Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure witho... more Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion with elevated cerebrospinal fluid (CSF) pressure but otherwise normal CSF composition. It has been found that pregnancy occurs in IIH patients at about the same rate as in the general population, that IIH can occur in any trimester of pregnancy, that patients have the same spontaneous abortion rate as the general population, and that the visual outcome is the same as for nonpregnant patients with IIH. Although it is also stated that pregnant patients with IIH should be managed and treated the same way as any other patient with IIH, the use of imaging and drug contraindications do make a difference between the two groups. The treatment has two major goals, which are to preserve vision and to improve symptoms. The medical therapy includes weight control, nonketotic diet, serial lumbar punctures, diuretics, steroids, and certain analgesics. When medical thera...
The goal of this study was to review, evaluate, and perform a meta-analysis on the current litera... more The goal of this study was to review, evaluate, and perform a meta-analysis on the current literature that reports rates of postoperative endophthalmitis after small gauge transconjunctival sutureless vitrectomy (TSV) and compare it to 20-gauge pars plana vitrectomy (20G PPV). We performed an extensive review of the current literature. We included only large comparative institutional reviews. Meta-analysis of these reviews was performed. We found six large retrospective comparative cases series on the 25-gauge (25G) TSV as compared to 20G PPV. The test for homogeneity for the meta-analysis indicates that the studies are not homogeneous and therefore the evidence is tentative. We cannot conclude that 25G TSV has a higher rate of postoperative endophthalmitis compared to the 20G PPV. Future retrospective or prospective trials need to take into consideration multiple factors.
... released. Two days later, the patient experienced a severe headache with nausea and vomiting ... more ... released. Two days later, the patient experienced a severe headache with nausea and vomiting and noticed a left homonymous visual field loss. She ... 1 MRI (A), MRA (B), and Humphrey 30-2 visual fields (C) of our patient. Past ...
A 50-year-old female presented with progressive painless vision loss in the left eye and was subs... more A 50-year-old female presented with progressive painless vision loss in the left eye and was subsequently diagnosed to have a pituitary macroadenoma, consistent with a prolactinoma, which was compressing the chiasm primarily on the left and involving the left cavernous sinus. She was treated with oral bromocriptine, resulting in marked shrinkage of the tumor and significant visual field recovery. Subsequently, she again began noting progressive vision loss in both eyes and was initially thought to have pituitary tumor regrowth. Repeat brain MRI, however, showed chiasmal prolapse with inferior tethering into an empty sella. Surgical fat padding to reposition the chiasm resulted in visual improvement with a different visual field pattern in the left eye. The clinical manifestations and etiopathogenesis of the empty sella syndrome are discussed. (Surv Ophthalmol 50:588--597, 2005. Ó 2005 Elsevier Inc. All rights reserved.) Key words. prolactinoma empty sella chiasmal prolapse bromocriptine chiasmopexy PROGRESSIVE PAINLESS VISION LOSS
The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory d... more The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema. Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks. At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy. Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Purpose: The purpose of this study was to determine the effect of varying insertion angles on the... more Purpose: The purpose of this study was to determine the effect of varying insertion angles on the fixation strength of screw-in devices placed in the glenoid rim. Type of Study: Cadaveric biomechanical analysis. Methods: Eighteen cadaveric glenoids had 3.0-mm cannulated screws inserted for a depth of 10 mm in all 4 quadrants: anterior superior (AS), anterior inferior (AI), posterior superior (PS), posterior inferior (PI). Screws were inserted along the orthogonal to the glenoid rim at the point of insertion or at angles that deviated from this vector by 20°and 40°. Load to failure was performed at 10 mm/s along the orthogonal to the point of insertion. Results: For screws inserted orthogonal to the glenoid rim, the average load to failure was highest for the PS quadrant (733 Ϯ 369 N) and lowest for the AI quadrant (272 Ϯ 69 N). The AS and PI quadrants showed intermediate values (549 Ϯ 334 N and 484 Ϯ 141 N, respectively). Deviation from orthogonal correlated with decreased fixation strength. This decrease was statistically significant in the AS and PI quadrants, with deviation of 40°, and in the AI quadrant, with deviation of 20°, as well as 40°. Conclusions: Insertion angles for screw-in fixation devices should be orthogonal to the glenoid rim at the point of insertion to maximize strength. Deviation of 40°from orthogonal compromises fixation in most quadrants and deviation as little as 20°can compromise fixation in the AI quadrant. Clinical Relevance: To maximize strength of labral reattachment to the bony glenoid, screw-in type fixation devices should be inserted as orthogonal to the glenoid rim as possible. This is especially true for Bankart repairs, because device pullout occurs at significantly lower loads in the anteroinferior quadrant compared with the other 3 quadrants. Deviating as little as 20°further decreases fixation strength significantly.
To determine whether anterior ischemic optic neuropathy and compressive optic neuropathy in human... more To determine whether anterior ischemic optic neuropathy and compressive optic neuropathy in humans alter the photopic flash ERG and to investigate the cellular origins of the waves that are affected by pharmacologic agents in primates.
Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure witho... more Idiopathic intracranial hypertension (IIH) is a syndrome of increased intracranial pressure without hydrocephalus or mass lesion with elevated cerebrospinal fluid (CSF) pressure but otherwise normal CSF composition. It has been found that pregnancy occurs in IIH patients at about the same rate as in the general population, that IIH can occur in any trimester of pregnancy, that patients have the same spontaneous abortion rate as the general population, and that the visual outcome is the same as for nonpregnant patients with IIH. Although it is also stated that pregnant patients with IIH should be managed and treated the same way as any other patient with IIH, the use of imaging and drug contraindications do make a difference between the two groups. The treatment has two major goals, which are to preserve vision and to improve symptoms. The medical therapy includes weight control, nonketotic diet, serial lumbar punctures, diuretics, steroids, and certain analgesics. When medical thera...
The goal of this study was to review, evaluate, and perform a meta-analysis on the current litera... more The goal of this study was to review, evaluate, and perform a meta-analysis on the current literature that reports rates of postoperative endophthalmitis after small gauge transconjunctival sutureless vitrectomy (TSV) and compare it to 20-gauge pars plana vitrectomy (20G PPV). We performed an extensive review of the current literature. We included only large comparative institutional reviews. Meta-analysis of these reviews was performed. We found six large retrospective comparative cases series on the 25-gauge (25G) TSV as compared to 20G PPV. The test for homogeneity for the meta-analysis indicates that the studies are not homogeneous and therefore the evidence is tentative. We cannot conclude that 25G TSV has a higher rate of postoperative endophthalmitis compared to the 20G PPV. Future retrospective or prospective trials need to take into consideration multiple factors.
... released. Two days later, the patient experienced a severe headache with nausea and vomiting ... more ... released. Two days later, the patient experienced a severe headache with nausea and vomiting and noticed a left homonymous visual field loss. She ... 1 MRI (A), MRA (B), and Humphrey 30-2 visual fields (C) of our patient. Past ...
A 50-year-old female presented with progressive painless vision loss in the left eye and was subs... more A 50-year-old female presented with progressive painless vision loss in the left eye and was subsequently diagnosed to have a pituitary macroadenoma, consistent with a prolactinoma, which was compressing the chiasm primarily on the left and involving the left cavernous sinus. She was treated with oral bromocriptine, resulting in marked shrinkage of the tumor and significant visual field recovery. Subsequently, she again began noting progressive vision loss in both eyes and was initially thought to have pituitary tumor regrowth. Repeat brain MRI, however, showed chiasmal prolapse with inferior tethering into an empty sella. Surgical fat padding to reposition the chiasm resulted in visual improvement with a different visual field pattern in the left eye. The clinical manifestations and etiopathogenesis of the empty sella syndrome are discussed. (Surv Ophthalmol 50:588--597, 2005. Ó 2005 Elsevier Inc. All rights reserved.) Key words. prolactinoma empty sella chiasmal prolapse bromocriptine chiasmopexy PROGRESSIVE PAINLESS VISION LOSS
The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory d... more The purpose of this study was to evaluate the addition of topical nonsteroidal antiinflammatory drugs (NSAIDs) to intravitreal corticosteroid and antivascular endothelial growth factor injections for the treatment of chronic cystoid macular edema. Thirty-nine patients with chronic pseudophakic cystoid macular edema completed a single-center, randomized, investigator-masked study. All patients were treated with an intravitreal triamcinolone and bevacizumab injection at study entry; the bevacizumab injection was repeated at 1 month. To evaluate the effect of adding an NSAID, patients were randomized to treatment with 1 of 4 topical NSAIDs (diclofenac 0.1%, ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09%) or placebo for 16 weeks. At Weeks 12 and 16, both the nepafenac and bromfenac groups showed a significant reduction in retinal thickness compared with that in placebo (nepafenac, P = 0.0048, bromfenac, P = 0.0113). A difference, however, between these 2 NSAID groups was observed in that only the nepafenac group was able to maintain the demonstrated retinal thickness decrease at Weeks 12 and 16. The nepafenac group also experienced a significant improvement in visual acuity at Weeks 12 (P = 0.0084) and 16 (P = 0.0233). The addition of NSAIDs did not produce an increase in mean intraocular pressure over the course of therapy. Although NSAID therapy seems to potentiate the improvements produced by corticosteroids and antivascular endothelial growth factor therapy for chronic pseudophakic cystoid macular edema, only nepafenac- and bromfenac-treated eyes showed reduced retinal thickness at 12 weeks and 16 weeks. Furthermore, nepafenac produced a sustained improvement in visual acuity.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004
Purpose: The purpose of this study was to determine the effect of varying insertion angles on the... more Purpose: The purpose of this study was to determine the effect of varying insertion angles on the fixation strength of screw-in devices placed in the glenoid rim. Type of Study: Cadaveric biomechanical analysis. Methods: Eighteen cadaveric glenoids had 3.0-mm cannulated screws inserted for a depth of 10 mm in all 4 quadrants: anterior superior (AS), anterior inferior (AI), posterior superior (PS), posterior inferior (PI). Screws were inserted along the orthogonal to the glenoid rim at the point of insertion or at angles that deviated from this vector by 20°and 40°. Load to failure was performed at 10 mm/s along the orthogonal to the point of insertion. Results: For screws inserted orthogonal to the glenoid rim, the average load to failure was highest for the PS quadrant (733 Ϯ 369 N) and lowest for the AI quadrant (272 Ϯ 69 N). The AS and PI quadrants showed intermediate values (549 Ϯ 334 N and 484 Ϯ 141 N, respectively). Deviation from orthogonal correlated with decreased fixation strength. This decrease was statistically significant in the AS and PI quadrants, with deviation of 40°, and in the AI quadrant, with deviation of 20°, as well as 40°. Conclusions: Insertion angles for screw-in fixation devices should be orthogonal to the glenoid rim at the point of insertion to maximize strength. Deviation of 40°from orthogonal compromises fixation in most quadrants and deviation as little as 20°can compromise fixation in the AI quadrant. Clinical Relevance: To maximize strength of labral reattachment to the bony glenoid, screw-in type fixation devices should be inserted as orthogonal to the glenoid rim as possible. This is especially true for Bankart repairs, because device pullout occurs at significantly lower loads in the anteroinferior quadrant compared with the other 3 quadrants. Deviating as little as 20°further decreases fixation strength significantly.
To determine whether anterior ischemic optic neuropathy and compressive optic neuropathy in human... more To determine whether anterior ischemic optic neuropathy and compressive optic neuropathy in humans alter the photopic flash ERG and to investigate the cellular origins of the waves that are affected by pharmacologic agents in primates.
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Papers by Hasan Bahrani