Clinical Focus


  • Ophthalmology

Academic Appointments


  • Instructor, Ophthalmology

Professional Education


  • Fellowship: Stanford University Ophthalmology Fellowships (2021) CA
  • Fellowship, Byers Eye Institute at Stanford, Uveitis (2021)
  • Fellowship, Magrabi Eye Hospital, Retina (2020)
  • Residency, Tanta University Hospital, Ophthalmology (2017)
  • Internship: Tanta University Hospital (2014) Egypt
  • Medical Education: Tanta University Faculty of Medicine (2014) Egypt

Clinical Trials


  • Methotrexate For The Prevention and Treatment of Proliferative Vitreoretinopathy in Pediatric Patients Not Recruiting

    Rhegmatogenous retinal detachment (RRD) is a sight-threatening condition. Children with RRD usually present late with clinical features of longstanding RRD, specifically a serious condition named: proliferative vitreoretinopathy (PVR). Therefore, children with RRD often have poorer outcomes. The objective of this study is to investigate the efficacy and safety of methotrexate in the treatment and prevention of PVR. Methotrexate is a medication that has been used to treat inflammatory conditions in children and adults for a long time and it has been recently used to treat PVR in adults.

    Stanford is currently not accepting patients for this trial. For more information, please contact Edward Wood, MD, 650-723-6995.

    View full details

All Publications


  • Six-month outcomes of infliximab and tocilizumab therapy in non-infectious retinal vasculitis. Eye (London, England) Karaca, I., Uludag, G., Matsumiya, W., Regenold, J., Or, C., Mobasserian, A., Halim, M. S., Zaidi, M., Lajevardi, S., Dongchau, A., Ghoraba, H., Nguyen, Q. D. 2022

    Abstract

    To evaluate the efficacy of infliximab (IFX, 5-10 mg/kg) (Group 1) and tocilizumab (TCZ, 4-8 mg/kg) (Group 2) infusions in non-infectious retinal vasculitis (RV) using Angiographic Scoring for the Uveitis Working Group fluorescein angiography (FA) scoring system.Records of 14 patients (24 eyes) in Group 1 and 8 patients (11 eyes) in Group 2 were retrospectively evaluated to assess visual acuity (VA), anterior chamber cell and flare, vitreous haze, central subfield thickness (CST), and FA scoring at baseline and 6 months of follow-up. The measurements were employed to grade in each group.In Group 1 and 2, respectively, there was no underlying disease in 9 (60%) and 3 (42.9%) patients. Three (42.9%) patients in Group 2 had juvenile idiopathic arthritis (JIA) as the most common identified cause. Mean improvement in VA (log MAR) and CST were 0.04 ± 0.14 and 40.3 ± 78.5 µm in Group 1; 0.04 ± 0.09 and 47.3 ± 82.3 µm in Group 2, respectively. Mean FA scores were significantly reduced from 12.4 ± 5.2 and 11.6 ± 4.4 at baseline to 6.4 ± 5.0 and 5.8 ± 3.9 at 6-month in Group 1 and 2, respectively. In Group 2, 9 eyes of 6 patients (75%) had the history of IFX use prior to TCZ initiation. There was no significant safety concern requiring treatment discontinuation during the follow-up in either group.IFX and TCZ infusions showed statistically significant improvement of non-infectious RV as shown by ASUWOG FA Scoring System. TCZ, as well as IFX, appeared to be effective treatment options for non-infectious RV.

    View details for DOI 10.1038/s41433-022-02315-9

    View details for PubMedID 36443499

    View details for PubMedCentralID 4893321

  • Multifocal electroretinographic findings in angiographic macular leakage in the setting of intermediate, posterior, or panuveitis. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Ghoraba, H., Hwang, J., Karaca, I., Khojasteh, H., Or, C., Regenold, J., Zaidi, M., Yavari, N., Than, N. T., Park, S. W., Yasar, C., Akhavanrezayat, A., Nguyen, Q. D. 2022

    Abstract

    To evaluate the functional implications of angiographic macular leakage without the presence of intraretinal fluid on optical coherence tomography (OCT) in eyes with intermediate, posterior, or panuveitis.Retrospective study on patients with a diagnosis of intermediate, posterior, or panuveitis. Patients who had fluorescein angiography, OCT, and multifocal electroretinography (mfERG) within a predetermined time frame were included. Demographic and clinical data including types of ocular inflammation and best-corrected visual acuity (BCVA), in addition to OCT, fluorescein angiography, and mfERG data were collected. The study cohort was divided into 2 groups based on the presence of angiographic macular leakage and macular edema (ME): group 1 (no ME and no macular leakage) and group 2 (presence of macular leakage without ME).A total of 29 patients (43 eyes) were included in the study, with 13 patients (17 eyes) in group 1 and 16 patients (26 eyes) in group 2. No statistically significant differences in age, sex, anterior-chamber cells, lens status, vitreous cells, vitreous haze, BCVA, or mean central subfoveal thickness were found between groups 1 and 2. All mfERG values, including N1 and P1 response densities and timings for rings 1-5, did not show any statistically significant difference between group 1 and 2. No correlation was found between either of BCVA or central subfoveal thickness and any of mfERG values for rings 1-3.In absence of ME, angiographic macular leakage in eyes with uveitis might not be associated with worse macular function when compared with eyes without angiographic macular leakage.

    View details for DOI 10.1016/j.jcjo.2022.11.002

    View details for PubMedID 36442516

  • Retinal arterial tortuosity in Ehlers-Danlos syndromes. Eye (London, England) Ghoraba, H. H., Moshfeghi, D. M. 2022

    Abstract

    PURPOSE: To report a novel finding of retinal arterial tortuosity (RAT) associated with Ehlers-Danlos syndromes (EDS).METHODS: We queried the STAnford Research Repository (STARR) database to identify patients diagnosed with EDS. We included patients with a confirmed diagnosis of any subtype of EDS who had any form of readable retinal imaging including colour fundus photos, autofluorescence, red-free photos, red-free optical coherence tomography photos and fluorescein angiography. Patients who had no retinal imaging and those with no confirmed EDS diagnosis were excluded. Retinal images were reviewed for RAT and were graded into no, possible and definite RAT. Eyes with definite RAT were further graded into mild, moderate and severe. Eyes with definite RAT were again subclassified according to the type of involved vessels into first-order arteriolar, macular and arteriovenous.RESULTS: A total of 307 patients were identified using the STARR tool and 142 patients were included. Mean age was 40.9±18.1 years and 87% were female. Underlying EDS subtypes were hypermobile EDS (69.7%), classical EDS (2.8%), vascular EDS (2.1%), myopathic EDS (0.7%) and not specified (24.6%). We graded 37.3% of patients with definite RAT, 10.6% with possible RAT and 52.1% with no RAT. In patients with definite RAT, we graded 39.2% of eyes with mild RAT, 40.2% with moderate RAT and 20.6% with severe RAT. In all, 84.9% showed involvement of first-order retinal arterioles, 35.8% showed involvement of macular arterioles and 1.9% showed arteriovenous involvement.CONCLUSIONS: Variable degrees of RAT are associated with EDS.

    View details for DOI 10.1038/s41433-022-02278-x

    View details for PubMedID 36241846

  • Electroretinographic findings in retinal vasculitis. The British journal of ophthalmology Ghoraba, H. H., Matsumiya, W., Or, C., Khojasteh, H., Patel, P., Karaca, I., Regenold, J., Zaidi, M., Hwang, J., Lajevardi, S., Yavari, N., Than, N. T., Park, S. W., Akhavanrezayat, A., Uludag, G., Yasar, C., Leung, L. B., Nguyen, Q. D. 2022

    Abstract

    To describe and correlate electroretinographic responses with clinical and angiographic findings in retinal vasculitis (RV).Medical records of patients with diagnosis of RV at a tertiary eye centre from December 2017 to May 2021 were reviewed. Cases in which fluorescein angiography (FFA) and full field electroretinography (ffERG) were done within 1 month were included. FFAs were graded according to the Angiography Scoring for Uveitis Working Group from 0 to 40, where 0 is normal. A novel ffERG grading system was implemented where individual waves were graded for timing and amplitude and general ffERG score was determined with 6 being a perfect score.20 patients (34 eyes) were included. Mean age was 43.9±19.8 years; 70% were female. Median best-corrected visual acuity was 0.8 (0.08-1). Mean FFA score was 12.6±6.5. Median general ffERG score was 5 (0-6). 68% and 91% of eyes had responses with general ffERG scores ≥5 and 4, respectively. Flicker timing was most commonly affected.FFA scores weakly correlated with delayed photopic cone b-wave and flicker timing (p=0.03 and 0.016, respectively). Vitreous haze moderately correlated with delayed cone b-wave timing (p<0.001), delayed flicker timing (p=0.002) and weakly correlated with lower flicker amplitude (p=0.03). Underlying systemic disease was associated with poor ffERG responses.In this study, RV was not frequently associated with severe global retinal dysfunction Higher FFA scores, and vitreous haze grading were weakly, but significantly, correlated with cone-generated ffERG responses.

    View details for DOI 10.1136/bjo-2022-321716

    View details for PubMedID 36130816

  • C3 glomerulopathy associated with both hypertensive retinopathy and purtscher-like retinopathy. American journal of ophthalmology case reports Zaidi, M., Mishra, K., Nguyen, H. V., Miller, P. P., Ghoraba, H., Karaca, I., Matsumiya, W., Nguyen, Q. D., Leung, L. B. 2022; 27: 101683

    Abstract

    Purpose: This article reports the case of a 21-year-old woman with both hypertensive retinopathy and Purtscher-like retinopathy in association with C3 glomerulopathy.Observations: The patient was referred for bilateral painless vision loss with posterior pole cotton wool spots, optic disc edema, and confluent retinal whitening suggesting a mixed picture of hypertensive retinopathy, with initial blood pressure 236/152, and Purtscher-like retinopathy. She was subsequently diagnosed with C3 glomerulopathy which likely caused her severe hypertension and which likely occurred alongside Purtscher-like retinopathy due to a shared pathogenesis of complement dysregulation. Follow up examination and imaging revealed gradual improvement in visual acuity, almost complete resolution of fundus exam abnormalities, improvement in macular nonperfusion, resolution of disc leakage and choroidal leakage, resolution of macular edema, and residual outer retinal hyperreflective foci in both eyes.Conclusion and importance: This case represents the first report of both Purtscher-like retinopathy and hypertensive retinopathy occurring in association with C3 glomerulopathy. It supports investigation of anti-complement therapy as a potential treatment for Purtscher-like retinopathy.

    View details for DOI 10.1016/j.ajoc.2022.101683

    View details for PubMedID 36016724

  • Systemic and Intraocular Methotrexate for the Prevention and Treatment of Proliferative Vitreoretinopathy in Children With Rhegmatogenous Retinal Detachment and Underlying Inflammatory Disease. Journal of vitreoretinal diseases Al-Moujahed, A., Saleh, S., Ghoraba, H., Nguyen, Q. D., Wood, E. 2022; 6 (5): 399-404

    Abstract

    Purpose: This index study highlights the efficacy and safety of a combined surgical and medical therapy (with intraocular and systemic methotrexate) of pediatric rhegmatogenous retinal detachments (RRD) complicated by proliferative vitreoretinopathy (PVR).Methods: Three pediatric patients with RRD complicated by PVR in the setting of underlying atopic dermatitis and/or uveitis who were treated with a combination of vitreoretinal surgery and intraoperative intravitreal methotrexate (MTX) (40mg) infusion, followed by at least one injection of 200 mug of MTX into the silicone oil-filled vitreous cavity, are reported. In addition, the patients received short-term systemic immunosuppression with systemic (oral or subcutaneous 20 mg weekly MTX for 12 weeks) and/or steroids.Results: Retinal reattachment with improvement in visual acuity was achieved in all eyes following a single surgery and remained to the final follow-up examination after oil removal. There were no observed side effects of intraocular or systemic MTX.Conclusions: The safety and efficacy of this combination therapy suggests that it could be a successful strategy for treating pediatric patients with RRD with or without PVR in the presence or absence of underlying inflammatory diseases.

    View details for DOI 10.1177/24741264221076357

    View details for PubMedID 36380820

  • Port Delivery System With Ranibizumab: As Always - Risks Versus Benefits for the Recipients OPHTHALMIC SURGERY LASERS & IMAGING RETINA Ghoraba, H. H., Do, D., Quan Dong Nguyen 2022; 53 (8): 416-417

    View details for DOI 10.3928/23258160-20220713-01

    View details for Web of Science ID 000863293200001

    View details for PubMedID 35951716

  • Immunotherapy-induced retinopathy mimicking cancer associated retinopathy. American journal of ophthalmology case reports Ghoraba, H., Or, C., Karaca, I., Mishra, K., Akhavanrezayat, A., Park, S., Than, N., Leung, L., Sanislo, S., Dong Nguyen, Q. 2022; 26: 101449

    Abstract

    Purpose: To report a patient who developed a cancer associated retinopathy (CAR) like syndrome in the setting of pembrolizumab and lenvatinib combination therapy for metastatic endometrial carcinoma. Symptoms resolved with normalization of objective functional tests following cessation of medications.Observations: A 52-year-old female with history of endometrial carcinoma, managed with pembrolizumab infusions and daily oral lenvatinib treatment for 18 months, presented to a tertiary eye center with complaints of nyctalopia, photosensitivity and photopsia. Further investigations revealed a reduction in b-wave amplitude on full field ERG (ffERG), a mild color vision deficit, and positive antiretinal antibodies against carbonic anhydrase II, enolase and arrestin. A preliminary diagnosis of CAR was made. One month following diagnosis, the patient discontinued both lenvatinib and pembrolizumab and subsequently reported significant improvement in her eye symptoms and vision. Repeat ffERG had normalized with a robust b-wave, with an improvement noted on repeat color vision testing. A presumed diagnosis of immunotherapy-induced retinopathy was made, with clinical findings mimicking CAR.Conclusions and importance: Pembrolizumab and lenvatinib treatment may be associated with a reversible retinopathy, with presentation very similar to CAR.

    View details for DOI 10.1016/j.ajoc.2022.101449

    View details for PubMedID 35265774

  • Safety of Intravenous Methylprednisolone in Refractory and Severe Pediatric Uveitis. Clinical ophthalmology (Auckland, N.Z.) Ghoraba, H. H., Matsumiya, W., Khojasteh, H., Akhavanrezayat, A., Karaca, I., Or, C., Yavari, N., Lajevardi, S., Hwang, J., Yasar, C., Do, D., Nguyen, Q. D. 2022; 16: 1697-1706

    Abstract

    Purpose: To evaluate the safety of intravenous high-dose pulse methylprednisolone succinate (IVHDM) in the management of severe or refractory non-infectious pediatric uveitis.Methods: We reviewed all uveitis patients who were ≤16 years of age and who received IVHDM with a dose of ≥500 mg per day (1-3 days a month) for at least 3 months during their management at a tertiary care eye hospital.Results: Twenty pediatric patients with severe or refractory uveitis who received IVHDM were identified. Six patients received IVHDM either once, as a preoperative medication, or at a lower dose than 500 mg, and were excluded. The remaining 14 patients received IVHDM for at least 4 months. Age (mean±SD) was 11.9±2.4 years and 50% were female. Duration of treatment was 14.2±7.5 months. Thirteen patients received IVHDM in combination with other immunomodulatory therapy (IMT). Except for two outliers, IVHDM was given at a dose of 8-25 mg/kg per infusion. Three major adverse events (AEs) occurred in two patients: a single episode of bradycardia, compression fracture following minor trauma and adrenal insufficiency. The number of AEs (major and minor) strongly correlated with duration of treatment (p=0.004) and moderately correlated with the cumulative dose/weight (p=0.051). Weight gain was associated with the use of concomitant oral steroids and not with duration of treatment or cumulative dose.Conclusion: IVHDM may be a valid therapeutic option for aggressive/refractory pediatric uveitis. The reported AEs in this series can also be attributed to the concurrent IMT or the underlying disease itself.

    View details for DOI 10.2147/OPTH.S366370

    View details for PubMedID 35673349

  • Effect of Pupil Size on Fixed-Luminance Flicker Full-Field Electroretinogram Magnitude. Clinical ophthalmology (Auckland, N.Z.) Mobasserian, A., Zaidi, M., Halim, S., Hwang, J. J., Regenold, J., Akhavanrezayat, A., Karaca, I., Khojasteh Jafari, H., Yavari, N., Matsumiya, W., Yasar, C., Than, N. T., Uludag, G., Do, D., Ghoraba, H., Nguyen, Q. D. 2022; 16: 3733-3740

    Abstract

    Purpose: Diopsys NOVA fixed-luminance flicker full-field electroretinogram (ffERG) device is a potential adjunct to conventional flicker ffERG testing for assessing cone cell function. Magnitude of measured electrical response is known to vary with pupil size in conventional ffERG testing. The index study characterizes the relationship between magnitude of measured electrical activity and pupil size, both pupil diameter and pupil area, for this device.Methods: Seventeen patients (34 eyes) with no known ocular diseases were enrolled in the study. Electrophysiologic function of cone cells was evaluated using fixed-luminance flicker ffERG before and after dilation. Linear regression models, with inter-eye correlations controlled as fixed-effects, were used to characterize the effect of pupil dilation on the magnitude of the measured responses.Results: Mean age of study patients was 33.5 (standard deviation 7.4 years), and 35.3% of the subjects were female. Mean value of electrical response magnitude was 10.07±2.79V before dilation and 15.30±4.08V after dilation. The correlations of ERG magnitude with pupil diameter and with pupil area were not significant for either dilated or undilated eyes considered separately but were highly significant (p<0.001) for dilated and undilated eyes considered in aggregate. ERG magnitude tended to increase by 1.08 V for every 1 mm increase in pupillary diameter.Conclusion: An increase in pupil size, both pupil diameter and pupil area, is significantly associated with an increase in flicker ffERG magnitude recorded by the Diopsys device, suggesting that pupil size should be measured and considered when making clinical judgments based on the flicker ffERGs recorded by the device, and that pupil size-specific reference ranges could improve the clinical utility of the device.

    View details for DOI 10.2147/OPTH.S382207

    View details for PubMedID 36389637

  • Ocular Gene Therapy: A Literature Review with Special Focus on Immune and Inflammatory Responses. Clinical ophthalmology (Auckland, N.Z.) Ghoraba, H. H., Akhavanrezayat, A., Karaca, I., Yavari, N., Lajevardi, S., Hwang, J., Regenold, J., Matsumiya, W., Pham, B., Zaidi, M., Mobasserian, A., DongChau, A. T., Or, C., Yasar, C., Mishra, K., Do, D., Nguyen, Q. D. 2022; 16: 1753-1771

    Abstract

    Gene therapy has emerged as a research topic of choice in recent years. The eye in particular is one of few organs of the body for which gene therapy has received Food and Drug Administration approval, and it remains a field of great interest for gene therapy development. However, its associated immune and inflammatory reactions may render the treatment ineffective or harmful, which are of particular concern for the eyes due to their susceptibility to inflammation. The severity of immune and inflammatory reactions depends on the choice of vector and its route of administration. Furthermore, most preclinical and clinical studies have shown that the dose of vectors is correlated with the degree of humoral response and ocular inflammation. The route of administration directly impacts the degree of immune and inflammatory reaction. Subretinal delivery produces a weaker humoral response than the intravitreal route. However, some studies have demonstrated that the subretinal delivery induces a stronger inflammatory reaction. On the other hand, several instances of vision loss due to severe late onset intraocular inflammation were reported in a clinical trial involving intravitreal delivery of viral vectors. When compared with the intravitreal route, suprachoroidal gene delivery has been shown to produce weaker humoral response. However, unlike the subretinal space, the suprachoroidal space is not known to have immune privilege status. Inflammatory reactions following ocular gene therapy are typically mild and most clinical and preclinical studies have shown that they can be controlled with topical, local or systemic steroids. However, severe inflammatory responses may occur and require aggressive management to avoid permanent vision loss. Further investigations are required to elucidate and expand our knowledge of inflammatory reactions, and their optimal management, following ocular gene therapy.

    View details for DOI 10.2147/OPTH.S364200

    View details for PubMedID 35685379

  • Novel surgical approach for removing intraretinal loculated foveal hemorrhage in a patient with hypertensive retinopathy. American journal of ophthalmology case reports Khojasteh, H., Akhavanrezayat, A., Ghoraba, H., Nguyen, Q. D. 2021; 24: 101217

    Abstract

    Purpose: To present a surgical approach for removing intra-retinal loculated foveal hemorrhage due to hypertensive retinopathy (HR) in a patient with uncontrolled hypertension (HTN).Observations: A 67-year-old man presented to a tertiary retina clinic with the complaint of decreased vision in his left eye (OS) for the past six months. He had a history of uncontrolled HTN, which caused HR; otherwise, his past medical and ocular history were insignificant. His best-corrected visual acuity (BCVA) was 20/20 right eye (OD) and 20/400 OS. Fundus examination of OD did not show significant pathology except mild arterial narrowing. Fundus examination of OS revealed arterial narrowing and multiple areas of small retinal hemorrhage. Old, organized hemorrhage with a yellow foveal centered lesion appearance was detected on fundus examination. Spectral-domain optical coherence tomography (SD-OCT) showed a dense hyper-reflective intra-retinal lesion at the fovea. Pars plana vitrectomy was performed. Internal limiting membrane (ILM) was stained with Brilliant Blue G (BBG) and peeled off around the lesion using ILM forceps. Attempts to remove the lesion with cannula-assisted active backflush and aspiration were unsuccessful. Therefore, the lesion was gently dissected and extracted by using 41-gauge needle. After removing the clot, the rotational ILM flap technique was used to repair the developed macular hole-like tissue defect. At the two-month follow-up visit, BCVA improved considerably to 20/50, and significant anatomical restoration was observed.Conclusion and Importance: HR is relatively common among patients with elevated blood pressure. To date, management of HR and its complications such as retinal hemorrhage is limited to non-surgical methods. For the first time, a surgical approach is utilized to manage one of the HR's complications with prominent visual and structural improvement. The index case report presents a new management option for hypertensive retinal hemorrhage, but only in appropriate patients with ocular indications and understanding of the potential adverse events associated with the surgical procedure.

    View details for DOI 10.1016/j.ajoc.2021.101217

    View details for PubMedID 34646960

  • Unilateral acute anterior uveitis with macular edema following the use of sildenafil citrate in a patient with HLA-B27 positivity. American journal of ophthalmology case reports Regenold, J., Ghoraba, H., Akhavanrezayat, A., Matsumiya, W., Mobasserian, A., Karaca, I., Zaidi, M., Pham, B., Nguyen, Q. D. 2021; 24: 101228

    Abstract

    Purpose: To present a case of acute anterior uveitis with macular edema associated with sildenafil citrate use in an HLA-B27 positive patient.Observations: A 54-year-old Caucasian male presented at an ophthalmology tertiary center with complaint of pinkish discoloration, irritation, and photophobia in the left eye (OS). He noted that these symptoms appeared one day after using sildenafil for the first time to treat his erectile dysfunction. The patient had no significant ocular history besides refractive surgery in both eyes (OU) and his medical history was insignificant. Best-corrected visual acuity (BCVA) was 20/20 in the right eye (OD) and 20/25 in OS. Slit-lamp-examination (SLE) demonstrated trace cells and 1+ flare in the anterior chamber (AC) in OS and was nonrevealing in AC in OD. Spectral domain optical coherence tomography (SD-OCT) showed parafoveal subretinal hyperreflective deposits in OU. The patient was diagnosed with acute anterior uveitis (AAU) in the left eye and was placed on topical prednisolone acetate.At 2-week follow-up, the patient reported that his eye symptoms had improved since starting topical steroids but worsened again two days after he had used sildenafil for a second time. In OS, best-corrected visual acuity (BCVA) worsened to 20/40, and SLE revealed 1+ cells and 1+ flare in AC. SD-OCT revealed cystoid macular edema only in OS. Fluorescein angiography showed mild staining around the optic disc and significant macular leakage in OS and minimal macular leakage in OD. Uveitis evaluations revealed that the patient was human leukocyte antigen-27 (HLA-B27) positive. The patient was asked to remain off sildenafil and continue topical prednisolone acetate. At 3-month follow-up, BCVA improved to 20/20 in OS with no evidence of active inflammation.Conclusions and importance: Sildenafil citrate use might be associated with new onset of intraocular inflammation in predisposed patients. Further studies are necessary to establish this relationship.

    View details for DOI 10.1016/j.ajoc.2021.101228

    View details for PubMedID 34761138

  • Structural changes of corneal epithelium in belantamab-associated superficial keratopathy using anterior segment optical coherence tomography. American journal of ophthalmology case reports Matsumiya, W., Karaca, I., Ghoraba, H., Akhavanrezayat, A., Mobasserian, A., Hassan, M., Regenold, J., Yasar, C., Liedtke, M., Kitazawa, K., Nguyen, Q. D. 2021; 23: 101133

    Abstract

    Purpose: To describe structural changes in corneal epithelium using anterior segment optical coherence tomography (AS-OCT) in two relapsed and refractory multiple myeloma (RRMM) patients with bilateral belantamab-associated superficial keratopathy (BASK).Observations case 1: A 56-year-old male who was diagnosed with RRMM and initiated on belantamab mafodotin, presented on day 42 (three weeks after the second infusion) with decreased pinhole visual acuity from 20/20 and 20/25 to 20/70 and 20/50 in the right eye and left eye, respectively. Slit-lamp examination revealed moderate superficial keratopathy with microcystic-like epithelial changes (MECs) in the paracentral cornea in both eyes. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions as well as increased thickness in the paracentral corneal epithelium with uninvolved central cornea. Given bilateral MECs, the third infusion was withheld, and then given on day 62 after five weeks of drug-free interval. Although MECs had improved on day 82, pinhole visual acuity remained at 20/50 and 20/40 in the right eye and the left eye. AS-OCT showed that hyperreflective lesions mostly resolved and corneal epithelial thickness returned to baseline, despite a slightly increased persisting heterogeneous signal intensity in the peripheral corneal epithelium in both eyes.Case 2: A 77-year-old male with RRMM was started on belantamab mafodotin infusions. His pinhole visual acuity decreased from 20/40 and 20/30 at baseline to 20/60 and 20/40 on day 41 (three weeks after the second infusion) in the right eye and left eye, respectively. Slit-lamp examination showed diffuse, moderate MECs in both eyes, which was more severe in the peripheral cornea. AS-OCT demonstrated increased bilateral heterogeneous signal intensity and hyperreflective lesions in the corneal epithelium, which are more severe in the right eye along with increased corneal epithelial thickness. Therefore, belantamab mafodotin was withheld.Conclusions and Impotance: AS-OCT objectively demonstrated structural changes such as signal intensity and thickness alterations with hyperreflective lesions in the corneal epithelium related to BASK. AS-OCT might be useful for clinicians to monitor ocular surface adverse events in RRMM patients receiving belantamab mafodotin and to adjust therapeutic plans for the patients.

    View details for DOI 10.1016/j.ajoc.2021.101133

    View details for PubMedID 34169181

  • Oral montelukast is associated with decreased odds of diabetic retinopathy Pham, B., Matsumiya, W., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Hwang, J., Lajevardi, S., Lam, B., Regenold, J., Yavari, N., Bazojoo, V., Karaca, I., Mobasserian, A., Nguyen, H., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Effect of pupil size on fixed-luminance flicker full-field electroretinogram magnitude Mobasserian, A., Halim, M., Hwang, J., Regenold, J., Akhavanrezayat, A., Ghoraba, H., Matsumiya, W., Yavari, N., Karaca, I., Yasar, C., Lajevardi, S., Pham, B., Do, D., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Correlation between photoreceptor density in adaptive optics imaging with retinal structure and sensitivity in autoimmune retinopathy Matsumiya, W., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Mobasserian, A., Karaca, I., Lam, B., Pham, B., Hwang, J., Afridi, R., Halim, M., Do, D., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Posterior segment manifestations in patients with HLA-B27 associated uveitis Lajevardi, S., Onghanseng, N. L., Park, J., Khan, H., Atilgan, M., Halim, M., Uludag, G., Matsumiya, W., Yilmaz, M., Ghoraba, H., Hien Luong Doan, Mobasserian, A., Hwang, J., Quan Dong Nguyen, Hasanreisoglu, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Novel retinopathy identified in pediatric retinal vasculitis Yasar, C., Matsumiya, W., Akhavanrezayat, A., Ghoraba, H., Halim, M., Uludag, G., Pham, B., Hwang, J., Karaca, I., Lajevardi, S., Lam, B., Regenold, J., Sepah, Y. J., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Altered patient demography and increased complexity of ICD coding in uveitis over 10 years Hwang, J., Halim, M., Uludag, G., Yasar, C., Ghoraba, H., Pham, B., Lajevardi, S., Lam, B., Regenold, J., Bazojoo, V., Karaca, I., Mobasserian, A., Do, D. V., Sepah, Y. J., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Structural and functional changes in non-paraneoplastic autoimmune retinopathy Akhavanrezayat, A., Onghanseng, N. L., Halim, M., Uludag, G., Ghoraba, H., Matsumiya, W., Pham, B., Mobasserian, A., Regenold, J., Yasar, C., Karaca, I., Bazojoo, V., Lajevardi, S., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Safety of intravenous high-dose pulse methylprednisolone succinate in the management of pediatric uveitis Ghoraba, H., Akhavanrezayat, A., Matsumiya, W., Pham, B., Yasar, C., Karaca, I., Mobasserian, A., Regenold, J., Lam, B., Hwang, J., Lajevardi, S., Yavari, N., Halim, M., Sepah, Y. J., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2021
  • Limited Vitrectomy versus Observation for Bilateral Terson Syndrome in a Child OPHTHALMOLOGY RETINA Ghoraba, H. H., Johnson, M. W., Leila, M., Wasfy, T., Ghoraba, H. 2021; 5 (3): 312-314

    View details for Web of Science ID 000664192100019

    View details for PubMedID 32920207

  • Pars plana vitrectomy with internal limiting membrane flap versus pars plana vitrectomy with conventional internal limiting membrane peeling for large macular hole COCHRANE DATABASE OF SYSTEMATIC REVIEWS Ghoraba, H., Abdelkarem, A., Akhavanrezayat, A., Matsumiya, W., Karaca, I., Mishra, K., Yasar, C., Pham, B., Mobasserian, A., Quan Dong Nguyen 2021
  • Submacular perfluorocarbon liquid: long-term follow-up INTERNATIONAL OPHTHALMOLOGY Ghoraba, H., Ghoraba, H., Heikal, M., Elgouhary, S., Mansour, H., Abdelhafez, M., Zaky, A. 2020; 40 (5): 1209-1219

    Abstract

    To report the long-term follow-up of patients with inadvertent retained submacular perfluorocarbon liquid (PFCL) bubbles after vitrectomy surgery.PFCL has unique chemical and physical features which facilitate displacement of subretinal fluid from central toward periphery allowing intraoperative reattachment of the mobile retina and manipulation of the anterior part of the detached retina without performing drainage retinotomy. Despite these advantages, PFCL droplets may be inadvertently retained in the submacular space.A retrospective case series study was conducted. We reviewed 1224 consecutive patients who had undergone primary pars plana vitrectomy at one vitreoretinal center operated by single surgeon (Hammouda Ghoraba). Chart review was performed to identify patients and procedural factors that could predispose to retained submacular PFCL with anatomical and functional outcomes with follow-up at least 18 months.The retina was completely attached in 97% of eyes where PFCL was used after one or two vitrectomy surgeries. Submacular PFCL was found in 12 (0.98%) eyes. There was no statistical difference between perfluorodecalin and perfluoro-n-octane as regards retention rate. The possible risk factors associated with submacular retention of PFCL phenomenon are the presence of post-equatorial retinal breaks in six patients (50%) and large retinal break (2-3 clock hours) in three patients (25%).Submacular PFC migration occurs in nearly 1% of cases when it is used. It occurred in cases of RRD with post-equatorial or large breaks. Using perfluoro-n-octane or perfluorodecalin had no statistical difference. Different behaviors of submacular PFC droplets occurred. Some cases of small submacular PFC droplets maintained fair VA for a long period.

    View details for DOI 10.1007/s10792-020-01287-7

    View details for Web of Science ID 000509141300002

    View details for PubMedID 31981001

  • Comparative Study between Pars Plana Vitrectomy with Internal Limiting Membrane Peel and Pars Plana Vitrectomy with Internal Limiting Membrane Flap Technique for Management of Traumatic Full Thickness Macular Holes JOURNAL OF OPHTHALMOLOGY Ghoraba, H., Leila, M., Ghoraba, H., Heikal, M., Elgemai, E. 2019; 2019: 1959082

    Abstract

    To compare the efficacy of PPV and ILM peel versus PPV and IFT in patients with traumatic FTMH.Retrospective interventional comparative case series including two groups of patients with traumatic FTMH. Patients were divided into group I (ILM peel) and group II (IFT). The main outcome measure was closure of the macular hole and restoration of the foveal microstructure. The independent-samples T-test and ANOVA test were used to study the mean between 2 groups and calculate the P value, whereas the bivariate correlation procedure studied the interaction between the variables tested.Group I included 28 patients. Mean preoperative MLD was 757 µm. Mean preoperative BCVA was approximately 20/320. Group II included 12 patients. Mean preoperative MLD was 529.5 µm. Mean preoperative BCVA was 20/320. Group I had a macular hole closure rate of 75% versus 92% in group II P=0.05. Mean BCVA improvement was 2.5 lines in group I versus 5 lines in group II P=0.02. Disrupted ELM and IS/OS was the most salient finding in both groups.IFT has a significantly superior anatomic and functional outcome compared to ILM peel in traumatic FTMH.

    View details for DOI 10.1155/2019/1959082

    View details for Web of Science ID 000467114300001

    View details for PubMedID 31143468

    View details for PubMedCentralID PMC6501415

  • Safety of high-dose intravitreal triamcinolone acetonide as low-cost alternative to anti-vascular endothelial growth factor agents in lower-middle-income countries CLINICAL OPHTHALMOLOGY Ghorabau, H., Leila, M., Elgouhary, S., Elgemai, E., Abdelfattah, H., Ghoraba, H., Heikal, M. 2018; 12: 2383-2391

    Abstract

    The purpose of this study was to evaluate the safety of high-dose intravitreal triamcinolone acetonide (IVTA) as affordable low-cost alternative to anti-vascular endothelial growth factor (anti-vascular endothelial growth factor [anti-VEGF] agents) in lower-middle-income countries.This was a retrospective interventional non-comparative case series. The study recruited patients who received 20 mg IVTA for treating various retinal and optic nerve diseases over the past 5 years. Main outcome measure was assessment of complications secondary to high-dose IVTA. The crosstabs procedure was used to display the interaction between the variables tested. The ANOVA test was used to analyze the differences among group means.The study included 207 eyes of 168 patients. The main indication for high-dose IVTA were diabetic macular edema 64%, and macular edema secondary to retinal vein occlusion 19%. The mean follow-up period post-injection was 22 months. Mean number of injections was 1.3. Cataract developed in 54% of eyes. Glaucoma developed in 18.5% of eyes. Glaucoma surgery for intractable glaucoma attributed to high-dose IVTA was needed in 1% of eyes. Endophthalmitis and retinal detachment developed in one patient each.High-dose IVTA is a safe and cost-effective alternative to anti-VEGF agents. Cataract formation and intraocular pressure rise do not pose major adverse effects when weighed against the risk of vision loss due to inability to afford anti-VEGF treatment.

    View details for DOI 10.2147/OPTH.S185274

    View details for Web of Science ID 000451276200001

    View details for PubMedID 30538421

    View details for PubMedCentralID PMC6263217