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Körber M, Fellinger J, Fritsche M, Giese A, Kostourou K, Kopf D, Kottcke M, Luciani F, Schmidbauer JM, Wenk J, Braun B. Ophthalmic surgeries on post mortem porcine eyes with picosecond ultrashort laser pulses. Front Med (Lausanne) 2024; 11:1345976. [PMID: 38390574 PMCID: PMC10881746 DOI: 10.3389/fmed.2024.1345976] [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: 11/28/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Purpose This work demonstrates significant advantages in ophthalmic surgeries through the use of picosecond ultrashort laser pulses instead of state-of-the-art nanosecond laser pulses. These ultrashort lasers shall serve as universal tools more effectively combining advantages of high precision, low impact and economic advantages compared to existing instruments. Methods As samples, we used post-mortem porcine eyes on which we performed the experiments with both picosecond and nanosecond lasers. Performed surgeries were laser iridotomy, (post-) cataract treatment/capsulotomy and selective laser-trabeculoplasty. Pulse widths were between 12 ps and 220 ns with pulse energies between 30 μJ and 10 mJ at 532 nm and 1,064 nm. Additionally, we investigated accompanying shock waves, cavitation bubbles, and heat effects during the ablation processes. Results For all surgeries, significant differences were observed between picosecond and nanosecond pulses: It was possible to scale the pulse energy down to 10 of microjoules rather than requiring millijoules, and resulting tissue ablations are much more precise, more deterministic and less frayed. The shock wave and cavitation bubble investigation revealed major differences in pressure between picosecond pulses (0.25 MPa, 50 μJ) and nanosecond pulses (37 MPa, 5 mJ). The heat input during ablation could be lowered by two orders of magnitude. Conclusion Picosecond ultrashort laser pulses show substantial benefits for several ophthalmic surgeries, with regard to ablation precision, shock wave generation and heat input. They are better than state-of-the-art ophthalmic nanosecond lasers in all aspects tested.
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Affiliation(s)
- Michael Körber
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
- Paracelsus Medical University, Nuremberg, Germany
| | | | - Milan Fritsche
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
| | - Andreas Giese
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
| | | | | | - Manfred Kottcke
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
| | | | - Josef M Schmidbauer
- Paracelsus Medical University, Nuremberg, Germany
- Clinic of Ophthalmology, Klinikum Nürnberg Nord, Nuremberg, Germany
| | - Jonathan Wenk
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
| | - Bernd Braun
- Applied Mathematics, Physics and Humanities, Nuremberg Institute of Technology, Nuremberg, Germany
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In vitro assessment of the biocompatibility of chemically treated silicone materials with human lens epithelial cells. Sci Rep 2022; 12:4649. [PMID: 35301374 PMCID: PMC8931081 DOI: 10.1038/s41598-022-08443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/22/2022] [Indexed: 11/20/2022] Open
Abstract
Cytotoxicity testing is a regulatory requirement for safety testing of new ocular implants. In vitro toxicity tests determine whether toxic chemicals are present on a material surface or leach out of the material matrix. A method of evaluating the cytotoxicity of ocular implants was developed using fluorescent viability dyes. To assess the assay’s sensitivity in detecting toxic substances on biomaterials, zinc diethydithiocarbamate (ZDEC) and benzalkonium chloride (BAK) were deposited on silicone surfaces at different concentrations. Human lens epithelial cells (HLEC) were added to the surface of these treated silicone surfaces and were assessed for viability. The viability of both the adherent and non-adherent cells was determined using confocal microscopy with, annexin V, ethidium homodimer, and calcein. Cell metabolism was also evaluated using resazurin and the release of inflammatory cytokines was quantified using a multiplex Mesoscale Discovery platform. Confocal microscopy was shown to be a sensitive assay for evaluating material toxicity, as significant toxicity (p < 0.05) from ZDEC and BAK-treated surfaces compared to the untreated silicone control was detected. Patterns of cytokine release from cells varied depending on the toxin evaluated and the toxin concentration and did not directly correlate with the reduction in cell metabolic activity measured by alamarBlue.
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Uveal and capsular biocompatibility of a new hydrophobic acrylic microincision intraocular lens. J Cataract Refract Surg 2021; 46:459-464. [PMID: 32079847 DOI: 10.1097/j.jcrs.0000000000000117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate uveal biocompatibility and capsular bag opacification of a new hydrophobic acrylic microincision intraocular lens (IOL) in comparison with a commercially available 1-piece hydrophobic acrylic IOL. SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN Experimental study. METHODS Eight New Zealand rabbits underwent bilateral phacoemulsification and implantation of the preloaded Nanex multiSert IOL in one eye and a commercially available preloaded lens (AcrySof IQ in UltraSert, model AU00T0) in the contralateral eye. A slitlamp examination was performed weekly for 4 weeks. The rabbits were then killed humanely and their globes enucleated. Capsular bag opacification was assessed from the Miyake-Apple view, and the eyes were subjected to histopathologic evaluation. RESULTS Postoperative inflammatory reactions were similar between the test and control eyes in the 8 New Zealand rabbits. The mean postmortem central posterior capsule opacification (PCO) was 0.93 ± 0.73 in the test group and 1.19 ± 0.53 in the control group. The mean postmortem peripheral PCO was 1.75 ± 0.92 in the test group and 2.06 ± 0.77 in the control group. Central and peripheral PCO scores were not statistically different between the test and control groups (P = .41 and P = .35, respectively, 2-tailed t test: paired 2-sample for means). CONCLUSIONS A new 1-piece hydrophobic acrylic microincision IOL incorporating an ultraviolet-ozone treatment on the posterior surface performed similarly to a commercially available 1-piece hydrophobic acrylic IOL in terms of uveal and capsular biocompatibility in the rabbit model. To our knowledge, this is the first hydrophobic acrylic microincision IOL to demonstrate similar PCO performance when compared with a conventional, commercially available IOL.
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Louie A, Meyerle C, Francomano C, Srikumaran D, Merali F, Doyle JJ, Bower K, Bloom L, Boland MV, Mahoney N, Daoud Y, Singman EL. Survey of Ehlers-Danlos Patients' ophthalmic surgery experiences. Mol Genet Genomic Med 2020; 8:e1155. [PMID: 31989797 PMCID: PMC7196452 DOI: 10.1002/mgg3.1155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 01/24/2023] Open
Abstract
Background Ehlers‒Danlos Syndrome (EDS) is a rare disease affecting approximately 1 in 5,000 people. Although ophthalmic conditions associated with EDS have been described, little data exist concerning ophthalmic surgical outcomes experienced by EDS patients. Methods Patients with EDS were surveyed via the EDS Society and asked about their ophthalmic surgical experiences including procedure, complications, and the timing with respect to receiving the EDS diagnosis. Complications were confirmed as such by subspecialists. Results Of 579 respondents, 467 reported confirmed EDS, and 112 of those had an ophthalmic procedure, including refractive surgery, cataract/lens surgery, retinal surgery, strabismus surgery, oculoplastic surgery, corneal surgery, and laser surgery for glaucoma. The rate of confirmed complications was: 23%‐refractive, 33%‐lens/cataract, 33%‐retina, 59%‐strabismus, 23%‐ oculoplastics, 0%‐cornea, and 25%‐glaucoma laser. In addition, 76% of patients underwent surgery prior to the EDS diagnosis. Conclusions Patients with EDS may have elevated risk of postoperative ophthalmic surgical complications. It would seem reasonable to systemically and prospectively explore how patients with EDS respond to ophthalmic surgery. Furthermore, it would seem circumspect to ask surgical candidates patients about whether they carry a diagnosis of EDS or have signs and symptoms of EDS prior to surgery.
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Affiliation(s)
- Anita Louie
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Clair Francomano
- Harvey Institute for Medical Genetics of Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Farhan Merali
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kraig Bower
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Michael V Boland
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas Mahoney
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Yassine Daoud
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
| | - Eric L Singman
- Wilmer Eye Institute of Johns Hopkins Hospital, Baltimore, MD, USA
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Han Y, Tang J, Xia J, Wang R, Qin C, Liu S, Zhao X, Chen H, Lin Q. Anti-Adhesive And Antiproliferative Synergistic Surface Modification Of Intraocular Lens For Reduced Posterior Capsular Opacification. Int J Nanomedicine 2019; 14:9047-9061. [PMID: 31819418 PMCID: PMC6875265 DOI: 10.2147/ijn.s215802] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/30/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Posterior capsular opacification (PCO) is the main complication after intraocular lens (IOL) implantation in cataract surgery, which is the result of lens epithelial cell (LEC) adhesion, proliferation and migration on the IOL and at the lens capsule interface. Hydrophilic surface modification, such as surface heparinization, decreases the cell adhesion, which has been commercialized and used clinically. However, clinical long-term observation results show no significant difference between the pristine and heparinized IOLs. METHODS To prevent PCO over the long time span, we modified the IOLs with an antiproliferative drug-loaded hydrophilic coating. The antiproliferative drug doxorubicin (DOX)-incorporated chitosan (CHI) nanoparticle was fabricated by sodium tripolyphosphate (TPP) gelation. Such antiproliferative drug-loaded CHI-TPP-DOX nanoparticles (CTDNP) were used as one of the building blocks to prepare polyelectrolyte multilayer with heparin (HEP) via layer-by-layer assembly, obtaining (HEP/CTDNP)n multilayers. The assembly process was characterized by quartz crystal microbalance with dissipation (QCM-D). The drug release behavior of the coating was investigated by ultra-HPLC (UPLC). In vitro cell experiments were carried out to monitor the effects of multifunctional coatings on cellular adhesion, proliferation and migration. And the intraocular implantation was performed on rabbits to evaluate the in vivo PCO inhibitory effect of such surface-functionalized IOLs. RESULTS The positively charged CTDNP was successfully prepared by ionic gelation. The QCM-D results indicate the successful preparation of the (HEP/CTDNP)n multilayer film. Drug release profiles showed that surface-multifunctionalized IOL had drug-sustained release properties. In vitro cell culture results showed significant inhibition of adhesion, proliferation and migration of LECs after surface modification. The in vivo results showed that the IOLs with multifunctionalized surface can effectively reduce the posterior hyperplasia and Soemmering's ring (SR) formation. CONCLUSION These findings suggested that such multifunctionalized drug-eluting IOLs can effectively reduce the posterior hyperplasia and SR formation when intraocular implantation has a major impact on reducing PCO incidence. Thus they have a great potential in improving patient vision recovery and maintenance.
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Affiliation(s)
- Yuemei Han
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Junmei Tang
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Jiayi Xia
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Rui Wang
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Chen Qin
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Sihao Liu
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Xia Zhao
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
| | - Hao Chen
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou32500, People’s Republic of China
| | - Quankui Lin
- School of Ophthalmology & Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou325027, People’s Republic of China
- Wenzhou Institute of Biomaterials and Engineering, Chinese Academy of Sciences, Wenzhou32500, People’s Republic of China
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Tortolano L, Saunier J, Hammami S, Manerlax K, Matmati H, Do B, Jubeli E, Fattal E, Yagoubi N. Restructuration kinetics of amphiphilic intraocular lenses during aging. Colloids Surf B Biointerfaces 2018; 161:420-432. [PMID: 29121615 DOI: 10.1016/j.colsurfb.2017.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 12/11/2022]
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7
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Evaluation of stability and capsular bag opacification with a foldable intraocular lens coupled with a protective membrane in the rabbit model. J Cataract Refract Surg 2015; 41:1738-44. [DOI: 10.1016/j.jcrs.2015.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 11/22/2022]
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8
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Viveiros MMH, Soares RT, Omodei MS, Rainho CA, Padovani CR, Cruz N, Schellini SA, Rodrigues ACL. Adhesion study of cultured human lens capsule cells on hydrophilic intraocular lenses coated with polyethylene glycol. J Cataract Refract Surg 2015. [PMID: 26210051 DOI: 10.1016/j.jcrs.2014.11.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the adhesion of human lens capsule cells on hydrophilic acrylic intraocular lenses (IOLs) coated with polyethylene glycol (PEG). SETTING Department of Ophthalmology, Faculty of Medicine, Universidade Estadual Paulista-Botucatu, São Paulo, Brazil. DESIGN Experimental study. METHODS Human anterior lens capsules obtained during cataract surgery were cultured and seeded (200 cells/IOLs) in triplicates on the surface of a copolymer comprising hydroxyethyl methacrylate, ethyl methacrylate, and methyl methacrylate IOLs (Loflex) treated or not treated with PEG. After 26 hours, the number of viable adherent cells was estimated by counting in a hemocytometer. RESULTS The coating of hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion (P < .05). Cells showing 2 distinct morphologic patterns-epithelial and dendritic-like-were observed during the in vitro establishment of the cultures. A tendency toward greater adhesion of dendritic-like cells was observed in untreated IOLs compared with treated IOLs (P = .095). CONCLUSION Coating hydrophilic acrylic IOLs with PEG was effective in inhibiting cell adhesion. This treatment might play a role in posterior capsule opacification prevention. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Magda Massae Hata Viveiros
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil.
| | - Ricardo Torres Soares
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Michelle Sako Omodei
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Cláudia Aparecida Rainho
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Carlos Roberto Padovani
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Nilson Cruz
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Silvana Artioli Schellini
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
| | - Antonio Carlos Lottelli Rodrigues
- From the Graduate Program in General Basis of Surgery (Viveiros), Botucatu Medical School (Omodei), the Department of Genetics (Rainho), and the Department of Biostatistics (Padovani), Biosciences Institute, and the Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery (Schellini, Rodrigues), Universidade Estadual Paulista, Botucatu, and the Department of Control and Automation Engineering (Soares, Cruz), Universidade Estadual Paulista, Sorocaba, São Paulo, Brazil
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Walker JL, Bleaken BM, Wolff IM, Menko AS. Establishment of a Clinically Relevant Ex Vivo Mock Cataract Surgery Model for Investigating Epithelial Wound Repair in a Native Microenvironment. J Vis Exp 2015:e52886. [PMID: 26132117 DOI: 10.3791/52886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The major impediment to understanding how an epithelial tissue executes wound repair is the limited availability of models in which it is possible to follow and manipulate the wound response ex vivo in an environment that closely mimics that of epithelial tissue injury in vivo. This issue was addressed by creating a clinically relevant epithelial ex vivo injury-repair model based on cataract surgery. In this culture model, the response of the lens epithelium to wounding can be followed live in the cells' native microenvironment, and the molecular mediators of wound repair easily manipulated during the repair process. To prepare the cultures, lenses are removed from the eye and a small incision is made in the anterior of the lens from which the inner mass of lens fiber cells is removed. This procedure creates a circular wound on the posterior lens capsule, the thick basement membrane that surrounds the lens. This wound area where the fiber cells were attached is located just adjacent to a continuous monolayer of lens epithelial cells that remains linked to the lens capsule during the surgical procedure. The wounded epithelium, the cell type from which fiber cells are derived during development, responds to the injury of fiber cell removal by moving collectively across the wound area, led by a population of vimentin-rich repair cells whose mesenchymal progenitors are endogenous to the lens. These properties are typical of a normal epithelial wound healing response. In this model, as in vivo, wound repair is dependent on signals supplied by the endogenous environment that is uniquely maintained in this ex vivo culture system, providing an ideal opportunity for discovery of the mechanisms that regulate repair of an epithelium following wounding.
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Affiliation(s)
- Janice L Walker
- Pathology, Anatomy and Cell Biology, Thomas Jefferson University;
| | - Brigid M Bleaken
- Pathology, Anatomy and Cell Biology, Thomas Jefferson University
| | - Iris M Wolff
- Pathology, Anatomy and Cell Biology, Thomas Jefferson University
| | - A Sue Menko
- Pathology, Anatomy and Cell Biology, Thomas Jefferson University
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Kao EC, McCanna DJ, Jones LW. Utilization of in vitro methods to determine the biocompatibility of intraocular lens materials. Toxicol In Vitro 2011; 25:1906-11. [DOI: 10.1016/j.tiv.2011.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/06/2011] [Accepted: 06/07/2011] [Indexed: 11/28/2022]
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11
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Werner L, Izak AM, Isaacs RT, Pandey SK, Apple DJ. Evolution of Intraocular Lens Implantation. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Incision sizes before and after implantation of SN60WF intraocular lenses using the Monarch injector system with C and D cartridges. J Cataract Refract Surg 2008; 34:1748-53. [PMID: 18812128 DOI: 10.1016/j.jcrs.2008.06.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 06/16/2008] [Indexed: 11/22/2022]
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13
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Cheng JW, Wei RL, Cai JP, Xi GL, Zhu H, Li Y, Ma XY. Efficacy of different intraocular lens materials and optic edge designs in preventing posterior capsular opacification: a meta-analysis. Am J Ophthalmol 2007; 143:428-36. [PMID: 17224119 DOI: 10.1016/j.ajo.2006.11.045] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2006] [Revised: 11/16/2006] [Accepted: 11/19/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the efficacy of different intraocular lens (IOL) materials and optic edge designs in preventing posterior capsular opacification (PCO). DESIGN Systematic review and meta-analysis. METHODS Pertinent studies were selected through an electronic search of the Cochrane Library, MEDLINE, and Embase. The randomized controlled trials meeting the predefined criteria were reviewed systematically by meta-analysis. The treatment effects were measured as risk difference, and the pooled estimates were computed according to a random effect model. RESULTS In total, 23 randomized controlled trials were included in the present meta-analysis. The pooled risk differences of Nd:YAG laser capsulotomy rates were -24% (95% confidence interval [CI], -29% to -20%) comparing acrylic with polymethylmethacrylate (PMMA) lenses; -9% (95% CI, -17% to -1%) comparing silicone with PMMA lenses; 14% (95% CI, -8% to 36%) comparing hydrogel with PMMA lenses; 4% (95% CI, -2% to 10%) comparing silicone with acrylic lenses; 19% (95% CI, 8% to 30%) comparing hydrogel with acrylic lenses; and 28% (95% CI, 10% to 46%) comparing hydrogel with silicone lenses. The pooled risk differences of PCO rates were -39% (95% CI, -47% to -31%) comparing acrylic with PMMA lenses; -14% (95% CI, -29% to 0%) comparing silicone with acrylic lenses; 56% (95% CI, 36% to 75%) comparing hydrogel with acrylic lenses; and 48% (95% CI, 31% to 64%) comparing hydrogel with silicone lenses. When comparing sharp with rounded-edge designs, pooled risk differences of capsulotomy rates were -47% (95% CI, -77% to -17%) in PMMA lenses, -22% (95% CI, -47% to 2%) in acrylic lenses, and -9% (95% CI, -17% to 0%) in silicone lenses; pooled risk differences of PCO rates were -28% (95% CI, -50% to -7%) in acrylic lenses and -37% (95% CI, -46% to -27%) in silicone lenses. CONCLUSIONS The rates of PCO and Nd:YAG laser capsulotomy may be influenced by different IOL biomaterials and optic edge designs. The lenses made by acrylic and silicone and those with sharp optic edges are superior in lowering the rates of PCO and laser capsulotomy.
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Affiliation(s)
- Jin-Wei Cheng
- Department of Ophthalmology, Changzheng Hospital, Second Military Medical University, Shanghai, China
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14
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Elgohary MA, Dowler JG. Incidence and risk factors of Nd:YAG capsulotomy after phacoemulsification in non-diabetic and diabetic patients. Clin Exp Ophthalmol 2006; 34:526-34. [PMID: 16925699 DOI: 10.1111/j.1442-9071.2006.01263.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To estimate the cumulative incidence and identify the risk factors of posterior capsule opacification (PCO) that required Nd:YAG capsulotomy in non-diabetic and diabetic patients. METHODS Retrospective case-note review of 806 consecutive patients that underwent phacoemulsification and intraocular lens (IOL) implantation, 327 (40.6%) of whom were diabetic. RESULTS The cumulative incidence of Nd:YAG capsulotomy were 10.6%, 14.8%, 21.2% and 28.6% in non-diabetic patients; and 9%, 9.4%, 15.3% and 5.3% in diabetic patients after 1, 2, 3 and 4 years, respectively. A multivariate Cox regression analysis showed that, over the follow-up period, diabetes mellitus was associated with a decreased risk of Nd:YAG capsulotomy (hazard ratio [HR]=0.69; 95% confidence interval [CI] 0.47-0.99; P=0.047), whereas age of 65 years or younger (HR=1.58; 95% CI 1.09-2.27; P=0.02), polymethylmethacrylate (PMMA) (HR=3.98; 95% CI 1.60-9.95; P=0.003) or plate-haptic silicone IOLs (HR=3.75; 95% CI 1.60-8.80; P=0.002) in comparison with three-piece silicone IOLs, postoperative inflammation (HR=2.62; 95% CI 1.56-4.42; P<0.001) and pars plana vitrectomy (HR=1.85; 95% CI 1.20-2.83; P=0.005) were associated with an increased risk. Subgroup analysis showed that in non-diabetic patients, male gender (HR=1.63; 95% CI 1.04-2.57; P=0.03) was an additional risk factor and in diabetic patients there was no significant association between diabetes type, duration or retinopathy grade and the risk of Nd:YAG capsulotomy. CONCLUSION Although diabetes mellitus appears to be associated with a lower long-term incidence and a decreased risk of Nd:YAG capsulotomy, younger age, pars plana vitrectomy, postoperative inflammation, plate-haptic silicone and PMMA IOLs in addition to male gender in non-diabetic patients appear to be associated with a greater risk. Estimation of the incidence and risk factors of PCO should help in patient counselling and to design methods to reduce or prevent its development.
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Affiliation(s)
- Mostafa A Elgohary
- Medical Retina Service, Moorfields Eye Hospital, London, UK, and Tanta Ophthalmology University Hospital, Egypt.
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Dholakia SA, Vasavada AR, Singh R. Prospective evaluation of phacoemulsification in adults younger than 50 years. J Cataract Refract Surg 2005; 31:1327-33. [PMID: 16105602 DOI: 10.1016/j.jcrs.2004.11.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2003] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate intraoperative performance and long-term outcome of phacoemulsification in patients younger than 50 years. SETTING Iladevi cataract and IOL Research Centre, Ahmedabad, India. METHODS A prospective observational study was conducted comprising 54 patients (35 men and 19 women) under age 50 who had phacoemulsification. Preoperative evaluation included specular microscopy. Phacoemulsification with implantation of an AcrySof MA30BA intraocular lens (IOL) was performed. Intraoperatively, peripheral extension of capsulorhexis, intraoperative posterior capsule opacification (PCO; plaque), and serious complications (eg, posterior capsule rupture, vitreous loss) were noted. Postoperatively, endothelial cell loss, postoperative PCO, neodymium:YAG (Nd:YAG) laser posterior capsulotomy rate, and best corrected visual acuity (BCVA) were assessed for 3 years. Patients with intraoperative PCO were analyzed separately. RESULTS Mean patient age was 42.7 years +/- 5.2 SD (men) and 43.1 +/- 3.25 years (women). Continuous curvilinear capsulorhexis was achieved in 49 patients (90.7%). Intraoperative PCO was present in 14 (25.92%) patients. An Nd:YAG laser posterior capsulotomy was performed in 4 patients (28.5%). Posterior capsule rupture leading to vitreous loss occurred in 1 patient (1.85%). At 3-year follow-up, endothelial cell loss was 5.9%. Postoperative PCO developed in 8 patients (22.2%), and Nd:YAG laser posterior capsulotomy was performed in 5 patients (13.8%). The BCVA was > or = 20/40 in 47 patients (94%). CONCLUSION Young patients pose a challenge in creating a capsulorhexis and display significant incidence of intraoperative and postoperative PCO.
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Affiliation(s)
- Sheena A Dholakia
- Iladevi Cataract and IOL Research Centre, Gurukul Road, Memnagar, Ahmedabad, India
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De Groot V, Tassignon MJBR, Vrensen GFJM. Effect of bag-in-the-lens implantation on posterior capsule opacification in human donor eyes and rabbit eyes. J Cataract Refract Surg 2005; 31:398-405. [PMID: 15767165 DOI: 10.1016/j.jcrs.2004.04.061] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2004] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate bag-in-the-lens implantation by studying the feasibility of implanting a new type of intraocular lens (IOL) and the occurrence of posterior capsule opacification (PCO) in human postmortem eyes and in eyes of living rabbits. SETTING Department of Ophthalmology, University of Antwerp, Belgium, and Netherlands Research Institute of Amsterdam, Amsterdam, The Netherlands. METHODS The IOL was implanted in 10 postmortem human donor eyes (in vitro study) and in 17 eyes of 10 rabbits (in vivo study). The postmortem capsular bags were cultured for 4 to 6 weeks, and the rabbits were killed 1 to 5 months after implantation. All capsular bags with the bag-in-the-lens were examined by light microscopy and scanning electron microscopy. RESULTS The IOL design was highly effective in restricting lens epithelial cell (LEC) proliferation in the remaining lens bag in human donor eyes and in rabbit eyes. In eyes in which the capsules were not positioned well within the groove of the IOL, LEC proliferation and PCO occurred. CONCLUSION Bag-in-the-lens implantation was highly effective in preventing PCO in vitro and in vivo provided the anterior and posterior capsules were secured properly in the peripheral groove of the IOL.
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Affiliation(s)
- Veva De Groot
- Department of Ophthalmology, University of Antwerp, Edegem, Belgium.
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Wejde G, Kugelberg M, Zetterström C. Posterior capsule opacification: comparison of 3 intraocular lenses of different materials and design. J Cataract Refract Surg 2003; 29:1556-9. [PMID: 12954305 DOI: 10.1016/s0886-3350(03)00342-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare posterior capsule opacification (PCO) after cataract surgery with implantation of 3 intraocular lenses (IOLs) of different materials and design. SETTING St. Erik's Eye Hospital, Stockholm, Sweden. METHODS In this prospective clinical study, 180 patients had standardized phacoemulsification performed by a single surgeon and were randomized to have implantation of a heparin-surface-modified (HSM) poly(methyl methacrylate) (PMMA) IOL (809C, Pharmacia & Upjohn), a silicone IOL (SI-40NB, Allergan), or an acrylic IOL (AcrySof MA60BM, Alcon). To morphologically evaluate PCO, retroillumination photographs were obtained and analyzed using Evaluation of Posterior Capsule Opacification computer software. The neodymium:YAG (Nd:YAG) capsulotomy rate was recorded. RESULTS After 2 years, the HSM PMMA IOL group had significantly more PCO than the silicone and AcrySof IOL groups; the silicone group had significantly more PCO than the AcrySof group (P<.05). The Nd:YAG capsulotomy rate was 20% in the HSM PMMA group, 22% in the silicone group, and 8% in the AcrySof group. CONCLUSION Patients with an AcrySof IOL developed significantly less PCO than those with a silicone or HSM PMMA IOL with a round-edged design.
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Escobar-Gomez M, Apple DJ, Vargas LG, Werner L, Arthur SN, Pandey SK, Izak AM, Schmidbauer JM. Scanning electron microscopic and histologic evaluation of the AcrySof SA30AL acrylic intraocular lens. Manufacturing quality and morphology in the capsular bag. J Cataract Refract Surg 2003; 29:164-9. [PMID: 12551685 DOI: 10.1016/s0886-3350(02)01435-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To evaluate the properties of the AcrySof(R) SA30AL (Alcon Laboratories, Inc.) single-piece foldable posterior chamber intraocular lens (IOL). SETTING Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS Two nonimplanted clinical-quality AcrySof IOLs were examined by gross, light, and scanning electron microscopy (SEM). In addition, 2 eyes implanted with this IOL obtained post-mortem, the first such eyes accessioned in our laboratory and the first described to date, were examined using the Miyake-Apple posterior photographic technique and by histologic sections. RESULTS Scanning electron microscopy of the SA30AL IOL showed excellent surface finish. The edge of the optic was square (truncated) and had a matte (velvet or ground-glass) appearance, a feature that may minimize edge glare and other visual phenomena. A well-fabricated square or truncated optic edge was demonstrated. Miyake-Apple analysis revealed that the SA30AL IOL showed appropriate fit and configuration within the capsular bag. Histologic correlation of the IOL's square edge and its relation to the capsular bag and adjacent Soemmering's ring were noted. CONCLUSIONS The AcrySof SA30AL IOL is a well-fabricated lens that situates well in the capsular bag. The truncated optic and its relationship to adjacent structures show a morphological profile that has been shown to be highly efficacious in reducing the rate of posterior capsule opacification.
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Affiliation(s)
- Marcela Escobar-Gomez
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA
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Schmidbauer JM, Vargas LG, Apple DJ, Escobar-Gomez M, Izak A, Arthur SN, Golescu A, Peng Q. Evaluation of neodymium:yttrium-aluminum-garnet capsulotomies in eyes implanted with AcrySof intraocular lenses. Ophthalmology 2002; 109:1421-6. [PMID: 12153790 DOI: 10.1016/s0161-6420(02)01116-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE As of December 31, 2000, the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser posterior capsulotomy rate for the Alcon AcrySof intraocular lens (IOL) as measured in our database was 3.3%. This was the lowest of any IOL model used in the United States. Only 12 of 361 cases required treatment. We analyzed possible surgical reasons that may have been responsible for the posterior capsule opacification (PCO) in this small group. Special attention was given to the three surgical factors that we had previously identified as being important for PCO reduction: (1) quality of cortical clean up, (2) type of haptic fixation, and (3) continuous curvilinear capsulorhexis (CCC) size and shape. DESIGN Comparative autopsy tissue analysis. PARTICIPANTS Three hundred sixty-one human eyes obtained postmortem with Alcon AcrySof IOLs, accessioned between January 1995 and December 2000 from Lions Eye Banks. METHODS The eyes were evaluated by the Miyake-Apple posterior photographic technique. MAIN OUTCOME MEASURES The area and intensity of Soemmering's ring and type of fixation were studied in 361 eyes. The size and shape of the CCC and relation of the CCC edge to the IOL's optic rim were analyzed in 168 eyes. RESULTS The amount of Soemmering's ring formation was significantly larger in the group of IOLs requiring Nd:YAG capsulotomy (Nd:YAG group). The not in-the-bag fixated IOLs required more Nd:YAG capsulotomies. Although the trend was clear, the number of specimens was not large enough to acquire statistical significance. The Nd:YAG group showed a highly significant difference compared with the No Nd:YAG group with regard to the amount of clock hours of the CCC edge on the optic rim's surface (P < 0.001). Mean CCC diameters were significantly larger in the Nd:YAG group (P < 0.05). CONCLUSIONS The amount of Soemmering's ring correlates with the quality of cortical clean up. Cells within the Soemmering's ring are the direct precursors of PCO. This study confirms our previous laboratory studies and the clinical assumption that the incidence of PCO and thus the need for Nd:YAG capsulotomy is correlated with the cortical clean up. A second clinical assumption, that poor IOL fixation increases the risk of PCO, is also strongly suggested in this study. This study also verifies the relation of the CCC to PCO and the Nd:YAG laser, namely that a relatively small CCC without tears is best to prevent this complication. Use of a high-quality IOL combined with diligent attention to these three surgical factors should lower further the incidence of PCO.
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Affiliation(s)
- Josef M Schmidbauer
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston 29425-5536, USA
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Vargas LG, Peng Q, Apple DJ, Escobar-Gomez M, Pandey SK, Arthur SN, Hoddinott DSM, Schmidbauer JM. Evaluation of 3 modern single-piece foldable intraocular lenses: clinicopathological study of posterior capsule opacification in a rabbit model. J Cataract Refract Surg 2002; 28:1241-50. [PMID: 12106735 DOI: 10.1016/s0886-3350(02)01216-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the development of posterior capsule opacification (PCO) with 3 modern single-piece foldable intraocular lenses (IOLs) in a histopathological study and to compare the potential preventive effects of the IOL design and biomaterial in retarding PCO. SETTING Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS Thirty-one rabbit eyes were randomly operated on with phacoemulsification and implantation of 3 single-piece foldable lenses: a hydrophilic acrylic design, the Rayner Centerflex 570H (n = 11); a hydrophobic acrylic design, the Alcon AcrySof SA30AL (n = 10); and a silicone large-hole plate design, the Staar AA-4203VF (n = 10). Central PCO (CPCO), peripheral PCO (PPCO), and Soemmering's ring formation were evaluated 3 weeks after surgery using the Miyake-Apple posterior photographic technique. Histological sections of each globe were prepared to document capsular bag status and performance of IOL geometry. RESULTS The acrylic IOLs (Centerflex and AcrySof) had lower CPCO and PPCO scores than the silicone plate IOL (P <.05). There was no significant difference in Soemmering's ring formation among the 3 models. Pathological evaluations revealed effective blockage of migrating lens epithelial cells (LECs) at the site of the truncated optic edge of the Centerflex and AcrySof IOLs, even in the presence of large amounts of retained/regenerative cortical material. CONCLUSIONS The AcrySof IOL has a hydrophobic surface and the Centerflex a hydrophilic surface, but no correlation to these characteristics could be identified. The single-piece AcrySof optic geometry created a clear-cut barrier effect equal to that of its 3-piece predecessor. The anatomic profile of the Centerflex IOL shows the same characteristics. The optics of both acrylic lenses have square truncated edges that functionally block ingrowth of migrating LECs toward the central visual axis, leaving clear posterior capsules. The square optic edge was an appropriate geometric configuration to create a barrier effect. There was no effect of the biomaterial on PCO prevention.
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Affiliation(s)
- Luis G Vargas
- Center for Research on Ocular Therapeutics and Biodevices, Storm Eye Institute, Department of Ophthalmology, Medical University of South Carolina, Charleston, South Carolina 29425-5536, USA
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