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Kakkassery V, Winterhalter S, Nick AC, Joachim SC, Joussen AM, Kociok N. Vascular-Associated Muc4/Vwf Co-Localization in Human Conjunctival Malignant Melanoma Specimens-Tumor Metastasis by Migration? Curr Eye Res 2017. [PMID: 28622066 DOI: 10.1080/02713683.2017.1324630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate whether vascular differentiation marker von Willebrand factor (vWf) and proliferation marker KI67 expression correlate with MUC4 localization around stromal tumor vascularization in human conjunctival malignant melanoma (CMM). MATERIALS AND METHODS For the purposes of this study, we analyzed samples from human CMMs (n = 4), conjunctival compound nevi (n = 7), and samples from healthy conjunctiva (n = 7) for MUC1, 4, and 16 by immunohistochemistry. To test CMM vessel association of MUC4, we investigated the co-localization of MUC4 with vWf or KI67 in human CMM specimens (n = 10) by immunohistochemistry. Also, we investigated the MUC4 localization around vessels of healthy conjunctiva (n = 10). RESULTS The immunohistochemical analysis demonstrated membrane-associated mucin expression in epithelia of CMM, nevi and healthy conjunctiva, whereas only MUC4 was localized perivascular in CMM tissue in this preliminary analysis. Co-staining analysis with vWf and KI67 demonstrated MUC4 localization around stromal vessels in human CMM specimens. In contrast, no MUC4 localization has been seen around healthy conjunctiva stroma vessels. CONCLUSIONS MUC4 was detected around vWf/KI67-positive CMM stromal vascular tissue, but not around healthy conjunctival stroma vessels. Therefore, we assume that MUC4 might play a role in tumor cell migration toward vessels inducing metastasis.
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Rübsam A, Thieme CE, Schlomberg J, Winterhalter S, Müller B, Joussen AM, Stübiger N. Therapy Rationale for Mineralocorticoid-Receptor Antagonists, Acetazolamide and a Switch of Therapy in Nonresponders in Central Serous Chorioretinopathy. J Ocul Pharmacol Ther 2017; 33:141-148. [DOI: 10.1089/jop.2016.0068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Winterhalter S, Vom Brocke GA, Pilger D, Eckert A, Schlomberg J, Rübsam A, Klamann MK, Gundlach E, Dietrich-Ntoukas T, Joussen AM. Retrospective, controlled observational case study of patients with central retinal vein occlusion and initially low visual acuity treated with an intravitreal dexamethasone implant. BMC Ophthalmol 2016; 16:187. [PMID: 27784291 PMCID: PMC5081977 DOI: 10.1186/s12886-016-0363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 10/13/2016] [Indexed: 12/02/2022] Open
Abstract
Background Patients with initially low visual acuity were excluded from the therapy approval studies for retinal vein occlusion. But up to 28 % of patients presenting with central retinal vein occlusion have a baseline BCVA of less than 34 ETDRS letters (0.1). The purpose of our study was to assess visual acuity and central retinal thickness in patients suffering from central retinal vein occlusion and low visual acuity (<0.1) in comparison to patients with visual acuity (≥0.1) treated with Dexamethasone implant 0.7 mg for macular edema. Methods Retrospective, controlled observational case study of 30 eyes with macular edema secondary to central retinal vein occlusion, which were treated with a dexamethasone implantation. Visual acuity, central retinal thickness and intraocular pressure were measured monthly. Analyses were performed separately for eyes with visual acuity <0.1 and ≥0.1. Results Two months post intervention, visual acuity improved only marginally from 0.05 to 0.07 (1 month; p = 0,065) and to 0.08 (2 months; p = 0,2) in patients with low visual acuity as compared to patients with visual acuity ≥0.1 with an improvement from 0.33 to 0.47 (1 month; p = 0,005) and to 0.49 (2 months; p = 0,003). The central retinal thickness, however, was reduced in both groups, falling from 694 to 344 μm (1 month; p = 0.003,) to 361 μm (2 months; p = 0,002) and to 415 μm (3 months; p = 0,004) in the low visual acuity group and from 634 to 315 μm (1 month; p < 0,001) and to 343 μm (2 months; p = 0,001) in the visual acuity group ≥0.1. Absence of visual acuity improvement was related to macular ischemia. Conclusions In patients with central retinal vein occlusion and initially low visual acuity, a dexamethasone implantation can lead to an important reduction of central retinal thickness but may be of limited use to increase visual acuity. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0363-5) contains supplementary material, which is available to authorized users.
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Joussen AM, Strauß O, Winterhalter S, Klamann M, Dietrich-Ntoukas T, Müller B. [Ocular Hypotension: How the Retina Surgeon Sees the Causes and Therapeutic Options]. Klin Monbl Augenheilkd 2016; 233:1024-32. [PMID: 27617647 DOI: 10.1055/s-0042-109708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ocular hypotension is a result of a lack of production or a loss of intraocular fluid. Intraocular inflammation, drugs, or proliferative vitreoretinopathy (PVR) with overgrowth of the ciliary body can result in reduced secretion of intraocular fluid. Loss of intraocular fluid can result from external loss, such as in fistulating surgery or trauma, or internally, e.g. from cyclodialysis clefts or retinal detachment. In this review, we discuss the causal therapy of ocular hypotension: fixation of the ciliary body, removal of ciliary body membranes, surgery for PVR, choice of tamponade, possibilities and limitations of an iris diaphragm, and pharmacological options.
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Pohlmann D, Winterhalter S, Pleyer U. Intravitreal Dexamethasone for the Treatment of CMO Associated with Refractory Sclerouveitis. Ocul Immunol Inflamm 2016; 26:160-165. [PMID: 27438231 DOI: 10.1080/09273948.2016.1196712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess the efficacy and tolerability of intravitreal dexamethasone 0.7 mg sustained-release insert (Ozurdex®) in patients with sclerouveitis and recurrent cystoid macula edema (CMO) refractory to treatment. METHODS Interventional retrospective case series of five patients receiving 13 intravitreal dexamethasone inserts. RESULTS Three of five patients presented with an associated systemic disorder, whereas two patients had idiopathic sclerouveitis. All patients received immunosuppressive therapy. The CRT mean (SD) decreased in all eyes from 428 μm (137) (baseline) to 327 μm (149) (1 month), 342 μm (155) (3 months), 297 μm (99) (6 months) and reduced scleral inflammation. No morphologic adverse changes were noted, in particular, no scleral melting or necrosis occurred. CONCLUSIONS Intravitreal dexamethasone may be an effective and safe therapeutic option in sclerouveitis with otherwise treatment-resistant CMO. It resolves not only CMO, but also provides a reduction of scleral inflammation and ocular pain. Nonetheless, adequate immunosuppressive treatment of an underlying disease must ensue.
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Mueller B, Salchow DJ, Waffenschmidt E, Joussen AM, Schmalisch G, Czernik C, Bührer C, Schunk KU, Girschick HJ, Winterhalter S. Treatment of type I ROP with intravitreal bevacizumab or laser photocoagulation according to retinal zone. Br J Ophthalmol 2016; 101:365-370. [PMID: 27301450 DOI: 10.1136/bjophthalmol-2016-308375] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 04/22/2016] [Accepted: 05/18/2016] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the outcome of intravitreal bevacizumab (IVB) compared with laser photocoagulation in type I retinopathy of prematurity (ROP). METHODS Case records of 54 consecutive very low birth weight (VLBW) infants with type I ROP (posterior ROP, n=33; peripheral zone II, n=21) who were treated either with IVB (n=37) or laser photocoagulation (n=17) between 2011 and 2015 were retrospectively evaluated. RESULTS Patients with posterior ROP displayed significantly faster regression of active ROP within 12 days (range 9-15 days) if treated with IVB compared with laser photocoagulation, where active ROP regressed within 57 days (range 28-63 days) (p>0.001). No difference was observed in peripheral zone II.Five of seven patients (12%) who developed a recurrence in both eyes after IVB required additional laser photocoagulation within a mean of 12.7 weeks (11.3-15.6 weeks) after the previous treatment. After laser photocoagulation one patient with posterior ROP developed macular dragging and another patient developed a temporary exudative retinal detachment in both eyes. 12 months after treatment the spherical equivalent was not statistically significant different between IVB and laser photocoagulation in posterior ROP patients. However, IVB lead to a significant lower spherical equivalent in infants with posterior ROP (+0.37 dioptres, range -0.5 to +1.88 dioptres) compared with peripheral zone II (+3.0 dioptres range +2.0 to +4.0 dioptres, p<0.001). CONCLUSIONS IVB leads to faster regression of active ROP in infants with posterior ROP compared with laser photocoagulation. Spherical equivalent after 12 months was comparable in those treated with IVB and laser photocoagulation, but it was significantly lower in posterior ROP than in peripheral zone II.
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Stübiger N, Kakkassery V, Gundlach E, Winterhalter S, Pleyer U. [Diagnostics and treatment of primary vitreoretinal lymphoma]. Ophthalmologe 2016; 112:223-30. [PMID: 25698590 DOI: 10.1007/s00347-014-3204-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary vitreoretinal lymphoma (PVRL) is a rare ocular lymphoid malignancy, mostly a diffuse large B-cell lymphoma. The PVRL, previously called primary intraocular lymphoma (PIOL), is a subset of primary central nervous system lymphoma (PCNSL). DIAGNOSIS The diagnosis of PVRL is often difficult as it often mimics chronic intermediate or posterior uveitis; therefore, PVRL requires various procedures for the diagnostics, e.g. immunohistochemistry, cytology, pathology, molecular pathology and cytokine analysis (interleukin 10) after surgically obtaining ocular specimens. THERAPY Treatment forms that are effective for systemic lymphomas have not been reliably successful for PVRL and PCNSL. Current management of PVRL consists of chemotherapy, such as methotrexate or rituximab, possibly combined with external beam radiation whereby both chemotherapeutic agents are administered systemically as well as intravitreally. Intravitreal treatment alone is recommended solely in the case of monocular PVRL, which is highly controversial. A PVRL usually responds well to initial treatment; however, relapse rates and CNS involvement are high, resulting in a poor prognosis and limited survival.
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Winterhalter S, Dietrich-Ntoukas T, Müller B, Joussen AM. Therapie von retinalen arteriellen Makroaneurysmen. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Klonner J, Schlomberg J, Rübsam A, Dietrich-Ntoukas T, Winterhalter S, Joussen AM, Müller B. Navigierte retinale Laserkoagulation (NaviLas®) als Therapiealternative bei Patienten mit therapierefraktärer Chorioretinopathia centralis serosa. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rachwalik D, Winterhalter S, Pleyer U. Intravitreales Dexamethason Implantat zur Behandlung der therapierefraktären Sklerouveitis. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pahlitzsch M, Torun N, Gonnermann J, Maier AK, Winterhalter S, Bertelmann E, Klamann MKJ. MIGS und Filtrationschirurgie: Einfluss auf die Quality of Life? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Eckert A, Rehak M, vom Brocke GA, Maier AK, Joussen AM, Winterhalter S. Behandlung des Makulaödems im klinischen Alltag: Eine Ranibizumab-Dexamethason-Vergleichsstudie. Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stübiger N, Zeisberg AS, Winterhalter S. Ist Eplerenon eine Alternative in der Therapie azetazolamidresistenter entzündlicher Makulaödeme? Klin Monbl Augenheilkd 2015. [DOI: 10.1055/s-0035-1569171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Winterhalter S, Stuebiger N, Maier AK, Pleyer U, Heiligenhaus A, Mackensen F, Zierhut M, Joussen AM, Ness T. Acute Retinal Necrosis: Diagnostic and Treatment Strategies in Germany. Ocul Immunol Inflamm 2015; 24:537-43. [PMID: 26399848 DOI: 10.3109/09273948.2015.1034375] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To analyze the preferred practice respective diagnosis, treatment, and complications in patients with acute retinal necrosis in Germany. METHODS The uveitis-section of the German Ophthalmologic Society developed a questionnaire with 12 questions concerning patients with acute retinal necrosis seen in the 5 years up to August 2009. RESULTS In total, 35 eye hospitals answered the questionnaire and reported 213 patients with acute retinal necrosis. Diagnosis was made clinically in 86%. Anterior chamber tap, vitreous biopsy, diagnostic vitrectomy, and serology were performed for confirmation. Therapy was started with acyclovir in all institutions, and continued with ganciclovir, foscarnet and brivudine in some cases. Intravitreal injections were performed in 46%. Additional oral steroids were given in 80%. A following oral antiviral treatment was performed in 94%. CONCLUSIONS Relevant variations were seen in diagnosis and treatment practices. The survey outlines the need for a unique diagnostic and therapeutic guideline.
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Davids AM, Winterhalter S, Brocke GAV, Cordini D, Joussen AM, Rehak M. Die Bedeutung der Mikroperimetrie als diagnostisches Instrument. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Winterhalter S, Pleyer U. Dexamethasonimplantate zur Behandlung der nicht infektiösen Uveitis intermedia und posterior bei Kindern und Jugendlichen. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schönfeld S, Metzner S, Winterhalter S, Thieme C, Pleyer U. Behandlungsergebnisse der Cytomegalievirus-assoziierten anterioren Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brocke GAV, Steurer T, Jacob S, Thees S, Winterhalter S, Pleyer U. Ergebnisse zur Re-Injektion von Dexamethason im Langzeitverlauf bei nicht-infektiöser Uveitis. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pleyer U, Klamann M, Laurent TJ, Mänz M, Hazirolan D, Winterhalter S, Thurau SR. Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant. Ophthalmologica 2014; 232:000368987. [PMID: 25428335 DOI: 10.1159/000368987] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 10/02/2014] [Indexed: 02/28/2024]
Abstract
Purpose: To investigate the efficacy and safety of a single dexamethasone intravitreal implant (Ozurdex®, 700 µg). Methods: In this prospective noncomparative case series, 84 patients (54 females) received a dexamethasone intravitreal implant. At weeks 4, 12 and 24 after the injection, vitreous haze, macular thickness and best corrected visual acuity (BCVA) were assessed and adverse events reported. Results: Clearance of vitreous haze could be achieved after 4 weeks in 61% of all eyes (p < 0.001) and remained significant until week 24 (p < 0.001). This was paralleled by a reduction of central retinal thickness after 4 (p < 0.001), 12 (p < 0.001) and 24 weeks (p < 0.006). Significant and fast improvement of BCVA was already achieved after 4 weeks (p < 0.001) but vanished by week 24. Intraocular pressure reached ≥35 mm Hg in 3 eyes and was significantly more frequent in intermediate uveitis compared to posterior uveitis (p < 0.016). Conclusions: The dexamethasone implant is effective in controlling intraocular posterior segment inflammation and reduces central retinal thickness fast and effectively. © 2014 S. Karger AG, Basel.
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 2: Die unterschiedlichen Krankheitsbilder. AUGENHEILKUNDE UP2DATE 2014. [DOI: 10.1055/s-0033-1357917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 1: Diagnostik und Grundkonzepte der Therapie. AUGENHEILKUNDE UP2DATE 2014. [DOI: 10.1055/s-0033-1357915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 1: Diagnostik und Grundkonzepte der Therapie. Klin Monbl Augenheilkd 2014; 231:457-69; quiz 470-1. [DOI: 10.1055/s-0033-1357916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heiligenhaus A, Breitbach M, Spital G, Stübiger N, Winterhalter S, Deuter C, Becker M, Mackensen F. Posteriore Uveitis. Teil 2: Die unterschiedlichen Krankheitsbilder. Klin Monbl Augenheilkd 2014; 231:555-79. [DOI: 10.1055/s-0033-1357918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Müller B, Heede S, Winterhalter S, Joussen AM. Intravitreales Avastin und klassische Laserkoagulation bei Frühgeborenenretinopathie. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yermalitski A, Metzner S, Ruokonen P, Dobner B, Winterhalter S, Pleyer U. Klinische Befunde bei dem virusassoziierten Fuchs'schen Uveitis-Syndrom. Klin Monbl Augenheilkd 2013. [DOI: 10.1055/s-0033-1363363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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