing-related ocular injuries: the Stanford Northern Californian experience BRITISH JOURNAL OF SPORTS MEDICINE Zoumalan, C. I., Blumenkranz, M. S., McCulley, T. J., Moshfeghi, D. M. 2008; 42 (10): 855-857

  Abstract

  There is a growing body of literature describing severe surfing-related ocular injuries that result in permanent vision loss. We describe three severe surfing-related ocular injuries that occurred on beaches in northern California. One particular case stresses the need to tailor treatment to the patient and injury because of the possibility of good outcomes despite severe injury. Attention should also be directed towards commercially available safety gear and providing additional safety measures to prevent other orbital and ocular injuries.

  View details for DOI 10.1136/bjsm.2007.041657

  View details for Web of Science ID 000259995400017

  View details for PubMedID 18198199

• Posterior retinal breaks as a cause of vitreous hemorrhage in diabetes. Retinal cases & brief reports Hwang, T. N., Moshfeghi, D. M., Blumenkranz, M. S. 2008; 2 (4): 335-337

  Abstract

  To describe posterior retinal breaks as a cause of vitreous hemorrhage in diabetic patients.In two institutional practices, six posterior retinal breaks were identified in five eyes of five diabetic patients with vitreous hemorrhage. All eyes underwent fundus photography and fluorescein angiography. Four eyes received barrier photocoagulation. The outcome measures included retinal nonperfusion, proximity to retinal vessels, and progression to retinal detachment.All six posterior breaks were in areas of retinal ischemia. No eyes had neovascularization. Three breaks had a bridging vessel, and three were in a paravascular location. One untreated eye had progression to a retinal detachment.The differential diagnosis for vitreous hemorrhage in diabetic patients should include posterior retinal breaks, particularly in the absence of proliferative disease. These breaks are paravascular, are located in areas of retinal ischemia, and may involve avulsed bridging vessels. We suggest treatment with barrier rather than panretinal photocoagulation.

  View details for DOI 10.1097/ICB.0b013e318150697d

  View details for PubMedID 25390607

• Surveillance for potential adverse events associated with the use of intravitreal bevacizumab for retinal and choroidal vascular disease RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Wong, L. J., Desai, R. U., Jain, A., Feliciano, D., Moshfeghi, D. M., Sanislo, S. R., Blumenkranz, M. S. 2008; 28 (8): 1151-1158

  Abstract

  To systematically study potential adverse events associated with the use of intraocular bevacizumab at a single medical center.Retrospective study of all consecutive patients receiving intraocular bevacizumab injections at the Stanford University Department of Ophthalmology between November 15, 2005 and July 14, 2006. Bevacizumab was given for exudative age-related macular degeneration, retinal vascular occlusion, diabetic macular edema, neovascular glaucoma, and five other indications.We analyzed medical records of 186 subjects (203 eyes) who received a total of 578 injections of 1.25 mg of bevacizumab. The average follow-up was approximately 6 months. Five eyes with exudative age-related macular degeneration developed retinal pigment epithelial (RPE) tears, all with preexisting RPE detachments. These five eyes represented 2.9% of all age-related macular degeneration eyes treated and 7% of the age-related macular degeneration eyes with preexisting RPE detachments at initiation of treatment. Other adverse events were rare and included retinal ischemia, subretinal hemorrhage, vitreous hemorrhage, ocular irritation or pain, worsened hypertension, and headache. No death or thromboembolic events were observed.Intraocular bevacizumab appears to be well tolerated for the treatment of a variety of retinal and choroidal vascular diseases. RPE tears may occur when treating choroidal neovascularization, particularly in patients with preexisting RPE detachment.

  View details for Web of Science ID 000259329100018

  View details for PubMedID 18685542

• Persisent ocular hypertension following intravitreal ranibizumab GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Bakri, S. J., McCannel, C. A., Edwards, A. O., Moshfeghi, D. M. 2008; 246 (7): 955-958

  Abstract

  To describe the occurrence of ocular hypertension in four patients following injection of ranibizumab intravitreally.Case series.Four patients had high intraocular pressure after intravitreal ranibizumab 0.5 mg. Ocular hypertension occurred 1 month after the second ranibizumab injection in patients 1 and 3, and 1 month after the first ranibizumab in patient 2. In patient 4, it occurred several hours after the first ranibizumab injection. In all patients, the IOP increase was sustained across several visits, requiring control with topical glaucoma therapy, and in two cases the addition of a systemic carbonic anhydrase inhibitor. None of the patients had a previous history of glaucoma, ocular hypertension or IOP asymmetry and the IOP was as high as 30, 34, 46, and 50 mmHg in the four patients.Severe and sustained ocular hypertension may occur after intravitreal ranibizumab. Although the mechanism of the pressure rise is unknown, all eyes in our series were controlled with medical therapy.

  View details for DOI 10.1007/s00417-008-0819-2

  View details for Web of Science ID 000256315400003

  View details for PubMedID 18425523

• Bacterial contamination of ocular surface and needles in patients undergoing intravitreal injections 109th Annual Meeting of the American-Academy-of-Ophthalmology De Caro, J. J., Ta, C. N., Ho, H. V., Cabael, L., Hu, N., Sanislo, S. R., Blumenkranz, M. S., Moshfeghi, D. M., Jack, R., de Kaspar, H. M. LIPPINCOTT WILLIAMS & WILKINS. 2008: 877–83

  Abstract

  To evaluate potential sources of bacterial contamination during intravitreal (IVT) injection procedures.Patients scheduled for IVT injection were asked to enroll in the study at the California Vitreoretinal Center (Menlo Park, CA) and the Vantage Eye Center (Salinas, CA) between October 2004 and April 2005. A total of 104 patients participated in the study, with a total of 118 IVT injection procedures performed on 107 eyes. Standard microbiological techniques were used to culture, identify, and quantify bacterial contamination of injection needles and the bulbar conjunctiva at the injection site in patients undergoing IVT injections. The main outcomes measured were type and quantity of bacterial isolates.Two (2%) of 114 needles collected were contaminated with bacteria. The prevalence of bacterial contamination of the injection site on the bulbar conjunctiva was 43% before prophylaxis on the day of the injection with topical antibiotics and povidone-iodine, with a statistically significant reduction to 13% after prophylaxis (P < 0.0001). Coagulase-negative Staphylococcus, the most common bacterium isolated from the ocular surface, was isolated from both culture-positive needles.IVT injection needles became contaminated with bacteria during the injection procedure. Although the contamination rate was low, this supports a mechanism of postinjection endophthalmitis in which there is direct inoculation of ocular surface flora into the vitreous cavity by the injection needle.

  View details for Web of Science ID 000256714300014

  View details for PubMedID 18536606

• Retinopathy of prematurity in the United States BRITISH JOURNAL OF OPHTHALMOLOGY Lad, E. M., Nguyen, T. C., Morton, J. M., Moshfeghi, D. M. 2008; 92 (3): 320-325

  Abstract

  To determine the incidence of retinopathy of prematurity (ROP) based upon a national database and to identify baseline characteristics, demographic information, comorbidities, and surgical interventions.The National Inpatient Sample, a representative sample of all US hospital discharges from 1997 to 2002, was queried for all newborn infants with and without ROP. Primary outcome variables included demographics, comorbidities, hospital length of stay (LOS), and hospital charges. Multivariate logistic regression was used to predict risk factors for ROP.4.67 million live births were recorded during the study period. The total incidence of ROP was 0.12% overall and 7.35% for premature infants with LOS greater than 14 days. Newborns with ROP were more likely to be born at a teaching hospital and to have higher LOS and hospitalisation charges. The odds ratios for the development of ROP were greatest in infants weighing less than 1250 grams. The multivariate regression model revealed that only respiratory distress and intraventricular haemorrhage were predictive of the development of ROP and Hispanic infants were 33% more likely to develop ROP.This study represents the largest cohort of newborns analysed for ROP. The multivariate analysis emphasised the role of birth weight in extended-stay infants, as well as Hispanic race, respiratory distress syndrome, and intraventricular haemorrhage.

  View details for DOI 10.1136/bjo.2007.126201

  View details for Web of Science ID 000253991800005

  View details for PubMedID 18303153

• ThinPrep (R) vitreous-based diagnosis of choroidal malignant melanoma OCULAR IMMUNOLOGY AND INFLAMMATION Chan, A., Egbert, P. R., Moshfeghi, D. M. 2008; 16 (4): 135-137

  Abstract

  To report an alternative method for the diagnosis of atypical choroidal malignant melanoma-ThinPrep sampling of the vitreous cavity through 25-gauge vitrectomy.Case report.A 79-year-old gentleman presented with a progressive decline in visual acuity in his left eye. A clinical diagnosis of large choroidal malignant melanoma was made. Given the history of trauma and the possibility of enucleation, the patient wished to have histopathological confirmation. The patient underwent 25-gauge vitrectomy. However, he developed a choroidal hemorrhage during the procedure and the surgeon elected not to perform transretinal biopsy. Instead a sample of the vitreous was evaluated by ThinPrep analysis, and a diagnosis of choroidal malignant melanoma was made.Cytological evaluation of vitreous substance with ThinPrep may provide an alterative method for a diagnosis in select cases in which FNA is not possible or desirable. This technique is straightforward and minimizes the risk of retinal detachment or hemorrhage.

  View details for DOI 10.1080/09273940802140796

  View details for Web of Science ID 000258627000001

  View details for PubMedID 18716946

• Elevated vascular endothelial growth factor levels in Coats disease: rapid response to pegaptanib sodium GRAEFES ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Sun, Y., Jain, A., Moshfeghi, D. M. 2007; 245 (9): 1387-1388

  Abstract

  The purpose was to report a case of elevated intraocular vascular endothelial growth factor (VEGF) levels in a 2-year-old boy with stage 4 Coats disease.Interventional case report.A 2-year-old boy with severe Coats disease and complex retinal detachment refractory to surgical intervention underwent two injections of intravitreal pegaptanib sodium in his right eye 8 weeks apart.After intravitreal injection there was a marked reduction in VEGF (908 to 167 pg/ml) levels and improvement of exudation, hemorrhage, and nearly complete reattachment of his retina within 3 weeks of treatment. The patient remains stable 6 months post-treatment.Coats disease may have a component of dysregulation of VEGF-mediated angiogenesis as evidenced by elevated levels in this patient.

  View details for DOI 10.1007/s00417-007-0559-8

  View details for Web of Science ID 000248835200018

  View details for PubMedID 17342503

• Endogenous Scedosporium apiospermum endophthalmitis ARCHIVES OF OPHTHALMOLOGY Jain, A. T., Egbert, P., McCulley, T. J., Blumenkranz, M. S., Moshfeghi, D. M. 2007; 125 (9): 1286-1289

  View details for Web of Science ID 000249342100023

  View details for PubMedID 17846376

• Retinal pigment epithelium tears after intravitreal injection of bevacizumab (Avastin) for neovascular age-related macular degeneration RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Ronan, S. M., Yoganathan, P., Chien, F. Y., Corcostegui, I. A., Blumenkranz, M. S., Deramo, V. A., Elner, S. G., Fastenberg, D. A., Johnson, M. W., Lopez, M., Mateo, C., Moshfeghi, D. M., Navarro, R., Rosenblatt, B. J., Sanislo, S. R., Saxe, S. J., Zacks, D. N. 2007; 27 (5): 535-540

  Abstract

  Intravitreal bevacizumab (Avastin, Genentech, Inc., South San Francisco, CA) treatment of neovascular age-related macular degeneration (AMD) has become an important part of clinical retinal practice. We describe retinal pigment epithelium (RPE) tears that were noted after intravitreal injection of bevacizumab.In this multimember, retrospective case series, data on eyes that developed RPE tears after intravitreal bevacizumab injection were collected and analyzed. Previous treatments, type of lesion, time to tear, and preinjection and final visual acuities were all compared. The total numbers of bevacizumab injections were available from all four institutions and compiled to estimate the incidence rate.Four retina centers administered a total of 1,455 intravitreal 1.25-mg bevacizumab injections for neovascular AMD during the 9-month study period. Twelve patients presented with RPE tears within 4 days to 8 weeks of injection (mean +/- SD, 24.3 +/- 15.2 days from injection to tear). In each case, the RPE tear was preceded by an RPE detachment, and all had a component of serous sub-RPE fluid. On the basis of our collective data, we estimate an incidence rate of approximately 0.8%.RPE tears can occur after intravitreal injection of bevacizumab. The low incidence of this adverse event should not preclude anti-vascular endothelial growth factor therapy counseling for patients with neovascular AMD, but eyes with serous RPE detachments appear to be most vulnerable to this adverse event.

  View details for Web of Science ID 000247259400002

  View details for PubMedID 17558313

• Multifocal posterior necrotizing retinitis AMERICAN JOURNAL OF OPHTHALMOLOGY Margolis, R., Ferreira, O., Brasil, M., Lowder, C. Y., Smith, S. D., Moshfeghi, D. M., Sears, J. E., Kaiser, P. K. 2007; 143 (6): 1003-1008

  Abstract

  To describe the clinical features of an acute, inflammatory, and progressive retinal necrosis that affects primarily the posterior pole.Retrospective, interventional case series.Twenty-seven eyes of 24 patients diagnosed with and treated for acute retinal necrosis (ARN) were categorized into two groups according to the predominant location of retinitis at presentation: either in the peripheral retina or in the posterior pole. Clinical features, disease progression, visual outcomes, and complications of these two groups were compared.Fifteen eyes demonstrated the known peripheral retinitis pattern, and 12 eyes exhibited a pattern of retinitis that affected mainly the posterior pole. Eyes with peripheral retinitis showed focal, well-demarcated areas of retinal necrosis in the periphery with rapid circumferential progression and rare involvement of the posterior pole. All eyes with posterior pole retinitis had multifocal deep lesions posterior to the vortex veins at presentation, and half of these eyes had lesions in the macula. These lesions progressed to patches of confluent retinitis in both the periphery and the posterior pole. There was no significant difference between the two groups in the incidence of anterior chamber and vitreous cells, vascular sheathing, retinal hemorrhages, or optic disk edema. Patients with posterior retinitis involvement seemed to have a worse visual outcome during the first two years after diagnosis. The Cox proportional hazards model suggested a higher incidence of retinal detachment in patients with posterior retinitis (P = .07).The authors report a pattern of herpetic retinitis that affects predominantly the posterior pole and may have a worse visual prognosis and a higher rate of retinal detachment.

  View details for DOI 10.1016/j.ajo.2007.02.033

  View details for Web of Science ID 000247167000012

  View details for PubMedID 17434436

• Role of genetic factors and inflammation in age-related macular degeneration RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Moshfeghi, D. M., Blumenkranz, M. S. 2007; 27 (3): 269-275

  Abstract

  Complement factor H (CFH) has been implicated in the predisposition to advanced forms of age-related macular degeneration (AMD). The purpose of this review is to highlight recent discoveries implicating single nucleotide polymorphisms on 1q32, 6p21, and 10q26 in the risk for development of AMD. In addition, the central role of CFH in the complement cascade and its role in the inflammatory hypothesis for AMD are reviewed.

  View details for Web of Science ID 000246985100001

  View details for PubMedID 17460581

• Minimizing the risk of endophthalmitis following intravitreal injections. Comprehensive ophthalmology update Lad, E. M., Moshfeghi, D. M. 2006; 7 (6): 277-284

  Abstract

  Over the last decade, the use of intravitreal injections has gained increasing popularity in the treatment of many intraocular disorders. Intravitreal injections have been employed to deliver antibiotics, antivirals, steroids, gas, and antivascular endothelial growth factor. The specific methods and techniques employed for intravitreal injections differ among various studies. We comment on the use of preoperative and postoperative antibiotics, type of anesthesia, gauge of the needle, and coordinates of injection. Intravitreal injections can give rise to complications, of which the most significant and devastating is endophthalmitis. We describe the factors affecting incidence of endophthalmitis after intravitreal injections, recommendations for prophylaxis, and outcomes following endophthalmitis. With increasing experience, the future will bring a reduction in the incidence of endophthalmitis, particularly as the use of intravitreal injections is increasingly supplemented by sustained release devices.

  View details for PubMedID 17244443

• Macular hole with retinal pigment epithelium hyperplasia simulating neoplasm OPHTHALMIC SURGERY LASERS & IMAGING Pilyugina, S. A., Moshfeghi, D. M., Goldsmith, J., Kaiser, P. K. 2006; 37 (6): 484-485

  Abstract

  A case in which a retinal pigment epithelium migration through a stage IV macular hole onto the retinal surface simulated a retinal pigment epithelium neoplasm is described. A 69-year-old woman presented with a hyperpigmented membranous retinal surface growth temporal to a stage IV macular hole in the left eye. Clinical examination and optical coherence tomography were performed prior to pars plana vitrectomy with membrane peeling. Histopathologic processing revealed melanosomes and retinal pigment epithelium with no evidence of neoplastic cells. Retinal pigment epithelium migration can occur through a full-thickness macular hole onto the retinal surface, simulating a retinal pigment epithelium neoplasm. It may be a poor prognostic indicator for visual success.

  View details for Web of Science ID 000242198200007

  View details for PubMedID 17152543

• Presumed transient reactive astrocytic hyperplasia in immature retina Conference of the Pediatric-Retinal-Study-Group Moshfeghi, D. M. LIPPINCOTT WILLIAMS & WILKINS. 2006: S69–S73

  Abstract

  To describe the appearance and clinical course of small, white, endophytic calcific, peripheral lesions in developing retina of premature infants.Retrospective review of all patients evaluated for retinopathy of prematurity (ROP) at a level I neonatal intensive care unit (NICU) in San Jose, CA, between January 1, 2003, and December 31, 2004. Patients were examined either in the NICU or the affiliated outpatient clinic. Clinical examination consisted of dilated fundus examination with 360 degree scleral depression. Lesions were identified if they were white, calcific, peripheral, and transient. Ancillary testing and examination of family members was performed as indicated.A total of 302 unique patients were screened for ROP. Ten lesions were identified in seven eyes. Three eyes had two lesions each. All lesions were unilateral. The size of the lesions was estimated to range between 500 and 700 microm. All lesions were located anterior to the vascularized retina, had minimal elevation on scleral depression, and demonstrated a predilection for the nasal and temporal raphe. Ultrasound findings demonstrated an elevated, hyperechoic mass with orbital shadowing. Computed tomography and magnetic resonance imaging tests did not demonstrate the lesions. Lesions involute slowly over a period of 6 months. There were no systemic findings or familial dispositions.Immature retina in premature infants may predispose to the formation of transient reactive astrocytic hyperplasia. Development of mature retinal vascularization and spontaneous resolution of lesions should alleviate concerns regarding a more malignant diagnosis.

  View details for Web of Science ID 000247086400016

  View details for PubMedID 16946684

• Choroidal infiltration in juvenile myelomonocytic leukaemia BRITISH JOURNAL OF OPHTHALMOLOGY Chang, G. C., Moshfeghi, D. M., Alcorn, D. M. 2006; 90 (8): 1067-1067

  View details for DOI 10.1136/bjo.2006.090191

  View details for Web of Science ID 000239111000035

  View details for PubMedID 16854839

• Macular hole in the shaken baby syndrome ARCHIVES OF OPHTHALMOLOGY Ou, J. I., Moshfeghi, D. M., Tawansy, K., Sears, J. E. 2006; 124 (6): 913-915

  View details for Web of Science ID 000238199300024

  View details for PubMedID 16769851

• Choroidal neovascularization in patients with adult-onset foveomacular dystrophy caused by mutations in the RDS/peripherin gene 11th International Symposium on Retinal Degeneration Moshfeghi, D. M., Yang, Z. L., Faulkner, N. D., Karan, G., Thirumalaichary, S., Pearson, E., Zhao, Y., Tsai, T., Zhang, K. SPRINGER-VERLAG BERLIN. 2006: 35–40

  View details for Web of Science ID 000236276600006

  View details for PubMedID 17249552

• Transpupillary thermotherapy - Effect of wavelength on normal primate retina RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Ito, Y., Mori, K., Takita, H., Sodeyama, T., Anzai, K., Imai, D., Shibuya, M., Moshfeghi, D. M., Yoneya, S., Peyman, G. A. 2005; 25 (8): 1046-1053

  Abstract

  To correlate changes in primate fundus after transpupillary thermotherapy (TTT) at two wavelengths.Twelve primate eyes were treated with TTT using a wavelength of 635 nm (n=7) or 810 nm (n=5). Laser parameters were as follows: 635 nm (spot size, 1 mm; duration, 30-8 seconds; and fluence [power over time], 20-91.4 J/cm) and 810 nm (spot size, 2 mm; duration, 60 seconds; and fluence, 96-436 J/cm). Fundus photography, fluorescein and indocyanine green angiography, and enucleation were performed at time 0 or 2 weeks after TTT for histologic analysis.Threshold for fundus lesions (91.4 J/cm at 635 nm and 191 J/cm at 810 nm), acute and chronic retinal damage shown by histologic analysis (79.2 J/cm at 635 nm and 96 J/cm at 810 nm), and choroidal vessel occlusion (50 J/cm at 635 nm and 96 J/cm at 810 nm) were lower at 635 nm. Disorganization of the retina and retinal pigment epithelium was seen for both wavelengths at time 0 and 2 weeks after TTT. Occlusion of the choriocapillaris and choroidal stromal vessels was noted only in specimens obtained 2 weeks after TTT.TTT resulted in acute and delayed damage to the neurosensory retina that persisted at 2 weeks. The 635-nm wavelength demonstrated a lower threshold fluence for visible fundus lesions, retinal damage, and choroidal vascular occlusion than the 810-nm laser.

  View details for Web of Science ID 000235013000014

  View details for PubMedID 16340536

• Anaphylactoid reaction after verteporfin therapy AMERICAN JOURNAL OF OPHTHALMOLOGY Doshi, A. B., Moshfeghi, D. M., Jack, R. L. 2005; 140 (5): 936-937

  Abstract

  To report a case of anaphylactoid reaction in a woman after initial exposure to verteporfin and to alert physicians of this potentially life-threatening reaction.Interventional case report.An 80-year-old woman who was found to have exudative age-related macular degeneration on clinical examination and fluorescein angiography underwent treatment with verteporfin photodynamic therapy (PDT). Thirty minutes after verteporfin PDT infusion, the patient experienced throat constriction, swelling of her hands, and severe shortness of breath. She received immediate intravenous treatment with methylprednisolone, diphenhydramine, and famotidine and was admitted for observation.The patient's symptoms resolved, and she experienced no long-term side effects related to PDT. Routine noninvasive pulse oximetry, however, did result in finger discoloration and superficial burn. Evaluation revealed that her symptoms were noncardiac in origin.Verteporfin can result in an anaphylactoid reaction. Treating physicians should be advised of possible photosensitizing reactions once the patient has received verteporfin PDT.

  View details for Web of Science ID 000233755600032

  View details for PubMedID 16310483

• Intraocular surgery after treatment of germline retinoblastoma ARCHIVES OF OPHTHALMOLOGY Moshfeghi, D. M., Wilson, M. W., Grizzard, S., Haik, B. G. 2005; 123 (7): 1008-1012

  View details for Web of Science ID 000230352900021

  View details for PubMedID 16009848

• Presumed sterile endophthalmitis following intravitreal triamcinolone acetonide injection OPHTHALMIC SURGERY LASERS & IMAGING Moshfeghi, D. M., Kaiser, P. K., Bakri, S. J., Kaiser, R. S., Maturi, R. K., Sears, J. E., Scott, I. U., Belmont, J., Beer, P. M., Quiroz-Mercado, H., MIELER, W. F. 2005; 36 (1): 24-29

  Abstract

  To report acute postoperative, presumed sterile endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA).Retrospective, interventional, multicenter study of patients with acute sterile endophthalmitis following IVTA injection.A total of 922 IVTA injections were performed. Eight eyes of 8 patients with presumed sterile endophthalmitis were identified. The incidence of endophthalmitis was 0.87% (95% confidence interval, 0.38% to 1.70%). Median time to presentation was 1.5 days (range, 1 to 7 days). Median presenting visual acuity was 20/563 (range, 20/80 to light perception). Initial treatment included vitreous tap and injection of antibiotics (n = 4), pars plana vitrectomy and injection of intravitreal antibiotics (n = 2), or systemic treatment alone with oral levofloxacin (n = 2). Six of 6 intraocular cultures were sterile. Median follow-up was 5.9 months (range, 4 to 9 months) with a median visual acuity at last follow-up of 20/75 (range, 20/40 to counting fingers).Acute presumed sterile endophthalmitis following IVTA injection presents early in the postoperative period. Visual outcomes are generally good.

  View details for Web of Science ID 000226324800003

  View details for PubMedID 15688968

• Appositional suprachoroidal hemorrhage: A case-control study Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Moshfeghi, D. M., Kim, B. Y., Kaiser, P. K., Sears, J. E., Smith, S. D. ELSEVIER SCIENCE INC. 2004: 959–63

  Abstract

  To identify the risk factors, prognostic factors, and clinical outcomes of patients with perioperative appositional suprachoroidal hemorrhage (ASCH).Case-control study.Tertiary referral center.Subjects included all patients with perioperative ASCH documented by B-scan ultrasound between May 1990 and March 2001. Two or three control patients were selected for each case, matched by surgeon, procedure, and date of surgery within 1 month. Surgery was performed as necessary. main outcome measures. The odds of ASCH associated with clinical risk factors. secondary outcome measure: visual acuity.Thirty-seven cases with ASCH were identified. Ninety-two procedure- and surgeon-matched control subjects (2.48:1) were selected. Twenty-six cases (71%) of ASCH were related to a glaucoma operation. Risk factors for the development of ASCH included previous vitrectomy (P = .003, odds ratio of 12) and older age (P = .007, odds ratio 1.57/decade of increasing age). Hypertension was found to be protective (P = .02, odds ratio of 0.33). Factors associated with a poor visual outcome in patients with ASCH included apposition >30 days (P = .01), history of uveitis (P = .04), history of dry age-related macular degeneration (P = .05), and history of extracapsular cataract extraction (P = .05). Median pre-ASCH visual acuity was 20/100, and final median visual acuity was 20/1600.Risk factors for the development of ASCH include previous vitrectomy and older age. Patients with these risk factors should be informed of their greater chance of poor visual acuity and anatomic outcomes secondary to the development of ASCH.

  View details for DOI 10.1016/j.ajo.2004.07.002

  View details for Web of Science ID 000225960200007

  View details for PubMedID 15629286

• Churg-Strauss syndrome in a child: retina and optic nerve findings BRITISH JOURNAL OF OPHTHALMOLOGY Partal, A., Moshfeghi, D. M., Alcorn, D. 2004; 88 (7): 971-972

  View details for DOI 10.1136/bjo.2003.039859

  View details for Web of Science ID 000222093100033

  View details for PubMedID 15205253

• A novel RDS/peripherin gene mutation associated with diverse macular phenotypes. Ophthalmic genetics Yang, Z., Li, Y., Jiang, L., Karan, G., Moshfeghi, D., O'Connor, S., Li, X., Yu, Z., Lewis, H., Zack, D., Jacobson, S., Zhang, K. 2004; 25 (2): 133-145

  Abstract

  Pattern dystrophy is a heterogeneous group of retinal dystrophies of which butterfly-shaped pattern dystrophy (BPD) and adult-onset foveomacular dystrophy (AOFMD) are the two most common forms. BPD is characterized by a butterfly-shaped, irregular, depigmented lesion at the level of the retinal pigment epithelium. In contrast, AOFMD is characterized by the presence of slightly elevated, symmetric, solitary, round to oval, yellow lesions at the level of the retinal pigment epithelium. We identified three independent kindreds with pattern dystrophy, one with four patients affected with BPD and the other two with 14 affected patients with AOFMD. We performed complete ophthalmic examination, fluorescein angiography, linkage mapping, and mutational screening in the RDS/peripherin gene in the affected patients. Patients affected with BPD had a best-corrected vision of 20/20 to 20/25, whereas vision in the eyes of patients with AOFMD ranged from 20/20 to 20/400. In all three kindreds, sequence analysis identified an A-to-G change at nucleotide position 422 of the RDS/peripherin gene, predicting a novel Tyr-141-Cys substitution. A haplotype analysis revealed that these three kindreds shared an identical disease haplotype at the RDS/peripherin locus, indicating that the mutation reflects a founder effect. The sequence change that segregated with the disease phenotype was not observed in 200 control chromosomes. Our results identified a novel mutation in the RDS/ peripherin gene that can cause diverse macular phenotypes. Genetic and clinical investigation of pattern dystrophy may provide useful diagnostic tools and new treatment strategies for this disorder.

  View details for PubMedID 15370544

• Intravitreal triamcinolone acetonide RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Peyman, G. A., Moshfeghi, D. M. 2004; 24 (3): 488-490

  View details for Web of Science ID 000222156800032

  View details for PubMedID 15187684

• Diagnostic approaches to severe, atypical toxoplasmosis mimicking acute retinal necrosis OPHTHALMOLOGY Moshfeghi, D. A., Dodds, E. A., Couto, C. A., Santos, C. I., Nicholson, D. H., Lowder, C. Y., Davis, J. L. 2004; 111 (4): 716-725

  Abstract

  To describe the means of diagnosis and clinical features of atypical toxoplasmic chorioretinitis mimicking acute retinal necrosis.Observational case series.Twenty-two patients (25 eyes) with widespread chorioretinitis resulting from toxoplasmosis examined between 1990 and 2001.Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous and vitreous, serum and intraocular antibody determination, culture of intraocular fluid, retinal biopsy, histopathologic examination, therapeutic trial of antibiotics active against toxoplasmosis, or a combination thereof.The primary outcome measure was diagnosis of disseminated toxoplasmic chorioretinitis by any combination of tests or by empiric use of specific antibiotics. The secondary outcome measure was visual and anatomic outcome of treatment.Mean age was 53.5 years (range, 19-77 years), with a median of 59.5 years. There were 9 women and 13 men. Six patients were infected with HIV, and 3 patients, 1 with HIV, had bilateral disease. Mean initial vision was 20/110 (median, 20/400; range, 20/20 to no light perception [NLP]). Sixteen patients (73%) had received oral or injectable corticosteroids and 11 (50%) had received antiviral therapy before the diagnosis of toxoplasmosis. Diagnosis was made solely by clinical response to antitoxoplasmosis medications in 4 patients. Sixteen patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Visual acuity improved after treatment in 7 of 25 eyes (28%). Mean final visual acuity was 20/156 (median, 20/2500; range, 20/30 to NLP). Anatomically, 18 of 23 eyes with follow-up had healed or improved chorioretinitis. Retinitis was progressive in 1 eye, 2 eyes were enucleated, and 2 were phthisical.Diagnosis of atypical toxoplasmic chorioretinitis that mimics viral retinitis can be accomplished by several means. Prompt diagnosis may help avoid poor visual and anatomic outcomes after prolonged initial treatment with oral prednisone or antiviral medications.

  View details for DOI 10.1016/j.ophtha.2003.07.004

  View details for Web of Science ID 000220613300015

  View details for PubMedID 15051204

• Submacular surgery for choroidal neovascularization following nocardial endophthalmitis Retina Summit III Conference Moshfeghi, D. M., Sears, J. E., Lewis, H. LIPPINCOTT WILLIAMS & WILKINS. 2004: 161–64

  View details for Web of Science ID 000189234200026

  View details for PubMedID 15076962

• Age-related macular degeneration: Evaluation and treatment CLEVELAND CLINIC JOURNAL OF MEDICINE Moshfeghi, D. M., Lewis, H. 2003; 70 (12): 1017-?

  Abstract

  Any patient age 50 or older with distorted vision or vision loss may have age-related macular degeneration and should be immediately referred to an ophthalmologist. Early diagnosis and treatment are essential to preserve the current level of vision. We outline risk factors, clinical signs, what happens to the retina, and what treatments are currently available, as well as recommendations about vitamin and mineral supplementation.

  View details for Web of Science ID 000187241900003

  View details for PubMedID 14686682

• Acute endophthalmitis following intravitreal triamcinolone acetonide injection AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Kaiser, P. K., Scott, I. U., Sears, J. E., Benz, M., Sinesterra, J. P., Kaiser, R. S., Bakri, S., Maturi, R. K., Belmont, J., Beer, P. M., Murray, T. G., Quiroz-Mercado, H., MIELER, W. F. 2003; 136 (5): 791-796

  Abstract

  To report the clinical features, causative organisms, management, and visual acuity outcomes of eight eyes of eight patients who developed acute postoperative endophthalmitis following intravitreal injection of triamcinolone acetonide (IVTA).Retrospective, multicenter, interventional, case series.A retrospective, interventional, case series of all patients with acute postoperative endophthalmitis following IVTA at seven academic clinical centers between March 2001 and July 2002.A total of 922 IVTAs were performed. Eight eyes of eight patients with acute postoperative endophthalmitis were identified in the 6 weeks following IVTA for an incidence of 0.87% (95% confidence interval of 0.38% to 1.70%). The median time to presentation was 7.5 days (range, 1-15 days) after IVTA. The most common clinical findings were iritis (n = 8), vitritis (n = 8), hypopyon (n = 8), pain (n = 7), red eye (n = 6), and decreased vision (n = 5). The median presenting visual acuity was 20/1127 (range, 20/60 to light perception). Initial treatment consisted of vitreous tap and injection of antibiotics (n = 6) or pars plana vitrectomy and injection of intravitreal antibiotics (n = 2). Intraocular cultures yielded identification in seven patients. One demonstrated intracellular gram-positive cocci in chains with numerous polymorphonuclear cells on gram stain. The median postinfection vision was 20/400 (range, 20/40 to no light perception). Three patients ended up with no light perception visual acuity, including enucleation (n = 1) and phthisis (n = 1).Acute postoperative endophthalmitis following IVTA occurs rapidly and can result in severe loss of vision.

  View details for DOI 10.1016/S0002-9394(03)00483-5

  View details for Web of Science ID 000186146000001

  View details for PubMedID 14597028

• Orbital inflammatory syndromes with systemic involvement may mimic metastatic disease OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Foley, M. R., Moshfeghi, D. M., Wilson, M. W., Haik, B. G., Pappo, A. S., Hill, D. A. 2003; 19 (4): 324-327

  Abstract

  Physical examination of a 9-year-old girl with a 2-month history of swelling of the left orbit demonstrated an orbital mass, blepharoptosis, and proptosis. Computed tomography revealed a 2 x 3-cm mass in the superior left orbit that expanded orbital dimensions. Radiography showed abnormalities in the parietal and frontal bones and distal right tibia. Magnetic resonance imaging demonstrated an 8.5-cm abnormality of the marrow space of the right mid-tibia. Bone marrow biopsy was unremarkable. Orbital and tibial biopsies showed a nonspecific chronic inflammation. Idiopathic inflammation that involves the orbit (orbital pseudotumor) and that has systemic manifestations may mimic more serious conditions, such as metastases from rhabdomyosarcoma or Ewing sarcoma, chronic recurrent multifocal osteomyelitis (CRMO), and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis). Accurate diagnosis requires careful clinical and pathologic examinations.

  View details for DOI 10.1097/01.IOP.0000075022.14333.E9

  View details for Web of Science ID 000184369400014

  View details for PubMedID 12878885

• Transpupillary thermotherapy threshold parameters: Funduscopic, angiographic, and histologic findings in pigmented and nonpigmented rabbits RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Peyman, G. A., Genaidy, M., Moshfeghi, D. M., Ghahramani, F., Yoneya, S., Men, G., Kuo, P. C., Bezerra, Y., Nishiyama-Ito, Y. 2003; 23 (3): 371-377

  Abstract

  To evaluate the effect of pigmentation on threshold fluence levels, needed to produce visible and angiographic lesions, of transpupillary thermotherapy (TTT) in rabbits.Six pigmented and nine nonpigmented rabbits underwent TTT with an 810-nm diode laser coupled to a slit-lamp biomicroscope using a spot size of 2 or 3 mm. The power ranged from 80 to 200 mW with 1 to 3 minutes of laser exposure for pigmented rabbits and 750 to 1800 mW with 1 minute of exposure for albino rabbits. These parameters were also evaluated after compression of the globe using the contact lens to induce blanching of the optic nerve head. After the experiment, the eyes were enucleated under deep anesthesia, and the animals were killed immediately.In pigmented rabbits, the threshold fluence with the 2-mm spot size was 229 J/cm2 without compression and 153 J/cm2 with compression. With the 3-mm spot size, the threshold decreased from 200 to 150 mW as the duration of exposure lengthened (2 or 3 minutes), increasing the fluence from 170 to 382 J/cm2. In nonpigmented rabbits, the threshold fluence with the 2-mm spot size was 2,865 J/cm2 without compression and 2,674 J/cm2 with compression. With the 3-mm spot size, the threshold fluence of 1,528 J/cm2 was not affected by compression. Histopathologic studies showed transretinal damage at the lowest levels necessary to achieve angiographic evidence of a treatment lesion or a barely visible funduscopic lesion at the time of treatment.Nonpigmented rabbits required more than a 12-fold increase in total TTT fluence compared with pigmented rabbits with the 2-mm spot size and a ninefold increase with the 3-mm spot size. Inner and outer retinal damage was seen histopathologically at these levels.

  View details for Web of Science ID 000183932600014

  View details for PubMedID 12824839

• Quantitative verteporfin angiography in humans Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Moshfeghi, D. M., Blumenkranz, M. S., Sanislo, S. R., Hnik, P. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2003: U698–U698

  View details for Web of Science ID 000184607002497

• Clinicopathologic study after submacular removal of choroidal neovascular membranes treated with verteporfin ocular photodynamic therapy AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Kaiser, P. K., Grossniklaus, H. E., Sternberg, P., Sears, J. E., Johnson, M. W., Ratliff, N., Branco, A., Blumenkranz, M. S., Lewis, H. 2003; 135 (3): 343-350

  Abstract

  To report the clinicopathologic findings after submacular removal of choroidal neovascular membranes (CNV) treated with verteporfin ocular photodynamic therapy.Interventional case series.Retrospective review of eight eyes of eight patients who underwent submacular surgery for CNV after having previously received verteporfin ocular photodynamic therapy for presumed ocular histoplasmosis (one patient), age-related macular degeneration ([AMD] three patients) pathologic myopia (two patients), punctate inner choroiditis (one patient), and idiopathic CNV (one patient). All cases had undergone ocular photodynamic therapy with verteporfin using standard protocols. Six of eight patients suffered a submacular hemorrhage after ocular photodynamic therapy, and two of eight patients refused further ocular photodynamic therapy. All patients subsequently had submacular surgery with removal of the CNV. One membrane was routinely processed, sectioned, and stained with hematoxylin and eosin. Five membranes were stained with toluidine blue for light microscopic examination. Semithin (1.0 microm) sections were cut and stained with uranyl acetate-lead citrate for transmission electron microscopy.Choroidal neovascular membranes were removed at 3 days (presumed ocular histoplasmosis), 29 days (punctate inner choroiditis), 63 days (AMD, pathologic myopia), 66 days (AMD), 107 days (pathologic myopia), 116 days (AMD), and 152 days (idiopathic) after verteporfin ocular photodynamic therapy. Histopathologic and ultrastructural examination showed areas of vascular occlusion at 3 days that were not seen at later time points. All specimens had patent CNV. There were signs of vascular damage with extravasated erythrocytes and fibrin, pigment clumping in cells, and inflammatory cells in all but the 3-day specimen.This case series presents data only from patients who refused repeat treatment with ocular photodynamic therapy or who developed submacular hemorrhage after initial photodynamic therapy. Histopathologic evaluation of CNV 3 days after verteporfin ocular photodynamic therapy showed partial vascular occlusion that was not present in later specimens. These later specimens demonstrated evidence of vascular damage. Verteporfin ocular photodynamic therapy does not appear to lead to permanent and complete occlusion of the CNV. Thus, treatments that lead to permanent closure of CNV without damage to the retinal pigment epithelium and sensory retina are still needed.

  View details for Web of Science ID 000181258100012

  View details for PubMedID 12614752

• A novel mutation in the RDS/Peripherin gene causes adult-onset foveomacular dystrophy AMERICAN JOURNAL OF OPHTHALMOLOGY Yang, Z. L., Lin, W., Moshfeghi, D. M., Thirumalaichary, S., Li, X., Jiang, L., Zhang, H., Zhang, S., Kaiser, P. K., Traboulsi, E. I., Zhang, K. 2003; 135 (2): 213-218

  Abstract

  To describe a novel mutation in the RDS/Peripherin gene that results in a moderately severe form of adult-onset foveomacular dystrophy.Observational case series.Selected members of a family with adult-onset foveomacular dystrophy underwent complete ophthalmic evaluation, including fundus photography and fluorescein angiography, in a tertiary care referral center. The study population consisted of 12 members of a Caucasian kindred. After providing informed consent, patients donated blood for genomic DNA extraction and mutational screening using standard techniques. The main outcome measure were the presence of a RDS/Peripherin gene mutation in a patient with the disease and its absence in unaffected family members and controls.Eight affected family members and no unaffected family members demonstrated a single guanine base deletion at nucleotide 112 that led to premature termination at amino acid 38 of RDS/Peripherin polypeptide. This frameshift mutation results in truncation of nearly 90% of the gene product, thus probably representing a null allele. That results in a relatively severe phenotype, with choroidal neovascularization developing in two patients and geographic atrophy involving the macula in three patients.We describe a frameshift null mutation in the RDS/Peripherin gene associated with a relatively severe manifestation of adult-onset foveomacular dystrophy in affected family members.

  View details for Web of Science ID 000180709400013

  View details for PubMedID 12566026

• Occult orbital neuroblastoma detected after administration of an antitumor vaccine OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Wilson, M. W., Moshfeghi, D. M., Haik, B. G., Haight, A. E., Hill, D. A., Davidoff, A. M., Rousseau, R. F., Bowman, L. C. 2003; 19 (1): 77-79

  Abstract

  A 6-year-old girl with neuroblastoma developed swelling and erythema of her right upper eyelid following administration of an interleukin-2 and lymphotactin gene-modified allogeneic neuroblastoma cell vaccine. Computed tomography demonstrated a cystic lesion in the subperiosteal space. A biopsy of the mass showed necrotic neuroblastoma with minimal associated inflammation. To our knowledge, this case represents the first description of occult orbital metastases in a patient with neuroblastoma detected after administration of an antitumor vaccine.

  View details for DOI 10.1097/01.IOP.0000040671.73622.87

  View details for Web of Science ID 000180481900011

  View details for PubMedID 12544797

• Retinal and choroidal vascular occlusion after posterior sub-tenon triamcinolone injection AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Lowder, C. Y., Roth, D. B., Kaiser, P. K. 2002; 134 (1): 132-134

  Abstract

  To report a case of retinal and choroidal vascular occlusion occurring as a complication after posterior sub-Tenon triamcinolone injection for treatment of uveitic cystoid macular edema.Interventional case report.Retrospective study. A 32-year-old woman with uveitis and cystoid macular edema underwent a right posterior sub-Tenon injection of triamcinolone (40 mg/ml, 1 ml total) through a superotemporal approach after topical anesthesia. After the procedure, the patient experienced severe eye pain, orbital ecchymosis, and globe proptosis consistent with retrobulbar hemorrhage.Dilated fundus examination of the right eye (OD) demonstrated multiple intraretinal hemorrhages with particulate white emboli occluding the retinal and choroidal vessels. Visual acuity was no light perception. Ocular massage and hypotensive therapy was initiated for an intraocular pressure of 50 mm Hg. Canthotomy and cantholysis were performed. A total of 39 months post-incident, her visual acuity improved to 20/100.Posterior sub-Tenon triamcinolone injection can rarely result in retinal and choroidal occlusion. Immediate intervention may preserve limited visual acuity.

  View details for Web of Science ID 000176614600026

  View details for PubMedID 12095826

• Choroidal osteoma in a patient with contralateral persistent hyperplastic primary vitreous RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Wilson, M. W., Moshfeghi, D. M., Haik, B. G., Syed, N. A., Morris, W. R. 2002; 22 (3): 358-360

  View details for Web of Science ID 000176594200018

  View details for PubMedID 12055473

• Retinoblastoma metastatic to the ovary in a patient with Waardenburg syndrome AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Wilson, M. W., Haik, B. G., Hill, D. A., Rodriguez-Galindo, C., Pratt, C. B. 2002; 133 (5): 716-718

  Abstract

  To report a child with retinoblastoma and Waardenburg syndrome who developed ovarian metastases.Interventional case report.Unilateral retinoblastoma was diagnosed in a 3-year-old girl with Waardenburg syndrome and leukocoria in the right eye. The patient had a Reese-Ellsworth Group Va tumor and underwent enucleation. Two years later, she developed metastatic disease involving the bone marrow, right humerus, both supraorbital bones, and both tibias. She was treated with chemotherapy, orbital irradiation, and bone marrow transplant but returned 7 months later with back pain and urinary retention.Exploratory laparotomy revealed a right ovarian mass, and the excised ovary showed metastatic retinoblastoma. The child underwent chemotherapy and remained asymptomatic for 9 months, when brain metastases were diagnosed. She died within 2 days of admission.We believe that this is the first description of a patient with retinoblastoma and Waardenburg syndrome and of an ovarian metastasis from retinoblastoma.

  View details for Web of Science ID 000175513700025

  View details for PubMedID 11992879

• Swallowed ocular prostheses - Report of three cases in children with retinoblastoma OPHTHALMIC PLASTIC AND RECONSTRUCTIVE SURGERY Moshfeghi, D. M., Wilson, M. W., Martin, T. L., Haik, B. G. 2002; 18 (3): 211-213

  Abstract

  To report 3 instances of 2 children who swallowed their ocular prostheses.A 30-month-old boy whose eye had been enucleated for retinoblastoma swallowed his ocular prosthesis on 2 different occasions, and a 32-month-old boy whose eye had also been enucleated for retinoblastoma swallowed his ocular prosthesis once.In the second child, an abdominal radiograph was obtained, but the swallowed prosthesis was not apparent, and radiographic imaging of the recovered prosthesis failed to demonstrate an identifiable object. In each case, the prosthesis was recovered in the child's stool without incident several weeks later. Neither child had physical complications as a result of the swallowing events.We report 3 instances in which a child fitted for an ocular prosthesis after enucleation swallowed his prosthesis and had no untoward effects. The failure of imaging to detect the prostheses in the second child is attributed to the radiolucent nature of materials used in the manufacture of the prosthesis. Each of the children was having life stresses in addition to his medical treatment that may have accounted for his behavior.

  View details for Web of Science ID 000175793800011

  View details for PubMedID 12021653

• Mutations in the RPGR gene cause X-linked cone dystrophy HUMAN MOLECULAR GENETICS Yang, Z. L., Peachey, N. S., Moshfeghi, D. M., Thirumalaichary, S., Chorich, L., Shugart, Y. Y., Fan, K., Zhang, K. 2002; 11 (5): 605-611

  Abstract

  X-linked cone dystrophy is a type of hereditary retinal degeneration characterized by a progressive dysfunction of the day vision or photopic (cone) system with preservation of night vision or scotopic (rod) function. The disease presents with a triad of photophobia, loss of color vision and reduced central vision. This phenotype is distinct from retinitis pigmentosa (RP) in which there are prominent night and peripheral vision disturbances. X-linked cone dystrophy is a genetically heterogeneous disorder, with linkage to loci on Xp11.4--Xp21.1 (COD1, OMIM 304020) and Xq27 (COD2, OMIM 303800). COD1 maps to a region that harbors the RPGR gene, mutations in which account for >70% of patients with X-linked RP. The majority of these mutations reside in one purine-rich exon, ORF15, encoding 567 amino acids with a repetitive domain rich in glutamic acid residues. We mapped two families with X-linked cone dystrophy to the COD1 locus and identified two distinct mutations in ORF15 in the RPGR gene (ORF15+1343_1344delGG and ORF15+694_708del15) leading to a frame-shift and premature termination of translation in one case and a deletion of five amino acids in another. Consistent with expression of RPGR in rods and cones, our results show that mutations in RPGR, in addition to X-linked RP, can also cause cone-specific degeneration.

  View details for Web of Science ID 000174281300014

  View details for PubMedID 11875055

• Splice site mutation in the peripherin/RDS gene associated with pattern dystrophy of the retina AMERICAN JOURNAL OF OPHTHALMOLOGY Sears, J. E., Aaberg, T. A., Daiger, S. P., Moshfeghi, D. M. 2001; 132 (5): 693-699

  Abstract

  To report the phenotype and genotype of a splice site mutation at intron 2 of the peripherin/RDS gene in four half-siblings with pattern dystrophy of the retina.Experimental study.In four siblings with a common mother and three separate fathers, complete ophthalmic examination, pedigree, electrophysiologic testing, and fluorescein angiography studies were obtained. Genomic DNA from serum lymphocytes was isolated and used as a template for primers specific for the cone homeobox gene (CRX), rhodopsin (RHO), and peripherin/RDS genes to conduct single stranded conformational analysis and cycle sequencing.The pedigree of four affected siblings suggested probable autosomal dominance transmission of pattern dystrophy. In the four siblings, best corrected visual acuity ranged from 20/20 to 20/80 by Snellen chart. Clinical findings included discrete, localized degenerative changes of the macular retinal pigment epithelium in all patients, with subclassification foveal. One patient exhibited pigment clumping within the atrophic areas. Another patient exhibited yellow flecks diffusely in the macula. Fluorescein angiographic findings included central hypofluorescence with a surrounding rim of hyperfluorescence that corresponded to the observed fundus lesions and window defects. There was a range of electroretinography (ERG) and electrooculography (EOG) findings. One patient demonstrated both cone and rod dysfunction on ERG testing and another demonstrated decreased rod function. EOG testing was normal in two patients and mildly diminished in one patient. DNA sequencing identified a point mutation in intron 2 of the peripherin/RDS gene, consisting of an A to T change at 1068+3, present in all four affected patients.Four siblings with pattern dystrophy of the retina presented a splice site mutation in the peripherin/RDS gene.

  View details for Web of Science ID 000171884700010

  View details for PubMedID 11704030

• Multiagent chemotherapy as neoadjuvant treatment for multifocal intraocular retinoblastoma 104th Annual Meeting of the American-Academy-of-Ophthalmology Wilson, M. W., Rodriguez-Galindo, C., Haik, B. G., Moshfeghi, D. M., Merchant, T. E., Pratt, C. B. ELSEVIER SCIENCE INC. 2001: 2106–14

  Abstract

  To evaluate the efficacy of multiagent chemotherapy in the neoadjuvant treatment of retinoblastoma.Noncomparative, prospective case series.Twenty consecutive patients with multifocal intraocular retinoblastoma (4 unilateral, 16 bilateral [36 eyes]).Eight cycles of chemotherapy with carboplatin and vincristine were administered at 3-week intervals over a 6-month period. Supplemental therapy was withheld until disease progression was documented.Disease progression (defined as tumor growth, vitreous or subretinal seed progression, and new tumor formation), delay of external beam radiotherapy, and ocular survival.Thirty-six eyes were treated. Eighteen eyes had Reese-Ellsworth group I-III tumors, and 16 eyes had Reese-Ellsworth group IV-V tumors at diagnosis. Two patients, who had unilateral disease at diagnosis, subsequently had tumors develop in the contralateral eye. Nineteen of 20 patients (95%) completed eight cycles of chemotherapy without disease progression. Three eyes of three different patients were successfully treated with chemotherapy alone. Thirty-three of 36 eyes (92%) progressed after completion of chemotherapy: 15 of the 18 eyes (83.3%) with Reese-Ellsworth group I-III and 16 of 16 eyes (100%) with Reese-Ellsworth group IV-V tumors. Seventeen eyes (52%) had growth of a tumor, whereas 14 eyes (42%) had progressive vitreous seeding, and 2 eyes (6%) had new tumors develop. Fifteen eyes (42%) required external beam radiotherapy. Twenty-nine of 36 (80.5%) eyes were salvaged. The median follow-up after chemotherapy was 19 months (range, 3-42 months).Multiagent chemotherapy alone does not ensure a cure for multifocal intraocular retinoblastoma. Supplemental focal therapy is needed to control disease progression.

  View details for Web of Science ID 000171964500045

  View details for PubMedID 11713087

• Toxicity of the photosensitizer NPe6 following intravitreal injection OPHTHALMIC SURGERY AND LASERS El-Dessouky, E. S., Moshfeghi, A. A., Peyman, G. A., Yoneya, S., Mori, K., Kazi, A. A., Moshfeghi, D. M. 2001; 32 (4): 316-321

  Abstract

  To determine the retinal toxicity of mono-L-aspartyl chlorin e6 (NPe6) following intravitreal injection.Twelve Dutch-belted rabbits divided into 5 experimental groups (n=2 each) were injected intravitreally with 6.25, 12.5, 25, 50, or 100 microg of NPe6; one control group (n=2) was injected with intravitreal normal saline. One eye in each rabbit was sutured shut to test the effect of light exposure. Fundus photography and electroretinograms were performed before treatment and 2 days, 1 week, and 2 weeks after injection. Animals were euthanized and the eyes enucleated for histopathologic analysis.After 1 week, 4 uncovered eyes given 50 and 100 microg had central retinal vein occlusion and varying degrees of retinal hemorrhage. RPE proliferation was seen in the covered eyes given 50 or 100 microg. Electroretinograms revealed absent retinal response at 100 microg and mild toxicity at 50 microg, but no change from normal at doses of < or = 25 microg of NPe6.Intravitreal doses of < or = 25 microg NPe6 caused little or no apparent toxicity; however, toxicity was significant at doses of 50 microg and 100 microg.

  View details for Web of Science ID 000169933800008

  View details for PubMedID 11475398

• Photodynamic therapy of experimental choroidal neovascularization with a hydrophilic photosensitizer - Mono-L-aspartyl chlorin e6 RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Mori, K., Yoneya, S., Anzail, K., Kabasawa, S., Sodeyama, T., Peyman, G. A., Moshfeghi, D. M. 2001; 21 (5): 499-508

  Abstract

  To demonstrate the selective localization of the hydrophilic photosensitizer mono-L-aspartyl chlorin e6 (NPe6) in experimental choroidal neovascularization in nonhuman primate eyes.Sixty-seven experimental choroidal neovascular lesions (CNV) were created in the fundi of Macaca monkeys using the modified Ryan's model and documented by fluorescein and indocyanine green angiography. To determine the biodistribution of NPe6 and the optimal timing of laser irradiation after dye administration, NPe6 angiography and fluorescence microscopy with NPe6 were performed. Photodynamic therapy (PDT) was performed at various dye doses (0.5-10.0 mg/kg) and laser fluences (7.5-225.0 J/cm2) on the CNV and on 10 areas of normal retina and choroid. Treatment outcomes were assessed by fluorescein and indocyanine green angiography and confirmed by light and electron microscopy.NPe6 fluorescence microscopy demonstrated intense fluorescence of CNV and retinal pigment epithelial cells. Choroidal vessel walls and outer retina adjacent to CNV fluoresced moderately; retinal vessel walls and microcapillaries had trace fluorescence. The fluorescence of CNV lesions on fluorescein angiography became stronger than that of retinal vessels 20-60 minutes after dye injection. Choroidal neovascular lesion closure was achieved with NPe6 PDT without significant damage to the sensory retina. Histology demonstrated necrosis of CNV endothelial cells with minimal damage to surrounding tissues.NPe6 PDT selectively localizes to experimental CNV in nonhuman primates, resulting in occlusion of CNV with sparing of the neurosensory retina.

  View details for Web of Science ID 000171559000013

  View details for PubMedID 11642380

• Retreatment effect of Npe6 photodynamic therapy on the normal primate macula RETINA-THE JOURNAL OF RETINAL AND VITREOUS DISEASES Nakashizuka, T., Mori, K., Hayashi, N., Anzail, K., Kanail, K., Yoneya, S., Moshfeghi, D. M., Peyman, G. A. 2001; 21 (5): 493-498

  Abstract

  To evaluate the safety and efficacy of repeated photodynamic therapy (PDT) with mono-L-aspartyl chlorin e6 (NPe6) on normal primate fovea and choroid.Macaca fuscata monkeys were used as experimental subjects. Mono-L-aspartyl chlorin e6 at a dose of 2 mg/kg was administered by intravenous infusion. Laser irradiation was applied within 5 minutes using a 664-nm diode laser at a power output of 5.9 mW (750 mW/cm2), spot size of 1,000 microm, and time of 10 seconds. This resulted in a fluence of 7.5 J/cm2. Three consecutive PDT treatments at 2-week intervals were applied over the center of the fovea and posterior fundus near the arcade vessels of each eye. The animals were killed and the eyes were enucleated for histologic study 2 weeks after the last treatment.Limited changes could be observed in the sensory retina under light microscopy. Photoreceptor cells and outer segments were not damaged, even after repeated PDT. Proliferation and duplication of the retinal pigment epithelial cells were common findings. A plaque of fibrous tissue was present, interwoven with retinal pigment epithelial cells in eyes that received repeated PDT. The retinal vessels remained patent even after three sessions of PDT. However, occlusion of the choriocapillaris and the large choroidal vessels was observed after repeated PDT treatment.Repeated PDT of healthy nonhuman primate fundi using a hydrophilic photosensitizer (NPe6) shows preservation of the neurosensory retina components and architecture with damage confined to the retinal pigment epithelium and choriocapillaris.

  View details for Web of Science ID 000171559000012

  View details for PubMedID 11642379

• Mardi Gras Eye Injury Survey, 1998-1999 Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO) Moshfeghi, D. M., Moshfeghi, A. A., Belafsky, P. C., Kim, G., Sheffler, M., Fink, A. J., Kastl, P. R. LIPPINCOTT WILLIAMS & WILKINS. 2000: 1083–86

  Abstract

  We studied the nature of associated ocular trauma during the 1998 and 1999 New Orleans parade seasons and whether trends were observable from previous surveys.A prospective survey and retrospective analysis included 18 emergency rooms (ERs) in the New Orleans area.Sixteen surveys representing eight ERs were completed between February 19 and 24, 1998, and 32 surveys representing five ERs were completed between February 5 and 17, 1999. In both years, the most common ocular complaints were pain, blur, foreign body sensation, tearing, and photophobia. The most common slit lamp findings in 1998 were within normal limits, corneal abrasion, and conjunctival hyperemia. In 1999, the most common findings were subconjunctival hemorrhage, corneal abrasion, cell and flare, and lid laceration.Projectile injuries of the eyes are common during Mardi Gras due to the nature of interaction between paradegoers and float riders. We found no identifiable trend in the number or type of injuries reported in 1986, 1987, and 1998 Mardi Gras surveys.

  View details for Web of Science ID 000165436500008

  View details for PubMedID 11095558

• Threshold and retreatment parameters of NPe6 photodynamic therapy in retinal and choroidal vessels OPHTHALMIC SURGERY AND LASERS Peyman, G. A., Kazi, A. A., Moshfeghi, D., Unal, M., Khoobehi, B., Yoneya, S., Mori, K., Rivera, I. 2000; 31 (4): 323-327

  Abstract

  To determine the threshold fluence for producing choroidal and retinal vascular occlusion with mono-L-aspartyl chlorin e6 (NPe6) photodynamic therapy (PDT) during primary treatment and the effect of retreatment.Primary treatment: Rats, rabbits, and monkeys underwent NPe6 PDT to determine the threshold fluences for choroidal and retinal vessel occlusion. The threshold was determined by analyzing fluorescein angiograms for areas of nonperfusion. Retreatment: Dutch-belted rabbits underwent NPe6 PDT followed by fluorescein angiography. Rabbits were retreated one week later at the same parameters.Fluence levels and vascular damage thresholds were always higher for retinal than for choroidal vascular occlusion. Retreatment caused choroidal vessel closure at all tested fluences but retinal capillaries closed only at a fluence > 17.7 J/cm2.NPe6 PDT has a lower threshold to occlude choroidal vessels than retinal vessels. The cumulative effect of retreatment does not damage retinal vessels unless the threshold is exceeded during a single retreatment session.

  View details for Web of Science ID 000088262900009

  View details for PubMedID 10928670

• Threshold power levels for NPe6 photodynamic therapy Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO) Kazi, A. A., Peyman, G. A., Unal, M., Khoobehi, B., Yoneya, S., Mori, K., Moshfeghi, D., Moshfeghi, A. A. SLACK INC. 2000: 136–42

  Abstract

  To determine the threshold power levels for producing retinal and choroidal vascular occlusion using mono-L-aspartyl chlorin e6 (NPe6) photodynamic therapy; to evaluate its efficacy with longer intervals between photosensitizer injection and laser application; to determine the elapsed time between light application and appearance of angiographic changes.Pigmented and nonpigmented rabbits were injected intravenously with 2 mg/kg of NPe6 before laser irradiation of the retina-choroid. Group 1 was treated at increasing power levels; fluorescein angiograms were obtained at each fluence. Group 2 animals were exposed to laser irradiation at 5 minutes, and 1 and 3 hours postinjection to determine (by fluorescein angiography 24 hours post-treatment) if increasing the interval affected outcome. Group 3 animals underwent fluorescein angiography at 30 minutes, 1 hour, 2 hours, and 24 hours posttreatment to document the time between laser application and subsequent vessel closure.Choroidal vessel occlusion was angiographically evident in all lesions at fluences of > or = 2.65 J/cm2 in pigmented rabbits and at > or = 0.88 J/cm2 in nonpigmented rabbits. Lesion diameter decreased as the time between injection and treatment increased. Vessel occlusion was documented at least 2 hours after treatment.Choroidal vessel occlusion can occur at very low fluence.

  View details for Web of Science ID 000085962700009

  View details for PubMedID 10743925

• Problems with and pitfalls of photodynamic therapy Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology (ARVO) Peyman, G. A., Kazi, A. A., Unal, M., Khoobehi, B., Yoneya, S., Mori, K., Moshfeghi, D. M. ELSEVIER SCIENCE INC. 2000: 29–35

  Abstract

  To delineate the various factors that may influence the outcome of photodynamic therapy of the retina and choroid.Experimental animal study.Pigmented and nonpigmented rabbits; rhesus monkeys.The hydrophilic photosensitizer, mono-L-aspartyl chlorin e6, which is maximally activated at 664 nm, was studied after intravenous injection into pigmented and nonpigmented rabbits and rhesus monkeys. Laser light was supplied by a red diode laser coupled to a modified slit-lamp biomicroscope and delivered to the ocular fundus after passing through a standard fundus contact lens. Standard photodynamic parameters were used. The effects of fundus pigmentation, intraocular pressure, spot focus and defocus, region of fundus treated, equivalent fluence, and retreatment were observed in the different animal species.Slit-lamp biomicroscopy, fluorescein angiography, light and transmission electron microscopy.Fundus pigmentation appeared to be a factor only at the lowest fluence level tested, where only 4 of 12 lesions attempted in pigmented fundi were noted on fluorescein angiography, compared with 12 of 12 lesions in albino rabbits. At normal intraocular pressures and a given fluence, 10 of 10 lesions were fully manifested on fluorescein angiography, compared with 4 of 10 at 30 mmHg and 0 of 10 at pressures sufficient to blanch the optic nerve (>60 mmHg). For laser spots either focused or defocused, there were 6 of 6 lesions that were fully manifested on fluorescein angiography for each of the parameters. Lesions treated in the fovea resulted in larger spots on fluorescein angiography. The fluence of 5 mW for 10 seconds resulted in a larger lesion on angiography than the equivalent fluence of 10 mW for 5 seconds. Areas of retreatment in rabbits demonstrated more thinning of the neurosensory retina and loss of photoreceptor outer segments and nuclei than corresponding areas receiving one treatment.Photodynamic therapy results varied, depending on intraocular pressure, region of fundus treated, ocular pigmentation, and the total time of exposure to the photosensitizer. Retreatment resulted in progressive thinning of the neurosensory retina with loss of photoreceptor outer segments and nuclei in the rabbit eye.

  View details for Web of Science ID 000084724900019

  View details for PubMedID 10647715

• Enucleation SURVEY OF OPHTHALMOLOGY Moshfeghi, D. M., Moshfeghi, A. A., Finger, P. T. 2000; 44 (4): 277-301

  Abstract

  The three most common indications for enucleation are intraocular malignancy, trauma, and a blind, painful eye. Recommending enucleation is one of the most difficult therapeutic decisions in ophthalmology. In some cases of malignancy, cryotherapy, laser photocoagulation, diathermy, chemotherapy, and radiation therapy may be viable alternatives to surgery. When surgery is chosen, evisceration or exenteration may be alternatives to enucleation. Once the decision is made to perform enucleation or evisceration, the surgeon must choose from several types of implants and wrapping materials. These devices can be synthetic, autologous, or eye-banked tissues. With certain implants, the surgeon must decide when and if to drill for subsequent peg placement. In this review, the authors discuss choices, techniques, complications, and patient consent and follow-up before, during, and after enucleation. Controversies and results of the Controlled Ocular Melanoma Study are summarized.

  View details for Web of Science ID 000085108000002

  View details for PubMedID 10667436

• Fluorescence properties of a hydrophilic sensitizer in pigmented rats, rabbits, and monkeys OPHTHALMIC SURGERY AND LASERS Moshfeghi, D., Peyman, G. A., Kazi, A. A., Unal, M., Khoobehi, B., Yoneya, S., Mori, K. 1999; 30 (9): 750-753

  Abstract

  To evaluate fluorescence properties of mono-L-aspartyl chlorin e6 (NPe6; Meija Seika Kaisha, Ltd., Tokyo, Japan) photodynamic therapy, which allows real-time simultaneous imaging of choroidal and retinal vasculature during treatment without the addition of another dye.Four pigmented rabbits, 4 pigmented rats, and 2 African green monkeys were administered intravenous injections of the NPe6 dye. The animals were immediately placed in front of the scanning laser ophthalmoscope and the fundus was viewed with the helium-neon laser. The resulting fluorescence was viewed and recorded on super-VHS videotape.Fluorescence demonstrated clearly that NPe6 entered the retinal and choroidal circulation within seconds of intravenous injection. The concentration of NPe6 was diminished over a period of 1.5 hours in the monkey and 5 hours in the rat, as evidenced by considerable diminution of the intensity of fluorescence.NPe6 fluorescence allows evaluation of drug availability within the retinal and choroidal circulation and visualization of pathological lesions before commencement of photodynamic therapy.

  View details for Web of Science ID 000083687700009

  View details for PubMedID 10574497

• Angiographic and histologic effects of fundus photodynamic therapy with a hydrophilic sensitizer (mono-L-aspartyl chlorin e6) OPHTHALMOLOGY Mori, K., Yoneya, S., Ohta, M., Sano, A., Anzai, K., Peyman, G. A., Moshfeghi, D. M. 1999; 106 (7): 1384-1391

  Abstract

  To demonstrate the efficacy of the photosensitizer mono-L-aspartyl chlorin e6 (NPe6) in closing choroidal vessels at low energy levels, that tissue uptake and clearance are rapid, and that low concentrations of drug are needed to achieve clinical effects.Experimental animal study.Pigmented rabbits and Japanese monkeys were used in this study.Using a modified 664-nm diode laser, the fundi of pigmented rabbits and Japanese monkeys were irradiated after intravenous administration of NPe6 (2-100 mg/kg). Time from injection to irradiation varied from 5 to 15 minutes, and duration of exposure varied from 1 to 10 seconds. Power output at the corneal surface was either 3.6 or 5.9 mW. Animals were examined by indirect ophthalmoscopy and fluorescein angiography at 2 hours and 7 days after treatment. After enucleation 7 days after treatment, specimens were prepared for light and electron microscopy.Angiographic evidence of occlusion and histopathologic evidence of retinal damage.Both clinical and histopathologic examination demonstrated effects on the choroidal vasculature and the retinal pigment epithelium, including necrosis of endothelial cells and occlusion in choroidal vessels, particularly within the choriocapillaris, at low energy levels. Overlying neurosensory retina was minimally affected. Fluorescein angiography of lesions treated with 2 mg/kg and laser fluence of 2.3 to 7.5 J/cm2 showed a normal appearance 2 hours after treatment, which changed to early hypofluorescent and later hyperfluorescent lesions 7 days after treatment. In contrast, those animals receiving the 10-mg/kg dose and laser fluence of 0.46 to 0.75 J/cm2 showed marked hypofluorescence of choroidal lesions and occlusion of retinal vessels 7 days after treatment.Effective occlusion of normal choroidal vessels was achieved at 2 mg/kg using 2.3 to 7.5 J/cm2 or at 10 mg/kg using 0.46 to 0.75 J/cm2 with minimal injury to overlying neurosensory retina.

  View details for Web of Science ID 000081172400043

  View details for PubMedID 10406627

• Ocular vascular thrombosis following tin ethyl etiopurpurin (SnET2) photodynamic therapy: Time dependencies OPHTHALMIC SURGERY AND LASERS Moshfeghi, D. M., Peyman, G. A., Moshfeghi, A. A., Khoobehi, B., Primbs, G. B., Crean, D. H. 1998; 29 (8): 663-668

  Abstract

  To evaluate the optimal time from the end of photosensitizer injection to the commencement of light application for creating characteristic fundus lesions and the time to vascular occlusion following photodynamic therapy (PDT) with tin ethyl etiopurpurin (SnET2).Following intravenous injection of SnET2 0.5 mg/kg or lipid emulsion alone, the fundus of rabbits was irradiated at different times (5 to 240 minutes) after photosensitizer injection using 664 +/- 7-nm laser light with an irradiance of 354 mW/cm2 and fluence of 20 J/cm2. Ophthalmoscopy and fluorescein angiography were performed 1 day after SnET2 PDT. In separate groups of rabbits, treated areas of the fundus were imaged within 30 minutes following PDT using fluorescein vesicle and microsphere angiography with scanning laser ophthalmoscopy to document time of vascular occlusion. All animals were killed 1 day following treatment and eyes were examined by histopathology.Areas of hypofluorescence (indicating vascular occlusion) were seen when activating laser light was applied 5 to 20 minutes after SnET2 injection. Retinal vessels remained perfused in all cases. The time to vascular occlusion was 70 to 120 and 40 to 90 minutes in nonpigmented and pigmented rabbits, respectively. No safety issues were seen.PDT with SnET2 was effective in occluding the choriocapillaris. Activating light needs to be applied within a specific time frame after photosensitizer injection to achieve vascular occlusion.

  View details for Web of Science ID 000075314600008

  View details for PubMedID 9715492

• Reversal of blood flow in experimental branch retinal vein occlusion Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Peyman, G. A., Khoobehi, B., Moshfeghi, A., Moshfeghi, D. SLACK INC. 1998: 595–97

  Abstract

  To demonstrate that the obstructed vascular lumen of the experimentally induced branch retinal vein occlusion (BRVO) induces retrograde blood flow, resulting in flow from the occluded vein to the feeder arterioles.Photocoagulation was used to create occlusion of the branch retinal vein in a monkey model (n = 2; 1 cynomolgus, 1 rhesus). Twenty-four hours following photocoagulation, the eyes were examined for evidence of vascular occlusive disease. Vascular occlusion was proven by fluorescent vesicle angiography with scanning laser ophthalmoscopy; these results were recorded to SVHS videotape. The images were then serially analyzed frame by frame to track individual microsphere movement.The authors observed retrograde flow proximal to the point of vessel obstruction and extending backward into the arterial system.This demonstrates the existence of retrograde flow in an experimental model of BRVO and might explain vascular complications seen in this disease process.

  View details for Web of Science ID 000074746500009

  View details for PubMedID 9674011

• Blood velocity in an experimental iris tumor OPHTHALMIC SURGERY AND LASERS Peyman, G. A., Khoobehi, B., Moshfeghi, A., Sonmez, M., Moshfeghi, D., Shaibani, S., Alghadyan, A. 1998; 29 (6): 506-509

  Abstract

  Greene strain melanoma was implanted into the irides of eight nonpigmented rabbits to evaluate the blood flow in tumor vasculature.Conventional scanning laser ophthalmoscopy was used in conjunction with fluorescent microsphere angiography (FMA). Changes were documented on SVHS videotape for later analysis. Individual microsphere movement was tracked through the tumor vessels. Subsequently, blood velocity measurements were taken.The tumor vessels were poorly organized and inefficient. Tumor blood velocity was up to 2.5 times slower compared with normal blood velocity in the unaffected iris of the same eye of the same rabbit (P = .05). Tumor blood flow could be qualitatively visualized in real time in the liver rabbit model.The ability to visualize fluorescent microspheres within the poorly organized tumor vasculature coupled with the reduced blood velocity in the tumor helps to explain the success of hyperthermic tumoricidal therapy, and may allow for development of more efficient and selective drug delivery systems and tumoricidal agents.

  View details for Web of Science ID 000074198300011

  View details for PubMedID 9640574

• Photodynamic therapy for choriocapillaris using tin ethyl etiopurpurin (SnET2) 67th Annual Meeting of the Association-for-Research-in-Vision-and-Ophthalmology Peyman, G. A., Moshfeghi, D. M., Moshfeghi, A., Khoobehi, B., DOIRON, D. R., Primbs, G. B., Crean, D. H. SLACK INC. 1997: 409–17

  Abstract

  To investigate the use of photodynamic therapy (PDT) using tin ethyl etiopurpurin (SnET2) for occluding the choriocapillaris in the eyes of pigmented rabbits.Following intravenous injection of SnET2 (0.5 and 1 mg/kg) or lipid emulsion alone, the fundus of pigmented rabbits (n = 21) was irradiated starting 15 to 45 minutes after photosensitizer injection using 664-nm light at a fluence of 300 mW/cm2 and light doses of 5 to 20 J/cm2. Funduscopy, fluorescein angiography, and light and electron microscopy were performed at 1, 14, and 28 days after PDT.Following SnET2 and PDT, closure of the choriocapillaris was achieved with light doses as low as 5 J/cm2 (17 seconds) and a drug dose of 0.5 mg/kg of SnET2. Vascular occlusion was documented by fluorescein angiography and histology. Photodynamic damage was noted in the choriocapillary endothelial cells. Retinal pigment epithelial damage and outer retinal damage were also observed. No funduscopic, angiographic, or histologic findings were present in the eyes of pigmented control rabbits.PDT with SnET2 was effective in this animal model, using low levels of activating light for the occlusion of the choriocapillaris. This has clinical implications for the treatment of choroidal neovascularization and could be a more selective therapy than thermal laser photocoagulation.

  View details for Web of Science ID A1997WX93600006

  View details for PubMedID 9150524

• Intravitreal tolerance of a new perfluorocarbon vitreous replacement, Multifluor APF-144 CANADIAN JOURNAL OF OPHTHALMOLOGY-JOURNAL CANADIEN D OPHTALMOLOGIE Peyman, G. A., Soheilian, M., Luo, Q., Moshfeghi, D., Schweighardt, F. K. 1996; 31 (7): 345-349

  Abstract

  To evaluate the intravitreal tolerance of a new perfluorocarbon vitreous replacement, Multifluor APF-144 (perfluorotetramethylcyclohexane).Ten New Zealand albino rabbits (one eye from each) underwent vitrectomy. The vitreous was replaced in five eyes with Multifluor APF-144 and in five eyes with saline (control group).Appearance on indirect ophthalmoscopy, electroretinography recordings before and 2, 4 and 8 weeks after vitrectomy, findings on electron and light microscopy at 8 weeks.Endophthalmitis did not develop in any of the eyes. There was no significant change in electroretinography values for the experimental eyes after vitrectomy. No evidence of retinal toxicity was found on light or electron microscopic examination.Multifluor APF-144 shows promise as a short-term postoperative retinal tamponading agent.

  View details for Web of Science ID A1996VY94400002

  View details for PubMedID 8971454

• Fluorescent vesicle angiography with sodium fluorescein and indocyanine green OPHTHALMIC SURGERY AND LASERS Peyman, G. A., Moshfeghi, D. M., Moshfeghi, A. A., Khoobehi, B. 1996; 27 (4): 279-284

  Abstract

  The authors evaluated the feasibility of merging free-dye angiography and the fluorescent vesicle technique to achieve the best characteristics of both.Fluorescent vesicles encapsulated with either indocyanine green or carboxyfluorescein were mixed with free indocyanine green or free sodium fluorescein, respectively, and imaged with a scanning laser ophthalmoscope in both an in vitro model and primate and rabbit models.In the in vitro model of the sodium fluorescein combination, optimal viewing of vesicleen capsulated dye and free dye was at a ratio of 150:1; for indocyanine green, the ratio was 50:1. In vivo, high-quality fluorescent vesicle angiograms were obtained that demonstrated leakage of free dye from choroidal laser spots.Free dye and fluorescent vesicles can be combined to obtain an angiogram with all of the advantages of a traditional angiogram, while allowing the operator to assess the changes in retinal or choroidal circulation directly.

  View details for Web of Science ID A1996UE07600005

  View details for PubMedID 8705742

• Noninvasive monitoring of intraocular pharmacokinetics of daunorubicin using fluorophotometry INTERNATIONAL OPHTHALMOLOGY Kizhakkethara, I., Li, X., Elsayed, S., Khoobehi, B., Moshfeghi, D. M., Rahimy, M., Peyman, G. A. 1996; 19 (6): 363-367

  View details for Web of Science ID A1996VY83900007

• The effect of light-activated tin ethyl etiopurpurin (SnET2) on normal rabbit choriocapillaries 6th Ophthalmic Technologies Conference Peyman, G. A., Moshfeghi, D. M., Moshfeghi, A. SPIE - INT SOC OPTICAL ENGINEERING. 1996: 174–181

  View details for Web of Science ID A1996BF76G00024

• Noninvasive monitoring of intraocular pharmacokinetics of daunorubicin using fluorophotometry. International ophthalmology Kizhakkethara, I., Li, X., El-Sayed, S., Khoobehi, B., Moshfeghi, D. M., Rahimy, M., Peyman, G. A. 1995; 19 (6): 363-367

  Abstract

  Daunorubicin is a cytotoxic drug, which, in nontoxic doses, is effective in preventing cellular proliferation in experimental vitreoretinopathy. We studied dose and clearance of daunorubicin in various ocular tissues using fluorophotometry techniques.In vitro tests: The emission of fluorescence from the daunorubicin solution having a concentration range of 0.1 to 10 micrograms/mL in phosphate buffer was measured using an excitation wavelength range of 489 +/- 10 nm. The emission of fluorescence was measured at 514 nm; the linearity of the response was determined using linear regression analysis. There is a fluorescence peak of daunorubicin at 485 nm. The validity and reproducibility of the method were examined. In vivo tests: The rabbits were randomized into three groups and daunorubicin concentrations of 4, 6, or 8 micrograms/mL were injected into the vitreous. Fluorophotometry scanning from the retina to the anterior chamber was performed with a commercially available fluorophotometer at various times up to 48 hours after injection to quantify fluorescence emission of daunorubicin.The standard curve of fluorescence versus concentration of daunorubicin was linear in the range of 0.1 to 8 micrograms/mL. It was sensitive up to 0.1 microgram. The daunorubicin time concentration profile showed a dose response relationship over the 48-hour period studied. The half-life of daunorubicin in the vitreous was about 5 hours.We performed fluorophotometry using a fluorophotometer whose exciter emits light at 489 nm, which is very close to an absorption peak of daunorubicin. These two values are close enough to obviate the need for modifying the commercial fluorophotometer. Therefore the concentration of daunorubicin in the vitreous cavity can be measured noninvasively.

  View details for PubMedID 8970871

• RETROBULBAR EDEMA AFTER OPHTHALMIC PLAQUE RADIOTHERAPY BRITISH JOURNAL OF OPHTHALMOLOGY Finger, P. T., Byrne, S. F., Moshfeghi, D. M., Perry, H. D. 1993; 77 (9): 604-605

  View details for Web of Science ID A1993LY79300020

  View details for PubMedID 8218065

• VISUAL RECOVERY AFTER RADIATION-THERAPY OF ORBITAL LYMPHOMA AMERICAN JOURNAL OF OPHTHALMOLOGY Moshfeghi, D. M., Finger, P. T., Cohen, R. B., Choe, W. Y., Smilari, T. 1992; 114 (5): 645-646

  View details for Web of Science ID A1992JX30800028

  View details for PubMedID 1443037

• LASER-INDUCED EXPERIMENTAL VASCULAR OCCLUSION USING LIPOSOME-ENCAPSULATED ADP LASERS IN SURGERY AND MEDICINE Khoobehi, B., Peyman, G. A., Bhatt, N., Moshfeghi, D. 1992; 12 (6): 609-614

  Abstract

  The therapeutic occlusion of retinal vessels is often helpful in treating various pathological conditions. We compared the combined effects of argon laser photocoagulation and adenosine diphosphate (ADP) released from temperature-sensitive liposomes with argon laser photocoagulation alone on occlusion of retinal vessels in pigmented rats. In Group A, 8 eyes were treated with liposome-encapsulated ADP and laser photocoagulation. In Group B, 8 eyes were treated with laser photocoagulation alone. The laser parameters (power, spot size, exposure time) were maintained at the same levels for both groups. The laser was focused on the retinal vessels at the optic nerve head. The treated retinal vessels were observed at time zero, day 1, day 4, and weekly for a period of 3 months. At time zero, 6 of 8 eyes were totally occluded in Group A, with best results obtained at 80 mW. Only 1 of 8 eyes in Group B achieved total occlusion. After 3 months, 4 of 8 eyes in Group A remained totally occluded; no eyes in Group B were occluded. Complete and permanent occlusion of retinal vessels can be achieved by using ADP and laser photocoagulation of lower power density than traditional laser photocoagulation alone.

  View details for Web of Science ID A1992KA04700006

  View details for PubMedID 1453862

• PALLADIUM 103 OPHTHALMIC PLAQUE RADIOTHERAPY ARCHIVES OF OPHTHALMOLOGY Finger, P. T., Moshfeghi, D. M., Ho, T. K. 1991; 109 (11): 1610-1613

  Abstract

  We compared the ocular radiation distribution of palladium 103 (103Pd) vs iodine 125 (125I) ophthalmic plaques sewn to 12 human donor eyes. We then performed preoperative comparative simulations on the first seven patients to be treated with palladium 103 plaque therapy for choroidal melanoma. The in vitro experiment involved palladium 103 seeds placed into a Silastic seed holder, which was affixed into standard 14-mm gold eye plaques. Then the plaques were sewn onto 12 human donor eyes so as to approximate either the nasal (six eyes) or temporal (six eyes) equator. Three sets of two thermoluminescent dosimeters were used to quantify the amount of radiation delivered by the episcleral plaques. Thermoluminescent dosimeters were sewn to the sclera in three locations: on the center of the cornea, on the sclera beneath the macula, and at the equator in a position opposite the plaque. This experiment was then repeated with iodine 125 seeds and thermoluminescent dosimeters. After the plaques were adjusted to equalize their activity (plaque strength), the palladium 103 plaques were found to deliver less radiation to the three target points. Comparative clinical dosimetry also reflected this difference. Preoperative simulations comparing equal doses to the tumors' apex revealed that the palladium 103 ophthalmic plaques delivered more radiation to the tumor and less radiation to most normal ocular structures.

  View details for Web of Science ID A1991GP10600047

  View details for PubMedID 1755746

• MICROWAVE CYCLODESTRUCTION FOR GLAUCOMA IN A RABBIT MODEL ARCHIVES OF OPHTHALMOLOGY Finger, P. T., Moshfeghi, D. M., Smith, P. D., Perry, H. D. 1991; 109 (7): 1001-1004

  Abstract

  Microwave thermotherapy was used to treat experimentally induced glaucoma. Microwave-induced cyclodestruction was successful in reducing intraocular pressure in all treated glaucomatous eyes for 4 weeks. Two additional glaucomatous eyes were left untreated to serve as controls, and were noted to have persistently elevated intraocular pressures. Six additional eyes were then subjected to an equivalent treatment (50 degrees C in five 1-minute applications), which resulted in approximately 180 degrees of heat treatment just posterior to the corneoscleral limbus. These specimens were evaluated with light microscopy at baseline, 24 hours, and 7 days after treatment. Our clinical and histopathologic evaluations suggested that microwave thermotherapy (delivered under thermometry control) allowed for chorioretinal/ciliary body destruction that resulted in reductions of intraocular pressure in glaucomatous eyes.

  View details for Web of Science ID A1991FV41400036

  View details for PubMedID 2064553