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The Independent Effect of Various Cross-Linking Treatment Modalities on Treatment Effectiveness in Keratoconus. Cornea 2020; 39:63-70. [PMID: 31577628 DOI: 10.1097/ico.0000000000002168] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To investigate the 1-year outcomes of using various corneal cross-linking (CXL) techniques for treating keratoconus. METHODS Setting: This is a prospective longitudinal cohort study performed at a tertiary academic medical center. PATIENT POPULATION Six hundred seventy eyes of 461 patients with progressive keratoconus who underwent CXL were followed up for 1 year. INTERVENTION Eight combinations of CXL modalities were assessed, including 2 different CXL techniques (transepithelial or epithelium-off), 7 riboflavin formulations, and 2 ultraviolet-A protocols (conventional 3 mW/cm or accelerated 9 mW/cm). Patients treated using the Dresden protocol were used as the reference group. MAIN OUTCOME MEASURES Primary outcomes were maximum keratometry and mean keratometry 1 year after treatment. Multivariable linear regression was used which provides β coefficients (β). Secondary outcomes were uncorrected and corrected distance visual acuity, manifest refractive spherical equivalent, and corneal thickness 1 year after treatment. RESULTS Four treatment modalities differed significantly from the reference group regarding both maximum keratometry and mean keratometry: the transepithelial CXL (TE-CXL) group (β = 1.422; P = 0.001), 1 riboflavin formulation (Meran β = 1.210; P = 0.02), and both the 9 mW/cm protocols (Vibex Rapid β = 1.751; P < 0.001 and Collagex β = 1.170, P < 0.001). Overall, the visual outcome, manifest refractive spherical equivalent, and corneal thickness were similar among the treatment modalities. Infections were rare (1.6% of cases); however, re-treatment was required for 33.3% of cases that underwent TE-CXL. CONCLUSIONS TE-CXL, the use of Meran riboflavin, and applying the accelerated irradiation protocol appeared to be associated with reduced efficacy regarding controlling keratoconus progression. One-third of cases treated using TE-CXL required re-treatment.
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Tamayo GE, Castell C, Vargas P, Polania E, Tamayo J. High-Resolution Wavefront-Guided Photorefractive Keratectomy and Accelerated Corneal Crosslinking for Stabilization and Visual Rehabilitation of Keratoconus Eyes. Clin Ophthalmol 2020; 14:1297-1305. [PMID: 32494120 PMCID: PMC7229783 DOI: 10.2147/opth.s248787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/21/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the visual and refractive outcomes after high-resolution wavefront-guided (HRWG) surface ablation with corneal crosslinking (CXL) in keratoconus eyes. PATIENTS AND METHODS In this prospective, interventional case series, 47 eyes of 28 progressive keratoconus patients older than age 18 were enrolled. All patients underwent HRWG photorefractive keratectomy (PRK) with simultaneous accelerated CXL. The study parameters were manifest refraction spherical equivalent (MRSE), keratometric outcomes, uncorrected (UDVA) and corrected distance visual acuity (CDVA) at postoperative 6 and 12 months. RESULTS There was improvement in mean MRSE from -2.39±1.89 D preoperatively to -0.13 ± 0.68 D at 12 months, with corresponding improvement in UDVA from 0.77 ± 0.35 logMAR to 0.08 ± 0.12 logMAR and CDVA from 0.10 ± 0.11 logMAR to 0.02 ± 0.04 logMAR. Preoperative flat and steep keratometry (K) were 4wct 32.49 ± 1.67 D and 45.94 ± 2.10 D, respectively, and at postoperative 12 months were 41.36 ± 2.08 D and 42.65 ± 2.78 D, respectively. At postoperative 12 months, visual and refractive outcomes were maintained. Comparisons between preoperative and postoperative 12 month timepoints were statistically significant for all parameters. CONCLUSION Simultaneous wavefront-guided PRK followed by CXL is a promising treatment for the visual rehabilitation of keratoconus patients.
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Affiliation(s)
| | | | - Pilar Vargas
- Bogota Laser Ocular Surgery Center, Bogota, Colombia
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Abstract
The purpose was to review and document the methods used to calculate the power of the intraocular lens (IOL) to be implanted in cataract surgery in the specific scenario of eyes with keratoconus. This review included all scientific articles published in English that focused on the parameters and formulas used to calculate the power of the IOL to be implanted in eyes with keratoconus undergoing cataract surgery. There are few publications that show in detail how IOL power is calculated in these particular cases. If the keratometric value used was based on the standard refractive index (1.3375), it resulted in a postoperative refractive error with a tendency to hyperopia. The SRK/T formula yielded the best outcomes. The greater the severity of keratoconus the greater was the deviation of the postoperative refractive status from the target outcome.
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Mounir A, Mostafa EM. Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation for treatment of advanced superior keratoconus. GMS OPHTHALMOLOGY CASES 2020; 10:Doc10. [PMID: 32269908 PMCID: PMC7113618 DOI: 10.3205/oc000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Purpose: To report early results of combined accelerated corneal collagen crosslinking (CXL) and intrastromal Kerarings implantation by femtosecond laser in a case of advanced superior keratoconus. Methods: The patient was a 27-year-old male with left eye grade 3 keratoconus with superior cone. He was diagnosed by Sirius Scheimpflug corneal topography (CSO, Florence, Italy). The right eye had previously been subjected to penetrating keratoplasty. The uncorrected visual acuity (UCVA) in the right eye (RE) was 1.2 LogMAR, best corrected visual acuity (BCVA) was 0.8 by a refraction of –7.50Ds –3.00Dc @12. The UCVA in the left eye (LE) was 1.2 LogMAR, BCVA was 0.9 by a refraction of –8.50 Ds –5.50Dc @169. Intrastromal Kerarings implantation by femtosecond laser was carried out by IntraLase (iFS, Abbott) along with accelerated transepithelial corneal collagen crosslinking by KXL system (Avedro, USA) in the same session. Follow-up was done for a period of 12 months after surgery. Results: The patient was followed up for 12 months with improvement of visual acuity as regards UCVA and BCVA and improvement of corneal topographic parameters including keratometry and front and back elevations. Conclusion: Combined accelerated corneal collagen crosslinking and intrastromal Kerarings implantation by femtosecond laser is an effective method in the treatment of this uncommon type of keratoconus.
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Affiliation(s)
- Amr Mounir
- Sohag Faculty of Medicine, Ophthalmology Department, Sohag University, Sohag, Egypt
| | - Engy Mohamed Mostafa
- Sohag Faculty of Medicine, Ophthalmology Department, Sohag University, Sohag, Egypt
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Outcomes of MyoRing Implantation in Eyes with Keratoconus in the Eastern Province of Saudi Arabia: "A Single-Arm Cohort Study". J Ophthalmol 2019; 2019:2630704. [PMID: 31559090 PMCID: PMC6735184 DOI: 10.1155/2019/2630704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022] Open
Abstract
Purpose To evaluate the efficacy and safety of MyoRing implantation in eyes with keratoconus managed at a tertiary eye hospital in the Eastern Province of Saudi Arabia. Methods This one-armed historical cohort study included keratoconus patients operated for MyoRing implant. The cases were assessed before and 6 months after surgery. Uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), spherical equivalent (SE), central corneal thickness (CCT), and corneal curvature (Kmean) were noted and measured before and 6 months after the intervention. Intra- and postoperative complications were noted. Result We studied 12 eyes of 12 patients with moderate keratoconus. The median of Kmean was 50.6 mm (IQR 47.54; 52.5) and 44.5 mm (IQR 42.5; 46.8) before and 6 months after surgery. The change in Kmean was significant (P=0.002). The median spherical equivalent (SE) was −5.1D (interquartile range (IQR) 7.1; −3.6) and −0.6 (IQR −2.1; 0.8) before and 6 months after surgery. The difference in SE was significant (Wilcoxon signed-rank test P=0.004). The CCT was 447 ± 34 μm and 444 ± 30 μm before and 6 months after surgery, respectively. The CCT change was not significant (P=0.26). The UCVA and BCVA improved by 2 or more lines in 9 (75%) eyes, remained stable in 2 (16.7%) eyes, and decreased in 2 (16.7%) eyes. Conclusion MyoRing implant seems to be a safe and effective procedure to manage low and moderate keratoconus. The outcomes could be further enhanced by additional procedures such as collagen cross-linkage and photorefractive keratectomy if warranted.
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Ghiasian L, Abolfathzadeh N, Manafi N, Hadavandkhani A. Intraocular lens power calculation in keratoconus; A review of literature. J Curr Ophthalmol 2019; 31:127-134. [PMID: 31317089 PMCID: PMC6611933 DOI: 10.1016/j.joco.2019.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 01/11/2019] [Accepted: 01/24/2019] [Indexed: 11/29/2022] Open
Abstract
Purpose To review the published literature regarding cataract surgery in keratoconus (KCN) patients with emphasis on challenges encountered during intraocular lens (IOL) power calculation and their solutions. Methods A literature review was performed to investigate all the relevant articles on the advancements of IOL calculations in KCN patients. Results Cataract surgery in keratoconic eyes can improve patients' refraction, and proper patient selection and IOL calculation methods are necessary to get the best results. The main problem in KCN patients is unreliable biometric measurements. It is more difficult to make conclusions in more advanced keratoconic corneas, as the steep keratometric values in these eyes will result in the selection of a low-power IOL. Presence of a low-power IOL will yield in extreme postoperative hyperopia, and IOL exchange might be mandatory. In cases in which keratoplasty may be needed in the future, contact lens fitting can help surgeons make a better decision preoperatively. Axial length (AL) measurements may have better repeatability and reproducibility than keratometry (K) readings in keratoconic eyes. SRK II formula may provide the most accurate IOL power in mild KCN. There is still not a comprehensive consensus of which formula is the best one in moderate and severe KCN, as the literature is limited in this subject. Conclusions Various methods of IOL power calculation optimization and recommendations may hold the key to improve surgical outcomes in keratoconic eyes. There are multiple sources of biometric error in KCN patients, hence IOL calculation methods may not be as efficient as expected in these eyes.
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Affiliation(s)
- Leila Ghiasian
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Navid Manafi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Hadavandkhani
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Madeira C, Vasques A, Beato J, Godinho G, Torrão L, Falcão M, Falcão-Reis F, Pinheiro-Costa J. Transepithelial accelerated versus conventional corneal collagen crosslinking in patients with keratoconus: a comparative study. Clin Ophthalmol 2019; 13:445-452. [PMID: 30880905 PMCID: PMC6402612 DOI: 10.2147/opth.s189183] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To systematically compare the efficacy of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) with conventional corneal collagen crosslinking (C-CXL) in patients with progressive keratoconus. Methods Eyes of patients with progressive keratoconus who were treated with C-CXL (3 mW/cm2 for 30 minutes) were compared with those who underwent TE-ACXL (6 mW/cm2 for 15 minutes). Best-corrected visual acuity (BCVA), keratometry values, corneal thickness, and topometric indexes were compared before CXL, and at 2 months, 6 months, and 12 months postoperatively. Results The study enrolled 26 eyes of which 16 had TE-ACXL and 10 had C-CXL. Both groups were comparable at baseline and 12 months in terms of BCVA (P=0.16 and P=0.57), Kmax (maximum keratometry) (P=0.31 and P=0.73), pachymetry (P=0.75 and P=0.37), index of surface variance (ISV) (P=0.45 and P=0.86), index of vertical asymmetry (IVA) (P=0.26 and P=0.61), and index of height decentration (IHD) (P=0.27 and P=0.86, respectively). We did not observe significant differences between preoperative and 12-month postoperative readings in within-group analysis: ΔKmax (TE-ACXL, −2.13±5.41, P=0.25 vs C-CXL, 0.78±1.65, P=0.17), Δpachymetry (TE-ACXL, 4.10±14.83, P=0.41 vs C-CXL, −8.90±22.09, P=0.24), ΔISV (TE-ACXL, −8.50±21.26, P=0.24 vs C-CXL, 3.80±12.43, P=0.36), ΔIVA (TE-ACXL, −0.12±0.31, P=0.26 vs C-CXL, 0.03±0.18, P=0.61), and ΔIHD (TE-ACXL, −0.03±0.07, P=0.18 vs C-CXL, −0.01±0.03, P=0.88). Conclusion Both TE-ACXL and C-CXL were similarly effective. Further follow-up is required to determine whether these techniques are comparable in the long-term.
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Affiliation(s)
- Carolina Madeira
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Ana Vasques
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Beato
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Gonçalo Godinho
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal,
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal, .,Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal
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[The effects of corneal cross-linking on intraocular pressure measurement in keratoconus]. J Fr Ophtalmol 2019; 42:166-169. [PMID: 30679128 DOI: 10.1016/j.jfo.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022]
Abstract
Cross-linking (CXL) is a technique whose design aims to achieve a specific goal: to harden the corneal tissue of eyes with a progressive form of keratoconus. Other indications are being investigated, such as treatment of infectious keratitis and prevention of corneal ectasia post corneal ablative refractive surgery. Hardening the cornea means changing its biomechanical properties. The existence of true corneal hardening after CXL would inevitably result in an increase in measured intraocular pressure (IOP). This would have a considerable impact in the screening and follow-up of glaucoma patients who have undergone cross-linking because of the central role of IOP measurement in glaucomatous pathology.
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Panahi Y, Azimi A, Naderi M, Jadidi K, Sahebkar A. An analytical enrichment-based review of structural genetic studies on keratoconus. J Cell Biochem 2018; 120:4748-4756. [PMID: 30260013 DOI: 10.1002/jcb.27764] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 09/06/2018] [Indexed: 12/19/2022]
Abstract
Keratoconus is a progressive bilateral corneal protrusion that leads to irregular astigmatism and impairment of vision. Keratoconus is an etiologically heterogeneous corneal dystrophy and both environmental and genetic factors play a role in its etiopathogenesis. In this analytical review, we have studied all the genes that are structurally associated with keratoconus and have tried to explain the function of each gene and its association with other eye disorders in a concise way. In addition, using gene set enrichment analysis, it was attempted to find the most important impaired metabolic pathways in keratoconus. Several genetic studies have been carried out on keratoconus and several genes have been identified as risk factors involved in the etiology of the disease. In the current study, 16 studies, including nine association studies, five genome-wide association studies, one linkage study, and one meta-analysis, were reviewed and based on the 19 genes found, enrichment was performed and the most important metabolic pathways involved in the disease were identified. The enrichment results indicated that the two pathways, interleukin 1 processing and assembly of collagen fibrils, are significantly associated with the disease. Obviously, the results of this study, in addition to providing information about the genes involved in the disease, can provide an integrated insight into the gene-based etiology of keratoconus and therapeutic opportunities thereof.
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Affiliation(s)
- Yunes Panahi
- Chemical Injuries Research Center, System Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Azimi
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Naderi
- Chemical Injuries Research Center, System Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Khosrow Jadidi
- Chemical Injuries Research Center, System Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Neurogenic inflammation Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Abreu AC, Malheiro L, Coelho J, Neves MM, Gomes M, Oliveira L, Menéres P. Implantation of intracorneal ring segments in pediatric patients: long-term follow-up. Int Med Case Rep J 2018; 11:23-27. [PMID: 29445305 PMCID: PMC5808705 DOI: 10.2147/imcrj.s151383] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To analyze the long-term outcomes of intracorneal ring segments (ICRS) implantation for keratoconus management in pediatric patients. Methods Retrospective case series review of the long-term (>5 years) outcomes of Intacs® ICRS implantation for keratoconus in pediatric patients (age <18 years old at the time of surgery) between January 2008 and December 2011 at Ophthalmology Department of Hospital de Santo António. Demographic data, follow-up time, preoperative and postoperative uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA) in decimal scale, and corneal topography were evaluated. Statistical analysis was done using SPSS for windows (version 24). Significance was set at p<0.0125. Results Fourteen eyes of 14 patients, with a mean age of 15.36 years (range 10-18 years), were included in this study. All patients had been diagnosed with keratoconus with reported progression in the 6 months prior to surgery. Follow-up time was 6.36±0.97 years. UCVA and BCVA improved after ICRS implantation (p<0.0125). Keratometry (K) minimum (Kmin) and K maximum (Kmax) decreased after surgery (p<0.0125). During follow-up, UCVA, BCVA, Kmin, and Kmax values ranged, showing a tendency to worsen at the end of follow-up. However, statistically significant differences were not observed. Conclusion ICRS implantation showed good visual and topographic results in pediatric patients. Long-term follow-up suggests that, despite ICRS implantation, there is still progression of keratoconus. To the best of our knowledge, there are no reports regarding the long-term efficacy of ICRS implantation in pediatric patients.
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Affiliation(s)
- Ana Carolina Abreu
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Luisa Malheiro
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - João Coelho
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Miguel Mesquita Neves
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal
| | - Miguel Gomes
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Ophthalmology Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto, Porto, Portugal
| | - Luis Oliveira
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Ophthalmology Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto, Porto, Portugal
| | - Pedro Menéres
- Ophthalmology Department of Hospital de Santo António - Centro Hospitalar do Porto, Porto, Portugal.,Ophthalmology Department, Instituto de Ciências Biomédicas Abel Salazar (ICBAS) - Universidade do Porto, Porto, Portugal
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Baek JU, Park CH, Na KS, Kim HS. The Therapeutic Effect of Sclerocorneal Lens in Coexisting Corneal Ectasia and Stevens-Johnson Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.10.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jin Uk Baek
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Hyun Park
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Sun Na
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Seung Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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