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Saidane R, Fendouli I, Anane M, Lagneb C, Maalej A, Khallouli A. Unilateral optic disc granuloma as initial presenting sign of ocular sarcoidosis. J Fr Ophtalmol 2024; 47:103978. [PMID: 37867125 DOI: 10.1016/j.jfo.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/18/2023] [Accepted: 08/16/2023] [Indexed: 10/24/2023]
Affiliation(s)
- R Saidane
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia
| | - I Fendouli
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia.
| | - M Anane
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia
| | - C Lagneb
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia
| | - A Maalej
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia
| | - A Khallouli
- Ophthalmology Department, Military Hospital of Tunis, Mont Fleury 1008, Tunis, Tunisia; Faculty of Medicine of Tunis, University of Manar, Tunis, Tunisia
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Webb LM, Chen JJ, Aksamit AJ, Bhattacharyya S, Chwalisz BK, Balaban D, Manzano GS, Ali AS, Lord J, Clardy SL, Samudralwar RD, Mao-Draayer Y, Garrity JA, Bhatti MT, Turner LE, Flanagan EP. A multi-center case series of sarcoid optic neuropathy. J Neurol Sci 2020; 420:117282. [PMID: 33358503 DOI: 10.1016/j.jns.2020.117282] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The diagnosis of sarcoid optic neuropathy is time-sensitive, as delayed treatment risks irreversible vision loss. We sought to analyze its characteristics and outcomes. METHODS We performed a multi-center retrospective study of sarcoid optic neuropathy among 5 USA medical centers. Inclusion criteria were: 1) clinical optic neuropathy; 2) optic nerve/sheath enhancement on neuroimaging; 3) pathological confirmation of systemic or nervous system sarcoidosis. RESULTS Fifty-one patients were included. The median onset age of sarcoid optic neuropathy was 50 years (range, 17-70 years) and 71% were female. The median visual acuity at nadir in the most affected eye was 20/80 (range, 20/20 to no-light-perception). Thirty-four of 50 (68%) patients had radiologic evidence of other nervous system involvement and 20 (39%) patients had symptoms/signs of other cranial nerve dysfunction. Cerebrospinal fluid analysis revealed an elevated white blood cell count in 22 of 31 (71%) patients (median: 14/μL; range: 1-643/μL). Pathologic confirmation of sarcoidosis was by biopsy of systemic/pulmonary site, 34 (67%); optic nerve/sheath, 9 (18%); or other nervous system region, 8 (16%). Forty patients improved with treatment (78%), 98% receiving corticosteroids and 65% receiving steroid-sparing immunosuppressants, yet 11/46 patients (24%) had a visual acuity of 20/200 or worse at last follow-up. CONCLUSIONS Sarcoid optic neuropathy frequently occurs with other clinical and radiologic abnormalities caused by neurosarcoidosis and diagnostic confirmation occasionally requires optic nerve/sheath biopsy. Improvement with treatment is common but most patients have some residual visual disability. Improved recognition and a more expeditious diagnosis and treatment may spare patients from permanent vision loss.
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Affiliation(s)
- Lauren M Webb
- Mayo Clinic Alix School of Medicine, 200 1st St. SW, Rochester, MN, USA
| | - John J Chen
- Mayo Clinic, Department of Ophthalmology, 200 1st St. SW, Rochester, MN, USA; Mayo Clinic, Department of Neurology, 200 1st St. SW, Rochester, MN, USA
| | - Allen J Aksamit
- Mayo Clinic, Department of Neurology, 200 1st St. SW, Rochester, MN, USA
| | - Shamik Bhattacharyya
- Brigham and Women's Hospital, Department of Neurology, 75 Francis St., Boston, MA, USA
| | - Bart K Chwalisz
- Massachusetts General Hospital, Department of Neurology, Department of Ophthalmology, and Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA, USA
| | - Denis Balaban
- Brigham and Women's Hospital, Department of Neurology, 75 Francis St., Boston, MA, USA
| | - Giovanna S Manzano
- Brigham and Women's Hospital, Department of Neurology, 75 Francis St., Boston, MA, USA
| | - Ahya S Ali
- Brigham and Women's Hospital, Department of Neurology, 75 Francis St., Boston, MA, USA
| | - Jennifer Lord
- University of Utah, Department of Neurology, 50 N. Medical Dr., Salt Lake City, UT, USA
| | - Stacey L Clardy
- University of Utah, Department of Neurology, 50 N. Medical Dr., Salt Lake City, UT, USA
| | - Rohini D Samudralwar
- University of Texas Health Science Center, Department of Neurology, 6410 Fannin St., Houston, TX, USA
| | - Yang Mao-Draayer
- University of Michigan, Department of Neurology, 1500 E. Medical Center Dr., Ann Arbor, MI, USA
| | - James A Garrity
- Mayo Clinic, Department of Ophthalmology, 200 1st St. SW, Rochester, MN, USA
| | - M Tariq Bhatti
- Mayo Clinic, Department of Ophthalmology, 200 1st St. SW, Rochester, MN, USA; Mayo Clinic, Department of Neurology, 200 1st St. SW, Rochester, MN, USA
| | - Lindsey E Turner
- Mayo Clinic, Graduate School of Biomedical Sciences, 200 1st St. SW, Rochester, MN, USA
| | - Eoin P Flanagan
- Mayo Clinic, Department of Neurology, 200 1st St. SW, Rochester, MN, USA.
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Elnahry AG, Elnahry GA. Abdominal sarcoidosis presenting as bilateral simultaneous optic disc granulomas. Neuroophthalmology 2019; 43:91-94. [PMID: 31312232 DOI: 10.1080/01658107.2018.1467935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/18/2018] [Indexed: 10/14/2022] Open
Abstract
A 24-year-old male presents with diminution of vision in both eyes of acute onset with floaters. He has a history of fever of unknown origin. Examination revealed bilateral optic disc granulomas with mild vitritis. Serum angiotensin converting enzyme was found to be elevated and tuberculin skin test was negative. Computed tomography scan of the chest showed clear lung fields with no hilar lymphadenopathy but mildly enlarged pretracheal lymph nodes. Computed tomography scan of the abdomen revealed multiple enlarged abdominal lymph nodes with hepatosplenomegaly, and ultrasound-guided biopsy of one of these lymph nodes showed chronic granulomatous inflammation consistent with sarcoidosis. Immunosuppressive therapy resulted in resolution of ocular inflammation with no recurrence.
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Affiliation(s)
- Ayman G Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Elnahry Eye Clinics, Giza, Egypt
| | - Gehad A Elnahry
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Elnahry Eye Clinics, Giza, Egypt
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Serova NK, Shkarubo AN, Tropinskaya OF, Eliseeva NM, Shishkina LV. [Neurosarcoidosis of the anterior visual pathway (a case report and literature review)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:97-103. [PMID: 31577275 DOI: 10.17116/neiro20198304197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown nature. Patients often present with pulmonary, skin, eye, and orbital lesions. Involvement of the central nervous system (CNS) is accompanied by granulomatous leptomeningitis and damage to the basal brain structures with formation of granulomas near the cranial nerves, hypothalamus, pituitary gland, cavernous sinuses, optic chiasm, and intracranial optic nerves. The optic nerves can be affected independently of the other CNS regions, which may be the first manifestation of the disease. The article presents two clinical cases of sarcoidosis affecting the anterior visual pathway. Diagnosis of the disease was associated with certain difficulties. A biopsy revealed a sarcoidosis lesion.
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Affiliation(s)
- N K Serova
- Burdenko Neurosurgical Center, Moscow, Russia
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Jasse L, Vukusic S, Durand-Dubief F, Vartin C, Piras C, Bernard M, Pélisson D, Confavreux C, Vighetto A, Tilikete C. Persistent visual impairment in multiple sclerosis: prevalence, mechanisms and resulting disability. Mult Scler 2013; 19:1618-26. [DOI: 10.1177/1352458513479840] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to evaluate in multiple sclerosis (MS) patients the prevalence of persistent complaints of visual disturbances and the mechanisms and resulting functional disability of persistent visual complaints (PVCs). Methods: Firstly, the prevalence of PVCs was calculated in 303 MS patients. MS-related data of patients with or without PVCs were compared. Secondly, 70 patients with PVCs performed an extensive neuro-ophthalmologic assessment and a vision-related quality of life questionnaire, the National Eye Institute Visual Functionary Questionnaire (NEI-VFQ-25). Results: PVCs were reported in 105 MS patients (34.6%). Patients with PVCs had more frequently primary progressive MS (30.5% vs 13.6%) and more neuro-ophthalmologic relapses (1.97 vs 1.36) than patients without PVCs. In the mechanisms/disability study, an afferent visual and an ocular-motor pathways dysfunction were respectively diagnosed in 41 and 59 patients, mostly related to bilateral optic neuropathy and bilateral internuclear ophthalmoplegia. The NEI-VFQ 25 score was poor and significantly correlated with the number of impaired neuro-ophthalmologic tests. Conclusion: Our study emphasizes the high prevalence of PVC in MS patients. Regarding the nature of neuro-ophthalmologic deficit, our results suggest that persistent optic neuropathy, as part of the progressive evolution of the disease, is not rare. We also demonstrate that isolated ocular motor dysfunctions induce visual disability in daily life.
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Affiliation(s)
- Laurence Jasse
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
| | - Sandra Vukusic
- University Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-oncology and Neuro-inflammation Team, France
| | - Françoise Durand-Dubief
- Neurology A and EDMUS Coordinating Center for Multiple Sclerosis, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, University Lyon1, France
| | - Cristina Vartin
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Carolina Piras
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Martine Bernard
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Denis Pélisson
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
| | - Christian Confavreux
- University Lyon, France
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Neuro-oncology and Neuro-inflammation Team, France
| | - Alain Vighetto
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Caroline Tilikete
- INSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, France
- University Lyon, France
- Neuro-ophthalmology and Neurology D, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
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Progressive bilateral visual and hearing loss in an elderly woman. J Neuroophthalmol 2010; 30:372-5. [PMID: 21107125 DOI: 10.1097/wno.0b013e3181f50ba2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Valero-González S, Díaz-Vega B, Saucedo-Díaz G, Yebra-Bango M. Neurosarcoidosis aislada del nervio óptico. Med Clin (Barc) 2010; 135:137-8. [DOI: 10.1016/j.medcli.2009.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Accepted: 04/16/2009] [Indexed: 11/28/2022]
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Menezo V, Lobo A, Yeo TK, du Bois RM, Lightman S. Ocular Features in Neurosarcoidosis. Ocul Immunol Inflamm 2009; 17:170-8. [DOI: 10.1080/09273940802687812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lee JH, Tobias S, Kwon JT, Sade B, Kosmorsky G. Wilbrand's knee: does it exist? ACTA ACUST UNITED AC 2006; 66:11-7; discussion 17. [PMID: 16793428 DOI: 10.1016/j.surneu.2005.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 11/03/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In 1904, Hermann Wilbrand reported that nasal ON fibers form a loop into the contralateral ON, subsequently referred to as Wilbrand's knee. He had further theorized that a lesion affecting Wilbrand's knee would develop a distinct visual field defect characterized by an ipsilateral central scotoma with a contralateral superotemporal visual field defect. We present clinical evidence that disputes the existence of Wilbrand's knee. METHODS A retrospective analysis of 3 patients whose ONs were divided at the ON-chiasm junction is presented. Two patients had an ONS meningioma and the other patient had sarcoidosis of the ON. Resection of the lesion and the ON up to the nerve-chiasm junction was done to prevent the disease from extending into the OC and the contralateral ON. The patients had detailed neuro-ophthalmologic evaluations preoperatively and postoperatively. RESULTS After the resection of the ON at the ON-chiasm junction in the 3 patients, junctional scotoma could not be detected by visual perimetry. CONCLUSION No clinical perimetric evidence was found to support the existence of Wilbrand's knee in the anterior visual pathway.
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Affiliation(s)
- Joung H Lee
- Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Cem Y, Basar A, Ozlem O, Nilgul Y, Selcuk P. Primary Bilateral Optic Nerve Sarcoidosis. Neuroophthalmology 2005. [DOI: 10.1080/01658100500218038] [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] Open
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Abstract
PURPOSE OF REVIEW This review of the more recent literature and testing strategies in patients with chiasmal syndromes focuses on the clinical evaluation and management of these patients. Visual loss is often the initial manifestation of disorders involving the optic chiasm. Hemianopic defects and preferential involvement of the temporal visual field are the earliest and most common visual deficits. Progression of the lesion may cause compression of adjacent structures, including the optic nerves and cavernous sinuses, and may result in more profound visual loss, ocular motor deficits, and hypopituitarism. RECENT FINDINGS Although a number of modalities have been used to assess visual function in patients with chiasmal disorders, perimetry remains the most effective means of detecting and following the visual deficit. SUMMARY Most chiasmal syndromes can be categorized as intrinsic (thickening of the chiasm itself) or extrinsic (compression of the chiasm from an adjacent structure). Magnetic resonance imaging is the best mode of neuroimaging for most chiasmal lesions and may also provide clues to the etiology of an isolated chiasmal syndrome.
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Affiliation(s)
- Rod Foroozan
- Cuullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA
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Frohman LP, Guirgis M, Turbin RE, Bielory L. Sarcoidosis of the Anterior Visual Pathway: 24 New Cases. J Neuroophthalmol 2003; 23:190-7. [PMID: 14504590 DOI: 10.1097/00041327-200309000-00002] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the clinical spectrum and a rational approach to the diagnosis of anterior visual pathway sarcoidosis. METHODS Retrospective chart review of all patients examined in neuro-ophthalmic consultation by 1 author from 1989 to 1998 with a diagnosis of sarcoidosis. RESULTS There were 24 patients (17 female, 7 male, mean age 40 years) with anterior visual pathway sarcoidosis, 17 (71%) of whom were not previously known to have sarcoidosis. Visual acuity ranged from 20/20 to NLP. Normal fundi were observed in 15%. Among the 85% who had fundus abnormalities, pallor was present in 55%, disc edema in 26%, periphlebitis/sheathing in 14%, and optic disc granuloma in 10%. Ten patients (42%) had uveitis, active in only 3 (13%). An elevated angiotensin-converting enzyme (ACE) was present in 16 (76%) of 21 patients tested; evidence of sarcoidosis on chest radiograph was present in 13 (72%) of 18; gallium scanning was abnormal in 13 (93%) of 14; neuroimaging abnormalities of the optic nerves, chiasm, or tract were present in 16 (70%) of 23; lymphocytic pleocytosis or elevated cerebrospinal fluid protein was identified in 14 (88%) of 16 patients, with both values elevated in 7 (44%) patients. Histologic confirmation was obtained in 13 (81%) of 16 who underwent biopsy; in the remaining patients, diagnosis was based entirely on clinical and laboratory evidence. CONCLUSIONS Anterior visual pathway disease may be underrecognized as a presentation of sarcoidosis. Classic fundus findings of periphlebitis and optic granuloma are typically absent. An aggressive diagnostic evaluation may help establish the diagnosis early in its course.
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Affiliation(s)
- Larry P Frohman
- Institute of Ophthalmology and Visual Sciences, UMDNJ-New Jersey Medical School, 90 Bergen Street, Newark, NJ 07103, USA.
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Abstract
For 11 years, a 50-year-old woman with euthyroid Graves' disease experienced intermittent exacerbations of her orbitopathy associated with a decline in visual acuity. On each occasion, treatment with systemic corticosteroids led to prompt recovery of vision. Upon referral for consideration for orbital decompressive surgery, computed tomography and magnetic resonance imaging scanning detected bilateral optic-nerve sheath meningiomas, as well as typical findings of Graves' disease. Orbital radiation therapy led to stabilization of visual function and orbital findings, eliminating the need for systemic steroids. To our knowledge, this is the first reported case of Graves' disease associated with bilateral optic nerve sheath meningiomas.
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Affiliation(s)
- C B Dabbs
- Eye Foundation Hospital, Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, USA
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Abstract
Sarcoid manifesting as an optic nerve tumor without evidence of systemic disease is uncommon. Throughout a 2-year period, a 22-year-old white woman had progressive monocular loss of vision to the level of no light perception. Optic atrophy but no uveitis was noted in the affected eye. Magnetic resonance imaging revealed thickening and enhancement of the apical optic nerve, with "tram-tracking." The presumptive diagnosis was optic nerve sheath meningioma; however, a biopsy specimen from the optic nerve revealed sarcoid. Extensive postoperative investigations revealed no systemic sarcoidosis. To our knowledge, 17 cases similar to ours, with the diagnosis proved by optic nerve biopsy, have been previously reported in the English-language literature. Most of these were mistaken preoperatively for optic nerve sheath meningioma. None of the patients had evidence of systemic sarcoidosis on initial postoperative testing. Neuroimaging, serum level of angiotensin-converting enzyme, and clinical characteristics such as age, race, sex, and optochoroidal collaterals do not distinguish optic nerve sheath meningioma from sarcoid of the optic nerve. In the absence of uveitis or systemic involvement, optic nerve sarcoid manifesting as an orbital tumor is virtually impossible to diagnose without results of biopsy.
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Affiliation(s)
- E B Ing
- Department of Ophthalmology, Mayo Clinic Rochester, Minnesota 55905, USA
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