Darius M Moshfeghi

Publications (61)163.6 Total impact

• Article: Persistent plus disease after laser in retinopathy of prematurity with tetralogy of Fallot.

  Yannis M Paulus, Darius M Moshfeghi
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  ABSTRACT: Introduction: We present a patient with retinopathy of prematurity (ROP) who received panretinal photocoagulation (PRP), but in whom plus disease developed, likely secondary to a complicated cardiovascular history, including DiGeorge syndrome and tetralogy of Fallot. Method: Interventional case report with clinical and angiographic correlation. Results: Our patient had been born at 29 weeks and 2 days gestational age with a birthweight of 940 grams, tetralogy of Fallot, DiGeorge syndrome, and major aortopulmonary collaterals. Type 1 Early Treatment for Retinopathy of Prematurity ROP (zone 2, stage 2 with plus) developed, requiring PRP. Worsening plus disease developed and mild further PRP was performed. Despite this, plus disease persisted. Conclusions: We report plus disease even after appropriate PRP therapy for ROP. In this case, it is likely the patient's cardiovascular diseases that caused the persistent plus disease. Vascular tortuosity can be due to a number of different systemic disorders, so it is important to consider an infant's systemic conditions in the evaluation of ROP.
  European journal of ophthalmology 04/2013; · 0.96 Impact Factor
• Article: 16 and 24 Gy Low-voltage X-ray Irradiation With Ranibizumab Therapy for Neovascular Age-Related Macular Degeneration: 12-Month Outcomes.

  Virgilio Morales-Canton, Hugo Quiroz-Mercado, Raul Velez-Montoya, Alicia Zavala-Ayala, Andrew A Moshfeghi, E Mark Shusterman, Peter K Kaiser, Steven R Sanislo, Michael Gertner, Darius M Moshfeghi
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  ABSTRACT: PURPOSE: To describe the 12-month safety and efficacy outcomes of 16 or 24 Gy radiation using low-voltage x-ray irradiation in conjunction with intravitreal ranibizumab for neovascular age-related macular degeneration (AMD). DESIGN: Prospective, phase I, open-label, nonrandomized uncontrolled safety study. METHODS: setting: Institutional. study population: Neovascular AMD patients. intervention: One x-ray irradiation treatment at 16 or 24 Gy was administered externally through 3 locations in the inferior pars plana. After 2 initial monthly loading doses of ranibizumab, subsequent ranibizumab was administered according to predetermined criteria. main outcome measures: Visual acuity, number of ranibizumab injections, safety and efficacy metrics at 12 months. RESULTS: Forty-seven eyes of 47 patients were enrolled and completed 12 months of follow-up: 16 Gy (n = 28) and 24 Gy (n = 19). There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean visual acuity improved in both groups: +8.4 ± 11.9 letters and +7.8 ± 12 letters for 16 and 24 Gy, respectively. In both groups, 100% of subjects lost <15 letters, with 76% and 79% gaining ≥0 letters in the 16 Gy and 24 Gy groups, respectively. Patients received a mean of 1.0 additional injection over 12 months. The mean change in optical coherence tomography central subfield thickness from baseline to month 12 was -107 and -87 μm for the 16 Gy and 24 Gy groups, respectively. CONCLUSION: One treatment of 16 or 24 Gy low-voltage x-ray therapy with as-needed ranibizumab appears safe in subjects with neovascular AMD at 12 months. An overall improvement in visual acuity was observed. No radiation-related adverse effects were reported.
  American journal of ophthalmology 03/2013; · 3.83 Impact Factor
• Article: The importance of keeping a broad differential in retina clinic: the spectrum of ophthalmic disease seen by retina specialists in a tertiary outpatient clinic setting.

  Natalia Fijalkowski, Suzann Pershing, Darius M Moshfeghi
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  ABSTRACT: To describe the new patient population referred to retina specialists at tertiary ophthalmic academic centers in the United States. Retrospective chart review of all new patients seen by retina specialists at Stanford University from 2008 to 2011. Retina specialists saw 7,197 new patients during the study period, with a mean age of 52.2 ± 25.6 years (range: 0 to 108 years). Younger patients (0 to 10 years) were more likely male (P < .001) while older patients were more likely female (P < .01 for 61 to 70, 81+ years). The most common diagnoses were diabetic eye disease (17.0%), retinopathy of prematurity (9.9%) and age-related macular degeneration (9.5%). Retina specialists treat patients of all ages, and the most common diagnoses vary with age and gender. Patients present to retinal clinic with a vast spectrum of disease from various ophthalmic and systemic etiologies; therefore, it is important to maintain a broad differential diagnosis.[Ophthalmic Surg Lasers Imaging Retina. 2013;44:133-139].
  Ophthalmic surgery, lasers & imaging retina. 03/2013; 44(2):133-9.
• Article: Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Four-years of Screening with Telemedicine.

  Natalia Fijalkowski, Luo Luo Zheng, Michael T Henderson, Matthew B Wallenstein, Theodore Leng, Darius M Moshfeghi
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  ABSTRACT: Abstract Purpose: To report the four-year experience of the Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP) telemedicine initiative, which was developed to reduce the risk of blindness from retinopathy of prematurity (ROP). Materials and methods: A retrospective analysis of the SUNDROP archival data between 12/1/2005 and 11/30/2009. A total of 410 consecutively enrolled infants meeting ROP screening criteria had nurse-obtained fundoscopic images evaluated remotely by an ROP specialist. Every infant then received at least one dilated bedside binocular indirect ophthalmoscope (BIO) examination within one week of discharge. All infants were then followed with both telemedicine images and bedside evaluation in clinic according to recommended screening timelines. Primary outcomes were treatment-warranted ROP (TW-ROP), defined as Early Treatment of ROP Type 1, and adverse anatomical outcomes. Results: The SUNDROP telemedicine screening initiative has not missed any TW-ROP in its four-year evaluation period. A total of 410 infants (820 eyes) were imaged, resulting in 1486 examinations and 18,097 unique images. An average of 12.2 images were obtained per patient. Fourteen infants met TW-ROP criteria on telemedicine examination. After bedside evaluation, 13 infants required laser photocoagulation and one was followed until he spontaneously regressed. Infants with TW-ROP had a significantly lower gestational age (24.9 weeks), birth weight (658.7 grams), and were more likely to be male than the no TW-ROP cohort (all p values <0.00001). Telemedicine had a calculated sensitivity of 100%, specificity of 99.8%, positive predicative value of 92.9% and negative predictive value of 100% for the detection of TW-ROP. No patient progressed to retinal detachment or any adverse anatomical outcome. Conclusions: The SUNDROP initiative demonstrated a high degree of diagnostic reliability and was able to capture all infants with TW-ROP. Telemedicine offers a cost-effective, reliable and accurate screening methodology for identifying infants with TW-ROP without sacrificing quality of care.
  Current eye research 01/2013; · 1.51 Impact Factor
• Article: Herpes simplex virus type 2 mediated acute retinal necrosis in a pediatric population: case series and review.

  Ruwan A Silva, Audina M Berrocal, Darius M Moshfeghi, Mark S Blumenkranz, Steven Sanislo, Janet L Davis
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  ABSTRACT: BACKGROUND: We report 15 eyes with herpes simples virus type 2 (HSV-2) mediated acute retinal necrosis (ARN) in order to better characterize pathogenesis, clinical course, diagnosis, and outcomes of the disease. METHODS: Retrospective observational case series of 14 patients (15 eyes) all aged 21 years or younger with acute retinal necrosis resulting from HSV-2 and examined between 1995 and 2009. Patients were diagnosed by various techniques, including polymerase chain reaction (PCR) of aqueous, vitreous, and serum, antibody determination of serum and intraocular fluids, fundoscopic exam, a therapeutic trial of antivirals active against HSV-2, or a combination thereof. RESULTS: Mean age of presentation was 11.7 years (range, newborn to 21.0 years) with a standard deviation of 7.0 years. Mean initial vision was 20/200 (median, 20/400; range, 20/20 to LP). Eleven patients (73.3 %) had received oral, injectable, or topical corticosteroids, and 14 (93.3 %) had received antiviral therapy. All patients were diagnosed based on evaluation of intraocular fluids and tissue by antibody determinations, culture, PCR, histopathologic examination, or a combination thereof. Mean final visual acuity was 20/400 (median, CF; range, 20/25 to LP) with worsened visual acuity in five eyes (33.3 %). Anatomically, 14 of 15 eyes had healed or improved retinal appearance. CONCLUSIONS: In a pediatric population with acute retinal necrosis, HSV-2 should be considered as the prime candidate virus. Diagnosis of HSV-2 acute retinal necrosis is accomplished mainly by PCR of ocular specimens. Prompt diagnosis may lead to appropriate anti-viral therapy.
  Albrecht von Graæes Archiv für Ophthalmologie 10/2012; · 2.17 Impact Factor
• Article: Retinal glioneuronal hamartoma in neurofibromatosis type 1.

  Eleonora M Lad, Jason R Karamchandani, Deborah M Alcorn, Darius M Moshfeghi, Peter R Egbert
  Archives of ophthalmology 10/2012; 130(10):1335-7. · 3.86 Impact Factor
• Article: 16 Gy low-voltage x-ray irradiation followed by as needed ranibizumab therapy for age-related macular degeneration: 12 month outcomes of a 'radiation-first' strategy.

  Andrew A Moshfeghi, Virgilio Morales-Canton, Hugo Quiroz-Mercado, Raul Velez-Montoya, Alicia Zavala-Ayala, Eugene Mark Shusterman, Peter K Kaiser, Steven R Sanislo, Michael Gertner, Darius M Moshfeghi
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  ABSTRACT: To describe 'radiation-first' combination treatment with a non-invasive, low-voltage x-ray irradiation system followed by as needed ranibizumab for neovascular age-related macular degeneration (AMD). Phase I study of non-invasive, low-voltage 16 Gy x-ray irradiation delivered in three beams via the inferior pars plana in patients with active neovascular AMD. Ranibizumab was administered as needed per protocol. Patients were followed monthly for safety and efficacy over 12 months. 13 patients were enrolled and completed 12 months follow-up. Safety was good with no serious ocular/non-ocular adverse events or radiation-related ocular complications. 11 patients lost <15 Early Treatment of Diabetic Retinopathy Study (ETDRS) letters, seven gained ≥0 ETDRS letters and 0 gained ≥15 ETDRS letters. Patients received a total of 31 subsequent ranibizumab injections (of possible 156) over the 12 months following x-ray irradiation. Mean time to first injection was 3.9 months. One patient received no ranibizumab injections, three patients received one injection, four patients received two injections, and five patients received three or more injections. After 12 months, non-invasive, low-voltage x-ray irradiation with as needed ranibizumab rescue therapy demonstrated good safety with a visual acuity stabilising effect and reduction in retinal thickness in patients with neovascular AMD.
  The British journal of ophthalmology 08/2012; 96(10):1320-4. · 2.92 Impact Factor
• Article: Author reply.

  Darius M Moshfeghi, Audina M Berrocal
  Ophthalmology 05/2012; 119(5):1092-3. · 5.45 Impact Factor
• Article: Cannula-based 25-gauge vitreous tap and injection: a new surgical technique.

  Annie Chan, Theodore Leng, Darius M Moshfeghi
  Retina (Philadelphia, Pa.) 02/2012; 32(5):1021-2. · 2.93 Impact Factor
• Article: 16-Gy low-voltage x-ray irradiation with ranibizumab therapy for AMD: 6-month safety and functional outcomes.

  Virgilio Morales Canton, Hugo Quiroz-Mercado, Raul Velez-Montoya, Miriam J Lopez-Miranda, Andrew A Moshfeghi, Eugene M Shusterman, Peter K Kaiser, Steven R Sanislo, Michael Gertner, Darius M Moshfeghi
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  ABSTRACT: To describe the 6-month safety and preliminary efficacy outcomes of the use of 16-Gy radiation with intravitreal ranibizumab for patients with neovascular age-related macular degeneration (AMD). A single treatment of a non-invasive, externally delivered low-voltage 16-Gy x-ray irradiation was administered in one session through three locations in the inferior pars plana. Optical coherence tomography (OCT) and Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity (VA) examinations were performed at 1 week, 1 month, and monthly thereafter, with quarterly fluorescein angiography (FA). After the two initial ranibizumab injections, subsequent injections were administered according to the following criteria: VA decline of 10 ETDRS letters compared with baseline, increase of 100-μm central foveal thickness on OCT compared with baseline, the development of new submacular hemorrhage, and the development of a new area of classic choroidal neovascularization on FA. Twenty-six patients completed a 6-month follow-up. There was no evidence of radiation retinopathy, optic neuropathy, or cataract. The mean baseline ETDRS score was 46.6 letters (range: 5 to 80; standard deviation [SD]: 21.5). At 6 months, the corresponding ETDRS score was 55.6 letters (range: 25 to 80; SD: 18.9) and the mean change in VA was 9.5 ETDRS letters (SD: 10.3). On responder analysis, 96% lost 15 or fewer ETDRS letters, 81% gained 0 or more ETDRS letters, and 50% gained 15 or more ETDRS letters. Patients received a total of 13 ranibizumab injections following two initial injections. At 6 months, patients received an average of 0.5 additional injections following the initial two mandated injections. A single treatment of externally applied, non-invasive 16-Gy low-voltage x-ray therapy in conjunction with ranibizumab demonstrated an overall improvement of VA in patients with neovascular AMD at 6 months with no radiation-related adverse effects.
  Ophthalmic Surgery Lasers and Imaging 08/2011; 42(6):468-73. · 0.62 Impact Factor
• Article: 16-Gy low-voltage x-ray irradiation followed by as-needed ranibizumab therapy for AMD: 6-month outcomes of a "radiation-first" strategy.

  Andrew A Moshfeghi, Virgilio Morales Canton, Hugo Quiroz-Mercado, Raul Velez-Montoya, Miriam J Lopez-Miranda, Eugene M Shusterman, Peter K Kaiser, Steven R Sanislo, Michael Gertner, Darius M Moshfeghi
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  ABSTRACT: To describe the effect of a "radiation-first" combination treatment strategy for neovascular age-related macular degeneration (AMD) with ranibizumab rescue therapy. Non-invasive, externally delivered low-voltage x-ray irradiation at a dose of 16 Gy was given in a single session through three locations in the inferior pars plana in a consecutive series of patients with neovascular AMD. Ranibizumab was administered according to prospectively determined criteria. Thirteen patients completed a 6-month follow-up. All patients lost 15 or fewer ETDRS letters, 7 gained 0 or more ETDRS letters, and 0 gained more than 15 ETDRS letters. Patients received a total of 15 ranibizumab injections following x-ray irradiation at baseline. Two patients received no ranibizumab injections, seven patients received 1 injection, and four patients received 2 injections. Low-voltage x-ray treatment followed by ranibizumab rescue demonstrates an independent visual acuity stabilizing effect for patients with wet AMD.
  Ophthalmic Surgery Lasers and Imaging 08/2011; 42(6):460-7. · 0.62 Impact Factor
• Source

  Available from: posterous.com

  Article: Retinopathy of prematurity in the time of bevacizumab: incorporating the BEAT-ROP results into clinical practice.

  Darius M Moshfeghi, Audina M Berrocal
  Ophthalmology 07/2011; 118(7):1227-8. · 5.45 Impact Factor
• Article: Radiation treatment for age-related macular degeneration.

  Ruwan A Silva, Andrew A Moshfeghi, Peter K Kaiser, Rishi P Singh, Darius M Moshfeghi
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  ABSTRACT: Age-related macular degeneration (AMD) remains a devastating cause of visual loss among elderly individuals. While considerable progress has been made towards combating the disease, most recently with intravitreal anti-VEGF agents, visual outcomes are still limited by continued retinal pigment epithelium (RPE) degeneration and subsequent neurosensory retinal atrophy. Among the promising new treatment options being explored, radiotherapy appears apt to address the multifactorial etiology of AMD. Current investigative studies underway will hopefully yield clinical efficacy to complement this theoretical suitability for arresting visual loss.
  Seminars in ophthalmology 05/2011; 26(3):121-30.
• Article: Medical school and residency influence on choice of an academic career and academic productivity among neurosurgery faculty in the United States. Clinical article.

  Peter G Campbell, Olatilewa O Awe, Mitchell G Maltenfort, Darius M Moshfeghi, Theodore Leng, Andrew A Moshfeghi, John K Ratliff
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  ABSTRACT: Factors determining choice of an academic career in neurological surgery are unclear. This study seeks to evaluate the graduates of medical schools and US residency programs to determine those programs that produce a high number of graduates remaining within academic programs and the contribution of these graduates to academic neurosurgery as determined by h-index valuation. Biographical information from current faculty members of all accredited neurosurgery training programs in the US with departmental websites was obtained. Any individual who did not have an American Board of Neurological Surgery certificate (or was not board eligible) was excluded. The variables collected included medical school attended, residency program completed, and current academic rank. For each faculty member, Web of Science and Scopus h-indices were also collected. Ninety-seven academic neurosurgery departments with 986 faculty members were analyzed. All data regarding training program and medical school education were compiled and analyzed by center from which each faculty member graduated. The 20 medical schools and neurosurgical residency training programs producing the greatest number of graduates remaining in academic practice, and the respective individuals' h-indices, are reported. Medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academics the most frequently. The neurosurgery training program at the University of Pittsburgh produced the highest number of academic neurosurgeons in this sample. The use of quantitative measures to evaluate the academic productivity of medical school and residency graduates may provide objective measurements by which the subjective influence of training experiences on choice of an academic career may be inferred. The top 3 residency training programs were responsible for 10% of all academic neurosurgeons. The influence of medical school and residency experiences on choice of an academic career may be significant.
  Journal of Neurosurgery 04/2011; 115(2):380-6. · 2.96 Impact Factor
• Source

  Available from: Mitchell Maltenfort

  Article: Medical school and residency influence on choice of an academic career and academic productivity among US neurology faculty.

  Peter G Campbell, Young H Lee, Rodney D Bell, Mitchell G Maltenfort, Darius M Moshfeghi, Theodore Leng, Andrew A Moshfeghi, John K Ratliff
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  ABSTRACT: To evaluate the effectiveness of medical schools and neurology training programs in the United States by determining their contribution to academic neurology in terms of how many graduates choose academic careers and their respective influence on current medical knowledge through bibliometric analysis. Biographical information from current faculty members of neurology training programs in the United States was obtained through an Internet-based search of departmental Web sites. Collected variables included medical school attended, residency program completed, and current academic rank. For each faculty member, ISI Web of Science and Scopus h -indices were also collected. Data from academic neurologists from 120 training programs with 3249 faculty members were collected. All data regarding training program and medical school education were compiled and analyzed by the institution from which each individual graduated. The 20 medical schools and neurology residency training programs producing the greatest number of graduates remaining in academic practice and the mean h -indices are reported. More medical school graduates of the Columbia University College of Physicians and Surgeons chose to enter academic neurology practice than the graduates of any other institution. Analyzed by residency training program attended, New York Presbyterian Hospital (Columbia University), Mayo Clinic (Rochester, Minnesota), and Mount Sinai Medical Center (New York, New York) produced the most graduates remaining in academics. This retrospective, longitudinal cohort study examines through quantitative measures the academic productivity and rank of academic neurologists. The results demonstrate that several training programs excel in producing a significantly higher proportion of academically active neurologists.
  Archives of neurology 04/2011; 68(8):999-1004. · 6.31 Impact Factor
• Article: The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy.

  Andrew A Moshfeghi, Thomas A Albini, John W Kitchens, Theodore Leng, Darius M Moshfeghi
  Retina (Philadelphia, Pa.) 02/2011; 31(2):426-7; author reply 427. · 2.93 Impact Factor
• Source

  Available from: psu.edu

  Article: Stereotactic low-voltage x-ray irradiation for age-related macular degeneration.

  Darius M Moshfeghi, Peter K Kaiser, Michael Gertner
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  ABSTRACT: The IRay stereotactic low-voltage x-ray irradiation treatment system for age-related macular degeneration consists of a low voltage x-ray tube, an eye tracking system, a robotically controlled delivery system, a coupling device to facilitate tracking and stabilisation, a graphical user interface and gating software. Low-voltage x-rays are delivered in a series of three spots to the macula in a non-invasive manner through the inferior pars plana. These beams are designed to overlap on the centre of the macula. Each beam delivers one-third of the total dose, such that the total macula dose is three times an individual beam's dose. The device is designed to run off standard domestic electrical power, and no special shielding is necessary for the room. This system has been validated in Monte Carlo simulations, human cadaver eye studies, pre-clinical animal studies and in a phase I clinical trial.
  The British journal of ophthalmology 02/2011; 95(2):185-8. · 2.92 Impact Factor
• Article: Telemedicine as a tool for evaluation of retinopathy of prematurity.

  Ruwan A Silva, Darius M Moshfeghi
  International ophthalmology clinics 01/2011; 51(1):33-48.
• Source

  Available from: orayainc.com

  Article: Stereotactic radiosurgery for AMD: a Monte Carlo-based assessment of patient-specific tissue doses.

  Justin Hanlon, Michael Firpo, Erik Chell, Darius M Moshfeghi, Wesley E Bolch
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  ABSTRACT: To define the radiation doses to nontargeted ocular and adnexal tissues with Monte-Carlo simulation using a stereotactic low-voltage x-ray irradiation system for the treatment of wet age-related macular degeneration. Thirty-two right/left eye models were created from three-dimensional reconstructions of 1-mm computed tomography images of the head and orbital region. The resultant geometric models were voxelized and imported to the MCNPX 2.5.0 radiation transport code for Monte Carlo-based simulations of AMD treatment. Clinically, treatment is delivered noninvasively by three divergent 100-kVp photon beams entering through the sclera and overlapping on the macula cumulating in a therapeutic dose. Tissue-averaged doses, localized point doses, and color-coded dose contour maps are reported from Monte Carlo simulations of x-ray energy deposition for several tissues of interest, including the lens, optic nerve, macula, brain, and orbital bone. For all eye models in this study (n = 32), tissues at risk did not receive tissue-averaged doses over the generally accepted thresholds for serious complication, specifically the formation of cataracts or radiation-induced optic neuropathy. Dose contour maps are included for three patients, each from separate groups defined by coherence to clinically realistic treatment setups. Doses to the brain and orbital bone were found to be insignificant. The computational assessment performed indicates that a previously established therapeutic dose can be delivered effectively to the macula with the scheme described so that the potential for complications to nontargeted radiosensitive tissues might be reduced.
  Investigative ophthalmology & visual science 11/2010; 52(5):2334-42. · 3.43 Impact Factor
• Article: Declining incidence of neonatal endophthalmitis in the United States.

  Andrew A Moshfeghi, Resmi A Charalel, Tina Hernandez-Boussard, John M Morton, Darius M Moshfeghi
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  ABSTRACT: To determine the incidence of neonatal endogenous endophthalmitis in the United States between 1998 and 2006 and to identify associated risk factors. Retrospective cohort study. We used the Nationwide Inpatient Sample database, a 20% representative sample of all hospital discharges in the United States, to help refine our understanding of this condition. International Classification of Diseases, ninth edition, codes for endophthalmitis, sepsis, and suspected endophthalmitis risk factors in hospitalized infants and neonates were searched in the database and were tracked over time. The main outcome measure was incidence of neonatal endophthalmitis over the study period. Of 3.64 million live births in 1998, 317 newborns were identified with endophthalmitis (8.71 cases per 100 000 live births). Of 4.14 million live births in 2006, only 183 newborns were identified with endophthalmitis (4.42 cases per 100 000 live births) by comparison. The incidence of endophthalmitis decreased at a rate of 6% per year (P = .01130) between 1998 and 2006. Neonates with endophthalmitis were more likely to have systemic bacteremia (odds ratio, 21.114; P < .0001), Candidemia (odds ratio, 2.356; P < .0001), a birth weight of less than 1500 g (odds ratio, 1.215; P < .0001), and retinopathy of prematurity (odds ratio, 2.052; P < .0001). We objectively validated the commonly held belief that Candidemia, bacteremia, retinopathy of prematurity, and low birth weight are significant risk factors for endophthalmitis development in infants, which seems to have had a decreasing incidence in recent years.
  American journal of ophthalmology 10/2010; 151(1):59-65.e1. · 3.83 Impact Factor