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Karahan E, Acan D, Toprak MK. Posterior vitreous attachment as a risk factor for endophthalmitis following intravitreal antivascular endothelial growth factor injection. Int Ophthalmol 2024; 44:225. [PMID: 38748185 DOI: 10.1007/s10792-024-03101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/24/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE To evaluate the importance of the status of posterior vitreous in eyes with endophthalmitis following intravitreal anti-vascular endothelial growth factor (anti-VEGF). METHODS The absence or existence of posterior vitreous detachment (PVD) was elicited in 23 eyes of 23 patients with injection related endophthalmitis, during pars plana vitrectomy (PPV) and compared with 24 control eyes of 24 patients who received intravitreal anti-VEGF without any complication. RESULTS Thirtten (54.2%) out of 24 patients in the control group had full PVD, whereas only 2 (9.5%) out of 23 eyes in endophthalmitis group (p < 0.001) had full PVD. In all eyes without PVD, posterior vitreous was inducted to be detached at least from optic nerve and macular area without any iatrogenic tear. CONCLUSION The absence of PVD is a factor that increases the risk of endophthalmitis after intravitreal injections. Uncomplicated separation of the posterior vitreous from the retina in PPV contributes to better prognosis.
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Affiliation(s)
- Eyyup Karahan
- Department of Ophthalmology, Balikesir University School of Medicine, Balıkesir, Turkey
| | - Durgul Acan
- Department of Ophthalmology, Balikesir University School of Medicine, Balıkesir, Turkey.
| | - Mine Koru Toprak
- Department of Ophthalmology, Balikesir University School of Medicine, Balıkesir, Turkey
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Sinisi F, Della Santina M, Loiudice P, Figus M, Casini G. The Role of Silicone Oil in the Surgical Management of Endophthalmitis: A Systematic Review. J Clin Med 2022; 11:jcm11185445. [PMID: 36143089 PMCID: PMC9505397 DOI: 10.3390/jcm11185445] [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: 07/20/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
(1) Background: We aimed to systematically review the current literature to evaluate if in patients with postoperative endophthalmitis treated with pars plana vitrectomy, silicone oil tamponade could provide a useful contribution to the control and eradication of infection and if it could influence anatomical recovery and functional outcome. (2) Randomized controlled trials, cross-sectional studies, case series, and case reports published in the English language in peer-reviewed journals were included. No restriction was placed based on the study location. We used medical subject headings (MeSH) and text words. We searched MEDLINE (OVID and PubMed), Google Scholar, ISI Web of Science (Thom-on-Reuters), and the Cochrane Library (Wiley) from January 1995 to the present. To ensure literature saturation, we scanned the reference lists of included studies or relevant reviews identified through the search. Risk of Bias was assessed using the Newcastle-Ottawa scale for longitudinal studies and Cochrane risk-of-bias tool for randomized trials. (3) Results: abstracts of 75 articles were selected for full-text reading; after full-text reading, 44 articles were taken into consideration in the systematic review. 5 out of 7 in vitro experimental studies demonstrated antimicrobial activity against different species of bacteria and fungi. The use of SO as endotamponade associated with PPV led to better visual acuity and a lower rate of retinal detachment and the need for additional surgery. (4) Conclusions: Silicone oil reduces the risk of postoperative retinal detachment, especially in case of undetected retinal breaks, produces compartmentalization of the eye, may lead to early visual recovery, allows laser photocoagulation, prevents severe postoperative hypotony and has antimicrobic activity due to an inhibitory effect for several species of pathogens. Concerns regarding possible toxic effects on the retina and optic disc, compartmentalization and impaired washout of pathogen toxins have been reported. It may also influence intravitreal antibiotic distribution and clearance.
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Affiliation(s)
- Fabrizio Sinisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Marco Della Santina
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Pasquale Loiudice
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
- Complex Operative Ophthalmology Unit, “F. Lotti” Hospital, 56025 Pontedera, Italy
- Correspondence:
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Giamberto Casini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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Valentín‐Bravo FJ, García‐Onrubia L, Andrés‐Iglesias C, Valentín‐Bravo E, Martín‐Vallejo J, Pastor JC, Usategui‐Martín R, Pastor‐Idoate S. Complications associated with the use of silicone oil in vitreoretinal surgery: A systemic review and meta-analysis. Acta Ophthalmol 2022; 100:e864-e880. [PMID: 34846097 DOI: 10.1111/aos.15055] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/24/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
Silicone oil (SO) still represents the main choice for long-term intraocular tamponade in complicated vitreoretinal surgery. This review compared the complications associated with the use of SO and other vitreous substitutes after pars plana vitrectomy in patients with different underlying diseases. Meta-analysis was conducted in accordance with PRISMA guidelines. We retrieved randomized clinical trials (RCTs), retrospective case-control and cohort studies evaluating the risk of using SO, published between 1994 and 2020, conducting a computer-based search of the following databases: PubMed, Web of Science, Scopus and Embase. Primary outcome was the rate of complications such as intraocular hypertension, retinal re-detachment, unexpected vision loss or hypotony. Secondary outcome was to compare the rate of adverse events of different SO viscosities, especially emulsification. Forty-three articles were included. There were significant differences in intraocular hypertension (p = 0.0002, OR = 1.66; 95% CI = 1.27-2.18) and the rate of retinal re-detachment (p < 0.0009, OR = 0.65; 95% CI = 0.50-0.64) between SO and other agents, including placebo. However, there were no differences in other complication rates. Silicone oil (SO)-emulsification rate was non-significantly higher in low than high SO viscosity, and results from other complications were comparable in both groups. The high quality of most of the studies included in this study is noteworthy, which provides some certainty to the conclusions. Among them is the high variability of the SO residence time. The fact that ocular hypertension and not hypotension is related to SO use. A clear relationship is not found for the so-called unexplained vision loss, which affects a significant percentage of eyes. Re-detachment cases are less if SO is used and that surprisingly there does not seem to be a relationship in the percentage of emulsification between the low- and high-viscosity silicones. All these data warrant more standardized prospective studies.
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Affiliation(s)
- Fco. Javier Valentín‐Bravo
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
| | - Luis García‐Onrubia
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
| | | | | | - Javier Martín‐Vallejo
- Department of Statistics. Medical School University of Salamanca. Salamanca Biomedical Research Institute (IBSAL) Salamanca Spain
| | - José Carlos Pastor
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
| | - Ricardo Usategui‐Martín
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
| | - Salvador Pastor‐Idoate
- Department of Ophthalmology University Clinical Hospital of Valladolid Valladolid Spain
- Institute of Applied Ophthalmobiology (IOBA) University of Valladolid Valladolid Spain
- Medical School University of Valladolid Valladolid Spain
- Cooperative Network for Research in Ophthalmology (Oftared) Carlos III National Institute of Health, ISCIII Madrid Spain
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Sborgia G, Niro A, Pastore V, Favale RA, Sborgia A, Gigliola S, Giuliani G, Grassi MO, Coassin M, Aiello F, Iaculli C, Reibaldi M, Boscia F, Alessio G. Mid-term safety and effectiveness of intravitreal dexamethasone implant to treat persistent cystoid macular edema in vitrectomized eyes for bacterial endophthalmitis. Graefes Arch Clin Exp Ophthalmol 2022; 260:2703-2710. [PMID: 35254512 DOI: 10.1007/s00417-022-05615-8] [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: 10/02/2021] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the mid-term safety and effectiveness of intravitreal dexamethasone implant (DEX-i) for treating unresponsive to medical therapy cystoid macular edema (CME) in vitrectomized eyes for endophthalmitis. METHODS Retrospective and interventional case series study conducted on vitrectomized eyes for endophthalmitis that developed a CME that did not adequately respond to medical therapy, who underwent 0.7-mg DEX-i. Main outcome measures were changes in central retinal thickness (CRT) and best corrected visual acuity (BCVA). RESULTS Eleven eyes were included in the study. Microbiological findings of vitreous biopsies were 7 (63.6%) staphylococcus epidermidis; 3 (27.3%) Pseudomonas aeruginosa; and 1 (9.1%) Propionibacterium acnes. Median (interquartile range, IqR) duration of CME was 4.0 (3.0-4.0) months. Median (IqR) time between vitrectomy and DEX-i was 9.0 (9.0-11.0) months. Median CRT was significantly decreased from 548.0 (412.8-572.5) µm at baseline to 308.0 (281.3-365.5) µm at month 6 (p = 0.0009, Friedman test). Median BCVA significantly improved from 38.0 (30.5-44.8) letters at baseline to 50.0 (46.8-53.0) letters at month 6 (p < 0.0001, Friedman), with 9 (81.8%) eyes gaining ≥ 10 letters. Elevation of intraocular pressure was observed in one (9.1%) eye, which was successfully controlled with medical therapy. No recurrence of endophthalmitis or other complications was observed. Eight (72.7%) eyes required an additional DEX-i, while 3 (27.3%) were successfully controlled with only one DEX-i. CME recurrence occurred in 5 (62.5%) Gram-positive and 3 (100.0%) Gram-negative bacteria (p = 0.2357). CONCLUSION In vitrectomized eyes for endophthalmitis affected by CME unresponsive to medical therapy, DEX-i had an acceptable safety profile and achieved favorable outcomes. The possibility of suppressing mechanisms for infection control should be taken into account, although correct management of endophthalmitis and long time without reactivation before DEX-i reduce the risk.
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Affiliation(s)
- Giancarlo Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alfredo Niro
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy.
| | - Valentina Pastore
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Rosa Anna Favale
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Alessandra Sborgia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Samuele Gigliola
- Eye Clinic, Hospital "SS Annunziata", ASL Taranto, Via F. Bruno, 1, 74010, Taranto, Italy
| | - Gianluigi Giuliani
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Maria Oliva Grassi
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Marco Coassin
- Ophthalmology, University Campus Bio Medico of Rome, 00128, Rome, Italy
| | - Francesco Aiello
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Cristiana Iaculli
- Department of Ophthalmology, Policlinico Riuniti Di Foggia, University of Foggia, 71122, Foggia, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10126, Turin, Italy
| | - Francesco Boscia
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
| | - Giovanni Alessio
- Department of Medical Science, Neuroscience and Sense Organs, Eye Clinic, University of Bari, 70124, Bari, Italy
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Tabl A, Masoud M, Abdelhalim G, Tabl M. Outcomes of early vitrectomy for endophthalmitis after cataract surgery in delta population, Egypt, 2015–2020. JOURNAL OF THE EGYPTIAN OPHTHALMOLOGICAL SOCIETY 2022. [DOI: 10.4103/ejos.ejos_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mautone L, Skevas C, Spitzer MS. [Treatment of postoperative endophthalmitis : Operate or only inject?]. Ophthalmologe 2021; 118:219-229. [PMID: 33566160 DOI: 10.1007/s00347-021-01320-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Postoperative endophthalmitis is among the most feared complications encountered after intraocular surgery. A prompt diagnosis and initiation of treatment are crucial for the visual prognosis, which also depends on the causative microorganism. Despite advances in prevention and the availability of more epidemiological data, most of the evidence for treatment dates back to a single study, the early vitrectomy study (EVS) carried out in the early 1990s. The EVS showed that vitrectomy with intravitreal antibiotics was superior to intravitreal antibiotics alone, only when visual acuity was light perception or below. The addition of systemic antibiotics did not have any benefits. Over the last 30 years, however, surgical techniques have continued to evolve and the medicinal options have also been expanded. Moreover, the EVS examined only endophthalmitis after cataract surgery and strictly speaking the results cannot be transferred to endophthalmitis from other causes. OBJECTIVE This review discusses the current evidence for the different treatment modalities of the most important types of postoperative endophthalmitis. CONCLUSION The EVS provided important guidelines for the initial management of endophthalmitis and these guidelines remain relevant to this day; however, in view of the refinement of surgical techniques, novel treatment options, especially the nowadays continuously growing number of intravitreal injections and even some new antibiotics, it would be desirable if new controlled trials addressing the treatment of endophthalmitis would be performed.
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Affiliation(s)
- L Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland
| | - C Skevas
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - M S Spitzer
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf (UKE), Gebäude W40, Martinistr. 52, 20246, Hamburg, Deutschland
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Surgical Management of Complications after Dexamethasone Implant. Case Rep Ophthalmol Med 2020; 2020:4837689. [PMID: 32095301 PMCID: PMC7035535 DOI: 10.1155/2020/4837689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/22/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To report surgical management of ocular complications occurred after dexamethasone (DEX) implant (Ozurdex®) injection. Methods Retrospective interventional case series. Results Different surgical procedures including viscoexpression to manage the migration of the implant into the anterior chamber, "phaco-rolling" technique for the intralenticular injection, and vitrectomy with implant removal for an acute endophthalmitis were performed. Successful management of different complications after DEX implant by using individualized surgical approaches was observed. Conclusions Early and targeted surgical management is required in selected cases of ocular complications after DEX implant. The implant removal was needed to preserve ocular anatomy and function.
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Leung EH, Stout JT. Antibiotics and antifungals in silicone oil. Int J Retina Vitreous 2019; 5:50. [PMID: 31890279 PMCID: PMC6907248 DOI: 10.1186/s40942-019-0199-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/04/2019] [Indexed: 11/29/2022] Open
Abstract
Background Antimicrobials may be injected into silicone oil-filled eyes with endophthalmitis, but the interaction with oil is unclear. The purpose of the experiment is to determine whether vancomycin, amikacin, and amphotericin B mix with silicone oil. Methods Using the relative proportions of the human eye, 4 ml of 1000 centistokes silicone oil was centrifuged with 0.1 ml of vancomycin 1 mg/0.1 ml, amikacin 0.4 mg/0.1 ml, or amphotericin B 5 µg/0.1 ml in vitro and eluted. The aqueous was immediately analyzed with a liquid chromatographer/mass spectrometer and after 24 h. Results Within 24 h, a mean of 26.9 μmol/L of vancomycin, 0 nmol/L of amikacin, and 0 nmol/L of amphotericin B were recovered. When the concentrations of amikacin and amphotericin B were increased 100-fold, 0 nmol/L of amikacin and 75.7 µmol/L of amphotericin B were recovered. Conclusions Vancomycin and amphotericin B partially mixed with the silicone oil. Amikacin was not recovered from the antibiotic–silicone oil mixture.
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Affiliation(s)
- Ella H Leung
- Cullen Eye Institute, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030 USA
| | - J Timothy Stout
- Cullen Eye Institute, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX 77030 USA
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RISK OF SILICONE OIL AS VITREOUS TAMPONADE IN PARS PLANA VITRECTOMY: A Systematic Review and Meta-Analysis. Retina 2018; 37:1989-2000. [PMID: 28248823 DOI: 10.1097/iae.0000000000001553] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The authors examined the differences between silicone oil and other vitreous tamponades or placebo in performing pars plana vitrectomy. METHODS This review and meta-analysis was conducted in accordance with the PRISMA guidelines. Seven databases and the reference lists of the retrieved randomized controlled trial articles were searched to identify eligible studies. The primary outcomes were the rate of redetachment after endotamponade removal, the rate of reoperation, and poor visual acuity. The secondary outcomes were adverse events and quality of life related to postoperative position. RESULTS Ten articles (12 trials) were included. There were no significant differences between silicone oil and other agents in most of the primary and second outcomes. Only the risk of hypotony was found to be significantly lower when filling with silicone oil, compared with other agents. No trial reported the quality of life related to postoperative position. CONCLUSION Based on the available studies, the authors conclude that there is no significant difference in the risk of poor outcomes between pars plana vitrectomy with silicone oil and that with other vitreous tamponades with different surgical histories.
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Visual Outcomes and Prognostic Factors after Pars Plana Vitrectomy for Traumatic Endophthalmitis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5851318. [PMID: 28246599 PMCID: PMC5299176 DOI: 10.1155/2017/5851318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 08/08/2016] [Accepted: 08/18/2016] [Indexed: 11/19/2022]
Abstract
Purpose. To evaluate visual outcomes and identify prognostic factors after pars plana vitrectomy (PPV) surgery for traumatic endophthalmitis. Methods. Medical records of 121 consecutive patients (121 eyes) diagnosed with traumatic endophthalmitis that had undergone pars plana vitrectomy were retrospectively reviewed. Results. 121 patients, aged from 6 to 71 years, all underwent PPV surgery. 113 cases had improved best corrected visual acuity (BCVA) after surgery and 60% of them obtained BCVA better than fingers counting (FC). Good final visual prognosis was significantly associated with time between trauma and initial treatment less than 12 hrs (40% versus 98%; P < 0.001), time between trauma and PPV treatment less than 24 hrs (62% versus 98%; P < 0.001), laceration length less than 10 mm (63% versus 96%; P < 0.001), and presenting VA better than LP (42% versus 96%; P < 0.001), while gender, type of laceration, presence of IOFB or retinal detachment, and the use of silicone oil tamponade were not significant factors resulting in better BCVA. Bacteria were identified in 43.8% of specimens and most of the microorganisms were identified as nonvirulent ones. Conclusions. Pars plana vitrectomy surgery was preferred as a primary treatment option for traumatic endophthalmitis. A good final visual prognosis was significantly associated with timely treatment, prompt vitrectomy surgery, shorter length of laceration, and better presenting visual acuity.
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Nagpal M, Jain P. Author Reply to "Letter to the Editor on the Article: Nagpal M, Jain P, Nagpal K. Pars Plana Vitrectomy With or Without Silicone Oil Endotamponade in Surgical Management of Endophthalmitis". ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:385. [PMID: 26107733 DOI: 10.1097/apo.0b013e3182710f2a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Manish Nagpal
- Vitreo Retinal Consultant RETINA FOUNDATION Ahmedabad-4 Gujarat India
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Patel A, Gentile R. Pars Plana Vitrectomy With or Without Silicone Oil Endotamponade in Surgical Management of Endophthalmitis. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:384-5. [PMID: 26107732 DOI: 10.1097/apo.0b013e3182710f18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anu Patel
- 1 Departments of Ophthalmology The New York Eye and Ear Infirmary New York, New York and New York Medical College Valhalla, New York 2 Department of Ophthalmology Winthrop University Hospital Mineola, New York
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