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Szabó Á, Árpádffy-Lovas T, Hagyó K, Cseke I, Vámosi P, Tóth-Molnár E. The effect of cumulative energy in repeated subliminal transscleral cyclophotocoagulation: a retrospective study. BMC Ophthalmol 2024; 24:233. [PMID: 38831268 PMCID: PMC11145849 DOI: 10.1186/s12886-024-03505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND The long-term safety and efficacy of repeated applications of subliminal transscleral cyclophotocoagulation (SL-TSCPC) with a focus on cumulative energy was evaluated in glaucoma patients. METHODS In this retrospective, multicentric study the data of a total of 82 eyes with various causes of glaucoma that were treated with a single or multiple applications of SL-TSCPC were collected. Treatments were performed under general or local anesthesia with an 810 nm diode laser. Power was 2000 mW; duty cycle, 31.3%; total treatment duration, 80-320 s; equaling a total energy of 50-200 J per treatment session. Fifty-five eyes (55 patients) presented for all follow-ups, and these eyes were selected for further statistical analysis. The mean age was 60.0 ± 17.1 years, and 22 (40%) of the patients were female. Intraocular pressure (IOP) and dependence on further glaucoma medication were evaluated at 12 months following the initial treatment. RESULTS Eyes underwent 1 or 2 consecutive SL-TSCPC treatments. Median (min-max) baseline IOP of 34 (13-69) decreased to 21.5 (7-61), 22 (8-68), 20 (9-68), and 19.5 (3-60) mmHg at the 1, 3, 6, and 12-month postoperative timepoints respectively. The mean (± SD) IOP decrease at 12 months was 26 ± 27%, 39 ± 32%, and 49 ± 33% in the low (below 120 J, n = 18), medium (120-200 J, n = 24), and high (above 200 J, n = 13) cumulative energy groups respectively. At the 12-month timepoint, oral carbonic anhydrase use was discontinued in ¾ of the cases. CONCLUSIONS It was found that the repeated application of SL-TSCPC safely and efficiently decreases IOP in a Caucasian population with heterogenous causes of glaucoma, eyes with silicone oil responded to a greater extent. Inclusion of cumulative energy scales may contribute to better addressing repeated procedures in a standardized fashion.
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Affiliation(s)
- Áron Szabó
- Department of Ophthalmology, University of Szeged, Szeged, Hungary.
| | | | - Krisztina Hagyó
- Department of Ophthalmology, Péterfy Hospital, Budapest, Hungary
| | - István Cseke
- Department of Ophthalmology, Erzsébet Teaching Hospital, Sopron, Hungary
| | - Péter Vámosi
- Department of Ophthalmology, Péterfy Hospital, Budapest, Hungary
| | - Edit Tóth-Molnár
- Department of Ophthalmology, University of Szeged, Szeged, Hungary
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Logioco C, Delgado MF, Podesta N, Galetto L, Rodriguez-Libarona A, Valvecchia F, Zanutigh V. MicroPulse Transscleral Laser Therapy in Patients With Glaucoma and Ocular Cicatricial Pemphigoid. J Glaucoma 2023; 32:e109-e111. [PMID: 36946909 DOI: 10.1097/ijg.0000000000002211] [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: 03/29/2022] [Accepted: 03/04/2023] [Indexed: 03/23/2023]
Abstract
A non-comparative retrospective case-series study was performed on 6 patients (12 eyes) with a confirmed diagnosis of ocular cicatricial pemphigoid (OCP), treated with MicroPulse Transscleral Laser Therapy (MP-TLT), between January 2018 and 2020, with a minimum follow-up of 2 years, in a private ophthalmology practice with offices in Argentina and Colombia. Mean age was 75±6.3 years (66-83 yrs). The severity of ocular cicatricial pemphigoid remained stable 2 years after MP-TLT. Baseline mean IOP was 19.5±5.9 mmHg (13-30 mmHg) and, 24 months after treatment, IOP decreased to a mean of 13.9±1.9 mmHg (10-18 mmHg). The mean IOP reduction was 25.1% ( P : 0.002). The mean number of anti-glaucomatous drugs at baseline was 3.1±0.7, decreasing to 0.6±0.7, 2 years after MP-TLT ( P <0.001). MP-TLT may be considered as a non-incisional approach to glaucoma care for patients with ocular surface diseases, prospective long term studies are needed.
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Affiliation(s)
- Celina Logioco
- Centro de Ojos Quilmes. Quilmes, Buenos Aires, Argentina
| | | | - Noelia Podesta
- Centro de Ojos Quilmes. Quilmes, Buenos Aires, Argentina
| | - Leila Galetto
- Centro de Ojos Quilmes. Quilmes, Buenos Aires, Argentina
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Balendiran V, Landreneau J, An J. MicroPulse Transscleral Laser Therapy Dosimetry Utilizing the Revised P3 Delivery Device: A Randomized Controlled Trial. Ophthalmol Glaucoma 2023; 6:283-290. [PMID: 36179790 DOI: 10.1016/j.ogla.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/07/2022] [Accepted: 09/21/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To compare the long-term effectiveness and safety outcomes of 2 treatment dosages of the MicroPulse Transscleral Laser Therapy (MPTLT) procedure on intraocular pressure (IOP) control in patients with primary open-angle glaucoma. DESIGN Single-blinded randomized controlled trial. SUBJECTS A total of 19 patients with POAG without prior history of incisional glaucoma surgery. METHODS Subjects randomized into 2 treatment groups, 100-second (total energy 78.25 joules [J], fluence 109.2 J/cm2) or 120-second (total energy 93.9 J, fluence 131.0 J/cm2) total treatment duration, underwent the MPTLT procedure with the revised P3 delivery probe delivering 2.5 W energy, 31.3% duty cycle, applied in 3 sweeps per hemisphere, avoiding 3 and 9 o'clock. All subjects were followed at 1, 3, 6, 9, and 12 months to compare reduction in IOP and medication. MAIN OUTCOME MEASURES Absolute and percentage IOP reduction at 6 months. RESULTS The treatment groups were similar in age, sex, and stage of glaucoma at baseline (all P > 0.05). The 120-second group had significantly better baseline best-corrected visual acuity (BCVA) and a higher percentage of patients with prior MPTLT therapy (ranging from 4-19 months before study). Significantly greater IOP reduction was noted in the 120-second group compared with the 100-second group at 3 months, with mean IOP reduction of 7.3 ± 4.2 mmHg (vs. 0.9 ± 2.5 mmHg, P = 0.006) and percentage IOP reduction of 32.2% ± 18.3% (vs. 4.1% ± 13.7%, P = 0.007). The 120-second group continued to outperform at 6-month follow-up: mean IOP reduction of 9.0 ± 4.8 mmHg (vs. 0.8 ± 2.5 mmHg, P = 0.016) and percentage IOP reduction of 37.8% ± 19.8% (vs. 3.6% ± 13.3%, P = 0.021). At 12 months, 37.5% and 18.2% of the 100- and 120-second groups, respectively, required an additional IOP-lowering procedure (P = 0.35); however, Kaplan-Meier analysis of time to intervention was not significantly different (P = 0.38). There were no vision-threatening complications or changes in BCVA during the study period. CONCLUSIONS This study demonstrates a dose-response relationship with improved IOP control and excellent safety profile in patients treated with higher treatment total energy and fluence using the revised MPTLT probe. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Vaishnavi Balendiran
- Department of Ophthalmology, Mason Eye Clinic, University of Missouri-Columbia, Columbia, Missouri
| | - James Landreneau
- Department of Ophthalmology, Mason Eye Clinic, University of Missouri-Columbia, Columbia, Missouri
| | - Jella An
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Zanutigh V, Perrone LD, Gómez-Caride G, Perrone F, Valvecchia G, Logioco C. Success rate in micropulse diode laser treatment with regard to lens status, refractive errors, and glaucoma subtypes. Int Ophthalmol 2023:10.1007/s10792-023-02640-2. [PMID: 36715958 DOI: 10.1007/s10792-023-02640-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/19/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) considering different characteristics: glaucoma subtypes and lens status. METHODS A retrospective case-series study was designed to evaluate intraocular pressure (IOP), and the number of IOP-lowering medications, used by glaucoma patients treated with MP-TSCPC between 2016 and 2019. Cases had a follow-up period of 12 months. Achieving an IOP reduction higher than 20%, or the decrease of at least one IOP-lowering medication, was considered a successful outcome. The same population was analyzed by classifying them in two groups as: glaucoma subtypes and lens status. The baseline spherical equivalent (SE) was also calculated for considering association with the achieved IOP. RESULTS A total of 86 eyes were included. In most cases, IOP and IOP-lowering medications were decreased with a statistically significant difference (p < 0.0001), and all of them had a successful outcome. The percentage of IOP drop oscillated between 25.9% (open-angle glaucoma sub-group) and 37.5% (pseudoexfoliative glaucoma sub-group), 12 months after surgery. The difference between the groups was not statistically significant (p 0.20 and 0.32 for glaucoma subtypes and lens status, respectively). The Pearson's coefficient obtained was low for the SE and IOP association, at the 12 -month postoperative mark (- 0.009; p < 0.001). CONCLUSIONS The MP-TSCPC treatment was successful in decreasing IOP and IOP-lowering medications, in different glaucoma subtypes. Differences between groups (glaucoma subtypes, phakic and pseudophakic eyes) were not statistically significant. No association was found between the SE and the IOP achieved value after MS-TSCPC treatment.
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Affiliation(s)
- Virginia Zanutigh
- Centro de Ojos Quilmes, Humberto Primo, 298, Quilmes, Buenos Aires, Argentina.
| | | | - Gastón Gómez-Caride
- Centro de Ojos Quilmes, Humberto Primo, 298, Quilmes, Buenos Aires, Argentina
| | - Franco Perrone
- Centro de Ojos Quilmes, Humberto Primo, 298, Quilmes, Buenos Aires, Argentina
| | - Gerardo Valvecchia
- Centro de Ojos Quilmes, Humberto Primo, 298, Quilmes, Buenos Aires, Argentina
| | - Celina Logioco
- Centro de Ojos Quilmes, Humberto Primo, 298, Quilmes, Buenos Aires, Argentina
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Grippo TM, Töteberg-Harms M, Giovingo M, Francis BA, de Crom RRMPC, Jerkins B, Brubaker JW, An J, Radcliffe N, Noecker R. Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy - Surgical Technique, Post-Operative Care, Expected Outcomes and Retreatment/Enhancements. Clin Ophthalmol 2023; 17:71-83. [PMID: 36636622 PMCID: PMC9831072 DOI: 10.2147/opth.s389198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To provide expert consensus and evidence-based current guidelines on treatment technique, postoperative care, expected outcomes and retreatment for MicroPulse Transscleral Laser Treatment (TLT). Methods A comprehensive search of PubMed led to the identification and analysis of 61 studies on MicroPulse TLT. To provide guidance in areas where there was not enough available literature, a three-round Delphi method was conducted involving 10 international experts in MicroPulse TLT. Results The response rate was 70% in the first round, 70% in the second round, and 80% in the third round of the Delphi method. Once all responses were aggregated, a live meeting was held with 90% attendance, and consensus was achieved on each of the findings detailed in this manuscript. Conclusion Used within appropriate treatment parameters, with proper technique and patient selection, MicroPulse TLT is a safe and effective treatment for many types and severities of glaucoma. MicroPulse TLT represents a useful addition to the glaucoma armamentarium.
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Affiliation(s)
- Tomas M Grippo
- Grippo Glaucoma and Cataract Center, Buenos Aires, Argentina,Correspondence: Tomas M Grippo, Grippo Glaucoma and Cataract Center, 250 Luis Maria Campos, 1st Floor, Suite O, Capital Federal, 1426, Argentina, Tel +54-11-4-774-2930, Email
| | - Marc Töteberg-Harms
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Brian A Francis
- Department of Ophthalmology, Doheny and Stein Eye Institutes, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Ronald R M P C de Crom
- University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Brian Jerkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jella An
- Department of Ophthalmology, Wilmer Eye Institute, John Hopkins School of Medicine, Bethesda, MD, USA
| | - Nathan Radcliffe
- Glaucoma Department, New York Eye and Ear Infirmary, New York, NY, USA
| | - Robert Noecker
- Ophthalmic Consultants of Connecticut, Fairfield, CT, USA
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Grippo TM, de Crom RMPC, Giovingo M, Töteberg-Harms M, Francis BA, Jerkins B, Brubaker JW, Radcliffe N, An J, Noecker R. Evidence-Based Consensus Guidelines Series for MicroPulse Transscleral Laser Therapy: Dosimetry and Patient Selection. Clin Ophthalmol 2022; 16:1837-1846. [PMID: 35698599 PMCID: PMC9188391 DOI: 10.2147/opth.s365647] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Tomas M Grippo
- Department of Ophthalmology, Hospital Aleman, Buenos Aires, Argentina
- Correspondence: Tomas M Grippo, 250 Luis Maria Campos, 1st Floor, Suite O, Capital Federal, Buenos Aires, 1426, Argentina, Tel +54-11-4-774-2930, Email
| | - Ronald M P C de Crom
- University Eye Clinic, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Michael Giovingo
- Department of Ophthalmology, Cook County Health, Chicago, Illinois, USA
| | - Marc Töteberg-Harms
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian A Francis
- Department of Ophthalmology, Doheny and Stein Eye Institutes, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brian Jerkins
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Jella An
- Department of Ophthalmology, Wilmer Eye Institute, John Hopkins School of Medicine, Bethesda, MD, USA
| | - Robert Noecker
- Department of Ophthalmology, School of Medicine, Yale University, New Haven, CT, USA
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ELGwaily AM, Khedr SA, Assaf AH, Latif MAMAL, Elsayed HA, Latif AAMAL. MicroPulse® transscleral laser therapy in the management of glaucoma patients. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:640-648. [PMID: 34844684 DOI: 10.1016/j.oftale.2020.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/15/2020] [Indexed: 06/13/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients. METHODS A prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18 mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period. RESULTS MicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18 mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session. At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9 ± 14.2%; and 6 months after the second session, it was 36.2 ± 17.5% (p < 0.001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was +1.9 ± 0.8 at 1 day, +1.0 ± 0.7 at 1 week, and +0.2 ± 0.4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (p < 0.001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6 ± 1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7 ± 1.2, and sustained at 6 months follow-up after the last treatment session (p < 0.001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT. CONCLUSIONS MicroPulse TLT is safe and effective in lowering IOP in a variety of glaucoma types and severity.
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Affiliation(s)
- A M ELGwaily
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt.
| | - S A Khedr
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt
| | - A H Assaf
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt
| | - M A M A L Latif
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt
| | - H A Elsayed
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt
| | - A A M A L Latif
- Departamento de Oftalmología, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egypt
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ELGwaily AM, Khedrrrr SA, Assaf AH, Latif MAMAL, Elsayed HA, Latif AAMAL. MicroPulse® transscleral laser therapy in the management of glaucoma patients. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(21)00055-1. [PMID: 33663921 DOI: 10.1016/j.oftal.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of MicroPulse® transscleral laser therapy (TLT) in the management of glaucoma patients. METHODS A prospective, interventional, non-comparative case series was conducted in the department of ophthalmology, Ain Shams University Hospital on 61 eyes of 46 patients with various glaucoma types and of severity, ranging from mild to severe. In addition to best-corrected visual acuity (BCVA), intraocular pressure (IOP) and the number of glaucoma medications were recorded before and after treatment, along with the postoperative need for systemic carbonic anhydrase inhibitors (CAI), success rates, number of treatment sessions and postoperative complications. Success was defined as an IOP of 6-18mmHg or at least a 30% decrease from preoperative IOP in the absence of any vision-threatening complications during the 6-month follow-up period. RESULTS MicroPulse TLT was performed on 61 glaucomatous eyes. Eleven of the 61 eyes (18%) that did not achieve IOP between 6-18mmHg, or at least a 30% decrease from baseline at 6 months, had a repeat MicroPulse TLT session. At 6 months follow-up post a single MicroPulse TLT session, the mean IOP reduction was 35.9±14.2%; and 6 months after the second session, it was 36.2±17.5% (P<.001). The success rate after the first session was 73.8% which increased to 78.7% after the second session. The mean anterior chamber (AC) cell reaction was+1.9±.8 at 1 day,+1.0±.7 at 1 week, and+.2±.4 at 1 month postoperatively. No cells were detected in any of the cases at 3 and 6 months follow-up (P<.001). The average number of anti-glaucoma eye drops before MicroPulse TLT was 2.6±1.0. Postintervention, the average number of anti-glaucoma eye drops was 1.7±1.2, and sustained at 6 months follow-up after the last treatment session (P<.001). There were no significant complications were noted. One eye developed transient hypotony for 3 months after MicroPulse TLT. CONCLUSIONS MicroPulse TLT is safe and effective in lowering IOP in a variety of glaucoma types and severity.
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Affiliation(s)
- Amr Mohamed ELGwaily
- Departamento de Oftalmologíat, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egipto.
| | - Shaker Ahmed Khedrrrr
- Departamento de Oftalmologíat, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egipto
| | - Ahmed Hassan Assaf
- Departamento de Oftalmologíat, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egipto
| | | | - Hassan Ahmad Elsayed
- Departamento de Oftalmologíat, Ain Shams University Hospitals, Ain Shams University, El Cairo, Egipto
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