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Hui J, Nie X, Wei P, Deng J, Kang Y, Tang K, Han G, Wang L, Liu W, Han Q. 3D printed fibroblast-loaded hydrogel for scleral remodeling to prevent the progression of myopia. J Mater Chem B 2024; 12:2559-2570. [PMID: 38362614 DOI: 10.1039/d3tb02548a] [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: 02/17/2024]
Abstract
Pathologic myopia has seriously jeopardized the visual health of adolescents in the past decades. The progression of high myopia is associated with a decrease in collagen aggregation and thinning of the sclera, which ultimately leads to longer eye axis length and image formation in front of the retina. Herein, we report a fibroblast-loaded hydrogel as a posterior scleral reinforcement (PSR) surgery implant for the prevention of myopia progression. The fibroblast-loaded gelatin methacrylate (GelMA)-poly(ethylene glycol) diacrylate (PEGDA) hydrogel was prepared through bioprinting with digital light processing (DLP). The introduction of the PEGDA component endowed the GelMA-PEGDA hydrogel with a high compression modulus for PRS surgery. The encapsulated fibroblasts could consistently maintain a high survival rate during 7 days of in vitro incubation, and could normally secrete collagen type I. Eventually, both the hydrogel and fibroblast-loaded hydrogel demonstrated an effective shortening of the myopic eye axis length in a guinea pig model of visual deprivation over three weeks after implantation, and the sclera thickness of myopic guinea pigs became significantly thicker after 4 weeks, verifying the success of sclera remodeling and showing that myopic progression was effectively controlled. In particular, the fibroblast-loaded hydrogel demonstrated the best therapeutic effect through the synergistic effect of cell therapy and PSR surgery.
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Affiliation(s)
- Jingwen Hui
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Xiongfeng Nie
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Pinghui Wei
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Jie Deng
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yuanzhe Kang
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Kexin Tang
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Guoge Han
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
| | - Ling Wang
- State Key Laboratory of Medicinal Chemical Biology, College of Pharmacy, Nankai University, Tianjin 300071, China
| | - Wenguang Liu
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Quanhong Han
- Tianjin Eye Hospital, No. 4 Gansu Road, Heping District, Tianjin 300020, China.
- Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin, China
- Clinical College of Ophthalmology Tianjin Medical University, Tianjin Medical University, Tianjin, China
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He Q, Wang X, Shi Q, Xie C, Xue A, Wei R. Posterior scleral reinforcement for the treatment of myopic traction maculopathy. BMC Ophthalmol 2022; 22:273. [PMID: 35729520 PMCID: PMC9215056 DOI: 10.1186/s12886-022-02497-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the clinical effectiveness of posterior scleral reinforcement(PSR) for the treatment of myopic traction maculopathy (MTM). Methods This was a prospective study of 32 eyes from 20 patients with MTM treated with PSR using genipin-cross-linked donor sclera. The length of the scleral strip used for the surgery was designed to be 1.5-times the axial length of the eye, whereas its width was 0.4-times the axial length of the eye. The optical coherence tomography images, spherical equivalent of refractive error, axial length, best corrected visual acuity, electroretinogram findings, and intraocular pressure of the patients were assessed postoperatively. Results The mean duration of follow-up was 17.80 ± 8.74 months. The differences between the spherical equivalent of refractive error, best corrected visual acuity, axial length, and electroretinogram findings recorded preoperatively and those measured postoperatively were statistically significant (p < 0.05). The final reduction in axial length was 1.64 ± 0.85 mm. At the end of the follow-up, optical coherence tomography showed essential foveal reattachment in 30 eyes (93.75%), partial reattachment in two eyes (6.25%), and closure of macular holes in seven eyes (77.78%). No retinal detachment, vitreous haemorrhage, or other serious complications occurred following the surgery. Conclusions Posterior scleral reinforcement with genipin-cross-linked sclera showed safe and effective outcomes for the treatment of MTM during a follow-up period of at least one year. Trial registration 11\12\2018, ChiCTR1800020012. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-022-02497-6.
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Affiliation(s)
- Qing He
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No.251, Fukang Road, Nankai District, Tianjin, 300384, China
| | - Xiu Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No.251, Fukang Road, Nankai District, Tianjin, 300384, China
| | - Qianhui Shi
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No.251, Fukang Road, Nankai District, Tianjin, 300384, China
| | - Caiyuan Xie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No.251, Fukang Road, Nankai District, Tianjin, 300384, China
| | - Anquan Xue
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ruihua Wei
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No.251, Fukang Road, Nankai District, Tianjin, 300384, China.
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Zhu S, Xue A, Li H, Ye J, Pan A, Zheng J, Xu G. Posterior scleral contraction to treat myopic traction maculopathy at different stages. Am J Transl Res 2022; 14:389-395. [PMID: 35173857 PMCID: PMC8829633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/17/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We aimed to evaluate anatomical and functional outcomes and determine posterior scleral contraction (PSC) timing in treating myopic traction maculopathy (MTM). METHODS This is a retrospective study of MTM patients undergoing PSC with genipin cross-linked strip at a single hospital site. Differences in demographic and clinical characteristics were compared among three groups defined by the MTM staging system. All patients were followed up for at least one year postoperatively. The best-corrected visual acuity (BCVA), macular hole diameter, axial length (AL), optical coherence tomography findings, and the complications were evaluated. Additionally, regression analyses were performed to account for confounders. RESULTS Sixty-one MTM patients (24 eyes at stage 2, 22 eyes at stage 3, and 18 eyes at stage 4) were included. The macular holes were closed in 16 eyes (66.7%), 13 eyes (59.0%), and 11 eyes (61.1%) at stage 2, stage 3, and stage 4, respectively. PSC improved the BCVA in patients at each stage (all P < 0.05). Postoperative BCVA at stage 2 was significantly better than that at stage 4 (P = 0.0069). Preoperative BCVA was associated with postoperative BCVA (P < 0.001). Preoperative AL (OR 0.676, 95% CI 0.480 to 0.951, P = 0.025), AL shortening amount (OR 5.129, 95% CI 1.974 to 13.327, P = 0.001) and macular hole diameter (OR 1.003, 95% CI 1.000 to 1.006, P = 0.030) were associated with macular hole closure. CONCLUSIONS PSC is safe and effective in treating MTM at different stages. Early PSC intervention will have more significant visual benefits.
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Affiliation(s)
- Shuangqian Zhu
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow UniversitySuzhou, P. R. China
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
| | - Anquan Xue
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
| | - Haoyu Li
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
- Glaucoma Research Institute, Wenzhou Medical UniversityWenzhou, P. R. China
- National Clinical Research Center for Ocular DiseasesWenzhou, P. R. China
| | - Jie Ye
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
| | - Anpeng Pan
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
| | - Jingwei Zheng
- The Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical UniversityWenzhou, P. R. China
| | - Guoxu Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow UniversitySuzhou, P. R. China
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Ye J, Wu Y, Zhu S, Dong L, Qu J, Lu F, Xue A. EVALUATION OF THE EFFICACY OF POSTERIOR SCLERAL CONTRACTION IN THE TREATMENT OF MACULAR HOLE WITH RETINAL DETACHMENT IN HIGH MYOPIA. Retina 2021; 41:1874-1882. [PMID: 33492081 DOI: 10.1097/iae.0000000000003126] [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: 11/25/2022]
Abstract
PURPOSE To evaluate efficacy of posterior scleral contraction for macular hole with retinal detachment in high myopia. METHODS Seventy-three macular hole with retinal detachment eyes were treated with posterior scleral contraction. A strip was sent across inferior-temporal scleral surface to posterior pole, then two ends were led out from nasal-inferior to temporal-superior areas. It was tightened to contract posterior sclera with designed axial length shortening ([10% of preoperative axial length-0.5] mm) after aqueous humor was drained from anterior chamber. Recovery was classified as type I (retinal reattachment with MH bridged) and II (retinal reattachment without MH bridged). Follow-up duration was 25.3 ± 18.0 months. RESULTS Axial length was 30.01 ± 2.27 mm at preoperation and shortened by 2.57 ± 0.82 mm intraoperatively. At final postoperation, maintained axial length shortening was 1.87 ± 0.92 mm. Forty-six eyes (63.0%) recovered as type I, 26 eyes (35.6%) as type II, and 1 eye (1.4%) unrecovered. Postoperative best-corrected visual acuity (logarithm of minimal angle of resolution) was better than preoperative one (0.85 ± 0.50 [Snellen 20/125] vs. 1.11 ± 0.56 [Snellen 20/250], P < 0.001) with correlation (r = 0.662, P < 0.001) and consistency (Kappa = 0.34, P < 0.001) between two. Best-corrected visual acuity improvement did not differ between recovery types (P = 0.206). CONCLUSION Macular hole with retinal detachment was successfully recovered by posterior scleral contraction with axial length shortening. Visual improvement was achieved, correlated, and consistent with preoperative best-corrected visual acuity while independent of recovery types.
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Affiliation(s)
- Jie Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, China
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Abstract
PURPOSE To evaluate the efficacy of posterior scleral contraction to treat myopic foveoschisis (MF). METHODS The records of MF patients treated with posterior scleral contraction were reviewed. During posterior scleral contraction, a cross-linked fusiform strip from allogeneic sclera was used and designed axial length (AL) shortening amount was around 2.0∼3.0 mm based on preoperative AL. The middle part of the strip was placed at the posterior pole of the eye. After few aqueous humors were released, the strip was tightened to contract posterior sclera and shorten AL. Clinical data were collected at pre-operation (op) and post-op follow-ups for 12 months. RESULTS Twenty-four eyes were collected. The AL at pre-op, post-op 1-week, 3-month, 6-month, and 12-month were 29.84 ± 1.24, 27.39 ± 1.32, 27.73 ± 1.23, 27.86 ± 1.26, and 27.91 ± 1.29 mm. There was no AL difference between post-op 6-month and 12-month (P = 0.242). The accumulated MF reattachment rate at post-op 1-week, 3-month, 6-month, and 12-month were 8.3%, 16.7%, 50.5%, and 95.8%. The best-corrected visual acuity at post-op 6-month and 12-month were 0.71 ± 0.39 (Snellen acuity 20/80) and 0.64 ± 0.37 (Snellen acuity 20/63), improving significantly compared with pre-op (P = 0.006 and <0.001). CONCLUSION The posterior scleral contraction was effective to treat MF. The AL stabilized after post-op 6-month and MF reattached gradually with improved visual acuity up to post-op 12-month.
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Zhang P, Ye CX, Hou LX, Hao YH, Wang K, Shang QL. A pilot study on vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis-2y follow-up results. Int J Ophthalmol 2021; 14:263-268. [PMID: 33614456 DOI: 10.18240/ijo.2021.02.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/25/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of vitrectomy combined with scleral shortening for eyes with myopic macular retinoschisis. METHODS Thirty-seven patients with myopic macular retinoschisis who underwent pars plana vitrectomy (PPV) combined with scleral shortening were reviewed. Axial length (AL), the height of macular retinoschisis, the height of retinal detachment if existed, the diameter of macular hole if existed and best corrected visual acuity (BCVA) were obtained. The preoperative and postoperative parameters were compared. RESULTS At postoperative 24mo, the mean AL and height of macular retinoschisis were reduced significantly by 0.79 mm and 256.51 µm (t=8.064, P<0.0001; Z=-5.086, P<0.0001) respectively. In addition, the mean height of retinal detachment and diameter of macular hole were also reduced significantly by 365.38 µm and 183.68 µm (Z=-4.457, P=0.000008; Z=-2.983, P=0.003) respectively. Meanwhile, the postoperative BCVA was improved markedly (Z=-2.126, P=0.033). CONCLUSION Vitrectomy combined with scleral shortening is an effective surgical method for eyes with myopic macular retinoschisis, whether or not macular hole and retinal detachment are present.
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Affiliation(s)
- Peng Zhang
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Cun-Xi Ye
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Ling-Xin Hou
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Yu-Hua Hao
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Kun Wang
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
| | - Qing-Li Shang
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Xue A, Zheng L, Tan G, Wu S, Wu Y, Cheng L, Qu J. Genipin-Crosslinked Donor Sclera for Posterior Scleral Contraction/Reinforcement to Fight Progressive Myopia. Invest Ophthalmol Vis Sci 2019; 59:3564-3573. [PMID: 30025077 DOI: 10.1167/iovs.17-23707] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Myopia has become a global public health problem, particularly in East Asia where myopic retinopathy has become one of the leading causes of blindness and visual impairment in the elderly population. The purpose of this study was to evaluate the efficacy of posterior scleral contraction/reinforcement (PSCR) surgery on controlling the progressive elongation of axial length of highly myopic eyes in young patients. Methods This is a prospective self-controlled interventional case series. Forty young patients (<18-years old) with progressive high myopia received PSCR with a genipin-crosslinked donor scleral strip for one eye and the fellow eye served as concurrent control without surgery. The main outcome measurement was the change of axial length over 2 to 3 years of follow-up. Results Immediately after the surgery, axial length was shortened and subsequently increased by 0.32 mm over the follow-up period. In contrast, axial length of the fellow eyes increased by 0.82 mm over the same period (P < 0.001, paired t-test). PSCR delayed axial elongation in eyes with or without staphyloma. No significant change of visual acuity, cornea refractive power, or retina thickness was noted between the surgery and fellow eyes. None of the patients lost visual acuity compared with the baseline. The procedure was well tolerated with only temporary corneal refractive axis shifts that recovered by the 6-month postsurgical visit. Conclusions PSCR with genipin-crosslinked sclera is safe and effective to restrain eye globe elongation in young patients within a 2- to 3-year follow-up period.
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Affiliation(s)
- Anquan Xue
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical College, Zhejiang, China
| | - Linyan Zheng
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical College, Zhejiang, China
| | - Guilin Tan
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Shaoqun Wu
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Yue Wu
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China
| | - Lingyun Cheng
- Institute of Ocular Pharmacology, School of Ophthalmology and Optometry, Wenzhou Medical University, Zhejiang, China.,Jacob's Retina Center at Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, San Diego, California, United States
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical College, Zhejiang, China
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POSTERIOR SCLERAL CONTRACTION TO TREAT RECURRENT OR PERSISTENT MACULAR DETACHMENT AFTER PREVIOUS VITRECTOMY IN HIGHLY MYOPIC EYES. Retina 2019; 39:193-201. [DOI: 10.1097/iae.0000000000002217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Su Y, Pan A, Wu Y, Zhu S, Zheng L, Xue A. The efficacy of posterior scleral contraction in controlling high myopia in young people. Am J Transl Res 2018; 10:3628-3634. [PMID: 30662614 PMCID: PMC6291706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the clinical effectiveness and safety of posterior scleral contraction (PSC) surgery in controlling high myopia in young people. METHODS Twenty patients with high myopia (30 eyes) were treated with PSC. The average age for the patients was 11.45 ± 5.17 years old (range 3-22). A genipin cross-linked sclera was implanted to the posterior sclera in PSC surgery. Axial length and myopia progression rates were measured at least two years before and after PSC surgery. RESULTS Prior to surgery, the mean AL progression was 0.73 ± 0.33 mm, compared to -0.08 ± 0.31 mm (P=0.00) post-surgery; the degree of myopia increased was -1.40 ± 0.95 D, compared to 0.18 ± 1.10 D post-surgery (P=0.00). The best corrected visual acuity (BCVA, in LogMAR) improved from 0.21 ± 0.16 preoperatively to 0.13 ± 0.13 two years after PSC (P=0.014). CONCLUSIONS PSC can restrict AL extension and safely control high myopia progression in young people.
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Affiliation(s)
- Yanfeng Su
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
| | - Anpeng Pan
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
| | - Yue Wu
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
| | - Shuangqian Zhu
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
| | - Linyan Zheng
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
| | - Anquan Xue
- High Myopia Department, The Eye Hospital of Wenzhou Medical University, The Eye Hospital of Zhejiang Province Wenzhou, China
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