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Protecting the Corneal Endothelium during Cataract Surgery Using the Anterior Capsulorhexis Flap as a Corneal Protection Shield 利用前撕囊瓣作为角膜保护罩保护白内障手术中的角膜内皮
Pub Date : 2021-12-30 DOI: 10.33425/2639-9482.1017
Stjepanek Kristina, H. Nino, Amir-Asgari Sahand, Hienert Julius, F. Oliver
Purpose: Classification and quantification of swirling lens fragments during phacoemulsification with or without using the capsulorhexis flap as an additional endothelial protective shield. Also, to determine the effects on endothelial cell count (ECC) and central corneal thickness (CCT) caused by fragments during cataract surgery. Methods: Patients with dense cataracts scheduled for surgery were randomized into study and control groups (2:1). In the study group, the anterior capsule ‘flap’ from the capsulorhexis was used as an endothelial protection shield during phacoemulsification. The control group underwent standard surgery. During surgery, intra-operative optical coherence tomography was performed to score swirling lens fragments that hit the corneal endothelium. CCT and ECC were measured at several time points before and after surgery. Results: In total, 176 fragments in 49 eyes of 49 patients came in contact with the corneal endothelium. The mean number of fragments was 2.8 in the study group and 4.8 in the control group. There was no statistically significant change of ECC between the groups. Mean CCT increased by 16.6 µm in the study group and by 42µm in the control group 1 day postoperatively. There was no significant difference between the groups regarding the increase in CCT. Conclusions: No significant benefit concerning ECC or CCT was found in the study group compared to the control group, meaning that we were not able to prove that using the capsulorhexis flap as a protection shield is a sufficient method of protecting the corneal endothelium.
目的:对超声乳化术中有或没有使用撕囊瓣作为额外的内皮保护盾的旋转晶状体碎片进行分类和量化。同时,确定白内障手术中碎片对角膜内皮细胞计数(ECC)和角膜中央厚度(CCT)的影响。方法:将拟行手术的致密性白内障患者随机分为研究组和对照组(2:1)。在研究组中,来自撕囊的前囊“皮瓣”在超声乳化术中用作内皮保护盾。对照组接受标准手术治疗。术中进行光学相干断层扫描,对撞击角膜内皮的旋转晶状体碎片进行评分。分别于手术前后多个时间点测量CCT和ECC。结果:49例患者49只眼中有176块碎片接触到角膜内皮。研究组的平均碎片数为2.8个,对照组为4.8个。两组间ECC差异无统计学意义。术后1天,研究组平均CCT增加16.6µm,对照组平均CCT增加42µm。两组间CCT的增加没有显著差异。结论:与对照组相比,研究组在ECC或CCT方面没有发现明显的益处,这意味着我们无法证明使用撕囊瓣作为保护盾是保护角膜内皮的充分方法。
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引用次数: 0
Tonometric profile of patients at Kara University Teaching Hospital in Togo 多哥卡拉大学教学医院病人的张力测量剖面
Pub Date : 2021-12-30 DOI: 10.33425/2639-9482.1023
Amedome Kokou Messan, Assavedo Codjo Rodrigue Abel, Vonor Kokou, Ayéna Koffi Didier, Balo Komib
Aim: Our study aimed to describe the tonometric profile of patients consulting in the Ophthalmology department of University Teaching Hospital of Kara (UTH Kara). Study method: This is a descriptive cross-sectional retrospective study on the files of patients who consulted in the ophthalmology department of the CHU Kara and who performed a tonometric examination over the period from January 1, 2019 to June 30, 2021 i.e. a period of 02 and a half years. Results: During this 30-month study period, 225 patients consulted in the ophthalmology department of University Teaching Hospital of Kara, which corresponds to a six-monthly frequency of 20% (45 patients). The mean age of our patients was 29.78 ± 13.39 years with extremes of 5 and 69 years. The 11 to 21 age group was in the majority. the female sex was predominant (65.78%) with an M / F ratio of 0.52. Pupils / students (48.90%) and civil servants (31.20%) were the majority of the consultants. Eye pain (23.6%), blurring of vision (21.3%), Headache (17.8%) and reduced visual acuity (13.3%) were the main reasons for consultation. The mean intraocular pressure of our patients was 15.46 mm Hg. It was 15.52 mm Hg ± 4.26 in the right eye (OD) and 15.41 mm Hg ± 4.70 in the left eye (OG). In 4.4% of cases, ocular hypertonia between 22 and 29 mmHg was noted. Conclusion: The prevention of the occurrence of glaucoma in isolated hypertonia and better management of known glaucomatous patients seem to justify rigorous tonometric monitoring at all ages.
目的:本研究旨在描述卡拉大学教学医院(UTH Kara)眼科就诊患者的血压计特征。研究方法:对2019年1月1日至2021年6月30日在CHU Kara眼科就诊并进行眼压检查的患者档案进行描述性横断面回顾性研究,即02年半。结果:在30个月的研究期间,有225例患者在卡拉大学教学医院眼科就诊,相当于6个月的频率为20%(45例)。患者平均年龄29.78±13.39岁,极值为5岁和69岁。11至21岁年龄组占多数。雌性占多数(65.78%),雌雄比为0.52。小学生/学生(48.90%)和公务员(31.20%)是主要的顾问。眼部疼痛(23.6%)、视力模糊(21.3%)、头痛(17.8%)和视力下降(13.3%)是就诊的主要原因。平均眼压15.46 mm Hg,右眼(OD) 15.52 mm Hg±4.26,左眼(OG) 15.41 mm Hg±4.70。4.4%的病例出现22 - 29 mmHg的高眼压。结论:预防孤立性高渗性青光眼的发生和对已知青光眼患者的更好管理似乎证明了在所有年龄段严格的眼压监测是合理的。
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引用次数: 0
Epidemiological, Clinical, Therapeutic and Evolutionary Aspects of Corneal Abscesses at the Teaching Hospital of Bouaké (Côte d’Ivoire) bouak<s:1>教学医院角膜脓肿的流行病学、临床、治疗和进化方面(Côte科特迪瓦)
Pub Date : 2021-12-30 DOI: 10.33425/2639-9482.1019
O. Y, D. Z, G. Le, Koffi Kfh, T. Y, Babayeju Orl, Sékongo L, Bilé Pefk, Diomandé Gf, Diomandé Ia
Introduction: The purpose of this study was to describe the epidemiological, clinical, therapeutic and evolutionary aspects of corneal abscesses treated in the ophthalmology department at the Teaching Hospital of Bouaké, in order to contribute to an improvement in their management. Materials and methods: A longitudinal retrospective study based on the analysis of medical records of patients with corneal abscesses who received follow-up in the department. from 1 January 2012 to 31 December 2016 and 21 cases of unilateral abscesses were collected from a total of 18,585 cases. Results: The frequency of corneal abscesses was 0.11%. The average age of patients was 27.71 years (1-year and 73-year extremes) with a male predominance (1.1 sex ratio). Housewives and farmers accounted for 57.14%. Patients were admitted more than 7 days after the onset of signs in 33.33% of cases. At admission, the visual acuity of the affected eye was less than 1/20 in 16 patients (76.19%) and among them, 6 had no light perception. The abscess was localized to the left eye in 11 patients (52.38%). Its largest diameter was greater than 2 millimetres in 14 patients (66.66%), its seat was in the visual axis in 10 patients (47.61%) and in 12 patients (57.14%), its depth exceeded two-thirds of the corneal thickness. Corneal perforation was observed in 6 cases (28.57%) and severity factors were found in 19 patients (90.47%). No microbiological examination was performed and treatment was based on probabilistic antibiotic therapy. The cure was achieved but at the cost of anatomical sequelae whose functional consequences were visual acuity less than 1/20 in 76.19% of cases. Conclusion: corneal abscesses are infrequent but very serious with poor prognosis in our conditions. This prognosis can be improved by early and adequate management, including microbiology-guided antibiotic therapy.
前言:本研究的目的是描述在bouak教学医院眼科治疗的角膜脓肿的流行病学、临床、治疗和进化方面的情况,以有助于改善其管理。材料与方法:对在该科随访的角膜脓肿患者病历进行纵向回顾性分析。2012年1月1日至2016年12月31日,共18585例患者中收集单侧脓肿21例。结果:角膜脓肿发生率为0.11%。患者平均年龄27.71岁(1岁和73岁极值),以男性为主(性别比1.1)。家庭主妇和农民占57.14%。发病后7天以上住院的占33.33%。入院时患眼视力低于1/20者16例(76.19%),其中无光感者6例。脓肿集中于左眼11例(52.38%)。其最大直径大于2 mm的有14例(66.66%),位于视轴的有10例(47.61%),深度超过角膜厚度三分之二的有12例(57.14%)。角膜穿孔6例(28.57%),严重程度因素19例(90.47%)。未进行微生物学检查,治疗基于概率抗生素治疗。治疗成功,但以解剖学后遗症为代价,76.19%的病例视力低于1/20。结论:本组患者角膜脓肿发生率低,但病情严重,预后差。这种预后可以通过早期和适当的管理来改善,包括微生物学指导的抗生素治疗。
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引用次数: 1
Up-Dated the Critical Issues of Corneal Cross-Linking (Type-I and II): Safety Dose for Ultra-Thin Cornea, Demarcation Line Depth and the Role of Oxygen 更新角膜交联的关键问题(i型和II型):超薄角膜的安全剂量、分界线深度和氧的作用
Pub Date : 2021-12-30 DOI: 10.33425/2639-9482.1018
Jui-Teng Lin
Purpose: To update analytic formulas for the overall efficacy of corneal collagen crosslinking (CXL) including both type-I and oxygen-mediated type-II mechanisms, the role of oxygen and the initiator regeneration. Also, to derive the formulas for the minimum corneal thickness and demarcation line depth. Study Design: Modeling the kinetics of CXL in UV light and using riboflavin as the photosensitizer. Place and Duration of Study: New Taipei City, Taiwan, between June, 2021 and July, 2021. Methodology: Coupled kinetic equations are derived under the quasi-steady state condition for the 2-pathway mechanisms of CXL. For type-I CXL, the riboflavin (RF) triplet state [T] may interact directly with the stroma collagen substrate [A] to form radical (R) and regenerate initiator. For type-II process, [T] interacts with oxygen to form a singlet oxygen [1 O2 ]. Both reactive radical (R) and [1 O2 ], can relax to their ground state, or interact with the substrate [A]) for crosslinking. Based on a safety dose, formulas for the minimum corneal thickness and demarcation line depth (DLD) are derived. Results: Our updated theory/modeling showed that oxygen plays a limited and transient role in the process, in consistent with that of Kamave. In contrary, Kling et al believed that type-II is the predominant mechanism, which however conflicting with the epi-on CXL results. For both type-I and type-II, a transient state conversion (crosslink) efficacy in an increasing function of light intensity (or dose), whereas, its steady state efficacy is a deceasing function of light intensity. RF depletion in type-I is compensated by the RF regeneration term (RGE) which is a decreasing function of oxygen. For the case of perfect regeneration case (or when oxygen=0), RF is a constant due to the catalytic cycle. Unlike the conventional Dresden rule of 400 um thickness, thin cornea CXL is still safe as far as the dose is under a threshold dose (E*), based on our minimum thickness formula (Z*). Our formula for thin cornea is also clinically shown by Hafez et al for ultra thin (214 nm) CXL. Conclusion: For both type-I and type-II, a transient state conversion (crosslink) efficacy in an increasing function of light intensity (or dose), whereas, its steady state efficacy is a deceasing function of light intensity. CXL for ultra thin corneas are still safe, as far as it is under a threshold dose (E*), based on our minimum thickness formula, which has a similar tend as that of demarcation line depth. the type-II efficacy also provides the survival rate for the treatment of corneal keratitis.
目的:更新角膜胶原交联(CXL)整体疗效的分析公式,包括i型和氧介导的ii型机制、氧的作用和引发剂再生。并推导出最小角膜厚度和分界线深度的计算公式。研究设计:模拟CXL在紫外光下的动力学,并使用核黄素作为光敏剂。学习地点及时间:台湾新北市,2021年6月至2021年7月。方法:在准稳态条件下,推导了双通路CXL机理的耦合动力学方程。对于i型CXL,核黄素(RF)三态[T]可直接与基质胶原底物[A]相互作用形成自由基(R)和再生引发剂。对于ii型过程,[T]与氧相互作用形成单线态氧[1 O2]。活性自由基(R)和[1o2]都可以弛豫到基态,或与底物[A]相互作用进行交联。基于安全剂量,导出了最小角膜厚度和分界线深度(DLD)的公式。结果:我们更新的理论/模型表明,氧气在这一过程中起着有限和短暂的作用,与Kamave的结果一致。相反,Kling等人认为ii型是主要的机制,但这与epi-on CXL的结果相矛盾。对于i型和ii型,瞬态转换(交联)效率随光强(或剂量)的增加而增加,而其稳态效率随光强的减少而减少。i型的射频损耗由射频再生项(RGE)补偿,RGE是氧的递减函数。在完全再生情况下(或氧=0时),由于催化循环,RF为常数。与传统的400um厚度的德累斯顿规则不同,根据我们的最小厚度公式(Z*),只要剂量低于阈值剂量(E*),薄角膜CXL仍然是安全的。我们的薄角膜配方也被Hafez等人用于超薄(214 nm) CXL的临床应用。结论:无论是i型还是ii型,其瞬态转换(交联)功效都随光强(或剂量)的增加而增加,而其稳态功效则随光强的增加而减少。根据我们的最小厚度公式,对于超薄角膜,只要在阈值剂量(E*)以下,CXL仍然是安全的,其趋势与分界线深度相似。ii型疗效也为治疗角膜角膜炎提供了生存率。
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引用次数: 4
Efficacy of a New Antioxidants Blend in Protecting RPE Cells in vitro and in Improving the Visual Performance of Sport Pilots 一种新的抗氧化剂混合物在体外保护RPE细胞和改善运动飞行员视觉表现方面的功效
Pub Date : 2021-12-30 DOI: 10.33425/2639-9482.1022
Filippello Massimo, Scilio Cristina, Filippello Giulia, Cristaldi Martina, Spampinato Giorgia, Rusciano Dario
The rationale of this study stems from the consideration that vision is a dynamic process, during which photopigments of photoreceptor cells (rods and cones) are continuously consumed and regenerated by retinal pigmented epithelial (RPE) cells. The whole process of vision triggered by light radiation generates free radicals which are potentially toxic to the cells in the central retina (macula), which is the main player in vision. Therefore, the central retina contains carotenoid pigments (mainly lutein and zeaxanthin) with the double function of shielding the cells from light radiation and providing free radical-scavenging action due to their antioxidant power. Nonetheless, visual performance (including visual acuity, contrast sensitivity and stereoscopic perception) can be hampered by bright light and by sudden changes in illumination conditions, such as during the transit from the dark to intense light. Therefore, objective of this study has been to investigate whether the treatment with a food supplement regimen containing different antioxidant and protective elements shown to protect from photo-oxidative damage retinal pigment epithelial (RPE) cells, might also improve retina functions during challenging light conditions. We present here our findings, showing the protective effects on human RPE cells in vitro of lutein and cyanidin-3-glucoside (C3G) against photo-oxidative stress. Accordingly, the results of a retrospective analysis of a case series show that sport motorcycle test pilots (who need for their profession an optimal visual performance) taking a commercially available food supplement containing a blend of antioxidant and protective molecules (lutein, C3G, verbascoside and zinc), improved their visual abilities and reduced their sensibility to glaring lights in a dose/time-dependent fashion. In conclusion, these results suggest that a food supplement may increase the antioxidant defense of the retina, thus improving the visual performance also during challenging illumination conditions, hence increasing the safety of individuals finding themselves in such situations.
本研究的基本原理是考虑到视觉是一个动态的过程,在这个过程中,光感受器细胞(视杆细胞和视锥细胞)的光色素不断被视网膜色素上皮细胞(RPE)消耗和再生。由光辐射引发的整个视觉过程会产生自由基,这些自由基对视网膜中心(黄斑)细胞有潜在的毒性,而视网膜是视觉的主要参与者。因此,视网膜中央含有类胡萝卜素色素(主要是叶黄素和玉米黄质),由于其抗氧化能力,具有屏蔽细胞免受光辐射和清除自由基的双重功能。尽管如此,视觉表现(包括视觉灵敏度、对比敏感度和立体感)可能会受到强光和照明条件突然变化的影响,例如在从黑暗过渡到强光的过程中。因此,本研究的目的是研究含有不同抗氧化和保护元素的食物补充方案是否可以保护视网膜色素上皮(RPE)细胞免受光氧化损伤,也可以改善在恶劣光照条件下的视网膜功能。我们在这里展示了我们的发现,表明叶黄素和花青素-3-葡萄糖苷(C3G)对体外人RPE细胞抗光氧化应激的保护作用。因此,对一系列案例的回顾性分析结果表明,运动摩托车试飞员(他们的职业需要最佳的视觉表现)服用含有抗氧化和保护分子(叶黄素,C3G,毛bascoside和锌)的市售食品补充剂,提高了他们的视觉能力,并以剂量/时间依赖的方式降低了他们对强光的敏感性。总之,这些结果表明,食物补充剂可能会增加视网膜的抗氧化防御,从而改善在恶劣光照条件下的视觉表现,从而增加个体在这种情况下的安全性。
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引用次数: 0
Choroidal Neovascular Membrane Causing Vitreous Hemorrhage from Inactive Chorioretinal Scar due to a Case of Ocular Toxoplasmosis 眼弓形虫病致失活脉络膜视网膜瘢痕玻璃体出血1例
Pub Date : 2021-01-01 DOI: 10.29011/2689-7407.100050
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引用次数: 0
A Pilot Study of the Genetic Differences between P. aeruginosa Ocular Isolates Using Suppression Subtractive Hybridization 抑制减法杂交对铜绿假单胞菌眼部分离株遗传差异的初步研究
Pub Date : 2021-01-01 DOI: 10.29011/2689-7407.100049
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引用次数: 0
Two Types of Curved Hyperreflective Structures on Optical Coherence Tomography Images of the Outer Retina of Eyes with Different Macular Disorders 不同黄斑病变眼外视网膜光学相干断层成像的两种弯曲型超反射结构
Pub Date : 2021-01-01 DOI: 10.29011/2689-7407.100051
A. Bringmann, J. Unterlauft, T. Barth, R. Wiedemann, M. Rehak, P. Wiedemann
Hyperreflective materials on Spectral-Domain Optical Coherence Tomography (SD-OCT) images of eyes with different retinal disorders may have diverse shapes and origins and are a prognostic marker of disease progression. This study documents using SD-OCT the presence of Curved Hyper Reflective Structures (CHRS) in the outer macula of eyes with different retinal disorders. A retrospective case series of 22 eyes of 21 patients with CHRS is described. In addition, 12 eyes of 12 patients with other kinds of intra retinal hyperreflective structures were investigated. CHRS, which form curved thin lines or broad bands between the outer plexiform layer and external limiting membrane (ELM) in the macula, were found in eyes without edema. Thin CHRS were secondary to dry age-related macular degeneration (AMD; n=10 eyes), glaucoma (n=2), wet AMD, chorioretinitis, macular scarring, anterior ischemic optic neuropathy, proliferative diabetic retinopathy, adult-onset foveomacular vitelliform dystrophy, and ocular ischemia (each n=1), respectively. Broad CHRS were caused by hemorrhages in the inner foveal layers (n=3). CHRS were associated with focal photoreceptor layer defects. The defects were present before the formation of thin CHRS and during or after the formation of broad CHRS. The retina of eyes with edema showed hyper reflective foci and cystoid cavities which contained hypoor medium-reflective fluid and hyper reflective material, but not CHRS. It is concluded that CHRS in the outer macula are found in eyes with different retinal disorders without edema. Thin CHRS likely develop after photoreceptor damage from the ELM. Broad CHRS are caused by hemorrhages within the inner foveal layers.
不同视网膜疾病的眼睛的光谱域光学相干断层扫描(SD-OCT)图像上的高反射材料可能具有不同的形状和来源,是疾病进展的预后标志。本研究用SD-OCT记录了不同视网膜疾病的眼外黄斑存在弯曲超反射结构(CHRS)。本文描述了21例CHRS患者22只眼的回顾性病例系列。此外,对12例视网膜内其他类型高反射结构患者的12只眼进行了观察。无水肿的眼可见黄斑外丛状层与外限制膜(ELM)之间形成弯曲的细线或宽带。薄CHRS继发于干性年龄相关性黄斑变性(AMD;n=10只眼)、青光眼(n=2只)、湿性AMD、绒毛膜视网膜炎、黄斑瘢痕、前部缺血性视神经病变、增殖性糖尿病视网膜病变、成人发病的中央黄斑黄体营养不良和眼缺血(每只n=1只)。广泛的CHRS是由内中央凹层出血引起的(n=3)。CHRS与病灶感光层缺陷有关。缺陷主要出现在薄CHRS形成之前和宽CHRS形成期间或之后。水肿眼的视网膜表现为高反射灶和囊样腔,囊样腔内含有中低反射液体和高反射物质,但无CHRS。结论视网膜外黄斑CHRS存在于不同的视网膜病变,无水肿。薄CHRS可能是在ELM的光感受器损伤后形成的。广泛性CHRS是由内中央凹层出血引起的。
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引用次数: 1
Improved Subjective Visual Function and Best-Corrected Visual Acuity after External Beam Radiation Therapy of Pancreatic Adenocarcinoma Metastatic to the Choroid 转移至脉络膜的胰腺腺癌经外束放射治疗后主观视觉功能和最佳矫正视力的改善
Pub Date : 2021-01-01 DOI: 10.29011/2689-7407.100048
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引用次数: 0
Aspect of The Macular Region in Spectral Domain Optical Coherence Tomography in Retinal Vein Occlusions 视网膜静脉闭塞的光谱域光学相干断层扫描对黄斑区的影响
Pub Date : 2020-12-30 DOI: 10.33425/2639-9482.1014
Youssoufou Souley Abdoul Salam, Chammout Fatima Zahra, L. Nisrine, Elkhoyaali Adil, E. Fouad, R. Karim, O. Abdelbarre
Introduction: Macular edema is the main cause of decreased visual acuity following retinal vein occlusions. We propose to study at the macular level the changes of retinal layers in OCT. Material and method: This are a retrospective study of 43 patients with secondary macular edema to retinal vein occlusion (15 occlusions of the central vein and 28 venous occlusions). We analyzed the different modifications of the outer layers of the macula. Results: The nuclear layer appears irregular and of abnormal density. The cystoid cubicles disorganize the outer nuclear layers. The outer limiting is fragmented and disappears in places, and the interface outer segments / inner segments appear thickened hyperdense and irregular. In our study, only ECF is statistically significantly associated with a decrease in visual acuity. Discussion: Preliminary results of this study in agreement with what is currently admitted show retinal changes during venous occlusion of the retina. Conclusion: The high resolution of the SD-OCT allowed analyzing the changes in the reflectivity at the level of the retinal layers, evoking alterations in the normal structure of photoreceptors related to macular edema. The evolution of these modifications seems to be correlated with the visual prognosis. A longer-term prospective study would formalize this relationship between imaging and prognosis.
黄斑水肿是视网膜静脉阻塞后视力下降的主要原因。我们拟在黄斑水平研究oct视网膜层的变化。材料和方法:回顾性研究43例继发性黄斑水肿合并视网膜静脉阻塞(中央静脉闭塞15例,静脉闭塞28例)。我们分析了黄斑外层的不同修饰。结果:核层不规则,密度异常。囊状小隔间打乱了外层核层。外边界破碎,局部消失,界面外段/内段增厚、高密度、不规则。在我们的研究中,只有ECF与视力下降有统计学上的显著关系。讨论:本研究的初步结果与目前所承认的一致,显示视网膜静脉闭塞期间视网膜的变化。结论:SD-OCT的高分辨率可以分析视网膜层水平的反射率变化,引起与黄斑水肿相关的正常光感受器结构的改变。这些改变的演变似乎与视力预后有关。一项长期的前瞻性研究将确定影像学与预后之间的关系。
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引用次数: 0
期刊
Ophthalmology research and reports
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