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Ahmed I, Wakabayashi T, Gonzales AF, Ong SS, Light JG, Handa JT, Yonekawa Y, Scott AW. SURGICAL OUTCOMES OF RETINAL DETACHMENT ASSOCIATED WITH PROLIFERATIVE SICKLE CELL RETINOPATHY. Retina 2024; 44:1565-1571. [PMID: 39167578 DOI: 10.1097/iae.0000000000004145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To evaluate the long-term anatomic and visual outcomes in eyes with sickle cell retinopathy-related retinal detachments (RDs). METHODS Patients who underwent surgery for sickle cell retinopathy-related RDs at the Wilmer Eye Institute or Wills Eye Hospital between 2008 and 2020 and followed for at least 6 months postoperatively were retrospectively reviewed. The primary outcome was the rate of single-surgery anatomic success and final reattachment. RESULTS This study included 30 eyes from 28 patients (16 women and 12 men) with tractional RD (n = 13), rhegmatogenous RD (n = 1), and combined tractional RD/rhegmatogenous RD (n = 16). Mean age was 42.1 ± 15.1 years. The mean follow-up duration was 47.8 ± 34.1 months. Twenty-five (83.3%) eyes underwent pars plana vitrectomy and five (16.7%) eyes underwent pars plana vitrectomy with scleral buckling. Single-surgery anatomic success was achieved in 21 (70.0%) eyes at 6 months. Final reattachment was achieved in 28 (93.3%) eyes (22 eyes [73.3%] without tamponade). Recurrence of RDs was significantly associated with male gender (P = 0.041), absence of previous laser (P = 0.032), iatrogenic breaks (P = 0.035), retinectomy (P = 0.034), and silicone oil tamponade (P = 0.024). Overall, the logarithm of the minimum angle of resolution visual acuity improved from 1.53 ± 0.57 (Snellen equivalent, 20/678) to 1.15 ± 1.01 (20/283) at the final visit (P = 0.03); however, eyes with recurrent RD did not achieve significant visual improvement. CONCLUSION Pars plana vitrectomy to repair sickle cell retinopathy-related RDs was effective in achieving anatomic success and improving vision in most eyes. Single-surgery anatomic success is critical for optimizing visual outcomes.
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Affiliation(s)
| | - Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Sally S Ong
- Wilmer Eye Institute, Baltimore, Maryland
- Wake Forest School of Medicine, Med Center Boulevard, Winston-Salem, North Carolina
| | - Jacob G Light
- Wilmer Eye Institute, Baltimore, Maryland
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
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Rohowetz LJ, Shaheen A, Magraner M, Flynn HW, Williams BK, Smiddy WE, Sridhar J, Russell JF, Townsend JH, Berrocal AM, Albini T, Yannuzzi NA. SURGICAL OUTCOMES IN CONCURRENT SICKLE CELL AND DIABETIC RETINOPATHY. Retina 2024; 44:1560-1564. [PMID: 39167577 DOI: 10.1097/iae.0000000000004156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To report the clinical features and outcomes in eyes that underwent vitreoretinal surgery for complications of concurrent sickle cell retinopathy and diabetic retinopathy. METHODS Retrospective, consecutive case series of all eyes that underwent vitreoretinal surgery for complications secondary to concurrent sickle cell retinopathy and diabetic retinopathy between January 01, 2014, and December 31, 2021. RESULTS The study included 20 eyes of 14 patients. Indications for surgery included tractional retinal detachment in 12 eyes (60%), combined tractional retinal detachment/rhegmatogenous retinal detachment in 6 eyes (30%), and vitreous hemorrhage in 2 eyes (10%). Pars plana vitrectomy was performed in all eyes. One eye received a scleral buckle at the same time as pars plana vitrectomy. There was no change in mean best-corrected visual acuity at the last follow-up examination (1.5 [20/678]) when compared with mean preoperative best-corrected visual acuity (1.6 [20/762], P = 0.83). Preoperative best-corrected visual acuity correlated with postoperative best-corrected visual acuity at the last follow-up examination in eyes with retinal detachment (r = 0.49, P = 0.04). Single operation anatomic success was achieved in 11 of 17 eyes (65%) with retinal detachment. CONCLUSION Functional and anatomic outcomes after surgery in eyes with concurrent sickle cell retinopathy and diabetic retinopathy are relatively poor.
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Affiliation(s)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Abdulla Shaheen
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Maria Magraner
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Jayanth Sridhar
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | | | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Thomas Albini
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida; and
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Rohowetz LJ, Panneerselvam S, Williams BK, Smiddy WE, Berrocal AM, Townsend JH, Gayer S, Palte HD, Flynn HW. Proliferative Sickle Cell Retinopathy: Outcomes of Vitreoretinal Surgery. Ophthalmol Retina 2024; 8:832-837. [PMID: 38302055 PMCID: PMC11291710 DOI: 10.1016/j.oret.2024.01.023] [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: 10/07/2023] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE To report the clinical presentation and outcomes in patients who underwent surgery for proliferative sickle cell retinopathy (PSCR). DESIGN Retrospective, consecutive case series. SUBJECTS All patients who underwent vitreoretinal surgery for complications secondary to PSCR between January 1, 2014, and December 31, 2021, at a university referral center. METHODS Retrospective consecutive case series. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA), single operation anatomic success rate. RESULTS The study included 65 eyes of 61 patients. Disease distribution included 24 (44.4%) eyes with hemoglobin SC disease, 14 (25.9%) with hemoglobin SS disease, 13 (24.1%) with sickle cell trait, and 3 (5.6%) with sickle cell-β thalassemia. Preoperative transfusion was not performed in any study patients. Regional anesthesia with monitored anesthesia care (RA-MAC) was utilized in 58 (89.2%) eyes and general anesthesia in 7 (10.8%). In eyes that underwent surgery for retinal detachment (RD; N = 52) the rate of single operation anatomic success was 72.4% with combined scleral buckling/pars plana vitrectomy (SB/PPV; N = 29) compared with 47.8% with PPV alone (N = 23; P = 0.07). Mean BCVA at the last follow-up examination was 1.27 (20/372) in the SB/PPV group and 1.05 (20/226) in the PPV group (P = 0.48). In all SB cases, an encircling band was utilized and there were no known cases of anterior segment ischemia. All eyes that had surgery for vitreous hemorrhage (N = 13) underwent PPV with endolaser and mean BCVA improved from 1.67 (20/944) preoperatively to 0.45 (20/56) at last follow-up examination (P < 0.001). Mean preoperative BCVA, indication for surgery, single operation success rate, and mean BCVA at last follow-up examination did not differ based on sickle cell disease type (P > 0.05). CONCLUSIONS In patients with RD, SB/PPV achieved slightly higher rates of single operation anatomic success compared with PPV alone. Visual acuity outcomes were similar in the 2 groups. The majority of patients received RA-MAC anesthesia and preoperative transfusions were not performed. There were no cases of postoperative anterior segment ischemia. Hemoglobin SC disease was the most common disease type in the current study and surgical outcomes did not differ between sickle cell disease types. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Landon J Rohowetz
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Sugi Panneerselvam
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Basil K Williams
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Audina M Berrocal
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Justin H Townsend
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Steven Gayer
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Howard D Palte
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida
| | - Harry W Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida.
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Taylor C, Awadzi R, Enoch J, Dinah C. Proliferative Sickle Cell Retinopathy: A Patient and a Physician's Perspective on Quality of Life and Quality of Eye Care. Ophthalmol Ther 2024; 13:851-860. [PMID: 38345709 PMCID: PMC10912386 DOI: 10.1007/s40123-024-00893-3] [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: 12/26/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024] Open
Abstract
The impact of visual impairment in the context of sickle cell disease is poorly understood. Despite the significant advancements over the past three decades in retinal imaging and in the understanding of molecular mechanisms that drive retinal neovascularization, there has been little improvement in the management of proliferative sickle cell retinopathy. This article is co-authored by a patient impacted by proliferative sickle cell retinopathy. She highlights her personal experience of sight loss from proliferative sickle cell retinopathy and the impact on her daily life and mental health. Subsequent to diagnosis and management of proliferative sickle cell retinopathy, she continues to live with irreversible sight loss and provides crucial insight from a patient's perspective into the broad lack of high-quality educational materials online and lack of understanding of the disease within the clinical community. This article aims to provide a strong narrative to emphasize the need for further qualitative and quantitative research in this area, to bring about the holistic step-change required to improve visual outcomes and eyecare for people with sickle cell disease.
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Affiliation(s)
| | - Rossby Awadzi
- London Northwest University Healthcare Trust, London, UK
| | - Jamie Enoch
- School of Health and Psychological Sciences, City, University of London, London, UK
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Okonkwo ON, Hassan AO, Oyekunle I, Akanbi T, Agweye C. Visual outcome of treating proliferative sickle cell retinopathy in 108 eyes. Eur J Ophthalmol 2024; 34:558-565. [PMID: 37670511 DOI: 10.1177/11206721231199273] [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] [Indexed: 09/07/2023]
Abstract
AIM To report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR). DESIGN Retrospective interventional. METHODS Review of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed. RESULTS 108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05). CONCLUSION Several options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.
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Affiliation(s)
- Ogugua Ndubuisi Okonkwo
- Department of Ophthalmology, Eye Foundation Retina Institute, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Adekunle Olubola Hassan
- Department of Ophthalmology, Eye Foundation Retina Institute, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Idris Oyekunle
- Department of Ophthalmology, Eye Foundation Hospital, Lagos, Nigeria
| | - Toyin Akanbi
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - Chineze Agweye
- Ophthalmology Department, University of Calabar Teaching Hospital, Cross River, Nigeria
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Dinah C, Balaskas K, Greystoke B, Awadzi R, Beke P, Ahern R, Talks J. Sickle Eye Project: a cross-sectional, non-interventional study of the prevalence of visual impairment due to sickle cell retinopathy and maculopathy in the UK. BMJ Open 2024; 14:e082471. [PMID: 38418238 PMCID: PMC10910489 DOI: 10.1136/bmjopen-2023-082471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is one of the most common genetic disorders in the UK, with over 15 000 people affected. Proliferative sickle cell retinopathy (SCR) is a well-described complication of SCD and can result in significant sight loss, although the prevalence in the UK is not currently known. There are currently no national screening guidelines for SCR, with wide variations in the management of the condition across the UK. METHODS AND ANALYSIS The Sickle Eye Project is an epidemiological, cross-sectional, non-interventional study to determine the prevalence of visual impairment due to SCR and/or maculopathy in the UK. Haematologists in at least 16 geographically dispersed hospitals in the UK linked to participating eye clinics will offer study participation to consecutive patients meeting the inclusion criteria attending the sickle cell clinic. The following study procedures will be performed: (a) best corrected visual acuity with habitual correction and pinhole, (b) dilated slit lamp biomicroscopy and funduscopy, (c) optical coherence tomography (OCT), (d) OCT angiography where available, (e) ultrawide fundus photography, (f) National Eye Institute Visual Function Questionnaire-25 and (g) acceptability of retinal screening questionnaire. The primary outcome is the proportion of people with SCD with visual impairment defined as logarithm of the minimum angle of resolution ≥0.3 in at least one eye. Secondary outcomes include the prevalence of each stage of SCR and presence of maculopathy by age and genotype; correlation of stage of SCR and maculopathy to severity of SCD; the impact of SCR and presence of maculopathy on vision-related quality of life; and the acceptability to patients of routine retinal imaging for SCR and maculopathy. ETHICS AND DISSEMINATION Ethical approval was obtained from the South Central-Oxford A Research Ethics Committee (REC 23/SC/0363). Findings will be reported through academic journals in ophthalmology and haematology.
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Affiliation(s)
- Christiana Dinah
- Ophthalmology, London North West Healthcare NHS Trust, Harrow, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | | | - Rossby Awadzi
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | | | - James Talks
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Action on sickle cell retinopathy: the time is now. Eye (Lond) 2022; 36:1138-1139. [PMID: 35087214 PMCID: PMC9151806 DOI: 10.1038/s41433-021-01918-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
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Surgical and Medical Perioperative Management of Sickle Cell Retinopathy: A Literature Review. Int Ophthalmol Clin 2020; 60:77-87. [PMID: 33093318 DOI: 10.1097/iio.0000000000000323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Walkden A, Griffin B, Cheng C, Dhawahir-Scala F. Gross anterior segment ischaemia following vitreoretinal surgery for sickle-cell retinopathy. BMJ Case Rep 2019; 12:12/1/e227541. [PMID: 30700461 DOI: 10.1136/bcr-2018-227541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 32-year-old Afrocaribbean man with known stage 3 proliferative sickle-cell retinopathy who presented with a mixed picture of tractional and rhegmatogenous macula off detachment. He underwent left primary 25 g vitrectomy with silicone oil, delamination and endolaser photocoagulation under a general anaesthetic. He, however, presented 48 hours postoperatively with gross anterior segment ischaemia. His pain and ocular signs settled over the course of a few days following administration of supplemental oxygen, oral steroids, analgesia and intravenous hydration. Examination showed resolution of his proptosis and orbital signs as well as anterior segment inflammation. He remains under follow-up.
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Affiliation(s)
- Andrew Walkden
- Vitreo-retinal Unit, Manchester Royal Eye Hospital, Manchester, UK
| | - Benjamin Griffin
- Manchester University NHS Foundation Trust, Manchester Royal Eye Hospital, Manchester, UK
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Tang MS, Zhang SQ, Ma LW. Comparison of postoperative ciliary body changes associated with the use of 23-gauge and 20-gauge system for pars plana vitrectomy. BMC Ophthalmol 2018; 18:262. [PMID: 30305073 PMCID: PMC6180526 DOI: 10.1186/s12886-018-0925-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background To compare the ciliary body changes associated with the use of 23-gauge (23G) and 20-gauge (20G) systems for pars plana vitrectomy. Methods A total of 60 patients (60 eyes) with idiopathic epiretinal membrane who were scheduled for surgical treatment were selected and randomly assigned to 20G group or 23G group. Time required for incision making, vitrectomy, and incision closure was compared between the two groups. Changes in ciliary body were evaluated by ultrasound microscopy (UBM). Anterior chamber inflammation was assessed with laser flare meter instrument. Results Incision-making time (4.5 ± 0.9 min) and incision-closure time (2.8 ± 0.7 min) in the 23G group were significantly shorter than those in the 20G group (10.1 ± 1.5 min and 11.3 ± 2.2 min, respectively). No significant intergroup difference was observed with respect to time required for vitrectomy (21.6 ± 3.3 min and 20.7 ± 3.2 min, respectively). Ciliary body thickness in the 23G group recovered back to preoperative levels after 4 weeks, as against 8 weeks in the 20G group. Postoperative ciliary body thickness in the 20G group was significantly higher than that in the 23G group (p < 0.05). The aqueous protein concentration in 23G group recovered back to preoperative levels after 2 weeks, as against 4 weeks in the 20G group. Postoperative aqueous protein concentration in the 20G group was significantly higher than that in the 23G group (p < 0.05). Conclusions The use of 23G system was associated with significantly milder injury to the ciliary body as compared to that associated with the use of 20G system. Trial registration The study was retrospectively registered on Chinese Clinical Trial Registry. The clinical study registration number was ChiCTR-INR-17011082. Date of registration: 2017-04-07.
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Affiliation(s)
- Meng-Su Tang
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, No. 11 Xinhua Road, Heping District, Shenyang, 110004, Liaoning Province, China
| | - Shu-Qi Zhang
- Department of Ophthalmology, the 463 Hospital of the Chinese People's Liberation Army, Shenyang, 110021, Liaoning Province, China
| | - Li-Wei Ma
- Department of Ophthalmology, the Fourth Affiliated Hospital of China Medical University, No. 11 Xinhua Road, Heping District, Shenyang, 110004, Liaoning Province, China.
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