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Zhao T, Laotaweerungsawat S, Chen Y, Liu X, Liu D, Stewart JM. Right versus left eye asymmetry of microvasculature in diabetes revealed by optical coherence tomography angiography. Sci Rep 2023; 13:9332. [PMID: 37291258 PMCID: PMC10250307 DOI: 10.1038/s41598-023-36058-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/28/2023] [Indexed: 06/10/2023] Open
Abstract
In this study, we explored inter-ocular asymmetry (between the two eyes of the same patient) using optical coherence tomography angiography (OCTA) in patients with diabetes mellitus (DM) at different retinopathy stages. A total of 258 patients were divided into four groups: no DM, DM without diabetic retinopathy (DR), non-proliferative DR (NPDR), and proliferative DR (PDR). Superficial and deep vessel density (SVD, DVD), superficial and deep perfusion density (SPD, DPD), foveal avascular zone (FAZ) area, perimeter and circularity were calculated, and asymmetry index (AI) was used to evaluate the asymmetry of two eyes of the same subject. AIs of SPD, SVD, FAZ area and FAZ perimeter in the PDR group were larger than all other 3 groups (all p < 0.05). The AIs of DPD, DVD, FAZ area and FAZ perimeter in males were larger than in females (p = 0.015, p = 0.023, p = 0.006 and p = 0.017). Hemoglobin A1c (HbA1c) was positively correlated with AI of FAZ perimeter (p = 0.02) and circularity (p = 0.022). In conclusion, PDR patients' eyes were significantly asymmetric in both vascular density and FAZ metrics. Male sex and HbA1c are risk factors that influenced symmetry. This study highlights that right-left asymmetry should be taken into account in DR-related studies, particularly those analyzing microvascular changes with OCTA.
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Affiliation(s)
- Tong Zhao
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
| | - Sawarin Laotaweerungsawat
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, Charoenkrung Pracharak Hospital, Bangkok, Thailand
| | - Yi Chen
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- School of Optometry, Shenzhen University, Shenzhen, China
| | - Xiuyun Liu
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Dongwei Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA
- Department of Ophthalmology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jay M Stewart
- Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.
- Department of Ophthalmology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
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Li Z, Tong J, Liu C, Zhu M, Tan J, Kuang G. Analysis of independent risk factors for progression of different degrees of diabetic retinopathy as well as non-diabetic retinopathy among type 2 diabetic patients. Front Neurosci 2023; 17:1143476. [PMID: 37090790 PMCID: PMC10115960 DOI: 10.3389/fnins.2023.1143476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/17/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose To study the independent risk factors for development of different degrees of diabetic retinopathy (DR) as well as non-DR (NDR) among type 2 diabetic patients. Methods This cross-sectional study included 218 patients with type 2 diabetes between January 2022 and June 2022. All the patients were divided into two groups: the DR group and the NDR group. The DR group was subdivided into the mild, moderate and severe non-proliferative DR (NPDR) group and the proliferative DR (PDR) group. Data recorded for all patients included age, gender, duration of diabetes, blood pressure, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), blood lipids, best corrected visual acuity (BCVA), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), and renal function. Logistic regression methods were used to analyze the risk factors for DR. Results The prevalence of DR in type 2 diabetes was 28.44%. The duration of diabetes, age, mean arterial pressure (MAP), HbA1c, FBG, urinary albumin/creatinine ratio (UACR), BCVA, AL, and ACD were significantly different between the DR and the NDR groups (p < 0.05). Multivariate logistic regression analysis identified age, FBG, UACR, and AL as the independent risk factors for DR (OR = 0.843, 2.376, 1.049, 0.005; p = 0.034, 0.014, 0.016, p < 0.001). Conclusion Young age, short AL, higher levels of FBG and UACR were the independent risk factors for the progression of DR in type 2 diabetes.
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Affiliation(s)
- Zheng Li
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Jie Tong
- Department of Spinal Surgery, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Spinal Surgery, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Chang Liu
- Department of Endocrinology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
| | - Mingqiong Zhu
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Jia Tan
- Department of Ophthalmology, Xiangya Hospital of Central South University, Changsha, Hunan, China
- *Correspondence: Jia Tan,
| | - Guoping Kuang
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
- Guoping Kuang,
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Male sex increases the risk of diabetic retinopathy in an urban safety-net hospital population without impacting the relationship between axial length and retinopathy. Sci Rep 2022; 12:9780. [PMID: 35697817 PMCID: PMC9192741 DOI: 10.1038/s41598-022-13593-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/09/2022] [Indexed: 11/08/2022] Open
Abstract
This study sought to assess the association between axial length (AL) and diabetic retinopathy (DR) in a diverse cohort of patients and to investigate the impact of sex on this relationship. An urban safety net hospital database was used for this cross-sectional observational study. Diabetic patients who underwent fundus photography and AL measurement between March 2017 and June 2020 were included. The fundus photographs were graded following the Early Treatment of Diabetic Retinopathy Study criteria. The study enrolled 1843 patients with diabetes (mean age: 56.9 ± 12.1 years; AL: 23.56 ± 1.12 mm), including 931 men and 912 women. Male sex was a risk factor for diabetic retinopathy (P = 0.001; odds ratio [OR] 1.5, 95% confidence interval [CI] 1.18–1.98). A higher DR prevalence was associated with shorter AL both in men (P = 0.003; OR 0.77; 95% CI 0.66–0.91) and women (P = 0.02; OR 0.83; 95% CI 0.71–0.97) after adjusting for systemic risk factors using multivariable logistic regression. There was no significant impact of sex on the relationship between AL and DR (P = 0.56). In the subset of patients with asymmetric DR, the percentage of patients whose shorter eye had a higher stage of DR was not significantly different between men and women (P = 0.20). Male sex is a risk factor for DR in a diverse safety-net hospital population. Longer AL is associated with a lower risk of DR, and this relationship is not affected by sex.
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Zhang Q, Yang L, Xu X, Lan X, Wang Z, Sun Y, Fu S, Xiong Y. The Association of Axial Length with Macular Microvascular Changes in Chinese Diabetic Retinopathy Patients. Int J Gen Med 2022; 15:3895-3902. [PMID: 35431576 PMCID: PMC9005356 DOI: 10.2147/ijgm.s364790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To use optical coherence tomography angiography (OCTA) to compare macular blood flow density, subfoveal choroidal thickness (SFCT) and outer retina thickness (ORT) in non-proliferative diabetic retinopathy (NPDR) patients with different axial length (AL). Methods Total 42 patients with NPDR with different eye axis were divided into three groups: group A: 22 mm≤AL<24 mm; group B: 24 mm≤AL<26 mm; group C: AL≥26 mm. Superficial capillary plexus (SCP) in the macular area, vascular length density (VLD) and vascular perfusion density (VPD) in the foveal region, the parafoveal region, the perifoveal region and whole macular region were analyzed. The correlations among axial length, macular microvascular density, SFCT and outer retinal thickness (ORT) were analyzed. Results Compared with group A and B, VLD and VPD in group C were significantly lower except the foveal region, and VLD and VPD were negatively correlated with AL. The difference in SFCT among group A, B and C was significant, and SFCT was negatively correlated with AL. Compared with group A, parafoveal ORT in group C was significantly lower than that in group A, and parafoveal ORT was negatively correlated with AL. Conclusion In NPDR patients with different AL, macular microvascular density, SFCT, and parafoveal ORT decreased with the increase of AL.
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Affiliation(s)
- Qian Zhang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Liu Yang
- Department of Ophthalmology, The First People’s Hospital of Fuzhou City, Fuzhou, 344000, People’s Republic of China
| | - Xiaoling Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Xinmei Lan
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Ziwei Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Yali Sun
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Shuhua Fu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
| | - Yu Xiong
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China
- Correspondence: Yu Xiong, Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People’s Republic of China, Email
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INFLUENCE OF HIGH MYOPIA ON CHORIOCAPILLARIS PERFUSION AND CHOROIDAL THICKNESS IN DIABETIC PATIENTS WITHOUT DIABETIC RETINOPATHY. Retina 2022; 42:1077-1084. [PMID: 35174807 DOI: 10.1097/iae.0000000000003427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the impact of high myopia on choriocapillaris (CC) perfusion and choroidal thickness (CT) in diabetic patients without diabetic retinopathy. METHODS Healthy subjects and patients with diabetes mellitus were recruited from communities in Guangzhou. They were divided into four groups according to the presence of diabetes and high myopia: healthy control (n = 77), diabetes (n = 77), high myopia (n = 77), and diabetes with high myopia (n = 77). Swept-source optical coherence tomography angiography (SS-OCTA) measured CC perfusion and CT. CC perfusion was quantified using the choriocapillaris perfusion index (CPI). RESULTS A total of 308 subjects (308 eyes) were included in the study. The average CPI was 91.11 ± 0.84, 90.16 ± 1.46, 89.80 ± 1.42, and 89.36 ± 1.19% in the control, diabetes, high myopia, and diabetes with high myopia groups, respectively (p < 0.001); the average CT was 227.55 ± 43.13, 205.70 ± 59.66, 158.38 ± 45.24, and 144.22 ± 45.12μm, respectively (p < 0.001). After adjusting for age and sex, the average CPI decreased 0.95 ± 0.20% (p < 0.001) in the diabetes group, 1.33 ± 0.20% (p < 0.001) in the high myopia group, and 1.76 ± 0.20% (p < 0.001) in the diabetes with high myopia group relative to the control group; the average CT decreased 23.53 ± 8.12 (p = 0.004), 70.73 ± 9.41 (p < 0.001), and 85.90 ± 8.12 μm (p < 0.001), respectively. Further adjustment for other risk factors yielded a similar result. CONCLUSION Diabetes and high myopia significantly impact CPI and CT, and the presence of both conditions is more damaging to CPI and CT than diabetes or high myopia alone.
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Wang W, Chen Y, Xiong K, Gong X, Liang X, Huang W. Longitudinal associations of ocular biometric parameters with onset and progression of diabetic retinopathy in Chinese adults with type 2 diabetes mellitus. Br J Ophthalmol 2022; 107:738-742. [PMID: 35115303 DOI: 10.1136/bjophthalmol-2021-320046] [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: 07/10/2021] [Accepted: 01/13/2022] [Indexed: 11/04/2022]
Abstract
AIMS To investigate the associations of ocular biometric parameters with incident diabetic retinopathy (DR), incident vision-threatening DR (VTDR) and DR progression. METHODS This community-based prospective cohort study recruited participants with type 2 diabetes aged 35-80 years from 2017 to 2019 in Guangzhou, China. Refractive error and ocular biometric parameters were measured at baseline, including axial length (AL), axial length-to-corneal radius (AL/CR) ratio, corneal curvature (CC), lens thickness (LT), anterior chamber depth (ACD), lens power and corneal diameter (CD). RESULTS A total of 1370 participants with a mean age of 64.3±8.1 years were followed up for two consecutive years. During the follow-up period, 342 out of 1195 (28.6%) participants without DR at baseline had incident DR, 15 out of 175 (8.57%) participants with baseline DR had DR progression and 11 of them progressed to VTDR. After multiple adjustments, a longer AL (OR=0.76; 95% CI, 0.66 to 0.86; p<0.001) and a larger AL/CR ratio (OR=0.20; 95% CI, 0.07 to 0.55; p=0.002) were associated with significantly reduced risks of incident DR but were not associated with incident VTDR or DR progression. Refractive status and other ocular biometric parameters investigated, including ACD, CC, CD, lens power and LT were not associated with any of the DR outcomes (all p>0.05). CONCLUSIONS A longer AL and a larger AL/CR ratio are protective against incident DR. These parameters may be incorporated into future DR risk prediction models to individualise the frequency of DR screening and prevention measures.
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Affiliation(s)
- Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kun Xiong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xia Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoling Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wenyong Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China .,Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.,Guangdong Provincial Clinical Research Center for Ocular Diseases, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China
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He M, Chen H, Wang W. Refractive Errors, Ocular Biometry and Diabetic Retinopathy: A Comprehensive Review. Curr Eye Res 2020; 46:151-158. [PMID: 32589053 DOI: 10.1080/02713683.2020.1789175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To summarize the association between diabetic retinopathy and refractory status as well as ocular biometric parameters; To review the theories of the protective effect of high myopia against diabetic retinopathy. Methods: A comprehensive literature search on MEDLINE, EMBASE, Web of Science and Scopus databases as well as reference list search, and systematic review of relevant publications. Results: Myopia may delay the onset and progression of diabetic retinopathy. Increased axial length in myopia is associated with reduced risk of any diabetic retinopathy and vision-threatening diabetic retinopathy. The possible mechanisms for the protective effect of myopia against diabetic retinopathy may include posterior vitreous detachment, change in retinal blood flow and oxygen demand, choroidal thinning and altered cytokine profiles. Conclusions: High myopia may be a protective factor against the onset and progression of diabetic retinopathy. Further studies about the mechanisms of how myopia, axial length and ocular biometrics influence the onset and progression of DR are needed.
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Affiliation(s)
- Miao He
- Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences , Guangzhou, People's Republic of China
| | - Haiying Chen
- The Royal Melbourne Hospital , Melbourne, Victoria, Australia
| | - Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University , Guangzhou, People's Republic of China
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Abouelkheir HY, Badawi AE, Abdelkader AM, El-Kanishy A, Saleh S, Abou Samra WA, Kasem MA, Mokbel T. Does the scleral encircling band provide a protective effect against the progression of diabetic retinopathy? Int J Ophthalmol 2019; 12:1408-1414. [PMID: 31544035 DOI: 10.18240/ijo.2019.09.06] [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: 11/24/2018] [Accepted: 01/14/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the effect of scleral encircling bands on the development and progression of diabetic retinopathy (DR) in diabetic patients. METHODS The medical records of diabetic patients who underwent unilateral retinal detachment (RD) surgery using scleral buckle and encircling band were reviewed retrospectively. Both eyes of patients were included in the study: one eye in each patient had a scleral buckle with encircling band (the operated eye) and the other one is the non-operated eye. The demographic characters, duration of diabetes and period between surgery and the last recall visit were retrieved from each patient. All the cases underwent fundus photo and fluorescein angiography (when indicated) to confirm the DR staging. RESULTS Totally 25 patients fulfilled the inclusion and the exclusion criteria were become eligible for the study. A total of 50 eyes of 25 patients were enrolled in this analysis. The mean period of time passed from surgery with encircling band and the last reassessment visit was 12.5±2y. Even though DR could develop in the operated eyes, it was at a less degree of severity compared to the non-operated eyes of same patients (P=0.027). CONCLUSION Scleral encircling bands have protective effects against the development and progression of DR.
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Affiliation(s)
| | - Amani E Badawi
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Amr M Abdelkader
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Amr El-Kanishy
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Sameh Saleh
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Waleed Ali Abou Samra
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Manal Ali Kasem
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Tharwat Mokbel
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
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Ziemssen F, Marahrens L, Roeck D, Agostini H. Klinische Stadieneinteilung der diabetischen Retinopathie. DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0417-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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