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Wenxiu L, Guojiang H, Liying Q, Wenli D, Baoqin H, Liming J, Yan Y. Fabrication of bioactive glass/phosphorylated chitosan composite scaffold and its effects on MC3T3-E1 cells. Biomed Mater 2024; 19:025002. [PMID: 38181446 DOI: 10.1088/1748-605x/ad1bb0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 01/05/2024] [Indexed: 01/07/2024]
Abstract
This study aimed to synthesize bioactive glass (BG) and phosphorylated chitosan (PCS), and fabricate a BG/PCS composite scaffold. The physical properties (mechanical strength, swelling degree, and degradation rate) of the BG/PCS scaffold were tested. Thein vitromineralization properties of composite scaffolds in simulated body fluid were investigated. MC3T3-E1 cell responses with the BG/PCS scaffold were investigated using live/dead cell staining, actin staining, alkaline phosphatase (ALP) activity, and Alizarin red staining. Our results showed that the scaffold had an inner porous structure, good swelling properties, and good degradation rate. After immersion in SBF, the scaffolds demonstrated high properties in inducing mineralization. Leaching solutions of the composite scaffolds exhibited good cytocompatibility. MC3T3-E1 cells adhered, spread, and proliferated on the scaffold. The BG/PCS composite scaffold showed osteo-inductive activity by increasing ALP activity and calcium deposition. Our results indicated that the BG/PCS scaffold had potential applications as a bone-defect repair biomaterial.
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Affiliation(s)
- Liu Wenxiu
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
| | - Han Guojiang
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
| | - Qin Liying
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
| | - Dong Wenli
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
| | - Han Baoqin
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
| | - Jin Liming
- Key Laboratory of Biotechnology and Bioresources Utilization, Dalian Minzu University, Dalian 116600, People's Republic of China
| | - Yang Yan
- College of Marine Life Sciences, Ocean University of China, Qingdao 266003, People's Republic of China
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Dias AM, do Nascimento Canhas I, Bruziquesi CGO, Speziali MG, Sinisterra RD, Cortés ME. Magnesium (Mg2 +), Strontium (Sr2 +), and Zinc (Zn2 +) Co-substituted Bone Cements Based on Nano-hydroxyapatite/Monetite for Bone Regeneration. Biol Trace Elem Res 2023; 201:2963-2981. [PMID: 35994139 DOI: 10.1007/s12011-022-03382-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/06/2022] [Indexed: 11/30/2022]
Abstract
New bone cement type that combines Sr2 + /Mg2 + or Sr2 + /Zn2 + co-substituted nano-hydroxyapatite (n-HAs) with calcium phosphate dibasic and chitosan/gelatin polymers was developed to increase adhesion and cellular response. The cements were physicochemically described and tested in vitro using cell cultures. All cements exhibited quite hydrophilic and had high washout resistance. Cement releases Ca2 + , Mg2 + , Sr2 + , and Zn2 + in concentrations that are suitable for osteoblast proliferation and development. All of the cements stimulated cell proliferation in fibroblasts, endothelial cells, and osteoblasts, were non-cytotoxic, and produced apatite. Cements containing co-substituted n-HAs had excellent cytocompatibility, which improved osteoblast adhesion and cell proliferation. These cements had osteoinductive potential, stimulating extracellular matrix (ECM) mineralization and differentiation of MC3T3-E1 cells by increasing ALP and NO production. The ions Ca2 + , Mg2 + , Zn2 + , and Sr2 + appear to cooperate in promoting osteoblast function. The C3 cement (HA-SrMg5%), which was made up of n-HA co-substituted with 5 mol% Sr and 5 mol% Mg, showed exceptional osteoinductive capacity in terms of bone regeneration, indicating that this new bone cement could be a promising material for bone replacement.
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Affiliation(s)
- Alexa Magalhães Dias
- Dentistry Department, Faculty of Dentistry, Universidade Federal de Juiz de Fora, Rua São Paulo, 745 Governador Valadares/MG Brazil, Governador Valadares, MG, CEP, 31270901, Brazil
- Restorative Dentistry Department, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
| | - Isabela do Nascimento Canhas
- Biopharmaceutical and Technology Innovation Graduate Program, ICB, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
| | - Carlos Giovani Oliveira Bruziquesi
- Chemistry Department, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
| | - Marcelo Gomes Speziali
- Biopharmaceutical and Technology Innovation Graduate Program, ICB, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
- Chemistry Department, Instituto de Ciências Exatas E Biológicas, Universidade Federal de Ouro Preto, Campus Morro do Cruzeiro s/n, Ouro Preto, MG, CEP, 35400000, Brazil
| | - Rubén Dario Sinisterra
- Biopharmaceutical and Technology Innovation Graduate Program, ICB, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
- Chemistry Department, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil
| | - Maria Esperanza Cortés
- Biopharmaceutical and Technology Innovation Graduate Program, ICB, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil.
- Restorative Dentistry Department, Faculty of Dentistry, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos 6627, Belo Horizonte, MG, CEP, 31270901, Brazil.
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Zhou H, Yang L, Gbureck U, Bhaduri SB, Sikder P. Monetite, an important calcium phosphate compound-Its synthesis, properties and applications in orthopedics. Acta Biomater 2021; 127:41-55. [PMID: 33812072 DOI: 10.1016/j.actbio.2021.03.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022]
Abstract
This review recognizes a unique calcium phosphate (CaP) phase known as monetite or dicalcium phosphate anhydrous (DCPA, CaHPO4), and presents an overview of its properties, processing, and applications in orthopedics. The motivation for the present effort is to highlight the state-of-the-art research and development of monetite and propel the research community to explore more of its potentials in orthopedics. After a brief introduction of monetite, we provide a summary of its various synthesis routes like dehydration, solvent-based, energy-assisted processes and also discuss the formation of different crystal structures with respect to the synthesis conditions. Subsequently, we discuss the material's noteworthy physico-chemical properties including the crystal structure, vibrational spectra, solubility, thermal decomposition, and conversion to other phases. Of note, we focus on the biological (in vitro and in vivo) properties of monetite, given its ever-increasing popularity as a biomaterial for medical implants. Appropriately, we discuss various orthopedic applications of monetite as bone cement, implant coatings, granules for defect fillers, and scaffolds. Many in vitro and in vivo studies confirmed the favorable osteointegration and osteoconduction properties of monetite products, along with a better balance between implant resorption and new bone formation as compared to other CaP phases. The review ends with translational aspects of monetite and presents thoughts about its possible future research directions. Further research may explore but not limited to improvements in mechanical strength of monetite-based scaffolds, using monetite particles as a therapeutic agent delivery, and tissue engineering strategies where monetite serves as the biomaterial. STATEMENT OF SIGNIFICANCE: This is the first review that focusses on the favorable potential of monetite for hard tissue repair and regeneration. The article accurately covers the "Synthesis-Structure-Property-Applications" correlations elaborating on monetite's diverse material properties. Special focus is put on the in vitro and in vivo properties of the material highlighting monetite as an orthopedic material-of-choice. The synthesis techniques are discussed which provide important information about the different fabrication routes for monetite. Most importantly, the review provides comprehensive knowledge about the diverse biomedical applications of monetite as granules, defect--specific scaffolds, bone cements and implant coatings. This review will help to highlight monetite's potential as an effective regenerative medicine and catalyze the continuing translation of this bioceramic from the laboratory to clinics.
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Affiliation(s)
- H Zhou
- Center for Health Science and Engineering, School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China; International Research Center for Translational Orthopaedics (IRCTO), Jiangsu, China
| | - L Yang
- Center for Health Science and Engineering, School of Materials Science and Engineering, Hebei University of Technology, Tianjin, China; International Research Center for Translational Orthopaedics (IRCTO), Jiangsu, China
| | - U Gbureck
- Department for Functional Materials in Medicine and Dentistry, University Hospital of Würzburg, Würzburg, Germany
| | - S B Bhaduri
- Department of Mechanical, Industrial & Manufacturing Engineering, The University of Toledo, Toledo, OH, USA; ENG-EEC Division, The National Science Foundation (NSF), Alexandria, VA, USA
| | - P Sikder
- Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA.
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Preparation of PBS/PLLA/HAP Composites by the Solution Casting Method: Mechanical Properties and Biocompatibility. NANOMATERIALS 2020; 10:nano10091778. [PMID: 32911837 PMCID: PMC7559309 DOI: 10.3390/nano10091778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 12/21/2022]
Abstract
The use of biodegradable polymeric scaffolds for tissue regeneration is becoming a common practice in the clinic. Therefore, an inclined trend is developing with regards to improving the mechanical properties of these scaffolds. Here, we aim to improve the mechanical properties of poly (butylene succinate) (PBS)/poly (l-lactic acid) (PLLA) blends by incorporating hydroxyapatite nanoparticles (HAP) in the blends to form composites. PBS/PLLA = 100/0, 95/5, 90/10, 85/15, and 0/100 wt% blends, along-with the loadings of a few mg of HAPs, were prepared using the solution casting method. A scanning electron microscope showed the voids and droplets, indicating the immiscibility of blends. Due to this immiscibility, the tensile strength values of the blends were found to be in between that of pure PBS (42.85 MPa) and pure PLLA (31.39 MPa). HAPs act as a compatibilizer by incorporating themselves in the voids and spaces caused by the immiscibility, thus increasing the overall tensile strength of the resulting composite to a certain extent, e.g., the tensile strength of PBS/PLLA = 95/5 loaded with 50 mg HAPs was found to be 51.16 MPa. The structural analysis employing the X-ray diffraction (XRD) patterns confirmed the formation of polymer blends and composites. The contact angle analysis showed that the addition of HAPs increased the hydrophilicity of the resulting composites. Selective samples were investigated based on mechanical properties to see if the blends and composites are biocompatible. The obtained results showed that all of the samples with better mechanical properties demonstrated good biocompatibility. This indicates the effectiveness of scaffolds for tissue regeneration.
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Koju N, Sikder P, Gaihre B, B Bhaduri S. Smart Injectable Self-Setting Monetite Based Bioceramics for Orthopedic Applications. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E1258. [PMID: 30037147 PMCID: PMC6073613 DOI: 10.3390/ma11071258] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 11/22/2022]
Abstract
The present study is the first of its kind dealing with the development of a specific bioceramic which qualifies as a potential material in hard-tissue replacements. Specifically, we report the synthesis and evaluation of smart injectable calcium phosphate bone cement (CPC) which we believe will be suitable for various kinds of orthopedic and spinal-fusion applications. The smart nature of this next generation orthopedic implant is attained by incorporating piezoelectric barium titanate (BT) particles into monetite-based (dicalcium phosphate anhydrous, DCPA) CPC composition. The main goal is to take advantage of the piezoelectric properties of BT, as electromechanical effect plays a vital role in fracture healing at the defect site and bone integration with the implant. Furthermore, radiopacity of BT would help in easy detection of the CPC presence at the fracture site during surgery. Results reveal that BT addition favors important properties of bone cement such as good compressive strength, injectability, bioactivity, biocompatibility, and even washout resistance. Most importantly, the self-setting nature of the bone cements are not compromised with BT incorporation. The in vitro results confirm that the developed bone-cement abides by the standard orthopedic requirements making it apt for real-time prosthetic materials.
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Affiliation(s)
- Naresh Koju
- Department of Mechanical Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH 43606, USA.
| | - Prabaha Sikder
- Department of Mechanical Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH 43606, USA.
| | - Bipin Gaihre
- Department of Bioengineering, the University of Toledo, Toledo, OH 43606, USA.
| | - Sarit B Bhaduri
- Department of Mechanical Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH 43606, USA.
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Self-Setting Calcium Orthophosphate (CaPO4) Formulations. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2018. [DOI: 10.1007/978-981-10-5975-9_2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ain QU, Khan AN, Nabavinia M, Mujahid M. Enhanced mechanical properties and biocompatibility of novel hydroxyapatite/TOPAS hybrid composite for bone tissue engineering applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 75:807-815. [DOI: 10.1016/j.msec.2017.02.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/17/2016] [Indexed: 12/24/2022]
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Babaie E, Lin B, Goel VK, Bhaduri SB. Evaluation of amorphous magnesium phosphate (AMP) based non-exothermic orthopedic cements. Biomed Mater 2016; 11:055010. [DOI: 10.1088/1748-6041/11/5/055010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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LogithKumar R, KeshavNarayan A, Dhivya S, Chawla A, Saravanan S, Selvamurugan N. A review of chitosan and its derivatives in bone tissue engineering. Carbohydr Polym 2016; 151:172-188. [DOI: 10.1016/j.carbpol.2016.05.049] [Citation(s) in RCA: 328] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 04/24/2016] [Accepted: 05/15/2016] [Indexed: 10/21/2022]
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Zhou H, Luchini TJF, Boroujeni NM, Agarwal AK, Goel VK, Bhaduri SB. Development of nanosilica bonded monetite cement from egg shells. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 50:45-51. [PMID: 25746244 DOI: 10.1016/j.msec.2015.01.099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/30/2015] [Indexed: 10/24/2022]
Abstract
This work represents further effort from our group in developing monetite based calcium phosphate cements (CPC). These cements start with a calcium phosphate powder (MW-CPC) that is manufactured using microwave irradiation. Due to the robustness of the cement production process, we report that the starting materials can be derived from egg shells, a waste product from the poultry industry. The CPC were prepared with MW-CPC and aqueous setting solution. Results showed that the CPC hardened after mixing powdered cement with water for about 12.5±1 min. The compressive strength after 24h of incubation was approximately 8.45±1.29 MPa. In addition, adding colloidal nanosilica to CPC can accelerate the cement hardening (10±1 min) process by about 2.5 min and improve compressive strength (20.16±4.39 MPa), which is more than double the original strength. The interaction between nanosilica and CPC was monitored using an environmental scanning electron microscope (ESEM). While hardening, nanosilica can bond to the CPC crystal network for stabilization. The physical and biological studies performed on both cements suggest that they can potentially be used in orthopedics.
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Affiliation(s)
- Huan Zhou
- Institute of Biomedical Engineering and Health Sciences, Changzhou University, Changzhou, Jiangsu, China; Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH, USA.
| | - Timothy J F Luchini
- Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH, USA
| | - Nariman Mansouri Boroujeni
- Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH, USA
| | - Anand K Agarwal
- Department of Bioengineering, The University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Department of Bioengineering, The University of Toledo, Toledo, OH, USA
| | - Sarit B Bhaduri
- Department of Mechanical, Industrial and Manufacturing Engineering, The University of Toledo, Toledo, OH, USA; Division of Dentistry, The University of Toledo, Toledo, OH, USA
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Illy N, Fache M, Ménard R, Negrell C, Caillol S, David G. Phosphorylation of bio-based compounds: the state of the art. Polym Chem 2015. [DOI: 10.1039/c5py00812c] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aim of this review is to present both fundamental and applied research on the phosphorylation of renewable resources, through reactions on naturally occurring functions, and their use in biobased polymer chemistry and applications.
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Affiliation(s)
- Nicolas Illy
- Sorbonne Universités
- UPMC Univ Paris 06
- UMR 8232
- IPCM
- Paris
| | - Maxence Fache
- Institut Charles Gerhardt Montpellier UMR 5353 – Equipe Ingénierie et Architectures Macromoléculaires
- Ecole Nationale Supérieure de Chimie de Montpellier
- 34296 Montpellier, CEDEX 5
- France
| | - Raphaël Ménard
- Institut Charles Gerhardt Montpellier UMR 5353 – Equipe Ingénierie et Architectures Macromoléculaires
- Ecole Nationale Supérieure de Chimie de Montpellier
- 34296 Montpellier, CEDEX 5
- France
| | - Claire Negrell
- Institut Charles Gerhardt Montpellier UMR 5353 – Equipe Ingénierie et Architectures Macromoléculaires
- Ecole Nationale Supérieure de Chimie de Montpellier
- 34296 Montpellier, CEDEX 5
- France
| | - Sylvain Caillol
- Institut Charles Gerhardt Montpellier UMR 5353 – Equipe Ingénierie et Architectures Macromoléculaires
- Ecole Nationale Supérieure de Chimie de Montpellier
- 34296 Montpellier, CEDEX 5
- France
| | - Ghislain David
- Institut Charles Gerhardt Montpellier UMR 5353 – Equipe Ingénierie et Architectures Macromoléculaires
- Ecole Nationale Supérieure de Chimie de Montpellier
- 34296 Montpellier, CEDEX 5
- France
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Li YH, Cheng CY, Wang NK, Tan HY, Tsai YJ, Hsiao CH, Ma DHK, Yeh LK. Characterization of the modified chitosan membrane cross-linked with genipin for the cultured corneal epithelial cells. Colloids Surf B Biointerfaces 2014; 126:237-44. [PMID: 25576808 DOI: 10.1016/j.colsurfb.2014.12.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To modify a chitosan membrane (CM) by cross-linking the chitosan with genipin, a naturally occurring cross-linker extracted from Gardenia jasminoides fructus, with the aim of developing a new cell culture support and to observe the phenotypes of cultured human corneal epithelial cells (HCECs) on genipin-cross-linked chitosan membrane (GCM). METHODS We tested the cross-linking characteristics and mechanical strength of the GCM. CMs modified by cross-linking with different concentrations of genipin were prepared to investigate the rate of membrane degradation. The biocompatibility of the GCMs was investigated by determining the viability of HCECs cultured on them in vitro. The morphology of the HCECs cultured on CM or GCM was analyzed by confocal microscopy and scanning electron microscopy (SEM). Immunocytochemical staining was conducted to determine the phenotypes of the cultured cells. RESULTS The fixation index of the GCM was 31 ± 3% after treatment of CM with 0.5mM genipin. A stress-strain test showed that the GCM could tolerate three times the mechanical force of noncross-linked CM. The biodegradation rate of GCM was much slower than for CM. A 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide (MTT) assay showed that cell viability was not affected by cross-linking with 5.0mM genipin. SEM showed that the cultured HCECs adhered to and grew well on the surface of the GCM. Immunocytochemical staining showed keratin 3 (K3) and connexin 43 (Cx-43) immunoreactive HCECs on the GCM and their proliferative ability was not significantly affected by strong immunoreactivity of Ki-67 and p63 markers. CONCLUSIONS GCM has potential as a scaffold for corneal epithelium in ocular surface surgery and greater mechanical strength and slower degradation than unmodified CM.
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Affiliation(s)
- Ya-Han Li
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan
| | - Ching-Yi Cheng
- Department of Cosmetic Science, Graduate Institute of Health Industry Technology, Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kwei-Shan, Tao-Yuan, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Hsin-Yuan Tan
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Yueh-Ju Tsai
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Ching-Hsi Hsiao
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - David Hui-Kang Ma
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang-Gung Memorial Hospital, Linkou, Taiwan; Chang-Gung University College of Medicine, Taiwan.
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