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Tokumo K, Okada N, Onoe H, Komatsu K, Masuda S, Okumichi H, Hirooka K, Asaoka R, Kiuchi Y. Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:2525-2537. [PMID: 37662650 PMCID: PMC10473402 DOI: 10.2147/opth.s419765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma. Patients and Methods Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ -6 dB), moderate (-6 dB > MD ≥ -12 dB), and advanced (-12 dB > MD). Survival rates were calculated by subgroup. Results A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group. Conclusion Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.
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Affiliation(s)
- Kana Tokumo
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Naoki Okada
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiromitsu Onoe
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kaori Komatsu
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shun Masuda
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Asaoka
- Seirei Hamamatsu General Hospital Department of Ophthalmology, Shizuoka, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Okada A, Ikeda Kurakawa K, Harita Y, Shimizu A, Yamaguchi S, Aso S, Ono S, Hashimoto Y, Kumazawa R, Michihata N, Jo T, Matsui H, Fushimi K, Nangaku M, Yamauchi T, Yasunaga H, Kadowaki T. Comparison of bleeding complications after pediatric kidney biopsy between intravenous sedation and general anesthesia: a nationwide cohort study. BMC Pediatr 2023; 23:33. [PMID: 36670403 PMCID: PMC9854031 DOI: 10.1186/s12887-022-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND An increasing number of studies are evaluating the safety of intravenous sedation compared with that of general anesthesia; however, data on bleeding complications after pediatric percutaneous renal biopsy performed under intravenous sedation or general anesthesia are lacking. We aimed to examine differences in bleeding complications between intravenous sedation and general anesthesia in pediatric patients. METHODS Data of pediatric patients aged ≤ 15 years undergoing percutaneous kidney biopsy for kidney disease between July 2007 and March 2019 were retrieved from a national inpatient database in Japan. We examined differences in bleeding complications after renal biopsy performed under intravenous sedation, defined by the absence of the record of general anesthesia with intubation but by the presence of intravenous sedation during biopsy, and general anesthesia, defined by the presence of the record of general anesthesia with intubation during biopsy, among pediatric patients admitted for percutaneous renal biopsy. We performed binomial regression using overlap weights based on propensity scores for patients receiving intravenous sedation. Analyses stratified by age or sex, a sensitivity analysis using generalized estimating equations considering cluster effects by hospital among a propensity score-matched cohort, and another sensitivity analysis using the instrumental variable method were performed to confirm the robustness of the results. RESULTS We identified 6,560 biopsies performed in 5,999 children aged 1-15 years from 328 hospitals and 178 events. Only three severe complications and no death were observed. No significant difference in the proportion of bleeding complications was observed between procedures performed under intravenous sedation and those performed under general anesthesia (unadjusted proportions, 2.8% and 2.3%; adjusted proportions, 2.5% and 2.2%), with an unadjusted relative risk of 1.21 (95% confidence interval, 0.80-1.81) and adjusted relative risk of 1.13 (95% confidence interval, 0.74-1.73). Both age- and sex-stratified analyses yielded similar results. The analysis using generalized estimating equation and the instrumental variable method showed relative risks of 0.95 (95% confidence interval, 0.48-1.88) and 1.18 (95% confidence interval, 0.74-1.89), respectively. CONCLUSION This retrospective cohort study using a national database revealed that the risk of biopsy-related bleeding was comparable between intravenous sedation and general anesthesia during pediatric percutaneous kidney biopsy, suggesting that intravenous sedation alone and general anesthesia may have a similar bleeding risk in pediatric percutaneous kidney biopsies.
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Affiliation(s)
- Akira Okada
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Kayo Ikeda Kurakawa
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.419714.e0000 0004 0596 0617Department of Pediatrics, National Rehabilitation Center for Persons with Disabilities, Namiki, Saitama Japan
| | - Yutaka Harita
- grid.26999.3d0000 0001 2151 536XDepartment of Pediatrics, Graduate School of Medicine, the University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Akira Shimizu
- grid.410821.e0000 0001 2173 8328Department of Analytic Human Pathology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoko Yamaguchi
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shotaro Aso
- grid.26999.3d0000 0001 2151 536XDepartment of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- grid.26999.3d0000 0001 2151 536XDepartment of Eat-Loss Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Yohei Hashimoto
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan ,grid.45203.300000 0004 0489 0290Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nobuaki Michihata
- grid.26999.3d0000 0001 2151 536XDepartment of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- grid.26999.3d0000 0001 2151 536XDepartment of Health Services Research, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Respiratory Medicine, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- grid.265073.50000 0001 1014 9130Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaomi Nangaku
- grid.26999.3d0000 0001 2151 536XDivision of Nephrology and Endocrinology, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- grid.26999.3d0000 0001 2151 536XDepartment of Clinical Epidemiology and Health Economics, the University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- grid.26999.3d0000 0001 2151 536XDepartment of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Diabetes and Metabolism, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan ,grid.410813.f0000 0004 1764 6940Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, 105-8470 Tokyo, Japan
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Nakakura S, Asaoka R. Comparison of surgical outcomes between initial trabeculectomy and Ex-PRESS in terms of achieving an intraocular pressure below 15 and 18 mmHg: a retrospective comparative study. EYE AND VISION 2022; 9:9. [PMID: 35227315 PMCID: PMC8885135 DOI: 10.1186/s40662-022-00279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/29/2022] [Indexed: 12/03/2022]
Abstract
Background To evaluate the postoperative outcomes of initial trabeculectomy (Trab) and Ex-PRESS (EX) in terms of achieving an intraocular pressure (IOP) below 15 and 18 mmHg. Methods This study retrospectively analyzed 64 and 54 cases of Trab and EX, respectively, performed by the same surgeon with uniform management from April 2018 to March 2019. Surgical success was defined as 5 < IOP < 15 mmHg (criterion 1) and 5 < IOP < 18 mmHg (criterion 2) without additional glaucoma medication, needling, and bleb reconstruction 2 months after surgery. Survival analysis with Cox regression was performed to identify factors associated with postoperative outcomes. Results The Trab and EX groups had an IOP of 22.6 ± 6.2 vs. 21.8 ± 6.0 mmHg before surgery (P = 0.507), 12.6 ± 2.6 vs. 14.0 ± 4.4 mmHg (P = 0.06) at 6 months, 12.7 ± 2.3 vs. 12.9 ± 2.8 mmHg (P = 0.678) at 12 months, 13.3 ± 2.6 vs. 12.6 ± 2.8 mmHg (P = 0.260) at 18 months, and 13.2 ± 2.3 vs. 13.6 ± 2.8 mmHg (P = 0.444) at 24 months, respectively. The proportion of those with an IOP < 15 mmHg in the Trab and EX groups was 82% vs. 81% at 6 months, 68% vs. 62% at 12 months, 63% vs. 61% at 18 months, and 57% vs. 53% at 24 months, respectively. The log-rank test showed no significant difference between the groups for Criteria 1 (P = 0.755) and 2 (P = 0.138). The results of the multivariate logistic analysis identified only a high preoperative IOP as a risk factor for surgical failure (odds ratio for Criteria 1: 1.076, P = 0.009 and Criteria 2: 1.068, P = 0.048). Conclusion Postoperative outcomes of Trab and EX suggested similar ability for achieving an IOP below 15 and 18 mmHg without medications and interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-022-00279-1.
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Fujita A, Sakata R, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Aihara M. One-year costs of incisional glaucoma surgery and laser therapy. ANNALS OF CLINICAL EPIDEMIOLOGY 2022; 5:48-57. [PMID: 38505733 PMCID: PMC10944997 DOI: 10.37737/ace.23007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/04/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND This study aimed to calculate one-year total costs of incisional glaucoma surgery and laser therapy in a real-world clinical setting. METHODS We conducted a retrospective cohort study from July 2010 to March 2021 using the Diagnosis Procedure Combination database. We included patients hospitalized for incisional glaucoma surgery (trabeculectomy, trabeculotomy, tube shunt surgery, Ex-PRESS surgery, or iStent implantation) or laser therapy (laser peripheral iridotomy, surgical iridectomy, laser trabeculoplasty, cyclocryotherapy, or cyclophotocoagulation). The outcomes were total costs, including costs of hospitalization, re-admissions, antiglaucoma drugs, ophthalmic examinations, and outpatient visits for incisional glaucoma surgery and laser therapy within one year. RESULTS We identified 49,202 eligible hospitalizations. The one-year median total cost was 707,497 yen [interquartile range: 546,887-944,664 yen]. The median total cost was the highest in patients undergoing tube shunt surgery, followed by Ex-PRESS surgery, iStent implantation, and trabeculectomy. The number and cost of postoperative outpatient visits and length of hospital stay were higher in patients who underwent trabeculectomy and Ex-PRESS surgery than in those after tube shunt surgery. The total costs of laser therapies were lower than those of incisional glaucoma surgeries. The total cost was the highest in the 0-19 age group (856,398 [649,419-1,258,844] yen). CONCLUSIONS Tube shunt surgery was the costliest in terms of total one-year costs. Trabeculectomy and Ex-PRESS surgery were associated with long hospital stays and incurred high postoperative costs. The costs of laser therapies were relatively low. However, cost-effectiveness of laser therapies compared with incisional surgeries needs to be analyzed in future research.
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Affiliation(s)
- Asahi Fujita
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
| | - Yohei Hashimoto
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo
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Otsuka M, Tojo N, Hayashi A. Risk factors for Ex-Press ® surgery failure. Int Ophthalmol 2022; 43:1657-1663. [PMID: 36227402 DOI: 10.1007/s10792-022-02554-5] [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: 05/25/2022] [Accepted: 10/07/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the risk factors for Ex-Press® (EXP) surgery failure. PATIENTS AND METHODS This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed up ≥ 5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open-angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP + cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a postoperative reduction in the IOP ≥ 20% from the preoperative IOP and ≤ 18 mmHg. We determined the risk factors using multivariate cox regression models. RESULTS Performing EXP significantly decreased the IOP (preoperative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p values of the factors were age (p = 0.936), gender (p = 0.0587), hypertension (p = 0.409), DM (p = 0.967), previous glaucoma surgery (p = 0.940), type of glaucoma (p = 0.435) surgical methods (p = 0.521), CCT (p = 0.091), and preoperative IOP (p = 0.082). CONCLUSIONS No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for primary open-angle glaucoma and pseudo-exfoliation glaucoma.
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Affiliation(s)
- Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
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Long-Term Changes in Corneal Endothelial Cell Density after Ex-PRESS Implantation: A Contralateral Eye Study. J Clin Med 2022; 11:jcm11195555. [PMID: 36233423 PMCID: PMC9572056 DOI: 10.3390/jcm11195555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/10/2022] [Accepted: 09/18/2022] [Indexed: 11/17/2022] Open
Abstract
Our purpose is to evaluate long-term changes in corneal endothelial cells after Ex-PRESS shunt implantation for the treatment of glaucoma in Chinese patients by comparison with the contralateral eye. In this retrospective observational study, glaucoma patients with a single eye undergoing Ex-PRESS shunt implantation surgery were consecutively enrolled. For each patient, the clinical assessment, including corneal endothelial cell density (CECD) before surgery and at 6, 12 months, and at last follow-up (2.43 ± 0.63 years) after surgery was reviewed. The operated eyes were in the study group and the unoperated contralateral eyes were used as the control group to compare the CECD change. A total of 48 subjects (age, 51.02 ± 17.96 years) were included. The follow-up period was 2.08~3.17 years, with an average of 2.43 ± 0.63 years. At the last follow-up after the surgery, the CECD decrease in the operated eyes (5.0%) was similar to that in the contralateral eyes (3.2%) (p = 0.130). There were no significant differences in CECD reduction between the two groups at baseline and each postoperative follow-up (6 months, 12 months and at the last follow-up) (all p > 0.05). The average IOP reduction after the surgery was 50.8%, and the number of IOP-lowering medications was significantly reduced (p < 0.05). In addition, visual acuity showed no significant differences during follow-up (p > 0.05). In this study, we found that the CECD reduction of Ex-PRESS shunt-implanted Chinese eyes was similar to that of contralateral eyes without surgery.
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Marolo P, Reibaldi M, Fallico M, Maugeri A, Barchitta M, Agodi A, Parisi G, Caselgrandi P, Ventre L, Ahmed IIK. Reintervention rate in glaucoma filtering surgery: A systematic review and meta-analysis. Eur J Ophthalmol 2022; 32:2515-2531. [PMID: 35473447 DOI: 10.1177/11206721221093828] [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: 11/15/2022]
Abstract
PURPOSE Reintervention rate is an important factor impacting on patients, surgeons, and society. To date, only a few studies have focused on this topic. For this reason, a systematic review and meta-analysis was undertaken to assess the reintervention rate after glaucoma filtering surgery. MATERIALS AND METHODS Prospective studies reporting the reintervention rate after glaucoma filtering surgery and with at least 12 months of follow-up were systematically searched on PubMed, Medline and Embase databases. The primary outcome was the total reintervention rate following surgery. Secondary outcomes were: the rate of manipulation, in-clinic and in-operating room reintervention; the reintervention rate for intraocular pressure (IOP) control and for complications; demographic, clinical and surgical variables associated with reintervention rate. RESULTS Ninety-three studies with a total of 8345 eyes were eligible. The total reintervention rate was 1.84 (95% CI 1.57-2.13), with a lower rate for Baerveldt (0.53, 95% CI 0.29-0.83) and Preserflo (0.60, 95% CI 0.15-1.29), and a higher rate for Xen (4.26, 95% CI 2.59-6.31). The manipulation rate was 0.99 (95% CI 0.77-1.23), the in-clinic reintervention rate was 0.08 (95% CI 0.05-0.12) and the in-operating room reintervention rate was 0.28 (95% CI 0.22-0.35). The reintervention rate for IOP control was 1.26 (95% CI 1.04-1.51) and the reintervention rate for complications was 0.27 (95% CI 0.21-0.35). CONCLUSIONS All types of surgery presented a total reintervention rate similar to the overall findings, except studies on Baerveldt and Preserflo Microshunt, with a lower rate, and Xen, with a higher rate. None of the variables evaluated were found to be directly associated with the explored outcomes.
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Affiliation(s)
- Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, 9298University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Luca Ventre
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology & Vision Sciences, 7938University of Toronto, Toronto, Ontario, Canada
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