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Huang HL, Wang GH, Niu LL, Sun XH. Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography. Int J Ophthalmol 2024; 17:42-52. [PMID: 38239961 PMCID: PMC10754652 DOI: 10.18240/ijo.2024.01.06] [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: 06/25/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To compare the three-dimensional choroidal vascularity index (CVI) and choroidal thickness between fellow eyes of acute primary angle-closure (F-APAC) and chronic primary angle-closure glaucoma (F-CPACG) and the eyes of normal controls. METHODS This study included 37 patients with unilateral APAC, 37 with asymmetric CPACG without prior treatment, and 36 healthy participants. Using swept-source optical coherence tomography (SS-OCT), the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally. Pearson's correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors. RESULTS The mean subfoveal CVIs were 0.35±0.10, 0.33±0.09, and 0.29±0.04, and the mean subfoveal choroidal thickness were 315.62±52.92, 306.22±59.29, and 262.69±45.55 µm in the F-APAC, F-CPACG, and normal groups, respectively. All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes (P<0.05), while there were no significant differences between the F-APAC and F-CPACG eyes. In the peripapillary region, the mean overall CVIs were 0.21±0.08, 0.20±0.08, and 0.19±0.05, and the mean overall choroidal thickness were 180.45±54.18, 174.82±50.67, and 176.18±37.94 µm in the F-APAC, F-CPACG, and normal groups, respectively. There were no significant differences between any of the two groups in all peripapillary sectors. Younger age, shorter axial length, and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness (P<0.05). CONCLUSION The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls. Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG. A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.
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Affiliation(s)
- Hai-Li Huang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China
| | - Guan-Hong Wang
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China
| | - Liang-Liang Niu
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China
| | - Xing-Huai Sun
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai 200032, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai 200031, China
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Christou EE, Katsanos A, Georgalas I, Kozobolis V, Kalogeropoulos C, Stefaniotou M. The Choroid after Half-Dose Photodynamic Therapy in Chronic Central Serous Chorioretinopathy. ACTA MEDICA (HRADEC KRALOVE) 2023; 65:89-98. [PMID: 36735886 DOI: 10.14712/18059694.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To characterize choroidal structure and vasculature after half-dose verteporfin photodynamic therapy (hd-vPDT) in eyes with chronic central serous chorioretinopathy using Enhanced Depth Imaging Optical Coherence Tomography (EDI OCT) and Optical Coherence Tomography Angiography (OCT-A). METHODS This prospective case-control study included 10 eyes. Choroid was examined before and at 1 month following hd-vPDT. We measured choroidal thickness (CT) at subfoveal area and at 750 μm nasal and temporal of fovea and thickness of Haller and choriocapillaris/Sattler layers. Whole (WA), luminal (LA) and interstitial area (IA) at EDI-OCT, and perfusion density at OCT-A were analyzed. The unaffected fellow eyes were used for comparisons. RESULTS Mean CT at subfoveal area and at 750 μm nasal and temporal of fovea, values of Haller and choriocapillaris/Sattler layers and those of WA, LA and IA were reduced, while PD increased at 1 month after hd-vPDT (all p < 0.001). There was a significant (p < 0.05) negative correlation (ρ = -0.658) between PD and post-treatment logMARVA. None of analyzed parameters reached values of unaffected fellow eye. CONCLUSION Following hd-vPDT, choroidal thickness with both luminal and interstitial components markedly decreased, while perfusion of choriocapillaris improved.
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Affiliation(s)
- Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Greece
| | - Vassilios Kozobolis
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Christos Kalogeropoulos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Lee GW, Kim YY, Choi KJ, Kang SW. Factors related to changes in visual symptoms after successful photodynamic therapy in central serous chorioretinopathy. PLoS One 2023; 18:e0284899. [PMID: 37083728 PMCID: PMC10121034 DOI: 10.1371/journal.pone.0284899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/01/2023] [Indexed: 04/22/2023] Open
Abstract
To investigate biomarkers related to visual symptom and best corrected visual acuity (BCVA) improvement after photodynamic therapy (PDT) for central serous chorioretinopathy. This retrospective cross-sectional study involved 42 consecutive eyes, from 42 patients who underwent successful PDT, divided into two groups according to improvement in subjective visual complaints: complete (20 eyes) and incomplete recovery (22 eyes). The clinical characteristics of each group, including central foveal thickness (CFT), foveal avascular zone (FAZ) area, and degree of change in signal voiding of the choriocapillaris on optical coherence tomography angiography, were compared. Correlations between best-corrected visual acuity (BCVA) and baseline clinical features were investigated. At baseline, CFT and FAZ areas showed significant differences between the two groups (all p < 0.05). Multiple binary logistic regression analysis revealed that greater CFT predicted complete recovery from visual complaints (p = 0.002). Reduction or disappearance of signal voiding in the choriocapillaris 6 months post-PDT occurred more frequently in the complete recovery group (p < 0.05). FAZ area before PDT correlated with BCVA before and 6 months after PDT and BCVA improvement during the study period (all p < 0.05). CFT and FAZ area before PDT correlated with completeness of visual symptom recovery after PDT. Smaller FAZ area before PDT correlated with better BCVA before and after treatment.
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Affiliation(s)
- Geun Woo Lee
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Yun Young Kim
- Department of Ophthalmology, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kyung Jun Choi
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Woong Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Christou EE, Stavrakas P, Kozobolis V, Katsanos A, Georgalas I, Stefaniotou M. Evaluation of the choriocapillaris after photodynamic therapy for chronic central serous chorioretinopathy. A review of optical coherence tomography angiography (OCT-A) studies. Graefes Arch Clin Exp Ophthalmol 2022; 260:1823-1835. [PMID: 35044503 DOI: 10.1007/s00417-022-05563-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Emerging evidence suggests that choroidal microcirculation and microstructural changes after verteporfin photodynamic therapy (vPDT) for chronic central serous chorioretinopathy (CSC) can be shown in detail using OCT-Angiography (OCT-A). The use of OCT-A for the examination of choriocapillaris (CC) has attracted significant attention as the technique offers potential explanations for the effects of vPDT on choroidal tissue. METHODS A meticulous literature search was performed in the PubMed database without restriction on year of publication until June 2021. The reference list of all electronically retrieved articles was carefully reviewed for potentially relevant articles that had not been identified. RESULTS We identified and reviewed 11 studies reporting a comprehensive update on microvasculature and morphologic changes of the CC layer as seen on OCT-A in chronic CSC. The reviewed articles extensively analyze both the qualitative and quantitative characteristics of the CC flow pattern after applying vPDT safety-enhanced protocols. The changes in the CC plexus indicate the potential of beneficial or deleterious treatment effect on choroidal tissue remodeling. The reviewed series have revealed variability of flow pattern, vessel density, and perfusion of the CC over time. CONCLUSION The CC plexus alterations during the post-vPDT period in chronic CSC may imply the treatment effect on choroidal tissue, indicating the potential of anatomical or functional recovery over time. The reviewed literature may confirm the diagnostic value of OCT-A in the assessment of the pathophysiology of eyes with CSC.
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Affiliation(s)
- Evita Evangelia Christou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece.
| | - Panagiotis Stavrakas
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vassilios Kozobolis
- Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupoli, Greece.,Eye Institute of Thrace, Democritus University of Thrace, Komotini, Greece
| | - Andreas Katsanos
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, General Hospital of Athens G. Gennimatas, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Stefaniotou
- Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Stavrou Niarchou Avenue, 45500, Ioannina, Greece
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Jeong S, Kang W, Noh D, van Hemert J, Sagong M. Choroidal vascular alterations evaluated by ultra-widefield indocyanine green angiography in central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2022; 260:1887-1898. [PMID: 35022815 DOI: 10.1007/s00417-021-05461-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/06/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to evaluate choroidal vascular alterations in patients with central serous chorioretinopathy (CSC) using ultra-widefield (UWF) indocyanine green angiography (ICGA). METHODS This was a retrospective case-control study conducted at a single tertiary eye center. In total, 36 eyes in patients with either unilateral (24 patients) or bilateral (six patients) treatment-naïve CSC and 30 eyes in 24 age-matched controls were evaluated. The number of quadrants with vortex vein engorgement on UWF ICGA was evaluated. Dilated choroidal vessels affecting the macula were regarded as extended vortex vein engorgement. Choroidal vascular hyperpermeability (CVH) area on late-phase ICGA was quantified using stereographic projection. The parameters were compared with clinical and optical coherence tomographic findings. RESULTS Eyes with CSC had larger CVH area, thicker choroid, and more quadrants with vortex vein engorgement and extended vortex vein engorgement compared with control eyes (all P < 0.001). In patients with unilateral CSC, affected eyes had larger CVH area, thicker choroid, and more extended vortex vein engorgements compared with unaffected fellow eyes (all P < 0.001), but vortex vein engorgement did not significantly differ. CVH was significantly correlated with extended vortex vein engorgement (P < 0.001) and subfoveal choroidal thickness (P = 0.007). CONCLUSIONS The increased number and binocular symmetry of engorged vortex veins suggest an anatomical predisposition for CSC. CVH area and extended vortex vein engorgement were indicators of choroidal outflow congestion. These parameters may serve as diagnostic clues or predictors of disease development in eyes with CSC.
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Affiliation(s)
- Seongyong Jeong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea
| | - Wonki Kang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea
| | - Donghyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea.,Good Doctors Eye Hospital, Ulsan, South Korea
| | | | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, South Korea. .,Yeungnam Eye Center, Yeungnam University Hospital, #170 Hyunchungro, Nam-gu, Daegu, 42415, South Korea.
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Abstract
Blood supply is known to be required for tumor growth and metastasis, and the formation of the tumor's own vasculature plays a critical role in the development of solid neoplasms. The method of optical coherence tomography angiography (OCTA) is considered promising for the study of angioarchitectonics. PURPOSE To evaluate the OCTA signs of choroidal melanoma (CM) depending on its sizes. MATERIAL AND METHODS The study included 24 patients with CM (24 eyes, of them with small CM - 22 eyes) aged 55.0±12.08 years (37 to 80 years old) with mean prominence of 2.35±0.87 mm (1.0 to 4.7 mm). RESULTS AND DISCUSSION Retinal vascular attenuation in the tumor area was observed in 21 eyes. Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The development of vascular changes in CM can be represented as follows: initially, with CM prominence of up to 1.4 mm, indirect signs of increased blood flow in the overlaying choriocapillaris layer are visualized, most likely due to its compression; as the tumor grows and its thickness increases in its most dominant part, the choriocapillaris layer is completely destroyed, which leads to reactive expansion of the choroidal capillaries along the layer's edges. This is manifested as attenuation of the vascular signal in the central part of the tumor and its intensification along its edges. In the meantime, collaterals begin to form in the deep vascular plexus of the retina. Later on, chaotic vascular arches begin to form in the inner layers of the choroid along the tumor edge; as the tumor grows, they anastomose with the retinal vessels. Identification of the tumor's own vessels in the deeper-lying layers is possible with tumor prominence of at least 1.4 mm. At the level of the deep choroidal layers, the tumor's vascular pattern is more consistent with the angiographic data and patterns of vasculogenic mimicry described in literature. CONCLUSION Changes in angioarchitectonics in the area of CM localization can be detected at a thickness of 1 mm, and the tumor's own vasculature - starting with a thickness of 1.4 mm. The vascular pattern at the level of the deep choroidal layers best corresponds to the reported angiographic picture and patterns of vasculogenic mimicry.
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CHANGES IN CHORIOCAPILLARIS, SATTLER, AND HALLER LAYER THICKNESSES IN CENTRAL SEROUS CHORIORETINOPATHY AFTER HALF-FLUENCE PHOTODYNAMIC THERAPY. Retina 2020; 40:2373-2378. [PMID: 31985718 DOI: 10.1097/iae.0000000000002764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determinate the variation in thickness of the individual choroidal layers in patients with central serous chorioretinopathy treated with half-fluence photodynamic therapy. METHODS Twenty-two eyes were evaluated with spectral-domain optical coherence tomography. The images were taken before photodynamic therapy, 3 months, and 6 months after the treatment. Two investigators performed these measurements: 1) choroidal thickness (CT), 2) Haller layer thickness, defined as the most external layer containing a 100-μm vessel, and 3) choriocapillaris + Sattler layer (C&S). Nine measurements were taken in the macular region. RESULTS Choroidal thickness before photodynamic therapy was 471.8 µm ± 145.8. The Haller layer was 358.4 µm ± 122.6, and C&S was 114.3 µm ± 27.8. At 3-month follow-up, CT was 441.1 µm ± 150.7, Haller layer 348.8 µm ± 127.6, and C&S 92.4 µm ± 27.9. At 6-month follow-up, CT was 420.4 µm ± 118.4, Haller layer 331.8 µm ± 97.2, and C&S 89.5 µm ± 28.0. Using a multilevel mixed-effects linear regression, CT was found to be reduced at both 3 months (P < 0.03) and at 6 months (P < 0.001), Haller layer showed no significant reduction at 3 months (P = 0.483) or at 6 months (P = 0.055), and C&S showed reduction at 3 months (P < 0.001) and at 6 months (P < 0.001). Fellow nonaffected eyes showed no statistical variation at 3-month and 6-month follow-up. CONCLUSION Reduction in CT in patients affected by central serous chorioretinopathy after half-fluence photodynamic therapy occurs primarily in the choriocapillaris and medium diameter vessel layers of the choroid in a short- and medium-term follow-up.
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Sacconi R, Tomasso L, Corbelli E, Carnevali A, Querques L, Casati S, Bandello F, Querques G. Early response to the treatment of choroidal neovascularization complicating central serous chorioretinopathy: a OCT-angiography study. Eye (Lond) 2019; 33:1809-1817. [PMID: 31267094 DOI: 10.1038/s41433-019-0511-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/02/2019] [Accepted: 04/06/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To analyze the quantitative and qualitative early changes of choroidal neovascularization (CNV) associated with chronic central serous chorioretinopathy (CSC) after treatment using optical coherence tomography-angiography (OCT-A). METHODS Charts of consecutive patients with diagnosis of chronic CSC complicated by CNV were retrospectively reviewed. Included patients were divided in photodynamic therapy (PDT) or aflibercept group on the basis of the treatment received (half-fluence PDT or aflibercept 2.0 mg/0.05 ml intravitreal injection). Main outcome measures included the changes between baseline and 1-month follow-up in CNV vessel density (VD) and area on OCT-A images after thresholding and binarization. RESULTS A total of 30 eyes of 26 Caucasian patients were included: 17 eyes of 15 patients in PDT group (mean age 53 ± 11 years) and 13 eyes of 11 patients in aflibercept group (mean age 58 ± 8 years [p = 0.196]). In both PDT and aflibercept groups, best-corrected visual acuity improved at 1 month, and central macular thickness and subretinal fluid significantly decreased. VD did not change after the treatment in both groups (p = 0.502 and p = 0.086) although CNV area decreased significantly (from 0.586 ± 0.449 mm2 to 0.553 ± 0.453 mm2 [0.041]) in the PDT group, and nonsignificantly (from 0.767 ± 0.466 mm2 to 0.733 ± 0.472 mm2 [p = 0.095]) in the aflibercept group. The same results were confirmed in the subanalysis of the 18 treatment-naïve eyes. CONCLUSIONS We demonstrated that, despite all patients showed a favorable clinical response, VD of CNVs complicating chronic CSC did not change after treatment. These findings support the idea that arteriogenesis is the main driving force of CNV in pachychoroid-related macular disorders.
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Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Eye Clinic, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Livia Tomasso
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Corbelli
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Adriano Carnevali
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Ophthalmology, University of "Magna Graecia", Catanzaro, Italy
| | - Lea Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Stefano Casati
- Eye Clinic, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Bandello
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy.
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Optical coherent tomographic angiographic pattern of the deep choroidal layer and choriocapillaris after photodynamic therapy for central serous chorioretinopathy. Graefes Arch Clin Exp Ophthalmol 2019; 257:1365-1372. [DOI: 10.1007/s00417-019-04318-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/07/2023] Open
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