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Zanzottera EC, Marchese A, Bandello F, Coppola M. Intraocular perfluorodecalin and silicone oil tamponade (double filling) in the management of complicated retinal detachment: functional and anatomical outcomes using small-gauge surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:1105-1112. [PMID: 34550420 PMCID: PMC8455801 DOI: 10.1007/s00417-021-05395-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To describe the functional and anatomical results of complicated retinal detachment (RD) treated with small-gauge pars plana vitrectomy (PPV) and combined perfluorodecalin and polydimethylsiloxane tamponade (double filling, DF). Methods Retrospective analysis of consecutive patients with complex RD (severe proliferative vitreoretinopathy, inferior/posterior/giant retinal tears, and traumatic detachments) treated with small-gauge PPV, membrane peeling, and DF at the Department of Ophthalmology at San Gerardo Hospital, Monza, Italy. Main outcome measures included best-corrected visual acuity (BCVA), rates of retinal reattachment, and complications. Results This study included 15 patients with a median follow-up (FU) of 6 months (range 1–22). Three patients with early retinal redetachment under tamponade and FU shorter than 3 months were excluded from the final functional analysis, but they were considered anatomical failure. At the last examination, BCVA improved in 50% of patients and remained stable in 25% of patients and anatomical success was achieved in 73% of eyes, 64% of them without any endotamponade. Three eyes had retinal redetachment after perfluorodecalin/silicone oil exchange because of diffuse proliferative vitreoretinopathy (PVR) and required reoperation to achieve retinal attachment. In eyes with anatomical success, macular pucker was the most frequent long-term complication (27%). Conclusion In the management of complex RD, small-gauge pars plana vitrectomy, and double filling endotamponade using wide-angle viewing systems was a well-tolerated and effective technique to preserve visual acuity and achieve anatomical success.
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Affiliation(s)
- Emma Clara Zanzottera
- Department of Ophthalmology, Department of Ophthalmology, San Gerardo Hospital, via Gian Battista Pergolesi 33, 20900, Monza, Italy.
| | - Alessandro Marchese
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michele Coppola
- Department of Ophthalmology, Department of Ophthalmology, San Gerardo Hospital, via Gian Battista Pergolesi 33, 20900, Monza, Italy
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Narde HK, Puri P, Shaikh NF, Agarwal D, Kumar A. Vitrectomy without encircling band for rhegmatogenous retinal detachment with inferior break utilizing 3D heads up viewing system. Indian J Ophthalmol 2021; 69:1208-1212. [PMID: 33913861 PMCID: PMC8186608 DOI: 10.4103/ijo.ijo_2028_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: This study aimed to determine the anatomical and functional outcomes of pars plana vitrectomy without encircling band for primary rhegmatogenous retinal detachments with inferior breaks utilizing 3D heads up viewing system. Method: This prospective, single-center study included 22 consecutive eyes with primary rhegmatogenous retinal detachments with only inferior breaks with proliferative vitreoretinopathy (PVR) CP2 or less, who underwent pars plana vitrectomy without encircling band, with silicon oil as tamponade. All surgeries were performed by a single surgeon. The single operation success rate was recorded after silicon oil removal. Results: The patient population consisted of 08 women (36%) and 14 men (64%) with a mean age of 56.6 +/− 14.7 years. The mean follow-up period was 8 months. A single break was present in 13 cases (59%), and 2–4 breaks were present in 9 cases (40.9%). The mean time for the surgical procedure was 35 min (range: 25–50). The macula was found to be detached in 19 cases (86.36%) and attached in 3 cases (13.6%). Single operation success rate (SOSR) of vitrectomy, after silicon oil removal without encircling band, for primary rhegmatogenous retinal detachment (RRD) with inferior breaks was 95.4%. One case redetached due to PVR changes and underwent re-surgery. Final reattachment was achieved in all 22 cases (100%). Mean best-corrected visual acuity (BCVA) significantly improved from 1.43 ± 0.59 logarithm of the minimum angle of resolution (logMAR) to postoperative BCVA was 0.48 ± 0.34 logMAR (P = 0.001). Conclusion: Pars plana vitrectomy without encircling band, utilizing 3D heads up the system in RRDs with inferior breaks in eyes with PVR grade C2 or less, provides good outcome.
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Affiliation(s)
- Harpreet K Narde
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Prabhav Puri
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | - Divya Agarwal
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Atul Kumar
- Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Tobalem SJ, Weinberger A, Kropp M, Malcles A, Jonescu-Cuypers C, Souteyrand G, Thumann G. Chorioretinal Toxicity of Perfluorooctane (Ala Octa): Results From 48 Surgical Procedures in Geneva. Am J Ophthalmol 2020; 218:28-39. [PMID: 32445701 DOI: 10.1016/j.ajo.2020.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare outcomes of patient who underwent surgery using perfluorooctane (PFO; C8F18; Ala Octa) with those who underwent surgery with perfluorodecalin (F-Decalin). DESIGN Retrospective, consecutive, comparative, interventional case series. METHODS A total of 48 eyes that underwent vitrectomy with PFO were compared to 29 eyes that underwent vitrectomy with perfluorodecalin. Two experienced surgeons performed vitrectomies at the Geneva University Eye Clinic. Visual acuity before, at 8 and 24 weeks after surgery, was documented, and spectral domain optical coherence tomography (SD-OCT) images were analyzed for abnormalities. RESULTS Two patients experienced severe retinal toxicity, including 1 with severe vision loss. However, no statistical differences in VA were observed between the PFO and perfluorodecalin patients. Analysis of SD-OCT images showed differences in occurrence of several abnormalities, for example, inner segment-outer segment alterations were found in 60.4% of eyes treated with PFO and in 10.3% of perfluorodecalin-treated eyes; retinal atrophic areas were found in 41.7% of PFO and in none of the perfluorodecalin eyes; inner limiting membrane contraction was found in 58.4% of PFO and in none of perfluorodecalin eyes; inner retina cystic alterations were found in 58.3% of PFO eyes and 17.2% of perfluorodecalin eyes; outer retina cystic alterations were found in 39.6% of PFO eyes and 13.8% of perfluorodecalin eyes; retinal holes were found in 14.6% of PFO eyes and in none of the perfluorodecalin eyes; and outer retinal inclusions were found in 20.8% of PFO eyes and in 3.45% of perfluorodecalin eyes. CONCLUSIONS Perfluorooctane caused significantly more toxic damage than perfluorodecalin. Special consideration should be given to develop a central European Union (EU) control agency for medical devices and to reevaluate safety procedures currently accepted by the EU and International Organization for Standardization for intraocular surgery.
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Chehade LK, Guo B, Chan W, Gilhotra J. Medium-term tamponade with vitrectomy and perfluorodecalin for the management of complex retinal detachments. Eur J Ophthalmol 2020; 31:2625-2630. [PMID: 32698612 DOI: 10.1177/1120672120945108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe the clinical presentation, anatomical and visual outcome of a series of patients in our department with complex retinal detachments, managed with vitrectomy and perfluorodecalin (PFD) for medium-term tamponade. STUDY DESIGN Retrospective case series. METHODS Retrospective analysis of the medical records of all patients in the last 6 years presenting with complex retinal detachment managed with vitrectomy where PFD was used as a medium-term tamponade. RESULTS A total of 85 eyes in 85 patients were included in the study, with a mean follow-up period of 16.0 ± 2.67 months (range 3-59). About 26 detachments presented with associated PVR-C, and 10 had giant retinal tears. The location of the retinal detachment was inferior in 40% of cases, and total in 18.9% of cases. Anatomical success, defined as retinal reattachment at 12 months, was achieved in 98.8% of cases, and there was a mean improvement in BCVA of logMAR 0.64 ± 0.20, which was statistically significant (p < 0.001, paired t-test 6.23). Of the 41 phakic eyes included in the study, 20 underwent cataract surgery within the follow-up period. CONCLUSION In this case series, we have demonstrated a 98.8% anatomical success and significant improvement in BCVA, with no reports of retinal toxicity. Medium-term tamponade PFD appears to be an efficacious and safe technique for management of a variety of complex retinal detachments, including those secondary to GRT, the presence of PVR-C, inferior location, tractional, traumatic, and re-detachments.
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Affiliation(s)
- Luke K Chehade
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - Brad Guo
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - Weng Chan
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
| | - Jaqjit Gilhotra
- South Australian Institute of Ophthalmology, University of Adelaide, Adelaide, SA, Australia
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Die Pars-plana-Vitrektomie. SPEKTRUM DER AUGENHEILKUNDE 2017. [DOI: 10.1007/s00717-017-0368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Perfluorocarbon liquid: its application in vitreoretinal surgery and related ocular inflammation. BIOMED RESEARCH INTERNATIONAL 2014; 2014:250323. [PMID: 24800216 PMCID: PMC3985162 DOI: 10.1155/2014/250323] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
The application of perfluorocarbon liquids has been well acclaimed in vitreoretinal surgery. Its unique physical properties make it an ideal intraoperative tool to improve the efficiency and safety of surgical procedures in complicated cases. The main functions of perfluorocarbon liquids in vitreoretinal surgery include relocating and fixing the detached retina, displacing the subretinal and subchoroidal to fluid anteriorly, revealing proliferative vitreous retinopathy (PVR) for further maneuvers, protecting the macula from exposure to chemicals with potential toxicity, and assisting the removal of foreign body. The related clinical applications include retinal detachment with severe proliferative vitreoretinopathy, giant tear, diabetic retinopathy (DR), retinopathy of prematurity (ROP), and posterior dislocated crystalline and intraocular lenses. The application of perfluorocarbon liquids has been expended over the past fewer years. Several PFCLs related ocular inflammations have been observed in in vitro studies, animal studies, and clinical follow-up. The complete removal of PFCLs is recommended at the end of the surgery in most cases.
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Entwicklung der Netzhautchirurgie an der Wiener Universitäts-Augenklinik von 1954–2004. SPEKTRUM DER AUGENHEILKUNDE 2013. [DOI: 10.1007/s00717-013-0158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Brunner S, Binder S. Surgery for Proliferative Diabetic Retinopathy. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Georgalas I, Ladas I, Tservakis I, Taliantzis S, Gotzaridis E, Papaconstantinou D, Koutsandrea C. Perfluorocarbon liquids in vitreoretinal surgery: a review of applications and toxicity. Cutan Ocul Toxicol 2011; 30:251-62. [DOI: 10.3109/15569527.2011.560915] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chiquet C, Thuret G. [Perfluorocarbon liquids and vitreoretinal surgery in 2011]. J Fr Ophtalmol 2011; 34:663-77. [PMID: 21943797 DOI: 10.1016/j.jfo.2011.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 03/25/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
Abstract
Perfluorocarbon liquids (PFCLs) are one of the most innovative recent tools for vitreoretinal surgery. PFCLs are characterized by their number of carbon atoms, which has an impact on the density, viscosity, surface tension, vapor pressure, the boiling point, and the refraction index. PFCLs are routinely used because of their high gravity (double that of water) and their low viscosity. Furthermore, they are immiscible in water, optically clear with refraction indices similar to that of water, allowing visualization of an interface between the PFCL and saline. The use of intravitreally injected liquid PFCLs as adjunctive agents to vitreoretinal surgery plays an important role in facilitating retinal reattachment, especially in cases of giant retinal tear, trauma, and/or proliferative vitreoretinopathy. PFCLs are also used as intraoperative instruments to re-establish intraocular volume, assist in separating membranes adherent to the retina (in proliferative diabetic retinopathy, for example), and manage the dislocated crystalline lens and intraocular lens.
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Affiliation(s)
- C Chiquet
- Clinique universitaire d'ophtalmologie, université Joseph-Fourier-Grenoble-1, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
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Mutoh T, Matsumoto Y, Chikuda M. Use of pars plana vitrectomy with phacoemulsification in vitreous cavity to treat complete posterior dislocation of lens. Clin Ophthalmol 2011; 5:937-40. [PMID: 21792282 PMCID: PMC3141856 DOI: 10.2147/opth.s22725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The purpose of this study was to evaluate pars plana vitrectomy (PPV) with phacoemulsification in the vitreous cavity for treatment of complete posterior dislocation of the lens without any damage to the lens capsule. Methods We evaluated factors such as cause of dislocation, scleral fixation of an intraocular lens (IOL), preoperative and postoperative visual acuity, corneal endothelial cell density, and intraoperative and postoperative complications. Results Displacement in the eleven eyes studied was mostly caused by ocular trauma and was idiopathic (four eyes each). Scleral fixation of the IOL was performed in seven of the eyes during first-time PPV. Visual acuity was improved in two eyes, unchanged in eight eyes, and worse in one eye. Mean corneal endothelial cell density was 2485 cells/mm2 preoperatively and 2301 cells/mm2 postoperatively. No significant differences were seen before and after the surgeries (P = 0.15, paired t-test). Intraoperative complications included retinal detachment and suprachoroidal hemorrhage in one eye each. The most common postoperative complication was transient ocular hypertension, which occurred in three eyes. IOL dislocation and vitreous incarceration of the anterior chamber in one eye required a second operation, while retinal detachment in one eye required a third operation. Conclusion When treating a completely dislocated lens, prevention of retinal detachment which subsequently can affect the visual prognosis is the most important factor to be addressed after PPV with intravitreal phacoemulsification.
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Affiliation(s)
- Tetsuya Mutoh
- Department of Ophthalmology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan.
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Baino F. Towards an ideal biomaterial for vitreous replacement: Historical overview and future trends. Acta Biomater 2011; 7:921-35. [PMID: 21050899 DOI: 10.1016/j.actbio.2010.10.030] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 10/22/2010] [Accepted: 10/27/2010] [Indexed: 02/03/2023]
Abstract
Removal of the natural vitreous body from the eye and its substitution with a tamponade agent may be necessary in cases of complicated retinal detachment. Many materials have been variously proposed and tested over the years in an attempt to find an ideal vitreous substitute. This review highlights the evolution of research in the field of vitreous replacement and chronicles the main advances that have been made in such a context. The suitability and limitations of vitreous tamponade agents and substitutes in current clinical use are examined, and the future promise of experimentally tested biomaterials are described and discussed. Future trends in research are also considered and, specifically, the great potential of polymeric hydrogels is emphasized, as they seem to be very effective in closely mimicking the features of the natural vitreous and they could successfully act as long-term vitreous substitutes without inducing clinical complications in the patient's eye.
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Affiliation(s)
- Francesco Baino
- Materials Science and Chemical Engineering Department, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Torino, Italy.
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Williamson TH, Gupta B. Planned Delayed Relaxing Retinotomy for Proliferative Vitreoretinopathy. Ophthalmic Surg Lasers Imaging Retina 2010; 41:31-4. [DOI: 10.3928/15428877-20091230-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2009] [Indexed: 11/20/2022]
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Chang S, Kwun RC. Perfluorocarbon Liquids in Vitreoretinal Surgery. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schatz B, El-Shabrawi Y, Haas A, Langmann G. ADVERSE SIDE EFFECTS WITH PERFLUOROHEXYLOCTANE AS A LONG-TERM TAMPONADE AGENT IN COMPLICATED VITREORETINAL SURGERY. Retina 2004; 24:567-73. [PMID: 15300078 DOI: 10.1097/00006982-200408000-00010] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To report long-term intraocular tolerance of perfluorohexyloctane (F(6)H(8)). METHODS F(6)H(8) was used as an endotamponade in 18 patients (9 male and 9 female) with a median age of 65 years (range, 14-82 years) and complicated pathologic conditions of the inferior fundus: rhegmatogenous retinal detachment (17 patients) and tractional retinal detachment owing to proliferative diabetic retinopathy (1 patient). In six eyes, additional proliferative vitreoretinopathy was present. The use of F(6)H(8) was primary in 2 patients, and 16 patients had had previous retinal detachment surgery (median number, 2). F(6)H(8) was left in the eye for a median duration of 8 weeks (range, 2-14 weeks). RESULTS The median follow-up period was 6 months (range, 3-18 months). Permanent reattachment was achieved in 10 (56%) eyes after removal of F(6)H(8). In 8 (44%) of 18 eyes, a redetachment occurred. Two eyes became phthisic. Adverse side effects included photophobia in two patients, pain in two, hypotony in four, early emulsification in one, corneal lesion in one, fibrinous membranes in five, posterior lens opacification in one, and retinal scar formation in one. CONCLUSION Perfluorohexyloctane provides good support to the inferior retina. Because of numerous adverse side effects, it should be considered carefully when used as a long-term tamponade. Early removal may reduce the number of side effects.
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Affiliation(s)
- Beate Schatz
- Department of Ophthalmology, University of Graz, Graz, Austria.
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Abstract
Proliferative vitreoretinopathy (PVR) is still the most common cause of failure of surgery for rhegmatogenous retinal detachment, despite the substantial effort that has been devoted to better understanding and managing this condition during the past 25 years. Basic research has indicated that PVR represents scarring, the end stage of the wound-healing process that occurs after retinal detachment surgery. Medical treatment has been directed toward preventing inflammation, the first phase of the wound healing process, and inhibiting cell proliferation, the second phase. The 1983 Retina Society classification was modified in 1989 by the Silicone Study Group, whose classification differentiates between posterior and anterior forms of PVR and recognizes three patterns of proliferation: diffuse, focal, and subretinal. The anterior form has a worse prognosis than the posterior form, and its treatment requires more complex surgical procedures. In this review, risk factors and pathobiology of PVR are discussed, and management of PVR of various degrees of severity are considered.
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Affiliation(s)
- J C Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), University of Valladolid, Spain.
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