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Mejía-Salgado G, Muñoz-Vargas PT, Cifuentes-González C, Flórez-Esparza G, Paquentín-Jiménez R, Castro-Monreal MÁ, Medina-Galindo N, Hernández-Herrera GN, Concha-del-Río LE, de-la-Torre A. Quantitative changes in the corneal endothelium and central corneal thickness during anterior chamber inflammation: A systematic review and meta-analysis. PLoS One 2024; 19:e0296784. [PMID: 38181008 PMCID: PMC10769021 DOI: 10.1371/journal.pone.0296784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
PURPOSE To establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT). METHODS We conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712). RESULTS Thirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT. CONCLUSION ACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.
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Affiliation(s)
- Germán Mejía-Salgado
- Institute of Translational Medicine (IMT), Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Paula Tatiana Muñoz-Vargas
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Carlos Cifuentes-González
- Institute of Translational Medicine (IMT), Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Gabriela Flórez-Esparza
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Rebeca Paquentín-Jiménez
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Miguel Ángel Castro-Monreal
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Naomi Medina-Galindo
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Gilma Norella Hernández-Herrera
- Postgraduate Master’s Program in Epidemiology Universidad CES, Medellín, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
| | - Luz Elena Concha-del-Río
- Inflammatory Eye Disease Clinic, Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez Bulnes,” México City, México
| | - Alejandra de-la-Torre
- Institute of Translational Medicine (IMT), Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
- Post-gradual Master’s Program in Epidemiology Universidad del Rosario, Bogotá Colombia
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Cetin EN, Akbulut S, Tekin ZE, Yener GO, KeremBOZKURT, Pekel G, Yüksel S. Corneal and lenticular clarity in children with inflammatory disease as assessed by Scheimpflug imaging. Photodiagnosis Photodyn Ther 2022; 39:103032. [PMID: 35882290 DOI: 10.1016/j.pdpdt.2022.103032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Corneal and lenticular optical properties are not well-documented in pediatric patients with inflammatory diseases. Here we aimed to evaluate corneal and lenticular optical density as well as corneal morphology in children with ocular and/or systemic inflammation by Scheimpflug imaging. METHODS Fifty-five eyes of 29 children with non-infectious uveitis, 56 eyes of 28 children with systemic inflammation without uveitis and 60 eyes of 31 healthy children were included. Corneal/lenticular optical density, corneal volume, central corneal thickness, keratometry were analyzed by Pentacam HR. Corneal endothelial cell density, hexagonal cell ratio and coefficient of variation were measured by specular microscope. RESULTS The mean age was 12.0±3.1 years, 11.9±4.0 years and 11.3±3.4 years whereas the female/ratio was 15/14, 15/13 and 14/17 in uveitis, systemic inflammation and control groups respectively. Uveitis type was anterior uveitis in 16 (29.1%) eyes, intermediate uveitis in 32 (58.2%) eyes and panuveitis in 7 (12.7%) eyes. Twenty-two (40%) eyes had active uveitis whereas 33 (60%) eyes had inactive uveitis. Corneal optical density was greater in uveitis group compared with other groups (p=0.001, Kruskal-Wallis test). Lenticular density and corneal parameters other than optical density were not different between the groups (p>0.05). Corneal optical density was higher in active uveitis than inactive uveitis (22/33 eyes, p=0.017). CONCLUSION Children with uveitis had decreased corneal clarity compared with systemic inflammation group and healthy controls, while lenticular clarity was similar between the groups. Corneal endothelial parameters did not change significantly based on ocular/systemic inflammation. Scheimpflug imaging provides objective corneal and lenticular optical density measurements.
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Affiliation(s)
- Ebru Nevin Cetin
- Pamukkale University, Department of Ophthalmology, Denizli, Turkey.
| | - Selen Akbulut
- Yenişehir State Hospital, Department of Ophthalmology, Bursa, Turkey
| | - Zahide Ekici Tekin
- Ankara City Hospital, Department of Pediatric of Rheumatology, Ankara, Turkey
| | - Gulcin Otar Yener
- Gaziantep Medical Park Hospital, Department of Pediatric Rheumatology, Gaziantep, Turkey
| | - KeremBOZKURT
- Servergazi State Hospital, Department of Ophthalmology, Denizli, Turkey
| | - Gökhan Pekel
- Pamukkale University, Department of Ophthalmology, Denizli, Turkey
| | - Selçuk Yüksel
- Pamukkale University, Department of Pediatric Rheumatology, Denizli, Turkey
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Toprak I, Cetin EN, Akbulut S, Pekel G, Yuksel S, Cobankara V. Enhanced Ectasia Screening in Patients with Uveitis and Isolated Systemic Inflammatory Disease. Ocul Immunol Inflamm 2022; 30:324-329. [PMID: 33026932 DOI: 10.1080/09273948.2020.1817498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate corneal topographic alterations in patients with uveitis and isolated systemic inflammatory disease (SID). METHODS This retrospective cross-sectional study included 44 patients with uveitis with anterior chamber inflammation (uveitis group), 39 subjects with isolated SID, and 91 healthy controls (control group). Topographic images were classified as "normal," "keratoconus (KC) suspect" and "KC" based on maps of axial curvature, corneal thickness, front and back elevation in combination with Belin/Ambrósio Enhanced Ectasia Display (BAD). RESULTS The uveitis and SID groups had higher incidence of KC (6.8% and 10.2%, respectively) and KC suspect (45.5% and 33.3%, respectively), whereas 2.2% of the control subjects had KC and 26.4% represented KC suspect (p < .05). CONCLUSIONS Patients with uveitis with or without SID, and isolated SID without intraocular inflammation seem to be more likely to have KC and KC suspect, which might be due to systemic and/or local inflammatory background triggering pathophysiological mechanisms underlying KC.
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Affiliation(s)
- Ibrahim Toprak
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ebru Nevin Cetin
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Selen Akbulut
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gokhan Pekel
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Selcuk Yuksel
- Department of Pediatric Rheumatology and Nephrology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Veli Cobankara
- Department of Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Vaiciuliene R, Rylskyte N, Baguzyte G, Jasinskas V. Risk factors for fluctuations in corneal endothelial cell density (Review). Exp Ther Med 2022; 23:129. [PMID: 34970352 PMCID: PMC8713183 DOI: 10.3892/etm.2021.11052] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/29/2021] [Indexed: 12/17/2022] Open
Abstract
The cornea is a transparent, avascular and abundantly innervated tissue through which light rays are transmitted to the retina. The innermost layer of the cornea, also known as the endothelium, consists of a single layer of polygonal endothelial cells that serve an important role in preserving corneal transparency and hydration. The average corneal endothelial cell density (ECD) is the highest at birth (~3,000 cells/mm2), which then decrease to ~2,500 cells/mm2 at adulthood. These endothelial cells have limited regenerative potential and the minimum (critical) ECD required to maintain the pumping function of the endothelium is 400-500 cells/mm2. ECD < the critical value can result in decreased corneal transparency, development of corneal edema and reduced visual acuity. The condition of the corneal endothelium can be influenced by a number of factors, including systemic diseases, such as diabetes or atherosclerosis, eye diseases, such as uveitis or dry eye disease (DED) and therapeutic ophthalmological interventions. The aim of the present article is to review the impact of the most common systemic disorders (pseudoexfoliation syndrome, diabetes mellitus, cardiovascular disease), eye diseases (DED, uveitis, glaucoma, intraocular lens dislocation) and widely performed ophthalmic interventions (cataract surgery, intraocular pressure-lowering surgeries) on corneal ECD.
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Affiliation(s)
- Renata Vaiciuliene
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Neda Rylskyte
- Faculty of Medicine, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania
| | - Gabija Baguzyte
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
| | - Vytautas Jasinskas
- Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania
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Evaluation of corneal endothelial cell morphology by specular microscopy in patients with acute anterior uveitis. Int Ophthalmol 2021; 42:1339-1345. [PMID: 34822052 DOI: 10.1007/s10792-021-02122-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine the structure and morphology of corneal endothelial cell layer in patients with acute anterior uveitis. METHODS Thirty-four eyes of 34 acute anterior uveitis patients and 34 eyes of 34 healthy subjects were included. Mean cell density, coefficient of variation, maximum cell area, minimum cell area, average cell area and hexagonality ratio values were evaluated by non-contact specular microscopy. Parameters recorded in both groups were compared. RESULTS The mean maximum cell area was 1054,44 ± 251,14 µm2, minimum cell area was 152.29 ± 53.65 µm2 and average cell area was 386.91 ± 41.73 µm2 in acute anterior uveitis group and the mean maximum cell area was 1057.65 ± 261.23 µm2, minimum cell area was 147.26 ± 20.45 µm2 and average cell area was 383.53 ± 43.12 µm2 in the control group. There were no significant differences between the two groups in terms of maximum, minimum and average cell area (respectively, p = 0.080, p = 0.72, p = 0.62, p = 0.67). The mean cell density was 2607.74 ± 277.63 cells/ µm2 in acute anterior uveitis group and 2669.35 ± 265.22 cells/µm2 in the control group. (p = 0.358). In acute anterior uveitis group the mean coefficient of variation was 31.68 ± 8.16, hexagonality ratio was 63.85 ± 11.14 and mean central corneal thickness was 571.47 ± 55.99 µm; in control group the mean coefficient of variation was 25.29 ± 3.00, mean hexagonality ratio was 72.6 ± 4.80% and mean central corneal thickness was 534.82 ± 33.84 µm. Statistically significant differences were seen between the two groups (respectively, P = 0,00, P = 0,00, P = 0.02). CONCLUSION The mean central corneal thickness and coefficient of variation values were found higher, and the hexagonality ratio was found lower in acute anterior uveitis group. Our findings suggest that intraocular inflammation in anterior chamber negatively affects the endothelial function in patients with acute anterior uveitis.
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Ono T, Mori Y, Nejima R, Iwasaki T, Miyai T, Miyata K. Corneal endothelial cell density and morphology in ophthalmologically healthy young individuals in Japan: An observational study of 16842 eyes. Sci Rep 2021; 11:18224. [PMID: 34521951 PMCID: PMC8440503 DOI: 10.1038/s41598-021-97776-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
We aimed to investigate the cell density and morphology of the corneal endothelium in ophthalmologically healthy young Japanese, given the lack of normative data in literature. This observational study included eyes without ophthalmologic diseases, besides refractive errors, examined between 1996 and 2015 at Miyata Eye Hospital. Eyes with a history of ophthalmologic diseases or contact lens usage were excluded. Correlation of corneal endothelial cell density (ECD), coefficient of variation (CV), appearance rate of hexagonal cells (6A), and cell area with age were examined. Multivariate linear regression analysis was performed to determine the predictors of corneal parameters. We included 16842 eyes of 8421 individuals (19.6 ± 8.7 years). ECD was 3109.0 ± 303.7 cells/mm2 and significantly reduced with age (p < 0.001). The ECD reduction rate was 0.42%/year in the total population. On multivariate analysis, age and sex were significantly correlated with ECD, CV, 6A, and cell area (all p < 0.001). ECD, 6A, CV, and cell area are significantly associated with age in healthy young Japanese individuals. Monitoring their corneal endothelium is essential to assess the risk of endothelial damage.
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Affiliation(s)
- Takashi Ono
- Department of Ophthalmology, Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan. .,Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yosai Mori
- Department of Ophthalmology, Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Ryohei Nejima
- Department of Ophthalmology, Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takuya Iwasaki
- Department of Ophthalmology, Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
| | - Takashi Miyai
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazunori Miyata
- Department of Ophthalmology, Miyata Eye Hospital, 6-3, Kuraharacho, Miyakonojo, Miyazaki, 885-0051, Japan
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Zina S, Khochtali S, Sayadi S, Ksiaa I, Abroug N, Khairallah M. [Specular microscopy findings in active uveitis]. J Fr Ophtalmol 2021; 44:981-988. [PMID: 34172297 DOI: 10.1016/j.jfo.2020.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 10/21/2022]
Abstract
PURPOSE To study the effect of ocular inflammation in active uveitis on the corneal endothelium. MATERIALS AND METHODS This is a prospective cross-sectional study involving 63 eyes of 38 patients with active newly-diagnosed uveitis. Eighty-four eyes of 42 non-uveitic subjects served as a control group. All patients underwent detailed ophthalmic examination, laser flare photometry, and non-contact specular microscopy. Eyes with uveitis had a follow-up visit at one month after initiation of treatment, including laser flare photometry and specular microscopy. RESULTS The mean age of the active uveitis patients was 33 (range: 9-67 years) with 21 men (55%) and 17 women (45%). For the uveitis patients at baseline, the mean flare value was 32ph/ms (range: 15-100ph/ms) with flare photometry value ≥50ph/ms in 13 eyes (21%) and<50ph/ms in 50 eyes (79%). At baseline, cell density (CD) of the uveitis patients was similar to CD in control eyes (p꞊0.16). The percent of hexagonality was significantly lower (p<0.0001), and the coefficient of variance (CV) (p<0.0001) and central corneal thickness (CCT) (p<0.0001) were significantly higher than in the control group. After one month, there was a significant decrease in flare photometry values (p<0.0001), with a mean flare value of 14.5ph/ms (range: 4-60ph/ms). In the active uveitis group, the overall results of specular microscopy did not significantly vary between the initial examination and the 1-month examination. For eyes with flare photometry value ≥50ph/ms at baseline, CD and hexagonal cell count significantly increased on the 1-month examination (p꞊0.01 and p꞊0.02 respectively), while CV and CCT decreased significantly at the one-month follow-up visit (p꞊0.007/p꞊0.03 respectively). For eyes with flare photometry value at baseline <50ph/ms, there was no significant differences in specular microscopy results between the initial examination and the 1-month examination. CONCLUSIONS In eyes with newly-diagnosed uveitis and active anterior chamber inflammation, specular microscopy shows transient qualitative abnormalities of the corneal endothelium that depend on the severity of the anterior chamber inflammation as measured by the laser flare meter.
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Affiliation(s)
- S Zina
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - S Khochtali
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - S Sayadi
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - I Ksiaa
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - N Abroug
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
| | - M Khairallah
- Service d'ophtalmologie, Hôpital universitaire Fattouma Bourguiba, Faculté de Médecine, Université de Monastir, 5019 Monastir, Tunisia.
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Doughty MJ. Non-contact specular microscopy with Topcon instruments to assess central corneal thickness of healthy human eyes - A 20 year review. Cont Lens Anterior Eye 2020; 44:101385. [PMID: 33341365 DOI: 10.1016/j.clae.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/06/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The purpose of this review was to evaluate the consistency of central corneal thickness (CCT) values reported with use of Topcon SP-2000 P and SP-3000 P non-contact specular microscopes since their introduction in 1999 with the two microscopes having been commonly used in a wide range of studies. METHODS As a primary resource, PubMed was used to search for peer-reviewed articles in any language that included CCT values obtained with non-contact specular microscopy reported for humans with nominally healthy corneas. Relevant articles were obtained and any cited publications also checked. RESULTS A total of 76 articles were identified which reported CCT on different small-to-moderate sized groups of individuals, published between 1999 and 2019. From these, an overall group mean CCT value of 0.525 ± 0.013 mm (median 0.525 mm) can be calculated. An estimated 95 % confidence interval (CI, based on 1.96 SD) would be between 0.500 and 0.550 mm. For the two Topcon models, the group mean ± SD values were 0.529 ± 0.013 mm and 0.517 ± 010 mm respectively. An assessment of the CCT data sets in relation to the reported average age indicated no statistically significant effect (p = 0.289, r = -0.129). Very similar average CCT values were also encountered in 4 other reports where these microscopes were used in large-scale population studies as well as in 2 other reports using the newer Topcon SP-1 P model. CONCLUSIONS The Topcon stand-alone non-contact specular microscopes have yielded consistent and predictable corneal thickness measures over many years.
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Affiliation(s)
- M J Doughty
- Glasgow-Caledonian University, Dept Vis Sci, Glasgow, G4 OBA, United Kingdom
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Wong SW, Carley F, Jones NP. Corneal Decompensation in Uveitis Patients: Incidence, Etiology, and Outcome. Ocul Immunol Inflamm 2020; 29:771-775. [DOI: 10.1080/09273948.2019.1698747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Shiao W. Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fiona Carley
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nicholas P. Jones
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Medical Academic Health Science Centre, University of Manchester, Manchester, UK
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