All Publications

  • Aqueous humour interleukin-6 and vision outcomes with anti-vascular endothelial growth factor therapy. Eye (London, England) Sepah, Y. J., Do, D. V., Mesquida, M., Day, B. M., Blotner, S., Afridi, R., Halim, M. S., Hong, K., Wakshull, E., Fauser, S., Stoilov, I., Dong Nguyen, Q. 2024


    This analysis evaluated aqueous humour (AH) interleukin (IL)-6 concentrations and the association between AH IL-6 and visual outcomes in patients with neovascular age-related macular degeneration (nAMD) or diabetic macular oedema (DMO) receiving anti-vascular endothelial growth factor (VEGF) monotherapy.Post hoc analysis of the multicentre, double-masked, randomised HARBOR (NCT00891735) and READ-3 (NCT01077401) trials. HARBOR enrolled treatment-naïve nAMD patients. READ-3 enrolled treatment-naïve/previously treated DMO patients. HARBOR patients received ranibizumab 0.5 or 2.0 mg monthly or as needed; AH samples were collected at month 2, after two previous intravitreal injections. READ-3 patients received ranibizumab 0.5 or 2.0 mg as needed; AH samples were collected at baseline and months 3, 6, 9, and 12.association between AH IL-6 concentrations and month 24 best-corrected visual acuity (BCVA).In both trials (HARBOR, N = 36; READ-3, N = 137), patients with higher AH IL-6 concentrations had worse visual outcomes. HARBOR patients with low AH IL-6 concentrations at month 2 had a mean (95% CI) BCVA change at month 24 of +2.9 (-2.6, 8.3) letters, whereas patients with high AH concentrations had a mean (95% CI) BCVA change of -9.0 (-22.7, 4.7) letters. READ-3 patients with low AH concentrations at baseline had a mean (95% CI) BCVA change at month 12 of +9.3 (7.4, 11.3) letters, whereas patients with high AH concentrations had a mean (95% CI) BCVA change of +5.6 (2.2, 9.1) letters.Higher IL-6 AH concentrations may predict suboptimal visual responses to anti-VEGF monotherapy in patients with nAMD/DMO.

    View details for DOI 10.1038/s41433-024-03015-2

    View details for PubMedID 38622330

    View details for PubMedCentralID 4176007

  • The Role of Corticosteroids and Immunomodulatory Therapy in the Management of Infectious Uveitis. Ocular immunology and inflammation Akhavanrezayat, A., Uludag Kirimli, G., Matsumiya, W., Khojasteh, H., Or, C., Karaca, I., Pham, B., Ongpalakorn, P., Lajevardi, S., Lam, B., Hwang, J. J., Than, N. T., Park, S., Yavari, N., Bazojoo, V., Mobasserian, A., Khatri, A., Halim, M. S., Thng, Z. X., Ghoraba, H., Do, D. V., Tugal-Tutkun, I., Gupta, V., de Smet, M., Nguyen, Q. D. 2024: 1-12


    The index review aims to provide an update on the role of corticosteroids and steroid-sparing immunomodulatory therapy (IMT) in managing patients with infectious uveitis.Narrative literature review.Corticosteroids and immunomodulatory therapy (IMT) focus on the host defense system instead of the pathogen, adjusting exaggerated inflammatory reactions to reduce potential harm to ocular tissues. Systemic or local corticosteroids are primarily selected as adjunctive medication for infectious uveitis. Concomitant corticosteroids have also been used in cases of paradoxical worsening in ocular tuberculosis and immune recovery uveitis in cytomegalovirus (CMV) retinitis. While there is no well-established evidence to support the use of IMT in infectious uveitis, it is occasionally used in clinical settings to treat persistent inflammation following resolution of infection such as cases of ocular tuberculosis and ocular syphilis where an insufficient response is observed with corticosteroids.There is no consensus on the position of immunomodulatory therapy in the management of infectious uveitis with different etiologies. The index review provides an overview of available adjunctive corticosteroids and IMT options to assist clinicians in managing such disease entities more efficiently.

    View details for DOI 10.1080/09273948.2023.2296032

    View details for PubMedID 38330155

  • Implementation and Long-term Efficacy of a Multifaceted Intervention to Reduce Central Line-Associated Bloodstream Infections in Intensive Care Units of a Low Middle-Income Country. American journal of infection control Latif, A., Ali, W., Haleem, S., Mahmood, F., Munir, T., Virani, N., Khan, H., Qadir, M., Roshan, R., Hooda, K., Khan, N. M., Zafar, A., Pronovost, P. 2024


    Central line-associated bloodstream infections (CLABSIs) pose a significant risk to critically ill patients, particularly in intensive care units (ICU) and are a significant cause of hospital-acquired infections. We investigated whether implementation of a multifaceted intervention was associated with reduced incidence of CLABSIs.This was a prospective cohort study over 9 years. We implemented a bundled intervention approach to prevent CLABSIs, consisting of a comprehensive unit-based safety program (CUSP). The program was implemented in the Neonatal ICU (NICU), Medical ICU (MICU) and Surgical ICU (SICU) departments at the Aga Khan University Hospital in Pakistan.The three intervention ICUs combined were associated with an overall 36% reduction in CLABSI rates and a sustained reduction in CLABSI rates for > a year (5 quarters). The NICU experienced a decrease of 77% in CLABSI rates lasting ~1 year (4 quarters). An attendance rate above 88% across all stake-holder groups in each CUSP meeting correlated with a better and more sustained infection reduction.Our multi-faceted approach using the CUSP model was associated with reduced CLABSI-associated morbidity and mortality in resource limited settings. Our findings suggest that higher attendance rate (>80%) at meetings may be necessary to achieve sustained effects post-intervention.

    View details for DOI 10.1016/j.ajic.2024.02.001

    View details for PubMedID 38336128

  • Structural and Functional Changes in Non-Paraneoplastic Autoimmune Retinopathy. Diagnostics (Basel, Switzerland) Akhavanrezayat, A., Khatri, A., Onghanseng, N. G., Halim, M. S., Or, C., Sredar, N., Razeen, M., Hasanreisoglu, M., Regenold, J., Thng, Z. X., Mohammadi, S. S., Jain, T., Yavari, N., Bazojoo, V., Gupta, A. S., Mobasserian, A., Yasar, C., Than, N. T., Uludag Kirimli, G., Karaca, I., Shin, Y., Yoo, W., Ghoraba, H., Do, D. V., Dubra, A., Nguyen, Q. D. 2023; 13 (21)


    BACKGROUND: To describe longitudinal changes in patients with non-paraneoplastic autoimmune retinopathy (npAIR) by utilizing different diagnostic modalities/tests.METHODS: The index study is a retrospective longitudinal review of sixteen eyes of eight patients from a tertiary care eye hospital diagnosed with npAIR. Multiple diagnostic modalities such as wide-angle fundus photography (WAFP), WA fundus autofluorescence (WAFAF), spectral-domain optical coherence tomography (SD-OCT), Goldmann visual field (GVF) perimetry, microperimetry (MP), electrophysiologic testing, and adaptive optics scanning laser ophthalmoscopy (AOSLO) were reviewed and analyzed.RESULTS: At the baseline visits, anomalies were detected by multimodal diagnostic tests on all patients. Subjects were followed up for a median duration of 11.5 [3.0-18.7] months. Structural changes at the baseline were detected in 14 of 16 (87.5%) eyes on WAFP and WAFAF and 13 of 16 (81.2%) eyes on SD-OCT. Eight of the ten (80%) eyes that underwent AOSLO imaging depicted structural changes. Functional changes were detected in 14 of 16 (87.5%) eyes on GVF, 15 of 16 (93.7%) eyes on MP, and 11 of 16 (68.7%) eyes on full-field electroretinogram (ff-ERG). Multifocal electroretinogram (mf-ERG) and visual evoked potential (VEP) tests were performed in 14 eyes, of which 12 (85.7%) and 14 (100%) of the eyes demonstrated functional abnormalities, respectively, at baseline. Compared to all the other structural diagnostic tools, AOSLO had a better ability to demonstrate deterioration in retinal microstructures occurring at follow-ups. Functional deterioration at follow-up was detected on GVF in 8 of 10 (80%) eyes, mf-ERG in 4 of 8 (50%) eyes, and MP in 7 of 16 (43.7%) eyes. The ff-ERG and VEP were stable in the majority of cases at follow-up.CONCLUSIONS: The utilization of multimodal imaging/tests in the diagnosing and monitoring of npAIR patients can aid in identifying anomalous changes over time. Analysis of both the anatomical and functional aspects by these devices can be supportive of detecting the changes early in such patients. AOSLO shows promise as it enables the capture of high-resolution images demonstrating quantifiable changes to retinal microstructure.

    View details for DOI 10.3390/diagnostics13213376

    View details for PubMedID 37958272

  • Association of oral montelukast with reduced odds of developing exudative age-related macular degeneration. Retina (Philadelphia, Pa.) Matsumiya, W., Karaca, I., Pham, B. H., Akhavanrezayat, A., Uludag, G., Yasar, C., Ghoraba, H., Mobasserian, A., Regenold, J., Halim, M. S., Sepah, Y. J., Do, D. V., Chong, V., Nguyen, Q. D. 2023


    This study was conducted to evaluate the association of oral montelukast, selective antagonism for cysteinyl leukotriene receptor 1, with reduced odds of exudative age-related macular degeneration (exAMD) development.This case-control study was conducted using Institutional Cohort Finder tool, and included 1913 patients with exAMD (ICD: H35.32 and 362.52) and 1913 age- and gender-matched control subjects without exAMD. Sub-analysis among 1913 exAMD and 324 non-exudative AMD was also conducted.A total of 47 (2.5%) exAMD cases were identified to have a history of oral montelukast use prior to exAMD diagnosis, compared to 84 (4.4%) controls. Montelukast usage was significantly associated with reduced odds of exAMD in the multivariable analysis (adjusted OR: 0.50, 95% CI: 0.31 - 0.80) as well as NSAID usage (adjusted OR: 0.69). Caucasian race, history of smoking, non-exudative macular degeneration in either eye were also found to have significant relationship with increased odds of exAMD. In the sub-analysis, montelukast usage showed significant association with reduced odds of developing exAMD from non-exudative AMD (adjusted OR: 0.53 95% CI: 0.29 - 0.97) as well as the presence of atopic disease (adjusted OR: 0.60).The study results suggested that oral montelukast is linked to reduced odds of exAMD development.

    View details for DOI 10.1097/IAE.0000000000003870

    View details for PubMedID 37339446

  • Assessment of the relationship between presence of active retinal vasculitis and aqueous flare values using laser flare meter Tran, A., Akhavanrezayat, A., Karaca, I., Khojasteh, H., Halim, M., Uludag, G., Shin, Y., Ghoraba, H., Or, C., Hassan, M., Bromeo, A., Ongpalakorn, P., Yasar, C., Bazojoo, V., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • A novel objective method to detect the foveal center point in the rtx1™ device using artificial intelligence Akhavanrezayat, A., Bommanapally, V., Mudiyanselage, D., Khojasteh, H., Halim, M., Or, C., Karaca, I., Uludag, G., Yavari, N., Bazojoo, V., Mobasserian, A., Shin, Y., Hasanreisoglu, M., Chundi, P., Nguyen, Q., Subramaniam, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Utilization of automated deep learning approach toward detection of ocular toxoplasmosis using fundus photographs Hassan, M., Soledad Ormaechea, M., Halim, M., Uludag, G., Schlaen, A., Kesim, C., Colombero, D., Ozdemir, H., Rudzinski, M., Subramaniam, M., Ozdal, P., Chundi, P., Nguyen, Q., Hasanreisoglu, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Natural History of Dry Age-Related Macular Degeneration (The OREO Study) Sepah, Y., Halim, M., Janjua, K., Karaca, I., Or, C., Do, D., Esmaeelpour, M., Link, J., Yamaguchi, T., Tran, A., Akhavanrezayat, A. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Efficacy and tolerability of subcutaneous repository corticotropin injection in ocular inflammation Yavari, N., Ghoraba, H., Or, C., Karaca, I., Lyu, X., Le, A., Khojasteh, H., Akhavanrezayat, A., Mobasserian, A., Bajozoo, V., Jison, L., Park, S., Halim, M., Ahmed, M., Do, D., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2023
  • Evaluation of correlation between DiopsysNOVA fixed-luminance flicker ERG and DiagnosysEspion 2 flicker ERG parameters. Documenta ophthalmologica. Advances in ophthalmology Regenold, J., Doan, H. L., Ghoraba, H., Khojasteh, H., Jaclyn Hwang, J. J., Yavari, N., Akhavanrezayat, A., Than, N. T., Le, A. H., Halim, M. S., Nguyen, Q. D. 2023


    PURPOSE: DiopsysNOVA is a novel full-field electroretinography (ffERG) device that can make rapid measurements of retinal electrophysiologic function. Diagnosys Espion 2 is a clinical gold-standard ERG device. This study aimed to investigate whether light-adapted DiopsysNOVA fixed-luminance flicker ffERGmagnitude andimplicit time (converted from phase) measurements correlate with light-adapted DiagnosysEspion 2 flicker ffERG amplitude and implicit time measurements, respectively.METHODS: Twelve patients (22 eyes) with various retinal and uveitic diseases underwent light-adapted DiagnosysEspion 2 and DiopsysNOVA fixed-luminance flicker testing. Diopsysmagnitude and implicit time (converted from phase)measurements were compared to Diagnosysamplitude and implicit timemeasurements, and a Pearson correlation was used to evaluate any existing correlation. Groups were also compared using generalized estimating equations. Bland-Altman plots were utilized to determine agreement between the comparison groups.RESULTS: Age of patients ranged from 14 to 87 years. 58% (n=7/12) of patients were female. A significant, positive correlation (r=0.880, P<0.001) was observed betweenmagnitude(Diopsys) andamplitude(Diagnosys) measurements. Amplitude increases by 6.69V for each 1V increase in Magnitude (p-value<0.001). A statistically significant, strong positive correlation was observed between Diopsys implicit time measurements (converted from phase) and Diagnosys implicit time measurements (r=0.814, p-value<0.001). For each 1ms increase in Diopsys implicit time, Diagnosys implicit time increases by 1.13ms (p-value<0.001).CONCLUSIONS: There is a statistically significant positive correlation between light-adapted DiopsysNOVA fixed-luminance flicker amplitudeand Diagnosysflickermagnitude values. Additionally, there is a statistically significant positive correlation between DiopsysNOVA fixed-luminance flicker implicit time (converted from phase) and Diagnosysflickerimplicit time values. These results imply that the DiopsysNOVA module, which utilizes the nonstandard shortened International Society for Clinical Electrophysiology of Vision (ISCEV) ERG protocol, can produce reliable light-adapted flicker ffERG measurements.

    View details for DOI 10.1007/s10633-023-09934-x

    View details for PubMedID 37219642

  • Posterior Segment Ocular Findings in HLA-B27 Positive Patients with Uveitis: A Retrospective Analysis. Clinical ophthalmology (Auckland, N.Z.) Or, C., Lajevardi, S., Ghoraba, H., Park, J. H., Onghanseng, N., Halim, M. S., Hasanreisoglu, M., Hassan, M., Uludag, G., Akhavanrezayat, A., Nguyen, Q. D. 2023; 17: 1271-1276


    To describe the prevalence and characteristics of posterior segment manifestations in patients with HLA-B27-associated uveitis using wide field imaging.Medical records of patients diagnosed with HLA-B27-associated uveitis from a tertiary uveitis clinic were reviewed. Posterior segment involvements including but not limited to peripheral vasculitis, optic disc inflammation, and macula edema documented based on medical records and various imaging modalities including wide field fluorescein angiography and optical coherence tomography, were noted. Demographic characteristics, accompanied with systemic diseases as well as duration and chronicity of uveitis, were also evaluated. Patients with significant systemic and ocular comorbidities were excluded. Statistical analyses including chi-squared tests and paired t-tests were employed.Of the 44 patients with HLA-B27 associated uveitis, 22 patients (50%) were noted to demonstrate posterior segment involvement. Disc leakage and peripheral vasculitis were the most common findings of posterior involvement. Those with anterior chamber inflammation were found to have a significantly increased risk of posterior involvement. Those with posterior involvement were also noted to have a statistically significant decreased visual acuity. No significant association was found between documented duration of disease and posterior segment involvement.The prevalence of posterior segment involvement in HLA-B27 associated uveitis is higher compared to previous reports when evaluated with wide angle imaging modalities. Careful examination of the posterior segment is required in patients with HLA-B27 associated uveitis.

    View details for DOI 10.2147/OPTH.S408728

    View details for PubMedID 37152636

    View details for PubMedCentralID PMC10162386

  • Fundus topographical distribution patterns of ocular toxoplasmosis. The British journal of ophthalmology Hasanreisoglu, M., Halim, M. S., Cakar Ozdal, P., Ormaechea, M. S., Kesim, C., Ozdemir, H. B., Uludag, G., Sredar, N., Cankurtaran, M., Liu, X., Denniston, A. K., Rudzinski, M. N., Colombero, D. N., Schlaen, B. A., Keane, P. A., Pavesio, C., Nguyen, Q. D. 2023


    BACKGROUND: To establish topographic maps and determine fundus distribution patterns of ocular toxoplasmosis (OT) lesions.METHODS: In this retrospective study, patients who presented with OT to ophthalmology clinics from four countries (Argentina, Turkey, UK, USA) were included. Size, shape and location of primary (1°)/recurrent (2°) and active/inactive lesions were converted into a two-dimensional retinal chart by a retinal drawing software. A final contour map of the merged image charts was then created using a custom Matlab programme. Descriptive analyses were performed.RESULTS: 984 lesions in 514 eyes of 464 subjects (53% women) were included. Mean area of all 1° and 2° lesions was 5.96±12.26and 5.21±12.77mm2, respectively. For the subset group lesions (eyes with both 1° and 2° lesions), 1° lesions were significantly larger than 2° lesions (5.52±6.04mm2 vs 4.09±8.90mm2, p=0.038). Mean distances from foveola to 1° and 2° lesion centres were 6336±4267and 5763±3491m, respectively. The majority of lesions were found in temporal quadrant (p<0.001). Maximum overlap of all lesions was at 278m inferotemporal to foveola.CONCLUSION: The 1° lesions were larger than 2° lesions. The 2° lesions were not significantly closer to fovea than 1° lesions. Temporal quadrant and macular region were found to be densely affected underlining the vision threatening nature of the disease.

    View details for DOI 10.1136/bjo-2022-322747

    View details for PubMedID 36931697

  • Measuring the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC). BMJ open quality Ahmed, F. A., Asif, F., Munir, T., Halim, M. S., Feroze Ali, Z., Belgaumi, A., Zafar, H., Latif, A. 2023; 12 (1)


    BACKGROUND: Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).METHODS: The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and September 2019.RESULTS: The response rate of the survey was 50%. In the past 12 months, 979 respondents (33.1%) had submitted at least one event report. Results showed that the personnel viewed the patient safety culture at their hospital favourably. Overall, respondents scored highest in the following dimensions: 'feedback and communication on error' (91%), 'organisational learning and continuous improvement' (85%), 'teamwork within units' (83%), 'teamwork across units' (76%). The dimensions with the lowest positive per cent scores included 'staffing' (40%) and 'non-punitive response to error' (41%). Only the reliability of the 'handoffs and transitions', 'frequency of events reported', 'organisational learning' and 'teamwork within units' was higher than Cronbach's alpha of 0.7. Upon regression analysis of positive responses, physicians and nurses were found to have responded less favourably than the remaining professional groups for most dimensions.CONCLUSION: The measurement of safety culture is both feasible and informative in developing countries and could be broadly implemented to inform patient safety efforts. Current data suggest that it compares favourably with benchmarks from hospitals in the USA. Like the USA, high staff workload is a significant safety concern among staff. This study lays the foundation for further context-specific research on patient safety culture in developing countries.

    View details for DOI 10.1136/bmjoq-2022-002029

    View details for PubMedID 36931633

  • Acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis. American journal of ophthalmology case reports Ishihara, R., Khan, Y., Halim, M. S., Akhavanrezayat, A., Onghanseng, N., Levin, M. H., Nguyen, Q. D. 2023; 29: 101760


    Purpose: To report the clinical and anatomical features of an unusual case of acute idiopathic blind spot enlargement syndrome (AIBSES) with retinal vasculitis.Observations: A 39-year-old patient, who was a known case of chronic headache with nonspecific visual symptoms for nine years, developed scotomas in her right eye. She was initially diagnosed with AIBSES which had been stable, but later worsened with symptoms of subsequent blind spot enlargement and photopsia on the left eye a year later. Increase in the size of the blind spot over the left eye and stability of the blind spot enlargement over the right eye was documented on Humphrey visual field (HVF) testing. Due to the rapid onset and severity of symptoms, an inflammatory etiology was entertained and this prompted referral to our clinic. At initial presentation, fluorescein angiogram (FA) revealed moderate diffuse vasculitis and disc leakage in the left eye, which existed alongside the enlarged blind spot. Corticosteroid treatment was suggested and initiated. The patient was found to have a reduction in the size of her blind spot and a decrease in severity of retinal vasculitis a month later. Unfortunately, the patient was then lost to follow up and had stopped steroid treatment of her own accord. After nine months without treatment, the patient's blind spot increased to a larger size than her initial presentation, as documented on HVF, with recurrence of vasculitis in the left eye.Conclusion and Importance: This is an unusual case of AIBSES which presented with vasculitis and rapid progression and has responded to steroids. Though monocular AIBSES has been shown to later affect the contralateral eye, concurrent vasculitis with AIBSES has not previously been reported. Furthermore, the response to treatment with reduction in blind spot enlargement is unusual for AIBSES. These findings stress the need for regular monitoring in cases of AIBSES.

    View details for DOI 10.1016/j.ajoc.2022.101760

    View details for PubMedID 36561880

  • Birdshot Chorioretinopathy in Early Adulthood: Review of Current Literature and Case Report. International medical case reports journal Pham, B. H., Uludag, G., Hien, D. L., Than, N. T., Hwang, J. J., Akhavanrezayat, A., Matsumiya, W., Lajevardi, S., Regenold, J., Halim, M. S., Nguyen, Q. D. 2023; 16: 815-831


    Purpose: We describe the course of a patient diagnosed with birdshot chorioretinopathy (BSCR) in early adulthood and summarize clinical findings from similar BSCR patients reported in the literature.Observations: A 37-year-old male presented to our tertiary uveitis facility with bilateral ocular discomfort, hazy vision, and floaters. Ocular examination was notable for vitritis, optic disc edema, and ovoid hypopigmented chorioretinal lesions, visible on indocyanine green chorioangiography as multiple hypocyanescent spots in the intermediate phase. Full-field electroretinography and visual evoked potential showed global retinal dysfunction and optic nerve dysfunction. Laboratory evaluations were notable only for human leukocyte antigen (HLA)-A29 positivity. The patient was diagnosed with BSCR and started on oral prednisone and eventually managed with infliximab.Conclusions and Importance: BSCR can affect patients in early adulthood. Proper diagnostic work-up, including assessing HLA-A29 positivity, is needed to manage atypical cases.

    View details for DOI 10.2147/IMCRJ.S430981

    View details for PubMedID 38107027

  • Efficacy and Safety of Tocilizumab in the Management of Non-Infectious Uveitis Failed with Conventional Immunomodulatory and Anti-TNFα Therapies. Ocular immunology and inflammation Uludag, G., Karaca, I., Akhavanrezayat, A., Yasar, C., Matsumiya, W., Pham, B. H., Halim, M. S., Trong Tuong Than, N., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2022: 1-7


    To determine the outcomes of intravenous (IV) tocilizumab (TCZ) in patients with non-infectious uveitis who failed with conventional immunomodulatory and anti-TNFα therapies.Records of seven patients with non-infectious uveitis treated with monthly IV TCZ (4-10 mg/kg) or biweekly IV TCZ (8 mg/kg) were reviewed. Outcome measures were changes in visual acuity, anterior chamber cell and flare grade, vitreous haze, central subfield thickness (CST), and fluorescein angiography (FA) score.Ten eyes of seven patients received TCZ therapy. Median age of patients was 14 (range, 7-24) years. Median duration of TCZ therapy was 15 (range, 5-32) months. Mean CST reduced from 373 ± 101.0 μm to 298.2 ± 40.3 μm. Mean FA score reduced from 12.5 ± 4.3 to 3.6 ± 2.6. One patient developed elevated liver transaminases.IV TCZ is a potentially effective and safe therapeutic option for the management of refractory non-infectious uveitis.

    View details for DOI 10.1080/09273948.2022.2126374

    View details for PubMedID 36542775

  • Bilateral retinal vasculitis associated with cold agglutinin disease treated with obinutuzumab and infliximab. American journal of ophthalmology case reports Than, N. T., Yaşar, Ç., Pham, B. H., Lam, B. C., Doan, H. L., Akhavanrezayat, A., Halim, M. S., Iberri, D. J., Hien, D. L., Dong Nguyen, Q. 2022; 28: 101752


    To describe the clinical course and management of a patient with bilateral retinal vasculitis associated with cold agglutinin disease (CAD) treated with obinutuzumab and infliximab.A 69-year-old Hispanic woman was referred to a tertiary Uveitis Clinic with progressively worsening blurry vision, right eye (OD) worse than left eye (OS). Past ocular history was significant for epiretinal membranes in both eyes (OU). Past medical history was notable for non-specific joint disease, primarily affecting her knees bilaterally, and pulmonary symptoms (e.g., dyspnea, productive cough) of unclear etiologies one year before presentation. She had been evaluated by rheumatologists and pulmonologists and was placed on low doses of prednisone and methotrexate. Upon examination, her visual acuity was 20/40 in OD and 20/25 in OS. Anterior segment exam was unremarkable with no cell or flare in OU. Dilated fundus examination was notable for 0.5+ vitreous haze in OU and mild vessel attenuation in OU. Wide-angle fluorescein angiography (FA) revealed mild bilateral periphery peri-vasculature leakage in OU. Initial blood evaluations revealed decreased hematocrit, and positive anti-nuclear antibody. Her peripheral smear disclosed 3+ agglutination. She was initially treated with mycophenolate mofetil 1000 mg twice daily and prednisone 20 mg then referred to hematology. Further work up revealed high-titer cold agglutinin and positive thermal amplitude screen at 30 °C. Bone marrow examination demonstrated a chronic lymphocytic leukemia (CLL)-like monoclonal B-cell lymphocytosis. Anti-CD20 monoclonal antibody therapy with obinutuzumab was started in an effort to treat the underlying CLL clone and address the associated ocular vasculitis related to CAD. Three months later, after eight cycles of obinutuzumab, the patient's best- corrected visual acuity (BCVA) continued to be stable at 20/30 in OD and 20/20 in OS. However, FA showed persistent diffuse perivascular leakage. Intravenous infliximab with concurrent intravenous methylprednisolone infusions were started. After two cycles of treatment, FA showed significantly improved perivascular leakage. Visual acuity remained stable at 20/25 in OU.Ocular involvement in CAD is rare. The index case is the first report of retinal vasculitis in a patient with CAD. Our report not only describes the unique course of CAD-related retinal vasculitis, but also introduces and underscores a successful therapeutic plan.

    View details for DOI 10.1016/j.ajoc.2022.101752

    View details for PubMedID 36425783

    View details for PubMedCentralID PMC9679462

  • 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


    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

  • Longitudinal Comparative Analysis of Semi-Automated Aqueous Flare Measurements with Clinical Grading and Visual Outcomes in Uveitic Eyes. Ocular immunology and inflammation Hasanreisoglu, M., Halim, M. S., Kesim, C., Doan, H. L., Tran, A. N., Nguyen, W., Besalti, Z., Lajevardi, S., Hassan, M., Akhavanrezayat, A., Ahmed, M. I., Do, D. V., Sepah, Y. J., Nguyen, Q. D. 2022: 1-6


    To evaluate the correlation between longitudinal changes in aqueous flare measured by laser flare photometer (LFP), best-corrected visual acuity (BCVA), and clinical grade using both Standardization of Uveitis Nomenclature (SUN) and modified SUN (MSUN) scales uveitis patients.Patients were classified according to both SUN and MSUN grading scales. LFP measurements were acquired (Kowa FM-700) at each visit. Mean change in LFP was assessed longitudinally, comparing with those in visual acuity, SUN, and MSUN grading scales.Mean change in LFP was correlated to those in BCVA (p = .018), SUN scale (p < .001), and MSUN scale (p = .008). Cases within same initial SUN (0 and 1+) and MSUN (0.5+ and 1+) grades and different longitudinal flare prognosis (decreased/unchanged/increased) had significantly different initial LFP values (all p < .05).LFP measurement is beneficial in monitoring inflammatory activity. Cases of identical clinical flare scores with different clinical prognosis may be predicted by LFP.

    View details for DOI 10.1080/09273948.2022.2123365

    View details for PubMedID 36170559

  • Reflectance adaptive optics findings in a patient with Vogt-Koyanagi-Harada disease. American journal of ophthalmology case reports Pham, A. T., Onghanseng, N., Halim, M. S., Ormaechea, M. S., Hassan, M., Akhavanrezayat, A., Uludag, G., Tran, A. N., Razeen, M. M., Sredar, N., Dubra, A., Nguyen, Q. D. 2022; 27: 101660


    To describe the reflectance adaptive optics scanning laser ophthalmoscopy (AOSLO) findings in different stages of Vogt-Koyanagi-Harada (VKH) disease and correlate them to visual gain post treatment. Confocal (cAOSLO) and non-confocal split-detector AOSLO (sdAOSLO) were used to assess longitudinally the status of the photoreceptors in a patient with VKH managed on corticosteroid and immunomodulatory therapy.A 32-year-old Japanese American female presented with a 2-week history of blurred vision in both eyes (OU) and worsening headache previously diagnosed as a case of VKH and treated with high dose oral prednisone. At the time of presentation, though vision was improving, and frank serous retinal detachments were absent, spectral domain optical coherence tomography (SD-OCT) showed presence of residual subretinal fluid with disruption of the photoreceptor inner segments and outer segments (IS/OS) involving OU. The photoreceptor mosaic at the foveal center appeared very sparse with large areas devoid of visible photoreceptors on cAOSLO, in agreement with the SD-OCT data. sdAOSLO imaging over the same location shows a higher number of contiguous photoreceptors. After imaging, the patient was started on mycophenolate mofetil as steroid-sparing long-term therapy. Three months later, visual acuity improved to 20/20 OU, and SD-OCT showed almost complete resolution of subretinal fluid with significant improvement of the IS/OS SD-OCT signal, OU. cAOSLO imaging revealed a contiguous photoreceptor mosaic without gaps and of normal appearance.VKH patients may demonstrate transient photoreceptor abnormalities on SD-OCT and cAOSLO imaging. sdAOSLO imaging revealed intact photoreceptor segments in areas that appeared as voids on cAOSLO, which later showed structural recovery on SD-OCT and cAOSLO. Therefore, sdAOSLO may predict potential for improvement in patients wherein there appears to be photoreceptor loss in cAOSLO and/or SD-OCT.

    View details for DOI 10.1016/j.ajoc.2022.101660

    View details for PubMedID 35880207

    View details for PubMedCentralID PMC9307596

  • Corrigendum to Phase 1b Randomized Controlled Study of Short Course Topical Recombinant Human Nerve Growth Factor (rhNGF) for Neuroenhancement in Glaucoma: Safety, Tolerability, and Efficacy Measure Outcomes. Am J Ophthalmol 2022;234:223-234. American journal of ophthalmology Beykin, G., Stell, L., Halim, M. S., Nunez, M., Popova, L., Nguyen, B. T., Groth, S. L., Dennis, A., Li, Z., Atkins, M., Khavari, T., Wang, S. Y., Chang, R., Fisher, A. C., Sepah, Y. J., Goldberg, J. L. 2022

    View details for DOI 10.1016/j.ajo.2022.07.018

    View details for PubMedID 35977854

  • Efficacy and safety of intravitreal anti-VEGF therapy in diabetic retinopathy: what we have learned and what should we learn further? Expert opinion on biological therapy Uludag, G., Hassan, M., Matsumiya, W., Pham, B. H., Chea, S., Trong Tuong Than, N., Doan, H. L., Akhavanrezayat, A., Halim, M. S., Do, D. V., Nguyen, Q. D. 2022


    INTRODUCTION: Diabetic retinopathy (DR) is one of the most frequent microvascular complications of diabetes that can lead to blindness. Laser treatment has been the gold standard treatment for diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) for many years. Recently, the role of vascular endothelial growth factor (VEGF) has been established in the pathogenesis of DR, and the use of intravitreal anti-VEGF therapy has gained popularity for the management of DR.AREAS COVERED: This review includes a brief overview of the efficacy and safety of currently available (bevacizumab, ranibizumab and aflibercept) and potential future (brolucizumab, faricimab, and KSI-301) anti-VEGF agents in patients with DR based mainly on publicly available data from phase 1, 2 and 3 clinical trials.EXPERT OPINION: Clinical trials investigating the efficacy of intravitreal bevacizumab, ranibizumab, and aflibercept injections demonstrated favorable functional and anatomical outcomes in patients with DME. Moreover, the use of these anti-VEGF agents showed a significant improvement in the severity of DR in patients with non-proliferative diabetic retinopathy (NPDR) and PDR. Recent clinical research for future anti-VEGF molecules aims to provide higher target-protein binding affinity and prolonged therapeutic effect. Brolucizumab, faricimab, and KSI-301 are three novel anti-VEGF agents that demonstrate promising data for the management of DME and potentially DR.

    View details for DOI 10.1080/14712598.2022.2100694

    View details for PubMedID 35818801

  • Novel retinopathy in pediatric retinal vasculitis: long term follow up Yasar, C., Ghoraba, H., Regenold, J., Or, C., Halim, M., Uludag, G., Hwang, J., Karaca, I., Mobasserian, A., Akhavanrezayat, A., Yasar, M., Khojasteh, H., Sepah, Y. J., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Multifocal electroretinographic findings in eyes with posterior uveitis and angiographic macular leakage Hwang, J., Karaca, I., Lajevardi, S., Or, C., Zaidi, M., Regenold, J., Halim, M., Uludag, G., Yasar, C., Bazojoo, V., Than, N., Mobasserian, A., Sepah, Y. J., Khojasteh, H., Nguyen, Q., Ghoraba, H. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2022
  • Utilisation of composite endpoint outcome to assess efficacy of tocilizumab for non-infectious uveitis in the STOP-Uveitis Study. The British journal of ophthalmology Hassan, M., Sadiq, M. A., Ormaechea, M. S., Uludag, G., Halim, M. S., Afridi, R., Do, D. V., Sepah, Y. J., Nguyen, Q. D. 2022


    BACKGROUND/AIMS: To use a composite endpoint scoring system in assessing efficacy of two doses of intravenous tocilizumab (TCZ), in eyes with non-infectious uveitis.METHODS: Data from STOP-Uveitis Study (a phase 2 multicentre, randomised, interventional clinical trial), where monthly intravenous infusions of 4 mg/kg (Group 1) or 8 mg/kg (Group 2) TCZ until month 6 (M6) were administered, were used. Efficacy was ascertained by a composite endpoint scoring system consisting of: (1) visual acuity; (2) intraocular inflammation; (3) central retinal thickness; (4) posterior segment inflammation on fluorescein angiographic and (5) steroid taper. Each component of grading system was graded as ((+1) improvement, (-1) worsening or (0) no change) based on specific criteria. The clinical response was classified as positive (improvement in at least one parameter and worsening in none), negative (worsening of any parameter) or stable (neither improvement nor worsening of any parameter). The percentage achieving various clinical responses was compared between groups.RESULTS: Thirty-seven patients were analysed. At M6, 31 (83.8%) subjects demonstrated a positive clinical response (Group 1=14 (77.8%) and Group 2=17 (89.5%)). Three (8.1%) subjects (all Group 1) met the criteria for treatment failure, whereas three (8.1%) subjects showed a stable clinical response (Group 1=1and Group 2=2). The difference in clinical responses between study groups was not significant (p>0.05).CONCLUSIONS: Both doses of intravenous TCZ were effective in either improving or maintaining stability in patients using the composite endpoint scoring system. A composite scoring system as used in this study may be a better measure to assess efficacy outcomes as compared with only vitreous haze or other single outcome measures.

    View details for DOI 10.1136/bjophthalmol-2021-320604

    View details for PubMedID 35379598

  • Correlation of Clinical Aqueous Flare Grading to Semi-Automated Flare Measurements Using Laser Flare Photometry. Ocular immunology and inflammation Halim, M. S., Hasanreisoglu, M., Onghanseng, N., Tran, A. N., Hassan, M., Yilmaz, M., Segawa, A., Gurelik, G., Afridi, R., Ormaechea, M. S., Uludag, G., Kesim, C., Nguyen, N. V., Bae, J. H., Park, J. H., Do, D. V., Ibrahim, M. A., Sepah, Y. J., Nguyen, Q. D. 1800: 1-7


    PURPOSE: To compare laser flare photometry (LFP) measurements of aqueous flare with Standardization of Uveitis Nomenclature (SUN) and modified SUN grading.METHODS: In this prospective study with multicenter design, uveitis patients were classified according to SUN and modified SUN grading scales. LFP was performed with Kowa FM-700 flaremeter. Mean LFP values were compared with SUN and MSUN scores.RESULTS: The study included 475 LFP measurements, of which 216, 48, 150, 31, 28 and 2 had 0, 0.5+, 1+, 1.5+, 2+and 3+flare, respectively. LFP values were significantly different between each two consecutive steps for both clinical gradings (all P <.05). Cut-off values for modified SUN grading steps were defined as 5.7, 9.7, 15.7 and 43.2 for 0/0.5+, 0.5+/ 1+, 1+/1.5+and 1.5/2+borders of clinical flare, respectively.CONCLUSIONS: LFP proves to be an objective measurement in analyzing aqueous flare comparable to both SUN and MSUN clinical grading systems.

    View details for DOI 10.1080/09273948.2021.1971723

    View details for PubMedID 35081012

  • 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


    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

  • Evaluating optical coherence tomography (OCT) findings as potential biomarkers in central nervous system (CNS) lymphoma with or without ocular involvement INTERNATIONAL JOURNAL OF RETINA AND VITREOUS Hassan, M., Halim, M., Afridi, R., Nguyen, N. V., Nguyen, Q., Sepah, Y. J. 2021; 7 (1): 70


    To evaluate spectral domain optical coherence tomography (SD-OCT) findings as biomarkers in primary central nervous system lymphoma (PCNSL) with or without ocular involvement.This study was a cross-sectional study and patients with a confirmed diagnosis of PCNSL with or without ocular involvement were included. Patient cohort finder tool was used to identify patients with lymphoma using ICD-10 codes (C82-C88), from January 2004 to October 2017. A total of 14,820 patients were identified. Procedure code (92134) for optical coherence tomography (OCT) was then applied to identify patients who had underdone OCT imaging at ophthalmology clinic. Clinic charts of 460 patients with lymphoma and available OCT were reviewed to identify patients with confirmed diagnosis of PCNSL and divided into two groups (Group 1: with and Group 2: without ocular involvement). OCT scans of patients in both study groups were analyzed for the presence of (1) Hyperreflective deposits in choroid, retinal pigment epithelium (RPE), outer and inner retina; (2) RPE thickening; (3) Vitreous debris; (4) Intraretinal fluid; (5) Ellipsoid zone disruption by masked graders. Chi-square was used to analyze the difference between the groups.Twenty-two eyes (11 patients) with PCNSL were included this study (Group 1: 6 eyes and Group 2: 16 eyes). Mean age of subjects was 65 years. Five patients (45.45%) were female. There was no statistically significant difference between the groups for the presence of hyperreflective deposits in choroid, RPE, outer and inner retina, and presence of RPE thickening, intraretinal fluid, and ellipsoid zone disruption. Vitreous debris was found more commonly in group 1 subjects (83%) than group 2 (31.25%) (p = 0.029). All subjects in both groups showed hyperreflective deposits in the RPE demonstrating RPE infiltration. However, RPE thickening was noted only in 3 patients (Group1: 1 and Group2: 2).OCT finding of hyperreflective deposits present in eyes with lymphoma secondary to PCNSL are also observed in eyes with PCNSL without ocular disease. However, the vitreous deposits are more commonly found in eyes with ocular disease. These hyperreflective deposits can serve as biomarkers for early detection of ocular involvement by PCNSL.

    View details for DOI 10.1186/s40942-021-00345-1

    View details for Web of Science ID 000722191900001

    View details for PubMedID 34819169

  • Effect of light backscattering from anterior segment structures on automated flare meter measurements. European journal of ophthalmology Hasanreisoglu, M., Kesim, C., Yalinbas, D., Yilmaz, M., Uzunay, N. S., Aktas, Z., Halim, M. S., Sepah, Y. J., Nguyen, Q. D., Sahin, A. 2021: 11206721211039350


    BACKGROUND: To evaluate effect of maximal anterior cortical lens density, iris scatter and anterior chamber depth on laser flare photometry.METHODS: Patients diagnosed with clinical uveitis were enrolled in the study. Clinical flare gradings were recorded upon the Standardization of Uveitis Nomenclature. Aqueous flare was measured with an automated device (Kowa FM-700). Back-scattering from anterior cortical lens and anterior iris surface was calculated from Scheimpflug images. A curvilinear regression model was used to calculate estimated values for each clinical grade. These values were used to split cases in Group I (laser flare photometry lower than estimated) and Group II (laser flare photometry higher than estimated). Mean anterior chamber depth, pupil aperture, maximal anterior cortical lens density and iris scatter values were compared between two groups. A stepwise multiple regression analysis was performed to determine the effect of clinical flare gradings and ocular parameters on aqueous flare measurements.RESULTS: The study included 228 eyes of 114 cases. Scheimpflug images were obtained from 105 eyes. Estimated aqueous flare measurements (in photons/milliseconds) were 4.87, 8.50, 14.81, 25.83, 45.04 and 136.93 for 0, 0.5+, 1+, 1.5+, 2+ and 3+ clinical flare respectively. Group II had higher maximal anterior cortical lens density than Group I (96.6±37.1 vs 77.9±17.1 pixel unit, p=0.001). The measured aqueous flare was significantly related to clinical flare, maximal anterior cortical lens density and pupil aperture (adjusted R2: 0.480, p<0.001).CONCLUSION: The back-scattered light from anterior cortical lens could affect laser flare photometry measurements. This effect might be quantified by Scheimpflug imaging.

    View details for DOI 10.1177/11206721211039350

    View details for PubMedID 34382443

  • Distinct Patterns of Choroidal Lesions in Punctate Inner Choroidopathy and Multifocal Choroiditis Determined by Heatmap Analysis. Ocular immunology and inflammation Park, J. G., Halim, M. S., Uludag, G., Onghanseng, N., Sredar, N., Sepah, Y. J., Nguyen, Q. D. 2021: 1-6


    Purpose: A heatmap analysis of choroidal lesions in patients with punctate inner choroidopathy (PIC) or multifocal choroiditis (MFC) with or without uveitis was performed to determine if there were any distinguishing features among these uveitic entities.Methods: Retrospective review of medical records was conducted at the Byers Eye Institute, Stanford. Fundus photographs were masked and placed on a standardized template. Lesions were identified and heatmaps were generated in a standardized fashion.Results: 30 eyes were identified with PIC or MFC. Heatmap analysis revealed three distinct patterns of fundus lesions: posterior, peripheral, and combined. All patients with PIC had the posterior pattern. Patients with MFC had the peripheral or combined pattern, and all patients with MFC with uveitis had the combined pattern.Conclusion: Three patterns of fundus lesions were identified in patients with PIC and MFC. PIC and MFC may represent two separate disease entities with distinct phenotypes of choroidal lesions.

    View details for DOI 10.1080/09273948.2021.1939391

    View details for PubMedID 34228580

  • Oral antibiotics for chronic blepharitis. The Cochrane database of systematic reviews Onghanseng, N., Ng, S. M., Halim, M. S., Nguyen, Q. D. 2021; 6: CD013697


    BACKGROUND: Posterior blepharitis is common and causes ocular surface and lid damageas well as discomfort. It affects 37% to 47% of all ophthalmology patients; its incidence increasing with age. It is a multifactorial disease associated with multiple other pathologies, such as rosacea, meibomianitis, and infections. Treatment usually focuses on reliefing the symptoms by using artificial tears, lid scrubs, and warm compresses. The condition may be notoriously difficult to manage adequately once it becomes chronic. One such management approach for chronic blepharitis is the use of oral antibiotics for both their antibacterial as well as anti-inflammatory properties. There are currently no guidelines regarding the use of oral antibiotics, including antibiotic type, dosage, and treatment duration, for the treatment of chronic blepharitis.OBJECTIVES: To assess the benefits and harms of oral antibiotic use forpeople with chronic blepharitis.SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2020, Issue 8); Ovid MEDLINE;; PubMed; Latin American and Caribbean Health Sciences Literature Database (LILACS);, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 29 August 2020.SELECTION CRITERIA: We included randomized controlled trials (RCTs) comparingoral antibiotics with placebo in adult participants with chronic blepharitis (including staphylococcal, seborrhoeic, or Meibomian Gland Dysfunction (MGD)).DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology and graded the certainty of the body of evidence for six outcomes using the GRADE classification.MAIN RESULTS: We included two studies with 220 participants (numbers of eyes unclear). One parallel-group RCT comparing oral doxycycline (40 mg once a day) with placebo enrolled 70 participants with blepharitis and facial rosacea in the USA. Follow-up duration was three months. One three-arm RCT conducted in South Korea investigated the effect of high-dose (200 mg twice a day) and low-dose (20 mg twice a day) doxycycline versus placebo after one month of study medication. It enrolled 50 participants with chronic MGD in each study arm (i.e. 150 participants enrolled in total). The two studies did not evaluate the same outcome measurements, which precluded any meta-analysis. The evidence for the effect of oral antibiotics on subjective improvement in symptoms was very uncertain. One study suggested that there was little to no effect of oral doxycycline on subjective symptoms based on the Ocular Surface Disease Index (OSDI) scores ranging from 0 to 100 (higher score indicates worse condition) (mean difference (MD) 3.55, 95% confidence interval (CI) -4.61 to 11.71; n = 70) and bulbar conjunctival hyperemia ranging from 0 (clear) to 4 (severe) (MD -0.01, 95% CI -0.38 to 0.36; n = 70) at 12 weeks. The three-arm RCT showed that oral doxycycline may slightly improve number of symptoms (MD -0.56, 95% CI -0.95 to -0.17; n = 93 (high-dose doxycycline versus placebo); MD -0.48, 95% CI -0.86 to -0.10; n = 93 (low-dose doxycycline versus placebo)) and proportion of participants with symptom improvement (risk ratio (RR) 6.13, 95% CI 2.61 to 14.42; n = 93 (high-dose doxycycline versus placebo); RR 6.54, 95% CI 2.79 to 15.30; n = 93 (low-dose doxycycline versus placebo)) at one month, but the evidence is very uncertain. We judged the certainty of evidence for subjective symptoms as very low. One study evaluated aqueous tear production by Schirmer's test (mm/5 min) (higher score indicates better condition) and tear film stability by measuring tear film break-up time (TBUT) in seconds (higher score indicates better condition) at one month. We found very low certainty evidence that oral doxycycline may improve these clinical signs. The estimated MD in Schirmer's test score after one month of treatment was 4.09 mm (95% CI 2.38 to 5.80; n = 93) in the high-dose doxycycline group versus the placebo group and 3.76 mm (95% CI 1.85 to 5.67; n = 93) in the low-dose doxycycline group versus the placebo group. The estimated MD in TBUT after one month was 1.58 seconds (95% CI 0.57 to 2.59; n = 93) when comparing the high-dose doxycycline group with the placebo group, and 1.70 seconds (95% CI 0.96 to 2.44; n = 93) when comparing the low-dose doxycycline group with the placebo group. Although there was a noted improvement in these scores, their clinical importance remains uncertain. One study suggested that oral doxycycline may increase the incidence of seriousside effects:18 (39%) participants in the high-dose doxycycline group, 8 (17%) in the low-dose doxycycline group, and 3 (6%) out of 47 participants in the placebo group experienced seriousside effects (RR 6.13, 95% CI 1.94 to 19.41; n = 93 (high-dose doxycycline versus placebo); RR 2.72, 95% CI 0.77 to 9.64; n = 93 (low-dose doxycycline versus placebo)). Additionally, one study reported that one case of migraine headache and five cases of headache were observed in the oral doxycycline group, and one case of non-Hodgkin's lymphoma was observed in the placebo group. We judged the certainty of evidence for adverse events as very low.AUTHORS' CONCLUSIONS: There was insufficient evidence to draw any meaningful conclusions on the use of oral antibiotics for chronic blepharitis. Very low certainty evidence suggests that oral antibiotics may improve clinical signs, but may cause more adverse events. The evidence for the effect of oral antibiotics on subjective symptoms is very uncertain. Further trials are neededto provide high quality evidenceonthe use of oral antibiotics in the treatment of chronic blepharitis.

    View details for DOI 10.1002/14651858.CD013697.pub2

    View details for PubMedID 34107053

  • 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
  • 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
  • Evaluation of correlation between Diopsys (R) NOVA fixed-luminance flicker electroretinography and Diagnosys (R) full-fi eldelectroretinography Regenold, J., Hien Luong Doan, Akhavanrezayat, A., Halim, M., Mobasserian, A., Hwang, J., Yavari, N., Bazojoo, V., Matsumiya, W., Karaca, I., Pham, B., Lam, B., Khojasteh, H., Lajevardi, S., 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
  • Measuring Anterior Chamber Flare using Novel Slit-Lamp Imaging Technique Halim, M., Chakravarthy, A., Onghanseng, N., Hassan, M., Ormaechea, M., Hasanreisoglu, M., Matsumiya, W., Uludag, G., Tran, A., Sepah, Y., Subramaniam, M., Nguyen, Q. 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
  • 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
  • Efficacy and safety of tocilizumab in the management of non-infectious retinal vasculitis Uludag, G., Halim, M., Akhavanrezayat, A., Matsumiya, W., Yasar, C., Pham, B., Hwang, J., Lajevardi, S., Lam, B., Karaca, I., Mobasserian, A., Regenold, J., 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
  • Current concepts in the diagnosis and management of antiphospholipid syndrome and ocular manifestations. Journal of ophthalmic inflammation and infection Uludag, G., Onghanseng, N., Tran, A. N., Hassan, M., Halim, M. S., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2021; 11 (1): 11


    Antiphospholipid syndrome (APS) is an autoimmune disorder associated with obstetrical complications, thrombotic complications involving both arteries and veins, and non-thrombotic manifestations affecting multiple other systems presenting in various clinical forms. Diagnosis requires the presence of antiphospholipid antibodies. The exact pathogenesis of APS is not fully known. However, it has recently been shown that activation of different types of cells by antiphospholipid antibodies plays an important role in thrombosis formation. Ocular involvement is one of the important clinical manifestations of APS and can vary in presentations. Therefore, as an ophthalmologist, it is crucial to be familiar with the ocular findings of APS to prevent further complications that can develop. Furthermore, the ongoing identification of new and specific factors contributing to the pathogenesis of APS may provide new therapeutic options in the management of the disease in the future.

    View details for DOI 10.1186/s12348-021-00240-8

    View details for PubMedID 33834305

  • Differences in the characteristics of subjects achieving complete, partial, or no resolution of macular edema in the READ-3 study. Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie Halim, M. S., Afridi, R., Hasanreisoglu, M., Hassan, M., Ibrahim-Ahmed, M., Do, D. V., Sepah, Y. J., READ-3 Investigators 2021


    PURPOSE: To identify baseline characteristics of subjects enrolled in the READ-3 study that would predict the response of macular edema to ranibizumab (RBZ) therapy at year 1.METHODS: In this post hoc analysis of the READ-3 randomized, multicenter phase 2 clinical trial, subjects with diabetic macular edema (DME) were randomized to receive monthly intravitreal injections of RBZ (0.5 or 2.0 mg) for 6 consecutive injections followed by as-needed treatments based on pre-defined retreatment criteria. In this sub-study, subjects were divided into three groups (persistent, rebound, and resolved) based on edema status at month 12 (M12). Multi-logistic regression was utilized to assess the probability of edema outcomes M12, based on the baseline characteristics.RESULTS: One hundred twenty-three out of 152 subjects were analyzed for this sub-study. A significant difference was observed in the baseline (BL) central subfield thickness (CST) among the study groups (p < 0.05). BL CST was a significant predictor for edema outcome at M12 with > 80% probability of the subject having persistent edema if BL CST was > 570 mum (p < 0.05). This association persisted when controlled for the dose of RBZ (relative risk (RR), 1.007; p < 0.05). BL CST was also a significant predictor for having persistent edema at M12 in subjects without vitreomacular adhesion (VMA) (> 80% probability of edema persistence at CST > 570 mum [RR, 1.006; p < 0.05]). However, in the presence of VMA, BL CST was no longer a significant predictor of having persistent edema at month 12 (RR, 1.005; p > 0.05).CONCLUSIONS: Subjects with high CST (> 570 mum) at baseline may not benefit from repeated intravitreal injections of anti-VEGF for resolution of edema.

    View details for DOI 10.1007/s00417-021-05148-6

    View details for PubMedID 33792788

  • Phase 1b randomized controlled study of short course topical recombinant human nerve growth factor (rhNGF) for neuroenhancement in glaucoma: safety, tolerability and efficacy measure outcomes. American journal of ophthalmology Gala, B., Laurel, S., Sohail, H. M., Mariana, N., Lilia, P., Bac T, N., Sylvia L, G., Amy, D., Zhongqiu, L., Melissa, A., Tom, K., Sophia Y, W., Robert, C., Ann C, F., Yasir J, S., Jeffrey L, G. 2021


    No approved therapies directly target retinal ganglion cells (RGCs) for neuroprotection or neuroenhancement in glaucoma. Recombinant human nerve growth factor (rhNGF) has been shown to promote RGC survival and function in animal models of optic neuropathy. Here we evaluate safety, tolerability, and efficacy of short-term, high-dose rhNGF eye drops versus placebo in a cohort of glaucoma patients.This study is a single-center, randomized, double-masked, vehicle-controlled, parallel group study designed to assess safety and tolerability as well as short-term neuroenhancement of structure and function ( NCT02855450). Sixty open-angle glaucoma patients were randomized 40:20 to receive either 180 μg/ml rhNGF or vehicle control eye drops in both eyes, three times daily for 8 weeks, with a 24-week post-treatment follow-up. One eye was officially selected as the study eye, although both eyes were studied and dosed. Primary endpoints were safety, as assessed through adverse events, and tolerability, as assessed through patient reported outcomes. Secondary outcome measures included best corrected visual acuity (BCVA), Humphrey visual field (HVF), electroretinogram (ERG), and optical coherence tomography (OCT) of retinal nerve fiber layer (RNFL) thickness at baseline, after 8 weeks of treatment, and at 4 and 24 weeks after treatment (12- and 32-weeks total).Of the 60 randomized subjects, 23 were female (38%) and the average age was 66.1 years. Through week 32, there were no treatment-related serious adverse events, including no unexpectedly severe progression of optic neuropathy, no adverse events affecting ocular function or pressure, and no drug-related systemic toxicity. Topical high-dose rhNGF was tolerated well, with low level of symptom burden mainly eliciting periocular ache (in 52% of treated, 5% of placebo) and only 3 patients (7.5%) discontinuing treatment due to discomfort, out of whom 1 patient (2.5%) prematurely withdrawing from the study. There were no statistically significant differences in global indices of HVF, and no meaningful differences in total, quadrant, or clock-hour mean RNFL thickness between the groups, although both of these function and structure measures showed non-significant trends towards significance in favor of rhNGF. Real-world participant data was used to generate an estimate of cohort size needed to power subsequent studies.rhNGF is safe and tolerable in a topical 180 μg/ml formulation. Although no statistically significant short-term neuroenhancement was detected in this trial, given the strong effects of NGF in preclinical models and trends detected in this study, analysis for efficacy in a neuroprotection trial is warranted.

    View details for DOI 10.1016/j.ajo.2021.11.002

    View details for PubMedID 34780798

  • Case Report: A Human Case of Onchocerca lupi Mimicking Nodular Scleritis. The American journal of tropical medicine and hygiene Hasanreisoglu, M., Halim, M. S., Latrofa, M. S., Mendoza-Roldan, J. A., Öğüt, B., Yilmaz, M., Tefon Aribas, A. B., Caglar, K., Gönül, İ. I., Dogruman-Al, F., Nguyen, Q. D., Otranto, D. 2021


    We report a case of human ocular onchocerciasis by zoonotic Onchocerca lupi presenting as nodular scleritis. Molecular analyses were used to confirm diagnosis at species level. In addition to few existing reports of human infection by O. lupi in Turkey, this case further suggests that the pathogen might be more common than previously reported, thus requiring further attention and investigations.

    View details for DOI 10.4269/ajtmh.21-0186

    View details for PubMedID 34544040

  • Posterior Uveitis Associated with Large Vessel Giant Cell Arteritis. Ocular immunology and inflammation Nguyen, N. V., Karkhur, S., Yuksel, M., Hassan, M., Halim, M. S., Nguyen, Q. D., Hasanreisoglu, M. 2021: 1-4


    Purpose: To report a case of acute unilateral posterior uveitis as a rare manifestation of giant cell arteritis (GCA).Observation: A 62-year-old male presented to the clinic for evaluation of decreased vision in the right eye (OD). BCVA in OD was 20/60, and fundus examination revealed 3+ vitreous cells along with several inflammatory precipitates located in posterior vitreous and on surface of retina. Although TAB was inconclusive for GCA, the clinical diagnosis of GCA was made according to the GCA diagnostic criteria. This diagnosis was further supported by 18FDG-PET scan. The patient was started on corticosteroids, and the symptoms improved significantly after first week of treatment. At follow-up visit one month and half later, BCVA improved to 20/40 in the right eye.Conclusion: Although GCA is rarely present with uveitis, in case of unilateral posterior uveitis in elderly patient, it should be considered in the differential diagnosis.

    View details for DOI 10.1080/09273948.2021.1952274

    View details for PubMedID 34270381

  • Laryngopharyngeal Reflux Disease: Outcome of Patients After Treatment in Otolaryngology Clinics CUREUS Junaid, M., Ahmed, S., Kazi, M., Khan, H. U., Halim, M. 2020; 12 (12): e12195


    Introduction Laryngopharyngeal reflux (LPR) is a different entity from gastroesophageal reflux disease (GERD). Patients with LPR usually present with a variety of symptoms such as hoarseness, voice fatigue, burning sensation in the throat, persistent cough, sore throat, dysphagia, a sensation of a lump in the throat, and chronic throat clearing. The management of LPR is based on medications (proton pump inhibitors) along with lifestyle and dietary modifications. It has been suggested that the Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) are useful parameters to assess patients with LPR. The aim of this study is to assess the subjective and objective benefits of RFS and RSI for diagnosing and management of LPR in the tertiary care center and to find the difference in RSI and RSI scoring with respect to gender. Methods A prospective study was performed and 102 patients were included according to inclusion criteria. RFS and RSI questionnaires were filled on the first visit of patients and then treatment with proton pump inhibitors was started along with lifestyle modification instructions. Questionnaires were filled after four weeks and then 12weeks post-treatment. Repeated measure analysis of variance (ANOVA) was performed to compare the mean RFS and RSI from baseline to the end of treatment. The post hoc analysis was done using the Bonferroni test of multiple comparisons. An independent sample t-test was also used to compare the mean RFS and RSI between genders. P-values less than 0.05 were considered statistically significant Results RFS and RSI were found to be significantly decreased post-treatment after four weeks and 12 weeks post-treatment (p-value- <0.01). Eight point eight percent (8.8%) side effects were observed in the study, the change in quality of life after a three-month treatment was significantly improved among 62.7% patients, and 75.5% did lifestyle modifications. In the mean comparison of RFS and RSI with respect to gender, it was observed that the mean RFS of females samples after one month and three months of treatment were significantly less as compared to male samples, p<0.01. There was no significant mean difference observed for RSI after one month and three months of treatment with respect to gender (p>0.05). Conclusion RFS and RSI are convenient and helpful for diagnosing LPR, and they can be easily implemented in ear, nose, throat (ENT) clinics for the subjective and objective assessment of LPR. Females showed greater improvement on laryngoscopy findings (RFS scores) post-treatment as compared to males.

    View details for DOI 10.7759/cureus.12195

    View details for Web of Science ID 000602924400001

    View details for PubMedID 33489604

    View details for PubMedCentralID PMC7816050

  • Retraction Note to: Pharmacological agents in development for diabetic macular edema. International journal of retina and vitreous Sadiq, M. A., Halim, M. S., Hassan, M. M., Onghanseng, N., Karaca, I., Agarwal, A., Afridi, R., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2020; 6 (1): 65

    View details for DOI 10.1186/s40942-020-00271-8

    View details for PubMedID 33372631

  • Anti-interleukin-6 receptor therapy with tocilizumab for refractory pseudophakic cystoid macular edema. American journal of ophthalmology case reports Pham, B. H., Hien, D. L., Matsumiya, W., Tuong Ngoc, T. T., Doan, H. L., Akhavanrezayat, A., Yasar, C., Nguyen, H. V., Halim, M. S., Nguyen, Q. D. 2020; 20: 100881


    Purpose: To describe the clinical course of a patient with refractory pseudophakic cystoid macular edema treated with interleukin-6 receptor antagonist tocilizumab.Observations: An 80-year-old Caucasian man with past ocular history significant for glaucoma (right eye) and iritis presented with cystoid macular edema (CME) in the right eye (OD). His ocular surgery history was significant for cataract extraction with posterior chamber intraocular lenses in 1999 and YAG laser capsulotomy in 2014 in both eyes (OU). His medications at time of presentation included latanoprost and dorzolamide-timolol in OD for glaucoma, as well as prednisolone in OD for iritis. Upon examination, his visual acuity was 20/250 in OD and 20/20 in the left eye (OS). Intraocular pressure was 20mmHg in OD and 10mmHg in OS. Slit-lamp examination revealed no cells or flare in OU. Dilated fundus exam showed CME and a cup-to-disk ratio of 0.9 in OD and normal findings in OS. Initial spectral domain optical coherence tomography (SD-OCT) demonstrated intraretinal fluid in both outer and inner layers as well as mild subretinal fluid with an intact ellipsoid zone in OD. Fluorescein angiography revealed perifoveal leakage in OD. Laboratory evaluations, including infectious work-up, were unremarkable. While the patient's CME initially improved after initiation of therapy with topical prednisolone and oral acetazolamide, the CME later recurred after systemic acetazolamide was stopped due to intolerable side effects. Despite multiple therapeutic approaches, including topical and systemic corticosteroids (both oral and intravenous) and topical interferon alpha2b over the course of more than one year, the patient's visual acuity continued to worsen with increasing intra- and subretinal fluid in the macula. Due to the refractory CME, the patient was started on monthly infusions of anti-interleukin (IL)-6 receptor tocilizumab (8 mg/kg) with three days of methylprednisolone infusions (500 mg/day). After nine cycles of treatment, SD-OCT demonstrated restoration of normal foveal contour with complete resolution of CME.Conclusions and Importance: IL-6 inhibition with tocilizumab may be a safe and effective treatment for refractory CME. Further studies are needed to elucidate the nature and extent of therapeutic IL-6 inhibition in CME.

    View details for DOI 10.1016/j.ajoc.2020.100881

    View details for PubMedID 32875161

  • Effect of Fundus Fluorescein Angiography on Semiautomated Aqueous Flare Measurements. Ocular immunology and inflammation Halim, M. S., Onghanseng, N., Park, J. H., Yilmaz, M., Segawa, A., Ertop, M., Hassan, M., Tran, A. N., Aktas, Z., Ozdek, S., Gurelik, G., Do, D. V., Sepah, Y. J., Nguyen, Q. D., Hasanreisoglu, M. 2020: 1–4


    PURPOSE: To evaluate the effects of fluorescein fundus angiography (FFA) on semiautomated aqueous flare measurements.METHODS: Laser flare photometer (LFP) measurements was performed at baseline, 30min, and 4h after the intravenous administration of sodium fluorescein dye. FFA was performed immediately after the baseline LFP measurement. LFP values at 30min and 4h after FFA were compared to baseline values. Mean change in LFP measurements at 30min and 4hafter baseline was compared between FFA arm and controls.RESULTS: The mean flare measurement in the FFA and control arm dropped 6% (p value=0.002) and 9% (p value=0.04), respectively. Mean change in LFP measurement at 30min and 4h after baseline was not significant between FFA arm and controls.CONCLUSIONS: Administration of fluorescein dye does not increase LFP values. The decrease in the LFP measurement following FFA may be attributed to dilation drops.

    View details for DOI 10.1080/09273948.2020.1799036

    View details for PubMedID 32966150

  • Yet another case of ocular sarcoidosis. American journal of ophthalmology case reports Hien, D. L., Onghanseng, N., Ngoc, T. T., Hwang, J. J., Pham, B. H., Doan, H. L., Nguyen, H. V., Halim, M. S., Uludag, G., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2020; 19: 100825


    Purpose: To report a case of bilateral pan-uveitis resembling fungal and viral endophthalmitis in a patient who was ultimately diagnosed with sarcoidosis.Observation: A 64-year-old female presented with a four-day history of painless vision loss in the right eye. She presented with multiple concurrent systemic complaints, including a history of oral and genital sores, patches of hypopigmented skin on her forearms, and occasional shortness of breath. Upon further examination, she was noted to have bilateral pan-uveitis, which was more severe in the right than left eye. Posterior pole examination of the right eye revealed dense vitritis with multiple large whitish round balls that seemed suggestive of fungal or viral endophthalmitis. Initial therapies included intravitreal (IVT) foscarnet and intravenous (IV) acyclovir, followed by IV amphotericin B and oral voriconazole, which did not improve ocular signs and symptoms. Further evaluations ruled out infectious etiologies and lymphoma. Chest computerized tomography (CT) scan revealed findings suggestive of sarcoidosis, which was confirmed with lung biopsy. Anti-viral and -fungal treatments were discontinued, and the patient was started on IV methylprednisolone followed by oral prednisone and mycophenolate mofetil. Ocular symptoms improved, and the patient remained stable after treatment.Conclusion and Importance: The index report illustrates a case of ocular sarcoidosis that imitated the presentation of infectious endophthalmitis. Though ocular sarcoidosis is known to masquerade as a range of disorders and constitutes part of the differential diagnosis for infectious endophthalmitis, sarcoidosis has not been reported in recent literature to imitate the presentation of fungal endophthalmitis. The index case suggests that ocular sarcoidosis should be considered in the differential diagnoses of fungal endophthalmitis.

    View details for DOI 10.1016/j.ajoc.2020.100825

    View details for PubMedID 32715157

  • Longitudinal assessment of patients with anterior scleritis using scleral area vessel density Akhavanrezayat, A., Halim, M., Onghanseng, N. L., Hassan, M., Mahajan, S., Uludag, G., Ormaechea, M., Tran, A., Chea, S., Doan, H., Park, J., Do, D. V., Sepah, Y., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • A Distinct Pattern of Choroidal Lesions in Multifocal Choroiditis and Pan-uveitis Determined by Heatmap Analysis Park, J., Halim, M., Uludag, G., Onghanseng, N. L., Sredar, N., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Significance of External Limiting Membrane Integrity as an OCT Biomarker on Functional Outcomes in Eyes with Macular Edema Huy Vu Nguyen, Hassan, M., Yusuf, K., Ormaechea, M., Uludag, G., Halim, M., Afridi, R., Nam Nguyen, Vigil, E., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Ocular Toxoplasmosis Lesion Detection on Fundus Photograph using a Deep Learning Model Hasanreisoglu, M., Halim, M., Chakravarthy, A., Soledad Ormaechea, M., Uludag, G., Hassan, M., Ozdemir, H., Ozdal, P., Colombero, D., Rudzinski, M. N., Ariel Schlaen, B., Sepah, Y., Chundi, P., Subramaniam, M., Nguyen, Q. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2020
  • Correction of perceived visual distortions using a software application and correlation to age-related macular degeneration THERAPEUTIC ADVANCES IN OPHTHALMOLOGY Hassan, M., Chakravarthy, A. D., Subramaniam, M., Chundi, P., Sadiq, M., Halim, M., Afridi, R., Tran, A. T., Sepah, Y. J., Do, D., Quan Dong Nguyen 2020; 12: 2515841420917783


    To investigate the use of software-generated corrections in neutralizing perceived distortions in age-related macular degeneration.A tablet-based application was utilized to elicit distortions. Five subjects (seven eyes: neovascular age-related macular degeneration and three eyes: non-neovascular age-related macular degeneration) traced the reference lines, and their distortion traces were recorded. To counter distortion, a software-generated trace was re-traced by subjects to produce a corrected trace. Final traces were superimposed on optical coherence tomography images and following distances calculated: (a) dDT: distance between distortion trace and reference line; (b) dGT: distance between software-generated trace and corrected trace; (c) dCT: distance between corrected trace and reference line. Mean percent improvement in distortion was reported. Mean effectiveness of correction was also reported by utilizing t test to compare dDT and dCT. The number of distortion traces with underlying lesions on optical coherence tomography was also analyzed.Mean age of the subjects was 76.6 (±9.5) years. Each patient traced six reference lines and each was considered a separate case. Out of 30 cases, 17 (56.6%) elicited distortion. Mean percent improvement in distortion was 71.3 ± 23% (p < 0.05). Twelve cases (70.6%) had an underlying lesion (eight cases: disrupted photoreceptor layer and four cases: normal photoreceptor layer). Mean percent improvement in cases with normal photoreceptor layer (90.8 ± 5.45%) was higher than with abnormal photoreceptor layer (58.5 ± 7.17%) (p < 0.05). Five cases with distortion had no associated underlying lesion. Mean percent improvement in these subjects was significantly higher than those with photoreceptor layer disruption.Software-generated corrections can potentially correct for perceived distortions in patients with age-related macular degeneration, especially in cases with preserved photoreceptor layer.

    View details for DOI 10.1177/2515841420917783

    View details for Web of Science ID 000537030800001

    View details for PubMedID 32524073

    View details for PubMedCentralID PMC7235661

  • Severe vision loss secondary to retinal arteriolar occlusions after multiple intravitreal brolucizumab administrations. American journal of ophthalmology case reports Jain, A. n., Chea, S. n., Matsumiya, W. n., Halim, M. S., Yaşar, Ç. n., Kuang, G. n., Sepah, Y. J., Khanani, A. M., Do, D. V., Nguyen, Q. D. 2020; 18: 100687


    To describe a case of unilateral retinal arteriolar occlusion following multiple intravitreal brolucizumab injections for neovascular age-related macular degeneration (nAMD).A 92-year-old Caucasian woman presented with blurry vision in her left eye (OS) after receiving the third dose of intravitreal brolucizumab. At the time of presentation, visual acuity (VA) was 20/40 in her right eye (OD) and had decreased from 20/150 to count finger (CF) at 1-foot OS. On examination, there was no evidence of active inflammation in the anterior chamber OU. Dilated fundus examination showed no vitritis in OD and 1+ vitreous cells OS, flame-shaped hemorrhage at the superior optic disc margin, and retinal whitening surrounding the proximal portion of the supero-temporal branch of the central retinal artery. There were drusen in OS and retinal pigment epithelial (RPE) changes in the maculae of OU. Intra-arteriolar greyish deposits were seen OS. Fluorescein angiography (FA) showed hyper-fluorescence in the maculae corresponding to fibrovascular pigment epithelial detachments (PED) OU. No peri-vascular leakage was noted OU. Delayed filling of multiple arterioles in early and late phases OS was observed on FA. The patient was diagnosed with retinal arteriolar occlusion associated with repeated intravitreal brolucizumab administrations.Retinal arteriolar occlusion with severe vision loss, possibly secondary to inflammatory responses, can occur after subsequent intravitreal brolucizumab injections, even if no inflammation occurred after initial administrations. Vaso-occlusive disease should be considered as a potential ocular complication, with acute as well as delayed onset, following intravitreal brolucizumab therapy.

    View details for DOI 10.1016/j.ajoc.2020.100687

    View details for PubMedID 32280811

    View details for PubMedCentralID PMC7139151

  • Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial INTERNATIONAL ARCHIVES OF OTORHINOLARYNGOLOGY Junaid, M., Halim, M., Onali, M., Qadeer, S., Khan, H., Ali, N. 2020; 24 (1): E1-E6


    Introduction  Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective  To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods  In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results  Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo ( p  < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion  We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

    View details for DOI 10.1055/s-0039-1684037

    View details for Web of Science ID 000494728400001

    View details for PubMedID 31892959

    View details for PubMedCentralID PMC6828561

  • Directed Fine Tuning Using Feature Clustering for Instance Segmentation of Toxoplasmosis Fundus Images Abeyrathna, D., Subramaniam, M., Chundi, P., Hasanreisoglu, M., Halim, M., Ozdal, P., Quan Nguyen, IEEE IEEE. 2020: 767-772
  • Posterior segment inflammatory outcomes assessed using fluorescein angiography in the STOP-UVEITIS study. International journal of retina and vitreous Sadiq, M. A., Hassan, M. n., Afridi, R. n., Halim, M. S., Do, D. V., Sepah, Y. J., Nguyen, Q. D. 2020; 6: 47


    Although fluorescein angiography (FA) is a frequently used imaging modality in patients with non-infectious uveitis (NIU), it has not been reliably used for objective assessment of posterior segment inflammatory outcomes in these patients. In this index study we report the posterior segment inflammatory outcomes of two different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with NIU using a semi-quantitative FA scoring system.STOP-Uveitis is a randomized, multi-center clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with NIU. Thirty-seven (37) patients with NIU were randomized into one of two treatment groups in a ratio of 1:1. Group 1 received IV infusions of 4 mg/kg TCZ and group 2 received IV infusions of 8 mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Posterior segment inflammatory outcomes were assessed by evaluating FA at baseline and month 6 by graders at a central reading center. A previously reported, semi-quantitative, scoring system for FA was used to assess signs that represent ongoing inflammatory processes in the posterior segment. These signs included optic disc hyperfluorescence, macular edema, retinal vascular staining and/or leakage, capillary leakage, retinal capillary nonperfusion, neovascularization of the optic disc, neovascularization elsewhere, pinpoint leaks, and retinal staining and/or subretinal pooling. Statistical significance was set at p < 0.05. Main outcome measures included change in posterior segment inflammation as assessed using FA at month 6.37 eyes (37 patients) were randomized in the STOP-Uveitis study. 30 eyes were found to be eligible for this sub-study based on study criteria. Seven eyes had ungradable images at either baseline or month 6 and were therefore excluded from the analysis. The reduction in FA inflammatory scores at month 6 were statistically significant in both groups (p < 0.05). The difference between the two groups was not significant (p = 0.351).IV infusions of tocilizumab (both 4 and 8 mg/kg) are effective in improving posterior segment inflammation in eyes with NIU. A semi-quantitative FA scoring system may be used as a reliable outcome measure for assessment of posterior segment Identifier: NCT01717170.

    View details for DOI 10.1186/s40942-020-00245-w

    View details for PubMedID 33042579

    View details for PubMedCentralID PMC7539516

  • Pharmacological agents in development for diabetic macular edema. International journal of retina and vitreous Sadiq, M. A., Halim, M. S., Hassan, M. n., Onghanseng, N. n., Karaca, I. n., Agarwal, A. n., Afridi, R. n., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2020; 6: 29


    Diabetic macular edema (DME) is the leading cause of visual loss in patients with diabetic retinopathy. There has been a paradigm shift in the treatment of DME since the advent of anti-vascular endothelial growth factor (anti-VEGF) therapy. The safety and efficacy of anti-VEGF therapy has been well established. Although efficacious, currently approved anti-VEGF agents are associated with certain limitations, which include, among others: frequent need for injections, high treatment cost and variable response to treatment. These challenges have led to an active search for more novel agents that may be able to overcome these limitations.The index review focuses on novel treatment agents that target various pathways in patients with DME. These agents are used either as monotherapy or in combination with other agents in the management of DME. Drugs discussed include novel anti-VEGF inhibitors, TIE-2 receptor modulators, integrin peptide inhibitors, rho kinase inhibitors, and future therapies such as neuroprotection and gene therapy.The future of investigational pharmacological therapy appears promising for patients with DME. Results from early clinical trials indicate that newer agents highlighted in the study may be safe and efficacious treatment options for patients with DME. However, data from large multicenter clinical trials need to be analyzed before these agents can be incorporated into clinical practice.

    View details for DOI 10.1186/s40942-020-00234-z

    View details for PubMedID 32670612

    View details for PubMedCentralID PMC7341631

  • Retinal arterial occlusive vasculitis following intravitreal brolucizumab administration. American journal of ophthalmology case reports Haug, S. J., Hien, D. L., Uludag, G. n., Ngoc, T. T., Lajevardi, S. n., Halim, M. S., Sepah, Y. J., Do, D. V., Khanani, A. M. 2020; 18: 100680


    To describe retinal arterial occlusion and vasculitis following intravitreal brolucizumab administration in a patient with neovascular age-related macular degeneration (nAMD).An 88-year-old Caucasian woman with neovascular age-related macular degeneration (nAMD) complained of painless loss of vision with light sensitivity in both eyes (OU) four weeks after bilateral intravitreal brolucizumab. Upon examination, her visual acuity decreased to 20/40 in the right eye (OD) and 20/50 in the left eye (OS). Examination revealed 0.5+ and 1+ anterior chamber cells in OD and OS, respectively. The patient was treated with 1% prednisolone acetate eyedrops in both eyes, and after several weeks, the anterior chamber cells resolved. However, the patient still reported a decline in visual acuity (VA). Fluorescein angiography (FA) revealed retinal arterial occlusion, vasculitis, and optic nerve inflammation in the left eye. Retinal intra-arterial grayish materials were also detected. Laboratory evaluations were performed for common infectious and inflammatory causes and were normal or negative. A delayed inflammatory reaction to brolucizumab was suspected as the cause of the ocular inflammation and retinal vasculitis. An intravitreal dexamethasone implant was inserted into the left eye to treat the inflammation. One week after the dexamethasone implant, VA improved to 20/40 in OU; FA showed improvement, but residual peri-vascular leakage remained.Medication-associated uveitis is a rare adverse effect that can lead to vision loss. The index report illustrates a case of intraocular inflammation, retinal arterial vaso-occlusion and vasculitis associated with intravitreal brolucizumab. The delay in developing uveitis suggests that the inflammation is due to a delayed hypersensitivity reaction which can occur several days or weeks after administration of the inciting agent. Recently, several cases of uveitis and vasculitis associated with brolucizumab have been presented and those cases have similar features compared to the index case (1). Therapy with steroids (either intraocular or systemic), after infectious etiologies have been excluded, may be beneficial in halting inflammation and preventing further vision loss.

    View details for DOI 10.1016/j.ajoc.2020.100680

    View details for PubMedID 32258827

    View details for PubMedCentralID PMC7125319

  • Safety of systemic therapy for noninfectious uveitis. Expert opinion on drug safety Ormaechea, M. S., Hassan, M., Onghanseng, N., Park, J. H., Mahajan, S., Al-Kirwi, K. Y., Uludag, G., Halim, M. S., Schlaen, A., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2019; 18 (12): 1219–35


    Introduction: The treatment strategies for noninfectious uveitis (NIU) aim to achieve disease remission, prevention of recurrences, and preserving vision, while minimizing the side effects associated with the therapies used.Areas covered: The index review aims to provide a detailed overview of the adverse events and safety parameters associated with the systemic therapies for the management of the NIU.Expert opinion: Despite being the cornerstone of management of acute cases of NIU, long-term corticosteroid use is associated with multi-system side effects, requiring the use of steroid-sparing agents. Adalimumab was recently approved by the FDA for the management of NIU based on the results of VISUAL studies. Similarly, newer drugs targeting various aspects of the inflammatory cascade are being developed. However, until we completely understand the molecular pathways of the inflammatory diseases, the therapeutic profile of these newer agents needs to be broad enough to suppress inflammatory cascade and narrow enough to spare normal cellular processes. Another strategy that has shown some potential in decreasing the systemic side effects is to provide local drug delivery. Therefore, the future of management of NIU is very bright with many novel therapeutic agents and strategies of drug delivery on the horizon.

    View details for DOI 10.1080/14740338.2019.1692810

    View details for PubMedID 31801415

  • Correlation of Clinical Aqueous Flare Grade to Semi-automated Flare Assessment using Laser Flare Meter Anh Ngoc Tram Tran, Halim, M., Hassan, M., Hasanreisoglu, M., Afridi, R., Ormaechea, M., Uludag, G., Nguyen, N. V., Mahajan, S., Bae, J., Al-Kirwi, K., Do, D. V., Ibrahim, M. A., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Relationship Between Adult Body Height and Age-Related Macular Degeneration: A Korean Nationwide Population-Based Survey Bae, J., Hwang, I., Hassan, M., Halim, M., Ormaechea, M., Uludag, G., Tran, A. T., Mahajan, S., Al-Kirwi, K., Afridi, R., Sepah, Y., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Assessing Scleral Area Vessel Density in Subjects with Anterior Scleritis using Optical Coherence Tomography Angiography Mahajan, S., Halim, M., Hassan, M., Ormaechea, M., Uludag, G., Anh Ngoc Tram Tran, Bae, J., Afridi, R., Karkhur, S., Hasanreisoglu, M., Pham, A., Al-Kirwi, K., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Evaluating the Short-Term Effects on Semi-automated Aqueous Flare Assessment After Fundus Fluorescein Angiography Imaging Nguyen, N. V., Halim, M., Hassan, M., Segawa, A., Ertop, M., Aktas, Z., Ozdek, S., Gurelik, G., Anh Ngoc Tram Tran, Mahajan, S., Afridi, R., Ibrahim, M. A., Sepah, Y., Quan Dong Nguyen, Hasanreisoglu, M. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Role of Circumferential Full Thickness Scleral Debridement in Fulminant Infective Ring Scleritis Karkhur, S., Sen, A., Shenoy, P., Hassan, M., Halim, M., Hasanreisoglu, M., Afridi, R., Sepah, Y., Do, D. V., Quan Dong Nguyen, Gupta, V. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Adaptive Optics Findings in Vogt-Koyanagi-Harada Disease Pham, A., Halim, M., Razeen, M. M., Hassan, M., Ormaechea, M., Razeen, E., Uludag, G., Anh Ngoc Tram Tran, Al-Kirwi, K., Mahajan, S., Afridi, R., Dubra, A., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Evolving demographics, risk factors, and treatment strategies for uveitis at a tertiary care hospital over a decade: 2008-2018 Park, J., Halim, M., Ormaechea, M., Hassan, M., Anh Ngoc Tram Tran, Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2019
  • Alendronate induced chorioretinitis: The importance of meticulous assessments. American journal of ophthalmology case reports Hassan, M., Maleki, A., Ying, Q., Nguyen, N., Halim, M. S., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2019; 14: 21–25


    Purpose: To report a case of presumed bilateral chorioretinitis secondary to alendronate therapy.Observations: A 71-year-old female presented to the clinic in July 2017 with six months history of difficulty in reading along with floaters in both eyes which were more severe in the right eye. Past medical and surgical history revealed a history of hypertension, gout, hyperthyroidism, osteoporosis, and humerus fracture. She was started on alendronate three months before developing ocular symptoms. On ocular examination, best corrected visual acuity was 20/30 in the right and 20/25 in the left eye. Slit-lamp examination demonstrated normal anterior chamber examination in both eyes. Dilated fundus examination revealed geographic chorioretinal lesions around the optic nerve head in both eyes, more extensively in the right eye; and superior and temporal to the macula in the right eye. Past ocular records in February 2015 did not reveal any such findings. Fundus autofluorescence demonstrated hyper-autofluorescence in the peripapillary lesions in both eyes. The lesion adjacent to the macula in right eye displayed mixed hyper and hypo-autofluorescence. Fluorescein angiography showed combined hyper- and hypo-fluorescence compatible with window defect, staining and blockage. However, no leakage was appreciated in the macula, peripapillary, and peripheral lesions in both eyes. Optical coherence tomography scan showed septate hyporeflective intraretinal spaces in the right eye.Conclusion and importance: The index report underscore the importance of considering alendronate as an etiologic cause of chorioretinitis, especially in subjects with atypical lesions developing after alendronate therapy. We, therefore, recommend discontinuation of this medication in subjects who develop chorioretinitis after employing this medication.

    View details for PubMedID 30809598

  • New therapies in development for the management of non-infectious uveitis: a review. Clinical & experimental ophthalmology Hassan, M., Karkhur, S., Bae, J., Halim, M. S., Ormaechea, M. S., Nguyen, N. V., Afridi, R., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2019


    Uveitis is a spectrum of inflammatory disorders characterised by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease, and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with hi-dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid-sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non-infectious uveitis (NIU) consists of a step-ladder strategy with the first line option being corticosteroids in various formulations followed by the use of first, second, and third line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side-effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.

    View details for PubMedID 30938012

  • New therapies in development for the management of non-infectious uveitis: A review CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY Hassan, M., Karkhur, S., Bae, J. H., Halim, M. S., Ormaechea, M. S., Onghanseng, N., Nguyen, N. V., Afridi, R., Sepah, Y. J., Do, D. V., Nguyen, Q. D. 2019; 47 (3): 396–417

    View details for DOI 10.1111/ceo.13511

    View details for Web of Science ID 000466807900009

  • Blue light versus green light fundus autofluorescence in normal subjects and in patients with retinochoroidopathy secondary to retinal and uveitic diseases. Journal of ophthalmic inflammation and infection Bittencourt, M. G., Hassan, M., Halim, M. S., Afridi, R., Nguyen, N. V., Plaza, C., Tran, A. N., Ahmed, M. I., Nguyen, Q. D., Sepah, Y. J. 2019; 9 (1): 1


    PURPOSE: The aim of this study is to evaluate the differences in the fundus autofluorescence (FAF) signal between the blue light autofluorescence (BAF) from Spectralis (Heidelberg, CA) and green light autofluorescence (GAF) 200TxTM (OPTOS, UK, in normal subjects and in patients with retinochoroidopathies (RC).METHODS: In this prospective study, FAF was performed using BL (lambda=488nm) and GL (lambda=532nm) on normal subjects and patients with RC. The corresponding pairs of BAF and GAF images from both groups were analyzed using Photoshop. The strength of the FAF signal was measured on a gray scale, where optic disc was a standard to indicate absence of AF. In addition, gray values obtained from three identical points (foveal center, and points of hypo and hyper autofluorescence) in the corresponding BAF and GAF images of normal and RC subjects were divided by the optic disc value to calculate autofluorescence signal ratio (R). The R values at fovea (R1), hypoautofluorescent point (R2), and hyperautofluorescent point (R3) were compared between BAF and GAF modalities, in normal and in RC subjects separately.RESULTS: One hundred six pairs (106 eyes) of FAF images analyzed (37 pairs: normal and 69 pairs: RC subjects). In normal subjects, the mean R1, R2, and R3 values for BAF were (1.5±0.88, 1.23±0.58, and 4.73±2.85, respectively) and for GAF were (0.78±0.20, 0.78±0.20, and 1.62±0.39, respectively). Similarly, in subjects with RC, the mean R1, R2, and R3 values for BAF were (1.68±1.02, 1.66±1.15, and 7.75±6.82, respectively) and for GAF were (0.95±0.59, 0.79±0.45, and 2.50±1.65, respectively). The mean difference in the R1, R2, and R3 ratios between BAF and GAF in normal and in RC subjects was statistically significant (p<0.001). The strength of the correlation (r) between ratios for BAF and GAF was weak or not statistically significant in both normal and RC subjects (p>0.05).CONCLUSION: The distribution and intensity of the AF signal differ in BAF and GAF and cannot be used interchangeably. In BAF, optic disc signal is always weaker than in other areas, which was not true for GAF where optic disc signal was stronger than fovea and hypoautofluorescent point in both groups.

    View details for PubMedID 30617430

  • Blue light versus green light fundus autofluorescence in normal subjects and in patients with retinochoroidopathy secondary to retinal and uveitic diseases JOURNAL OF OPHTHALMIC INFLAMMATION AND INFECTION Bittencourt, M., Hassan, M., Halim, M., Afridi, R., Nguyen, N. V., Plaza, C., Tran, A. T., Ahmed, M., Quan Dong Nguyen, Sepah, Y. 2019; 9
  • Fungal Endogenous Endophthalmitis during Pregnancy as a Complication of In-Vitro Fertilization. Ocular immunology and inflammation Hasanreisoglu, M. n., Mahajan, S. n., Ozdemir, H. B., Ozdal, P. C., Halim, M. S., Hassan, M. n., Nguyen, Q. D. 2019: 1–4


    Purpose: To report a Candida endogenous endophthalmitis in a pregnant woman with a prior history of in-vitro fertilization (IVF).Methods: Case report.Results: 21-year-old healthy woman within the first trimester of her pregnancy of a successful IVF developed a focal retinitis and panuveitis. Ocular findings suggested fungal endophthalmitis. The patient was treated with pars plana vitrectomy and repeated intravitreal antifungal injections. No systemic therapy was given. Cultures showed Candida albicans. IVF procedure was the only identifiable risk factor for endogenous endophthalmitis.Conclusions: In-vitro fertilization appeared as a possible risk factor for endogenous endophthalmitis during pregnancy. In the absence of systemic fungal infection, local intravitreal antifungal injections seem to be effective options to treat endogenous candida endophthalmitis, especially in the first trimester.

    View details for DOI 10.1080/09273948.2019.1677917

    View details for PubMedID 31664877

  • Interleukin-6 inhibition in the management of non-infectious uveitis and beyond. Journal of ophthalmic inflammation and infection Karkhur, S. n., Hasanreisoglu, M. n., Vigil, E. n., Halim, M. S., Hassan, M. n., Plaza, C. n., Nguyen, N. V., Afridi, R. n., Tran, A. T., Do, D. V., Sepah, Y. J., Nguyen, Q. D. 2019; 9 (1): 17


    Uveitis consists of a spectrum of inflammatory disorders characterized by ocular inflammation. The underlying pathophysiology consists of a complex interplay of various inflammatory pathways. Interleukin 6 is an important mediator of inflammation in uveitis and constitutes focus of research toward development of newer biological therapies in the management of non-infectious uveitis.Pan-blockade of the inflammatory pathways with steroids is generally the first step in the management of acute non-infectious uveitis. However, long-term therapy with steroids is associated with systemic and ocular side effects, thereby necessitating the need for development of steroid sparing agents. IL-6 is a cytokine produced by various immune cells, in response to molecular patterns and affects multiple inflammatory cells. In particular, IL-6 is involved in differentiation of CD-4 cells into Th-17 cells that have been shown to play a significant role in various immune-mediated diseases such as uveitis. This broad-spectrum immunomodulatory activity makes IL-6 an excellent target for immunomodulatory therapy. Tocilizumab was the first IL-6 inhibitor to demonstrate efficacy in humans. It inhibits IL-6 from binding to both membrane-bound and soluble receptor and can be administered via intravenous (IV) and subcutaneous (SC) routes. It has been FDA approved for treatment of rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). Following the approval in systemic diseases, its efficacy was demonstrated in various uveitis studies including a phase 2 clinical trial (STOP-Uveitis). Overall, tocilizumab has shown a good safety profile with the risk of malignancy consistent with that expected in patients with rheumatoid arthritis. However, tocilizumab therapy has been shown to increase the risk for gastrointestinal perforation and dose-dependent neutropenia. Following the success of tocilizumab, several other agents targeting the IL-6 pathway are in the pipeline. These include sirukumab, siltuximab, olokizumab, clazakizumab, and EBI-031 which target IL-6; Sarilumab and ALX-0061 act on the IL-6 receptor.Studies have shown that IL-6 inhibitors can be effective in the management of NIU. In addition, the levels of IL-6 are elevated in other ocular vascular diseases such as retinal vein occlusion and diabetic macular edema. The roles of IL-6 inhibition may be broadened in the future to include the management of retinal vascular diseases and non-uveitic macular edema.

    View details for DOI 10.1186/s12348-019-0182-y

    View details for PubMedID 31523783

  • Effect of vitreomacular adhesion on the treatment outcomes in the STOP-Uveitis clinical trial for non-infectious uveitis. Journal of ophthalmic inflammation and infection Hassan, M. n., Nguyen, N. V., Halim, M. S., Afridi, R. n., Sadiq, M. A., Karkhur, S. n., Vigil, E. n., Karabekirogullari, S. n., Nguyen, Q. D., Do, D. V., Sepah, Y. J. 2019; 9 (1): 12


    To evaluate the role of vitreomacular adhesion (VMA) in visual and anatomic outcomes in patients with non-infectious uveitis.Phase 2 clinical trial PARTICIPANTS: Data from the Safety, Tolerability, and Efficacy of Tocilizumab in Patients with Non-infectious Uveitis (STOP-Uveitis) study was analyzed.In the STOP-Uveitis study, patients with non-infectious uveitis (NIU) received monthly intravenous infusions of either 4 or 8 mg/kg tocilizumab until month 6 (M6). Spectral domain optical coherence tomography (SD-OCT) images of patients that completed M6 of the study were analyzed at baseline to stratify the patients by the presence (VMA+) or absence (VMA-) of VMA. Patients with vitreomacular traction (VMT) or epiretinal membrane causing structural abnormalities within center 1 mm were excluded. All images were graded by two independent graders.Mean change in best-corrected visual acuity (BCVA), central retinal thickness (CRT), and vitreous haze (VH) at M6.Out of 37 patients randomized in the STOP-Uveitis study, 48 eyes (27 patients) were eligible based on the study criteria. At baseline, 19 eyes were classified as VMA+, and 32 eyes were classified as VMA-. The distribution of two doses of TCZ (4 mg/kg and 8 mg/kg) were similar between the two groups. At M6, the mean improvement in BCVA was 2.00 ± 5.3 and 6.50 ± 7.98 letters in the VMA+ and VMA- groups, respectively (p = 0.02). The mean improvement in CRT was 34.85 ± 72.36 and 80.37 ± 157.21 μm in the VMA+ and VMA- groups, respectively (p = 0.18). Similarly, the mean change in VH was - 0.65 ± 0.47 and - 0.76 ± 0.71 in the VMA+ and VMA- groups, respectively (p = 0.32). Out of 16 eyes with VMA at baseline, 3 eyes developed posterior vitreous detachment (PVD) at M6. The mean change in BCVA was significantly higher (p = 0.02), while CRT and VH score were similar (p > 0.05) in eyes with PVD compared to eyes with persistent VMA.The absence of VMA or development of PVD in eyes with VMA seems to have a beneficial effect on the vision of subjects receiving treatment for uveitis. Therefore, patients with uveitis should be assessed using SD-OCT for the presence of vitreomacular interface abnormalities.

    View details for DOI 10.1186/s12348-019-0179-6

    View details for PubMedID 31325001

  • An Approach Towards Automatic Detection of Toxoplasmosis using Fundus Images Chakravarthy, A. D., Abeyrathna, D., Subramaniam, M., Chundi, P., Halim, M., Hasanreisoglu, M., Sepah, Y. J., Quan Dong Nguyen, IEEE IEEE. 2019: 710-717
  • Comparison of montage with conventional stereoscopic seven-field photographs for assessment of ETDRS diabetic retinopathy severity. International journal of retina and vitreous Nguyen, N. V., Vigil, E. M., Hassan, M. n., Halim, M. S., Baluyot, S. C., Guzman, H. A., Afridi, R. n., Do, D. V., Sepah, Y. J. 2019; 5: 51


    The ETDRS stereoscopic seven-field (7F) has been a standard imaging and grading protocol for assessment of diabetic retinopathy (DR) severity score in many clinical trials. To the best of our knowledge, the comparison between montage and stereoscopic 7F has not been reported in the literature. Therefore, the main purpose of this study is to compare agreement between montage and stereoscopic seven-field (7F) photographs in the assessment of DR severity.Stereoscopic 7F photographs were captured from subjects with DR. Montages of monoscopic 7F images were created using Adobe Photoshop CS6 Extended©. The best quality image of each stereo pair was selected and placed on a 150 × 125-inch canvas field according to the standard location from field 1 to 7. All the fields were aligned following the vessels and overlaid using the built-in blending tool. The resulting montage was utilized for grading and compared with grading on stereoscopic 7F photographs. Three independent graders were asked to assess DR severity on stereoscopic 7F photographs and montage. Severity level agreement between stereo 7F and montage was cross-tabulated and the agreement of DR severity levels between stereoscopic 7-field images and montage was analyzed using κ intergrader agreement; statistical significance was set at p < 0.05.A total of 50 eyes were included in the study. There was a substantial agreement between stereoscopic 7F and montage (κ = 0.745, κweighted = 0.867) in assessment of DR severity. Of 50 eyes, 80% of the cases showed complete agreement, and 100% of the cases had agreement within one-step. There was a moderate agreement among graders, and κ-value ranged from 0.4705 to 0.5803.In this study, we found a substantial agreement in assessing DR severity score employing non-stereoscopic montage and stereoscopic 7F photographs.

    View details for DOI 10.1186/s40942-019-0201-z

    View details for PubMedID 31890280

    View details for PubMedCentralID PMC6909536

  • Scleral Vessel Density Using Novel Optical Coherence Tomography Angiography Methodology Halim, M., Hassan, M., Afridi, R., Nguyen, N. V., Maleki, A., Baluyot, S., Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Short-Term Effects of Ranibizumab on Diabetic Retinopathy Severity and Progression OPHTHALMOLOGY RETINA Hassan, M., Sadiq, M. A., Halim, M., Afridi, R., Nguyen, N. V., Sepah, Y. J. 2018; 2 (7): 749-751
  • Posterior Segment Inflammatory Outcomes (Month-6) in the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients with Non-Infectious Uveitis Sadiq, M., Hassan, M., Halim, M., Afridi, R., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Effects of Vitreomacular Adhesion on Treatment Outcomes in the Study of Safety and Bioactivity of TOcilizumab in Patients with Non-Infectious UVEITIS: The STOP-UVEITIS Study Nguyen, N. V., Hassan, M., Halim, M., Afridi, R., Baluyot, S., Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Can Fundus Photograph Montage Replace the Standard 7-Field Stereo Images for Diabetic Retinopathy Severity Scale Assessments? Baluyot, S., Hassan, M., Halim, M., Afridi, R., Nguyen, N. V., Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2018
  • Short-Term Effects of Ranibizumab on Diabetic Retinopathy Severity and Progression. Ophthalmology. Retina Hassan, M. n., Sadiq, M. A., Halim, M. S., Afridi, R. n., Nguyen, N. V., Sepah, Y. J. 2018; 2 (7): 749–51

    View details for PubMedID 31047386

  • Diurnal variation of choriocapillaris vessel flow density in normal subjects measured using optical coherence tomography angiography. International journal of retina and vitreous Sarwar, S., Hassan, M., Soliman, M. K., Halim, M. S., Sadiq, M. A., Afridi, R., Agarwal, A., Do, D. V., Nguyen, Q. D., Sepah, Y. J. 2018; 4: 37


    Background: Vessel flow density (VFD) may provide important information regarding perfusion status. Diurnal variation in VFD of choriocapillaris has not been reported in literature. In the index study, optical coherence tomography angiography (OCTA) was used to assess the diurnal variation of the VFD in the choriocapillaris of subjects with no known ocular disease.Methods: Fifty eyes with no known ocular disease (25 subjects) were included. OCTA images were acquired using AngioVue (Optovue, Fremont, CA, USA) at two different time points on a single day: 9:00 AM and 6:00 PM. Macular cube scan protocol (3*3mm) centered on the fovea was used. Automatic segmentation of the retinal layers and choriocapillaris was performed using ReVue software, which was also used to measure the choriocapillaris VFD. Horizontal line scan passing through fovea was obtained by the device at both time points to measure the subfoveal choroidal thickness (CT). Linear measurement tool of software was used to measure subfoveal CT according to a standardized reproducible method. Wilcoxon signed-rank test was used to assess the differences in choriocapillaris VFD and subfoveal CT at the two time points. Correlation between change in choriocapillaris VFD and subfoveal CT at the two time points was assessed using the Pearson correlation coefficient (r).Results: The mean age of the subjects was 31.96±11.23years. Choriocapillaris VFD was significantly higher at 9:00 AM compared to 6:00 PM (P<0.0001) with mean choriocapillaris VFD of 68.74±4.80% at 9:00 AM and 67.57±5.41% at 6:00 PM, with a mean diurnal amplitude of 1.17%. Mean subfoveal CT was 287.74±61.51m at 9:00 AM and 270.06±60.73m at 6:00 PM. Subfoveal CT was also significantly higher at 9:00 AM compared to 6:00 PM (P<0.0001) with a mean diurnal amplitude of 17.68m. Change in choriocapillaris VFD correlated with change in subfoveal CT (r=0.87, P<0.001).Conclusion: OCTA demonstrated significant diurnal change in choriocapillaris VFD in subjects without any ocular disease with VFD being higher in the morning and lower in the evening. Decrease in choriocapillaris VFD in the evening correlated with a reduction in subfoveal CT.

    View details for PubMedID 30338130

  • Primary (Month-6) Outcomes of the STOP-Uveitis Study: Evaluating the Safety, Tolerability, and Efficacy of Tocilizumab in Patients With Noninfectious Uveitis AMERICAN JOURNAL OF OPHTHALMOLOGY Sepah, Y., Sadiq, M., Chu, D. S., Dacey, M., Gallemore, R., Dayani, P., Hanout, M., Hassan, M., Afridi, R., Agarwal, A., Halim, M., Do, D. V., Quan Dong Nguyen 2017; 183: 71–80


    To report the primary endpoint analyses of the safety and efficacy of 2 different doses of intravenous (IV) infusions of tocilizumab (TCZ), an IL-6 inhibitor, in eyes with noninfectious intermediate uveitis, posterior uveitis, or panuveitis.Randomized, controlled, multicenter clinical trial.STOP-Uveitis is a randomized, open-label safety, efficacy, and bioactivity clinical trial conducted at 5 clinical centers across the United States. The study evaluated the role of TCZ in patients with noninfectious uveitis (NIU). Thirty-seven patients with NIU were randomized into one of 2 treatment groups in a ratio of 1:1. Group 1 received IV infusions of 4 mg/kg TCZ and group 2 received IV infusions of 8 mg/kg TCZ. Infusions were given every 4 weeks in both groups until month 6 (primary endpoint). Primary outcome measure was incidence and severity of systemic and ocular adverse events through month 6. Secondary outcome measures included mean change in visual acuity (VA), vitreous haze (VH), and central macular thickness (CMT) at month 6.A total of 37 patients were randomized in the study. At month 6, 43.5% of patients who had the potential for a 2-step decrease in VH demonstrated a 2-step decrease (40% in Group 1 and 46.1% in Group 2). Mean change in CMT was -83.88 ± 136.1 μm at month 6 (-131.5 ± 41.56 μm in Group 1 and -38.92 ± 13.7 μm in Group 2). Mean change in VA was +8.22 ± 11.83 ETDRS letters at month 6 (10.9 ± 14.6 in Group 1 and 5.5 ± 7.8 in Group 2). Repeated infusions of TCZ were well tolerated.Repeated IV administrations of TCZ are well tolerated. TCZ (both 4 and 8 mg/kg) is effective in improving VA and reducing VH and CMT in eyes with noninfectious intermediate uveitis, posterior uveitis, and panuveitis.

    View details for PubMedID 28887113

  • Effect of Myopia on the Macular Vessel Flow Density in Eyes Using Optical Coherence Tomography Angiography Sepah, Y., Hassan, M., Halim, M., Sadiq, M., Afridi, R., Do, D. V., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Correction of Perceived Visual Distortions Using a Software Application and Correlation to Age-Related Macular Degeneration. Hassan, M., Chakarvarthy, A., Subramaniam, M., Chundi, P., Jawed, M., Halim, M., Sadiq, M., Afridi, R., Sepah, Y., Quan Dong Nguyen, Do, D. V., Margalit, E. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Effect of Vitreomacular Adhesion on Treatment Outcomes in the Ranibizumab for Edema of the mAcula in Diabetes-3 (READ-3) Study -Month 24 Results Sadiq, M., Hassan, M., Afridi, R., Halim, M., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Differences in the characteristics of subjects achieving complete or partial resolution of diabetic macular edema in the READ-3 Study Halim, M., Afridi, R., Hassan, M., Sadiq, M., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Can the levels of inflammatory cytokines in the anterior chamber of eyes with diabetic macular edema predict response to therapy? Afridi, R., Halim, M., Sadiq, M., Hassan, M., Agarwal, A., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Assessment of Changes in Quality of Life Among Subjects in the STOP-Uveitis Study Greer, L. C., Jawed, M., Caldwell, K., Wilson, R., Halim, M., Hassan, M., Sadiq, M., Afridi, R., Do, D. V., Sepah, Y., Quan Dong Nguyen ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2017
  • Frequency of Cervical Nodal Metastasis in Early-Stage Squamous Cell Carcinoma of the Tongue Int Arch Otorhinolaryngol Ahmed, S. Q., Junaid, M., Awan, S., Kazi, M., Khan, H. U., Halim, S. 2017

    View details for DOI 10.1055/s-0037-1603626

  • Evaluation of macular and peripapillary vessel flow density in eyes with no known pathology using optical coherence tomography angiography. International journal of retina and vitreous Hassan, M. n., Sadiq, M. A., Halim, M. S., Afridi, R. n., Soliman, M. K., Sarwar, S. n., Agarwal, A. n., Do, D. V., Nguyen, Q. D., Sepah, Y. J. 2017; 3: 27


    To assess normal vessel flow density (VFD) in macular and peripapillary regions of eyes with no known ocular pathology using optical coherence tomography angiography (OCTA).AngioVue (Optovue, Fremont, CA, USA) was used to capture OCTA images. A 3 × 3 mm grid and a 4.5 × 4.5 mm grid was used to scan parafoveal and peripapillary regions, respectively. ReVue software was utilized to measure VFD in five sectors within the inner two circles of ETDRS grid in macular region and correlated to retinal thickness of same sectors. At optic disc, VFD was calculated in six sectors based on Garway-Heath map. Area and morphology of foveal avascular zone (FAZ) was correlated with VFD in central 1 mm. The influence of myopia on mean VFD was also assessed.Twenty-four eyes (mean age: 30 years) were analyzed. Mean VFD in macular sectors was 43.5 (±4.5) and 45.8 (±5.0) % in superficial and deep retinal plexuses, respectively. Mean VFD was significantly higher in deep retinal plexus compared to superficial retinal plexus in all sectors except central 1 mm (p < 0.05). Mean VFD in central 1 mm increases with an increase in central retinal thickness in both superficial and deep retinal plexuses (p < 0.001). Mean parafoveal VFD at level of both superficial and deep retinal plexuses decrease with an increase in spherical equivalent in myopics (p < 0.05). Mean VFD in myopics was found to be significantly lower in parafoveal region of deep retinal plexus (p < 0.05). Mean area of FAZ was 0.33 (±0.15) and 0.47 mm2 (±0.15) in superficial and deep retinal plexuses, respectively. Area of FAZ decreases with an increase in central 1 mm thickness and foveal VFD (p < 0.001).OCTA may be used to measure VFD in macular and peripapillary regions. Vessels in the parafoveal region are more densely packed in the deep retinal plexus leading to higher VFD compared to superficial plexus. Thicker retina in fovea translates into higher foveal VFD due to more compact arrangement of retinal layers and continuity of inner nuclear layer (INL). Myopia is associated with lower VFD in parafoveal region at level of deep retinal plexuses which may explain thinning of INL in myopics.

    View details for PubMedID 28781889

    View details for PubMedCentralID PMC5535290

  • Evaluation of Macular and Peripapillary Vessel Flow Density in Eyes with no known Pathology Using Optical Coherence Tomography Angiography. Hassan, M., Sadiq, M., Agarwal, A., Soliman, M., Afridi, R., Sarwar, S., Jawed, M., Do, D. V., Quan Dong Nguyen, Sepah, Y. ASSOC RESEARCH VISION OPHTHALMOLOGY INC. 2016
  • Using Elasticated Retractors in Head and Neck Surgeries JCPSP-JOURNAL OF THE COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN Junaid, M., Shafiq, M., Qadeer, S., Haleem, S., Kazi, M. 2016; 26 (5): 430-431


    Elasticated retractors, a recent advancement in surgical techniques, provide an enhanced and effective way of retraction during head and neck surgeries. These have been used for a number of procedures and are known for their effective retraction and minimizing surgical time span. This article highlights the authors' experience and the pros and cons of this technique.

    View details for Web of Science ID 000377769100019

    View details for PubMedID 27225152

  • Emergency general surgery in a low-middle income health care setting: Determinants of outcomes SURGERY Shah, A. A., Latif, A., Zogg, C. K., Zafar, S. N., Riviello, R., Halim, M. S., Rehman, Z., Haider, A. H., Zafar, H. 2016; 159 (2): 641-649


    Emergency general surgery (EGS) has emerged as an important component of frontline operative care. Efforts in high-income settings have described its burden but have yet to consider low- and middle-income health care settings in which emergent conditions represent a high proportion of operative need. The objective of this study was to describe the disease spectrum of EGS conditions and associated factors among patients presenting in a low-middle income context.March 2009-April 2014 discharge data from a university teaching hospital in South Asia were obtained for patients (≥16 years) with primary International Classification of Diseases, 9(th) revision, Clinical Modification diagnosis codes consistent with an EGS condition as defined by the American Association for the Surgery of Trauma. Outcomes included in-hospital mortality and occurrence of ≥1 major complication(s). Multivariable analyses were performed, adjusting for differences in demographic and case-mix factors.A total of 13,893 discharge records corresponded to EGS conditions. Average age was 47.2 years (±16.8, standard deviation), with a male preponderance (59.9%). The majority presented with admitting diagnoses of biliary disease (20.2%), followed by soft-tissue disorders (15.7%), hernias (14.9%), and colorectal disease (14.3%). Rates of death and complications were 2.7% and 6.6%, respectively; increasing age was an independent predictor of both. Patients in need of resuscitation (n = 225) had the greatest rates of mortality (72.9%) and complications (94.2%).This study takes an important step toward quantifying outcomes and complications of EGS, providing one of the first assessments of EGS conditions using American Association for the Surgery of Trauma definitions in a low-middle income health care setting. Further efforts in varied settings are needed to promote representative benchmarking worldwide.

    View details for DOI 10.1016/j.surg.2015.08.004

    View details for Web of Science ID 000367869400031

    View details for PubMedID 26361098

  • Eliminating Infections in the ICU: CLABSI CURRENT INFECTIOUS DISEASE REPORTS Latif, A., Halim, M. S., Pronovost, P. J. 2015; 17 (7)


    Central line-associated bloodstream infections (CLABSI) are one of the leading causes of death in the USA and around the world. As a preventable healthcare-associated infection, they are associated with significant morbidity and excess costs to the healthcare system. Effective and long-term CLABSI prevention requires a multifaceted approach, involving evidence-based best practices coupled with effective implementation strategies. Currently recommended practices are supported by evidence and are simple, such as appropriate hand hygiene, use of full barrier precautions, avoidance of femoral lines, skin antisepsis, and removal of unnecessary lines. The most successful and sustained improvements in CLABSI rates further utilize an adaptive component to align provider behaviors with consistent and reliable use of evidence-based practices. Great success has been achieved in reducing CLABSI rates in the USA and elsewhere over the past decade, but more is needed. This article aims to review the initiatives undertaken to reduce CLABSI and summarizes the sentinel and recent literature regarding CLABSI and its prevention.

    View details for DOI 10.1007/s11908-015-0491-8

    View details for Web of Science ID 000356540100003

    View details for PubMedID 26031963

  • Aspiration in injections: should we continue or abandon the practice? F1000Research Sepah, Y., Samad, L., Altaf, A., Halim, M. S., Rajagopalan, N., Javed Khan, A. 2014; 3: 157-?


    Aspiration during any kind of injection is meant to ensure that the needle tip is at the desired location during this blind procedure. While aspiration appears to be a simple procedure, it has generated a lot of controversy concerning the perceived benefits and indications. Advocates and opponents of aspiration both make logically sound claims. However, due to scarcity of available data, there is no evidence that this procedure is truly beneficial or unwarranted. Keeping in view the huge number of injections given worldwide, it is important that we draw attention to key questions regarding aspiration that, up till now, remain unanswered. In this review, we have attempted to gather and present literature on aspiration both from published and non-published sources in order to provide not only an exhaustive review of the subject, but also a starting point for further studies on more specific areas requiring clarification. A literature review was conducted using the US National Institute of Health's PubMed service (including Medline), Google Scholar and Scopus. Guidelines provided by the World Health Organization, Safe Injection Global Network, International Council of Nursing, Center for Disease Control, US Federal Drug Agency, UK National Health Services, British Medical Association, Europe Nursing and Midwifery Council, Public Health Agency Canada, Pakistan Medical Association and International Organization of Standardization recommendations 7886 parts 1-4 for sterile hypodermics were reviewed for relevant information. In addition, curricula of several medical/nursing schools from India, Nigeria and Pakistan, the US pharmacopeia Data from the WHO Program for International Drug Monitoring network in regard to adverse events as a result of not aspirating prior to injection delivery were reviewed. Curricula of selected major medical/nursing schools in India, Nigeria and Pakistan, national therapeutic formularies, product inserts of most commonly used drugs and other possible sources of information regarding aspiration and injections were consulted as well.

    View details for DOI 10.12688/f1000research.1113.3

    View details for PubMedID 28344770

  • Tuberculosis verrucosa cutis in a patient with keloid over ear lobule. BMJ case reports Halim, M. S., Ahmed, S. Q., Junaid, M., Bashir, M. R. 2013; 2013


    Tuberculosis (TB) is a global health problem with predominance in resource-poor countries. Extrapulmonary TB constitutes approximately 10% of the cases and can present as different forms depending on the route of entry. Cutaneous TB is a small subset of the extrapulmonary TB. Cutaneous TB can either be of primary origin or secondary origin or it can be a part of a systemic infection. TB verrucosa cutis (TBVC) is the exogenous reinfection of TB in a previously sensitised patient. Routine cultures do not have a high yield in TBVC due to the paucibacillary nature of the organism. Here we are presenting a rare case of a patient who developed in a keloid over the right ear lobule following ear piercing. This has only been presented once in the previous literature and for the first time in the head and neck region.

    View details for DOI 10.1136/bcr-2013-010294

    View details for PubMedID 23845683

    View details for PubMedCentralID PMC3736208

  • Results of a Cross-Sectional Survey About Lipid-Management Practices Among Cardiologists in Pakistan: Assessment of Adherence to Published Treatment Guidelines CLINICAL THERAPEUTICS Gowani, S. A., Shoukat, S., Taqui, A. M., Bhulani, N., Khalid, S., Sheikh, A., Halim, M. S., Samreen, S., Jafary, F. H. 2009; 31 (7): 1604-1614


    The aims of this study were to assess how closely cardiologists in Pakistan followed published recommendations for lipid management and to identify the factors associated with such behavior.A cross-sectional survey was delivered in person between September and December 2007 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta, and Peshawar). A standard questionnaire was used to obtain information from cardiologists. Adherence to the guidelines established by the 2004 National Cholesterol Education Program Adult Treatment Panel III was computed based on answers to 14 questions; each correct answer (ie, the answer that followed the guidelines) was assigned 1 point, for a maximum cumulative score of 14. Multivariable linear regression was performed to determine the factors independently associated with guideline knowledge.A total of 295 cardiologists were approached; 239 consented to participate (overall response rate, 81.0%). The median score was 9 out of a maximum of 14 (interquartile range, 8-11). There were important points of divergence from practice recommendations, including suboptimal targets for low-density lipoprotein cholesterol (LDL-C) (< or = 70 mg/dL was the target used by only 16.7% of respondents [40/239]), undertreatment of revascularized patients (31.4% [75/239]), cessation of statin therapy once LDL-C targets were achieved (20.9% [50/239]), and use of different treatment thresholds for patients aged >65 years (41.8% [100/239]) and female patients (46.4% [111/239]). In the adjusted analysis, experienced physicians, interventional cardiologists, and those who pursued continuing medical education activities (journals and conferences) had higher scores (P = 0.005, P = 0.041, P = 0.008, and P = 0.001, respectively).We found important self-reported departures from recommended lipid-management guidelines among cardiologists in Pakistan.

    View details for DOI 10.1016/j.clinthera.2009.07.020

    View details for Web of Science ID 000269335600012

    View details for PubMedID 19695410