Farzin Forooghian

University of British Columbia - Vancouver, Vancouver, British Columbia, Canada

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Publications (66)218.67 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare intravitreal bevacizumab versus ranibizumab as adjuvant treatment prior to pars plana vitrectomy (PPV) in proliferative diabetic retinopathy (PDR) with respect to parameters of surgical complexity. Prospective, randomized, double-masked pilot study of patients requiring PPV for nonclearing vitreous hemorrhage or tractional retinal detachment (TRD) secondary to PDR. Patients were randomized to receive either intravitreal bevacizumab or ranibizumab at standard doses 1 week preoperatively. Measured parameters included total surgical time, presence of TRD, intraoperative bleeding, iatrogenic retinal breaks, and use of endolaser and endodiathermy or silicone oil. A total of 29 patients were recruited. For surgical parameters, there were no statistically significant differences between the groups in the univariate analyses. Multivariable analysis showed no statistically significant difference for total surgical time. This pilot study suggests that intravitreal bevacizumab and ranibizumab are equivalent as surgical adjuvants when used as pre-treatment in patients with PDR undergoing PPV. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:521-524.]. Copyright 2014, SLACK Incorporated.
    Ophthalmic surgery, lasers & imaging retina. 11/2014; 45(6):521-4.
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    ABSTRACT: PurposeTo describe the fundus autofluorescence (FAF) features of the inflammatory maculopathies and develop a quantification method for FAF analysis.MethodsThis is a retrospective, consecutive case series of patients with inflammatory maculopathies from two tertiary centers. The clinical findings, demographics, and FAF imaging characteristics were reviewed. Foveal autofluorescence (AF) was analyzed. Median and standard deviation (SD) of foveal AF intensity were measured.ResultsThirty eyes of 15 patients were evaluated with both qualitative and quantitative FAF analysis. In acute macular neuroretinopathy, the active phase showed foveal hypoautofluorescence, which became hypoautofluorescent with resolution. In acute posterior multifocal placoid pigment epitheliopathy, multiple lesions with hypoautofluorescent centers with hyperautofluorescent borders were observed in active disease and became hypoautofluorescent with disease convalescence. In multifocal choroiditis and punctate inner choroiditis, the active hyperautofluorescent lesions progressed to inactive, hypoautofluorescent scars. Active serpiginous choroiditis showed hyperautofluorescent borders adjacent to a helicoid-shaped, hypoautofluorescent scar. Active unilateral acute idiopathic maculopathy (UAIM) showed a complex pattern of hypo- and hyperautoflourescence in the macula. The median foveal AF was the greatest in acute macular neuroretinopathy and UAIM among the maculopathies, while the greatest SD of foveal AF intensity was observed in UAIM.ConclusionThe active phase of the majority of inflammatory maculopathies was characterized by hyperautofluorescent lesions. Increased SD of foveal AF correlated with a mixture of hypo-and hyperautoflourescence. Median and SD may be useful metrics in foveal AF and quantifiable values that may be assessed over time as a disease process evolves. Improvements in quantification methods of FAF imaging may allow us to objectively evaluate posterior uveitis.
    Clinical ophthalmology (Auckland, N.Z.) 09/2014; 8:2001-12.
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: To determine whether baseline drusen load, as measured using spectral domain optical coherence tomography (SD-OCT), is a useful predictor of development of advanced age-related macular degeneration (AMD).
    American Journal of Ophthalmology 06/2014; · 4.02 Impact Factor
  • Canadian Journal of Ophthalmology 06/2014; 49(3):e73-6. · 1.30 Impact Factor
  • Steven Yeh, Farzin Forooghian, Eric B Suhler
    JAMA The Journal of the American Medical Association 05/2014; 311(18):1912-3. · 29.98 Impact Factor
  • Kathryn L Pepple, Russell Van Gelder, Farzin Forooghian
    American Journal of Ophthalmology 04/2014; 157(4):752-3. · 4.02 Impact Factor
  • Kaivon Pakzad-Vaezi, Chris Or, Steven Yeh, Farzin Forooghian
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    ABSTRACT: Optical coherence tomography (OCT) has become an integral tool in the imaging of numerous diseases of the posterior segment. The diagnostic investigation of infectious and noninfectious uveitic conditions often requires multiple imaging modalities in the appropriate clinical context. Modern OCT technology has proved useful not only in the diagnostic investigation of these conditions, but also in monitoring of their clinical course and therapeutic response. Inflammation-induced changes at the level of the retina, retinal pigment epithelium, and choroid can now easily be identified in these conditions using OCT. Prognostic information on visual acuity outcome can also be estimated based on OCT findings. Numerous OCT findings have been described in the setting of the various uveitides. Although none of these findings appear to be pathognomonic for diagnosis of specific uveitic syndromes, in the appropriate clinical context they can add a great deal of information in the diagnosis and management of uveitis.
    Canadian Journal of Ophthalmology 02/2014; 49(1):18-29. · 1.30 Impact Factor
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    ABSTRACT: To study the progression of retinal pigment epithelium (RPE) and choroidal atrophy in patients with neovascular age-related macular degeneration (AMD) and to assess for a possible association with the number and type of anti-vascular endothelial growth factor treatments. Patients with neovascular AMD and a minimum of 1-year follow-up were reviewed. Fellow eyes with nonneovascular AMD were used as control eyes. Retinal pigment epithelial atrophy area and choroidal thickness were determined using spectral-domain optical coherence tomography. Multivariable regression models were used for statistical analyses. A total of 415 eyes were included in the study, with a mean follow-up of 2.2 years. Eyes with neovascular AMD had greater progression of RPE atrophy and choroidal atrophy compared with those with nonneovascular AMD (P < 0.001). Progression of RPE atrophy and choroidal atrophy was independently associated with the total number of injections of bevacizumab and ranibizumab (all P values ≤ 0.001). In the subgroup of 84 eyes with neovascular AMD and without RPE atrophy at baseline, only bevacizumab was associated with the progression of RPE atrophy (P = 0.003). This study likely lacked statistical power to detect an association with ranibizumab in this subgroup. Retinal pigment epithelial atrophy and choroidal atrophy in neovascular AMD seem to be exacerbated by anti-vascular endothelial growth factor treatment. Possible differences between bevacizumab and ranibizumab require further investigation.
    Retina (Philadelphia, Pa.) 01/2014; · 2.93 Impact Factor
  • Chris Or, Farzin Forooghian
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    ABSTRACT: Focal choroidal excavations (FCE) are characterized by foveal or perifoveal choroid excavations seen on optical coherence tomography (OCT). The authors report a case of FCE associated with a vitelliform lesion within the excavation. A case of FCE associated with a small vitelliform lesion has been described previously, but the larger extent of the vitelliform lesion observed in the current case has not been previously reported. This may represent a novel category of FCE, vitelliform focal choroidal excavation, in which deposition of vitelliform material is associated with its development. [Ophthalmic Surg Lasers Imaging Retina. 2014;45:e26-e28.
    Ophthalmic surgery, lasers & imaging retina. 01/2014; 45(4):e26-e28.
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    ABSTRACT: Vitreoretinal lymphoma is a diffuse large B cell non-Hodgkin lymphoma. Targeting malignant cells with rituximab is being used increasingly as local chemotherapy, but information on this treatment is scant. We aimed to describe current therapeutic approaches, as well as responses to and complications of, intravitreal rituximab in patients with vitreoretinal lymphoma. Clinical data were collected in a standardised manner retrospectively on patients with vitreoretinal lymphoma treated with intravitreal rituximab. 48 eyes (34 patients) with vitreoretinal lymphoma were treated with a median of 3.5 intravitreal injections of rituximab (1 mg/0.1 mL) for new diagnosis (68.8%), progressive disease (29.9%) and maintenance therapy (2.1%). Intravitreal rituximab±methotrexate was the sole treatment in 19 eyes (39.6%). 31 eyes (64.6%) eyes achieved complete remission, after a median of 3 injections; 7 of these eyes developed recurrent disease. 11 eyes (22.9%) achieved partial remission. Although rituximab may have contributed to complications reported in 12 eyes (25.0%), a 2-line loss of Snellen visual acuity occurred in only 2 of those eyes (4.2%). Approaches in rituximab-based intravitreal chemotherapy vary widely, but our findings suggest that this treatment may be safe and effective in inducing remission in a majority of eyes with vitreoretinal lymphoma.
    The British journal of ophthalmology 10/2013; · 2.92 Impact Factor
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    ABSTRACT: To investigate the relationship between systemic cytokines, the complement factor H (CFH) Y402H polymorphism, drusen load, and subfoveal choroidal thickness in patients with dry age-related macular degeneration (AMD). Cross-sectional study. Forty-four dry AMD patients under care of the Retina Service at the University of British Columbia were enrolled. Drusen load was measured with an automated software algorithm in spectral-domain optical coherence tomography; subfoveal choroidal thickness was measured manually using enhanced depth imaging. Bio-Plex suspension assays (Bio-Rad Laboratories) were used to analyze cytokines in plasma and CFH Y402H was genotyped. Statistical analyses included analysis of covariance and Pearson correlation, corrected for multiple comparisons. The levels of 3 of 4 studied cytokines were significantly different among patients with CC, CT, or TT variants of the CFH Y402H polymorphism (P < .01). Patients with the at-risk CC variant had higher systemic levels of interleukin-6, interleukin-18, and tumor necrosis factor α than those with the CT variants, the TT variant, or both (P < .01). Interleukin-1β did not reach significance (P = .02), but did demonstrate a consistent trend. No correlation was found between plasma cytokines and drusen load or choroidal thickness (all P > .15). The elevated systemic levels of selected proinflammatory cytokines, including those representing products of inflammasome activation, were associated with the CC at-risk variant of the Y402H polymorphism and suggest that genetic factors regulate the inflammatory status in dry AMD patients. Our data support the central role of inflammation in the pathogenesis of AMD and provide further evidence of a systemic involvement in AMD etiology.
    American Journal of Ophthalmology 09/2013; · 4.02 Impact Factor
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    ABSTRACT: Abstract Objective: To determine the risk of uveitis associated with the use of oral fluoroquinolones. Methods: Nested case-control study of all patients who visited an ophthalmologist in British Columbia, Canada, between 2000 and 2007, as captured in the British Columbia Health Linked Database. Results: A total 3383 incident cases of uveitis and 33,830 corresponding controls were identified. Among patients who had used oral fluoroquinolones within the past 30 days, the adjusted relative risk of uveitis was 3.53 (95% CI, 2.84-4.39). However, the relative risk of uveitis among patients taking oral macrolides and beta-lactams was also significantly elevated. Conclusions: Our data do not provide convincing evidence of an association between fluoroquinolones and uveitis, as this study found an association between several classes of antibiotics and uveitis. It is possible that the systemic processes for which these antibiotics are being prescribed are in fact the inciting factors for the uveitis.
    Ocular immunology and inflammation 07/2013; · 0.72 Impact Factor
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    ABSTRACT: Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Subretinal fluid (SRF) and sub-retinal pigment epithelium (sub-RPE) fluid are signs of AMD and can be detected in optical coherence tomography images. However, manual detection and segmentation of SRFs and sub-RPE fluids are laborious and time consuming. In this paper, a novel pipeline is proposed for automatic detection of SRFs and sub-RPE fluids. First, top and bottom layers of retina are segmented using a graph cut method. Then, a Split Bregman-based segmentation method is used to segment dark regions between layers. These segmented regions are considered as potential fluid candidates, on which a set of features are generated. After that, a random forest classifier is trained to distinguish between the true fluid regions from the falsely detected fluid regions. This method shows reasonable performance in a leave-one-out evaluation using a dataset from 21 patients.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 07/2013; 2013:7388-7391.
  • Chris Or, Jing Cui, Joanne Matsubara, Farzin Forooghian
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    ABSTRACT: AIM: Bisphosphonates have been shown to induce ocular inflammatory diseases such as uveitis and scleritis, while being protective against angiogenic diseases like neovascular age-related macular degeneration (AMD). Therefore, we studied the effects of bisphosphonates on primary culture of human fetal retinal pigment epithelium (hRPE), a cell type known to secrete both inflammatory and angiogenic factors. Alendronate and etidronate were selected for this experiment as they are members of the two structurally different classes of bisphosphonates. METHODS: Primary cultures of hRPE were serum-starved for 24 h and then treated for 24 h with alendronate (0.0001, 0.1, 100 µM) or etidronate (0.01, 1 µM). Cell viability was measured using the MTT assay. Investigation of secreted cytokines induced by bisphosphonates was performed using a human cytokine 29-Plex Panel (Bio-Plex) array and the results were analysed with an analysis of variance (ANOVA). RESULTS: Etidronate, at the lower concentration, significantly increased the expression of interleukin (IL)-6 (p=0.03) and IL-8 (p=0.04). At the higher concentration, etidronate significantly decreased the expression of granulocyte macrophage colony-stimulating factor (p=0.02) and basic fibroblast growth factor (bFGF) (p=0.02). Alendronate, at the highest concentration, significantly increased the expression of IL-8 (p=0.02) and decreased the expression of eotaxin (p=0.02). Alendronate also significantly decreased the expression of bFGF at all concentrations (p<0.05) and demonstrated a trend towards decreasing vascular endothelial growth factor expression at low concentration. CONCLUSIONS: Alendronate and etidronate display dose dependent effects in hRPE cells. Alendronate and etidronate administration resulted in concentration dependent elevations in inflammatory cytokines. Furthermore, alendronate and etidronate administration resulted in reduced expression of a number of angiogenic factors. These findings may explain the increased incidence of ocular inflammation as well as the therapeutic effect on neovascular AMD which have been described with bisphosphonates.
    The British journal of ophthalmology 06/2013; · 2.92 Impact Factor
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    ABSTRACT: PURPOSE: To investigate the safety and effects of subconjunctival sirolimus, a mTOR inhibitor and immunosuppressive agent, for the treatment of geographic atrophy (GA). METHODS: The study was a single-center, open-label phase II trial, enrolling 11 participants with bilateral GA; 8 participants completed 24 months of follow-up. Sirolimus (440µg) was administered every 3 months as a subconjunctival injection in only one randomly-assigned eye in each participant for 24 months. Fellow eyes served as untreated controls. The primary efficacy outcome measure was the change in the total GA area at 24 months. Secondary outcomes included changes in visual acuity, macular sensitivity, central retinal thickness, and total drusen area. RESULTS: Study drug was well-tolerated with few symptoms and related adverse events. Study treatment in study eyes was not associated with structural or functional benefits relative to the control fellow eyes. At Month 24, mean GA area increased by 54.5% and 39.7% in study and fellow eyes respectively (p = 0.41), while mean visual acuity decreased by 21.0 letters and 3.0 letters in study and fellow eyes respectively (p = 0.03). Substantial differences in mean changes in drusen area, central retinal thickness, and macular sensitivity were not detected for all analysis time-points up to 24 months. CONCLUSIONS: Repeated subconjunctival sirolimus was well-tolerated in patients with GA, however no positive anatomical or functional effects were identified. Subconjunctival sirolimus may not be beneficial in the prevention of GA progression, and may potentially be associated with effects detrimental to visual acuity.
    Investigative ophthalmology & visual science 04/2013; · 3.43 Impact Factor
  • Source
    Canadian Journal of Ophthalmology 04/2013; 48(2):e35-8. · 1.30 Impact Factor
  • Chris Or, Natasha Press, Farzin Forooghian
    Canadian Journal of Ophthalmology 04/2013; 48(2):e18-20. · 1.30 Impact Factor
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    ABSTRACT: PURPOSE: To compare the reproducibility and mutual agreement of the subfoveal choroidal thickness measurements by expert raters and an automated algorithm in enhanced depth imaging optical coherence tomography (EDI-OCT) images of eyes with non-neovascular age-related macular degeneration (AMD). METHODS: Forty-four patients with non-neovascular AMD were recruited and EDI-OCT images were acquired. Subfoveal choroidal thickness was measured manually by two expert raters and automatically by a graph-cut based algorithm. Drusen area was measured using the automated software (version 6) of Cirrus SD-OCT. The manual and automated choroidal thickness measurements were compared in reproducibility, mutual agreement, and correlation with drusen area. RESULTS: The mean subfoveal choroidal thickness was 246 ± 63 μm for the first rater, 214 ± 68 for the second rater, and 209 ± 53 for the automated algorithm. Intraclass correlation coefficients (ICC) and 95 % confidence intervals (CI) were 0.96 (CI: 0.94-0.98) between the raters, 0.85 (CI: 0.77-0.90) between the first rater and the automated algorithm, and 0.84 (CI: 0.75-0.89) between the second rater and the automated algorithm. Repeat scan measurement ICCs were 0.91 (CI: 0.86-0.94) for the first rater, 0.96 (CI: 0.94-0.97) for the second rater, and 0.87 (CI: 0.80-0.92) for the automated algorithm. Both manual and automated measurements were correlated with drusen area. CONCLUSION: The automated algorithm yielded generally yielded smaller choroidal thickness than the raters with a moderate level of agreement. However its repeat scan measurement repeatability was comparable to that of the manual measurements. The mean difference between the raters indicated possible biases in different raters and rating sessions. The correlation of the automated measurements with the drusen area was comparable to that of the manual measurements. Automated subfoveal choroidal thickness measurement has potential use in clinical practice and clinical trials with possibility for reduced time and labor cost.
    Investigative ophthalmology & visual science 03/2013; · 3.43 Impact Factor
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    ABSTRACT: PURPOSE:: Spectral domain optical coherence tomography can be used to measure both choroidal thickness and drusen load. The authors conducted an exploratory study using spectral domain optical coherence tomography to determine if a correlation between choroidal thickness and drusen load exists in patients with dry age-related macular degeneration. METHODS:: Forty-four patients with dry age-related macular degeneration were recruited. The drusen area and volume were determined using the automated software algorithm of the spectral domain optical coherence tomography device, and choroidal thickness was measured using enhanced depth imaging. Correlations were determined using multivariable and univariable analyses. RESULTS:: The authors found an inverse correlation between choroidal thickness and drusen load (r = -0.35, P = 0.04). Drusen load was also correlated with visual acuity (r = 0.32, P = 0.04). A correlation between choroidal thickness and visual acuity was suggested (r = -0.22, P = 0.21). CONCLUSION:: Spectral domain optical coherence tomography can be used to assess the correlation between drusen load and choroidal thickness, both of which show a relationship with visual acuity. The measurement of these outcomes may serve as important outcome parameters in routine clinical care and in clinical trials for patients with dry age-related macular degeneration.
    Retina (Philadelphia, Pa.) 03/2013; · 2.93 Impact Factor
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    ABSTRACT: Recent technological advances-new pathophysiological insights, new imaging techniques for diagnosis and management, and new treatments-have led to an improved understanding of central serous chorioretinopathy (CSC). The primary role of the choroid has become more widely accepted with widespread use of indocyanine green angiography. Optical coherence tomography (OCT), and particularly enhanced depth imaging OCT, demonstrate a thickened and engorged choroid. Adaptive optics, fundus autofluorescence, multifocal electroretinography, microperimetry, and contrast sensitivity testing reveal that patients with even a mild course suffer previously undetected anatomic and functional loss. Although focal laser and photodynamic therapy are the current standard of care for persistent subretinal fluid in CSC, they are not appropriate in all cases, and the optimal timing of intervention remains unclear.
    Survey of Ophthalmology 03/2013; 58(2):103-26. · 3.51 Impact Factor

Publication Stats

640 Citations
218.67 Total Impact Points


  • 2001–2014
    • University of British Columbia - Vancouver
      • • Department of Ophthalmology and Visual Sciences
      • • Brain Research Centre
      Vancouver, British Columbia, Canada
  • 2013
    • St. Paul's Hospital
      Saskatoon, Saskatchewan, Canada
  • 2008–2013
    • National Institutes of Health
      • • Branch of Clinical and Translational Epidemiology
      • • Laboratory of Immunology
      • • Division of Clinical and Epidimiological Research
      Maryland, United States
    • University of Alberta
      • Department of Ophthalmology
      Edmonton, Alberta, Canada
  • 2012
    • Emory University
      • Emory Eye Center
      Atlanta, GA, United States
  • 2010
    • Mount Sinai School of Medicine
      • Department of Ophthalmology
      Manhattan, NY, United States
  • 2009
    • National Institute of Child Health and Human Development
      Maryland, United States
    • National Eye Institute
      Maryland, United States
  • 2007
    • SickKids
      • Department of Ophthalmology and Vision Sciences
      Toronto, Ontario, Canada
  • 2005–2007
    • University of Toronto
      • • Department of Ophthalmology and Vision Sciences
      • • Hospital for Sick Children
      Toronto, Ontario, Canada