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Palbo A, Roed Rasmussen ML, Hansen MS, Subhi Y. Association between visual impairment and suicide: A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:263-273. [PMID: 37395145 DOI: 10.1111/aos.15730] [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: 01/04/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
Visual impairment severely impacts the life of the patients. In this study, we systematically reviewed studies on the potential relationship between visual impairment and suicidal behaviour, and conducted meta-analyses on the risk estimates. We searched 11 literature databases on 20 October 2022 and identified a total of 10 eligible studies with 5.8 million participants. Suicide behaviour was investigated according to three domains: suicide ideation, suicide attempt and suicide death. In the 10 eligible studies, seven reported data on suicide ideation, five reported data on suicide attempt, and three reported data on suicide death. All summary estimates extracted for use in the meta-analyses were adjusted estimates of association since we acknowledged that depression as well as other confounding factors may play an important role. We found that visual impairment was a significant risk factor of suicide ideation (OR 1.83; 95% CI: 1.40-2.40; p = 0.000012), suicide attempt (OR 2.62; 95% CI: 1.29-5.31; p = 0.0077) and suicide death (OR 7.00; 95% CI: 2.30-21.4; p = 0.000063). These high increases in risk of suicide from visual impairment underscore the importance of eye health on the overall mental health, and the potential devastating consequences of insufficient access to eye care, lack of treatment possibilities for any reason or low political priority of eye care.
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Affiliation(s)
- Amanda Palbo
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Marie Louise Roed Rasmussen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael Stormly Hansen
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Larsson JME, Boberg-Ans LC, Vangsted A, van Dijk EHC, Grauslund J, Hajari JN, Klefter ON, Schneider M, Subhi Y. Topical non-steroidal anti-inflammatory drugs for central serous chorioretinopathy: A systematic review and meta-analysis. Acta Ophthalmol 2024; 102:274-284. [PMID: 37551858 DOI: 10.1111/aos.15743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 08/09/2023]
Abstract
Central serous chorioretinopathy (CSC) is a prevalent exudative maculopathy and the ongoing verteporfin shortage restricts current treatment possibilities. Topical non-steroidal anti-inflammatory drugs (NSAID) have previously been proposed as a treatment for CSC, although its exact efficacy remains unclear. In this systematic review and meta-analysis, we outlined the efficacy of topical NSAIDs for the treatment of CSC. We searched 11 literature databases on 13 December 2022, for any study describing topical NSAID treatment for CSC. Thirteen eligible studies were included with a total of 1001 eyes of 994 patients with CSC. Six studies were case reports, two were cohort studies and five were non-randomized comparative studies. Where specified, topical NSAIDs used were bromfenac 0.09%, diclofenac 0.1%, ketorolac 0.4% and 0.5%, pranoprofen 0.1%, and nepafenac 0.1% and 0.3%. Studies were predominantly of cases with acute CSC and several case studies reported treatment outcomes simultaneously with discontinuation of corticosteroid use, which complicated treatment evaluation. Meta-analyses of comparative studies revealed a statistically significant but clinically irrelevant best-corrected visual acuity improvement of -0.04 logMAR (95% CI: -0.07 to -0.01 logMAR; p = 0.01) at 1-month follow-up, which became statistically insignificant at 3-month follow-up (-0.03 logMAR; 95% CI: -0.06 to 0.003 logMAR; p = 0.08). Further, we found no benefit in complete subretinal fluid resolution at 1-month follow-up (OR: 1.20; 95% CI: 0.81-1.76; p = 0.37) or 3-month follow-up (OR: 1.17; 95% CI: 0.86 to 1.59; p = 0.33). Taken together, available evidence does not support the use of topical NSAIDs for the treatment of CSC.
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Affiliation(s)
| | | | | | - Elon H C van Dijk
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jakob Grauslund
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark
- Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Javad N Hajari
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
| | - Oliver N Klefter
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Miklos Schneider
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hansen MS, Klefter ON, Terslev L, Jensen MR, Brittain JM, Døhn UM, Faber C, Heegaard S, Wiencke AK, Subhi Y, Hamann S. Is Erythrocyte Sedimentation Rate Necessary for the Initial Diagnosis of Giant Cell Arteritis? Life (Basel) 2023; 13:693. [PMID: 36983848 PMCID: PMC10058337 DOI: 10.3390/life13030693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Giant cell arteritis (GCA) is an ophthalmological emergency that can be difficult to diagnose and prompt treatment is vital. We investigated the sequential diagnostic value for patients with suspected GCA using three biochemical measures as they arrive to the clinician: first, platelet count, then C-reactive protein (CRP), and lastly, erythrocyte sedimentation rate (ESR). This retrospective cross-sectional study of consecutive patients with suspected GCA investigated platelet count, CRP, and ESR using diagnostic test accuracy statistics and odds ratios (ORs) in a sequential fashion. The diagnosis was established by experts at follow-up, considering clinical findings and tests including temporal artery biopsy. A total of 94 patients were included, of which 37 (40%) were diagnosed with GCA. Compared with those without GCA, patients with GCA had a higher platelet count (p < 0.001), CRP (p < 0.001), and ESR (p < 0.001). Platelet count demonstrated a low sensitivity (38%) and high specificity (88%); CRP, a high sensitivity (86%) and low specificity (56%); routine ESR, a high sensitivity (89%) and low specificity (47%); and age-adjusted ESR, a moderate sensitivity (65%) and moderate specificity (65%). Sequential analysis revealed that ESR did not provide additional value in evaluating risk of GCA. Initial biochemical evaluation can be based on platelet count and CRP, without waiting for ESR, which allows faster initial decision-making in GCA.
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Affiliation(s)
- Michael S. Hansen
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Oliver N. Klefter
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Mads R. Jensen
- Department of Clinical Physiology and Nuclear Medicine, Bispebjerg & Frederiksberg Hospital, DK-2400 Copenhagen, Denmark
| | - Jane M. Brittain
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Uffe M. Døhn
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Carsten Faber
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Eye Pathology Section, Department of Pathology, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Anne K. Wiencke
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
- Department of Clinical Research, University of Southern Denmark, DK-5230 Odense, Denmark
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2100 Copenhagen, Denmark
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Ruamviboonsuk P, Lai TYY, Chen SJ, Yanagi Y, Wong TY, Chen Y, Gemmy Cheung CM, Teo KYC, Sadda S, Gomi F, Chaikitmongkol V, Chang A, Lee WK, Kokame G, Koh A, Guymer R, Lai CC, Kim JE, Ogura Y, Chainakul M, Arjkongharn N, Hong Chan H, Lam DSC. Polypoidal Choroidal Vasculopathy: Updates on Risk Factors, Diagnosis, and Treatments. Asia Pac J Ophthalmol (Phila) 2023; 12:184-195. [PMID: 36728294 DOI: 10.1097/apo.0000000000000573] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/09/2022] [Indexed: 02/03/2023] Open
Abstract
There have been recent advances in basic research and clinical studies in polypoidal choroidal vasculopathy (PCV). A recent, large-scale, population-based study found systemic factors, such as male gender and smoking, were associated with PCV, and a recent systematic review reported plasma C-reactive protein, a systemic biomarker, was associated with PCV. Growing evidence points to an association between pachydrusen, recently proposed extracellular deposits associated with the thick choroid, and the risk of development of PCV. Many recent studies on diagnosis of PCV have focused on applying criteria from noninvasive multimodal retinal imaging without requirement of indocyanine green angiography. There have been attempts to develop deep learning models, a recent subset of artificial intelligence, for detecting PCV from different types of retinal imaging modality. Some of these deep learning models were found to have high performance when they were trained and tested on color retinal images with corresponding images from optical coherence tomography. The treatment of PCV is either a combination therapy using verteporfin photodynamic therapy and anti-vascular endothelial growth factor (VEGF), or anti-VEGF monotherapy, often used with a treat-and-extend regimen. New anti-VEGF agents may provide more durable treatment with similar efficacy, compared with existing anti-VEGF agents. It is not known if they can induce greater closure of polypoidal lesions, in which case, combination therapy may still be a mainstay. Recent evidence supports long-term follow-up of patients with PCV after treatment for early detection of recurrence, particularly in patients with incomplete closure of polypoidal lesions.
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Affiliation(s)
| | - Timothy Y Y Lai
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yasuo Yanagi
- Department of Ophthalmology and Microtechnology, Yokohama City University, Yokohama, Japan
| | - Tien Yin Wong
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- School of Medicine, Tsinghua University, Beijing, China
| | - Youxin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chui Ming Gemmy Cheung
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Kelvin Y C Teo
- Singapore National Eye Centre, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | - Srinivas Sadda
- Doheny Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo Medical University, Hyogo, Japan
| | - Voraporn Chaikitmongkol
- Retina Division, Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Andrew Chang
- Sydney Retina Clinic, Sydney Eye Hospital, University of Sydney, Sydney, NSW, Australia
| | | | - Gregg Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, HI
| | - Adrian Koh
- Eye & Retina Surgeons, Camden Medical Centre, Singapore, Singapore
| | - Robyn Guymer
- Centre for Eye Research Australia, University of Melbourne, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, WI
| | - Yuichiro Ogura
- Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | | | | | | | - Dennis S C Lam
- The C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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Holtz JK, Larsson JME, Hansen MS, van Dijk EHC, Subhi Y. Pachychoroid Spectrum Diseases in Patients with Cushing's Syndrome: A Systematic Review with Meta-Analyses. J Clin Med 2022; 11:4437. [PMID: 35956052 PMCID: PMC9369356 DOI: 10.3390/jcm11154437] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/11/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022] Open
Abstract
Cushing's syndrome is a rare disease with an endogenous cause of excess cortisol secretion. More evidence substantially links cortisol levels to the pachychoroid spectrum diseases. In this systematic review and meta-analysis, we summarize available evidence on pachychoroid spectrum diseases in patients with Cushing's syndrome. We performed a systematic literature search in 11 databases on 21 May 2022. Studies were considered eligible if they performed retinal examination of a consecutive group of patients with Cushing's syndrome using optical coherence tomography (OCT) scans. We extracted data on subfoveal choroidal thickness in patients with Cushing's syndrome compared to matched controls. We also extracted data on the prevalence of pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC), and polypoidal choroidal vasculopathy (PCV). We identified six eligible studies with a total of 159 patients with Cushing's syndrome. On average, patients with Cushing's syndrome have 49.5 µm thicker subfoveal choroidal thickness compared to matched healthy individuals. Pachychoroid spectrum diseases were relatively common in these patients: PPE in 20.8%, CSC in 7.7%, and PCV in 2.8%. We conclude that there should be low threshold to recommend ophthalmic examination to patients with Cushing's syndrome, and that a macular OCT is recommended during this examination.
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Affiliation(s)
- Jeppe K. Holtz
- Department of Ophthalmology, Odense University Hospital, DK-5000 Odense, Denmark;
- Department of Otolaryngology, Odense University Hospital, DK-5000 Odense, Denmark
| | - Janni M. E. Larsson
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (J.M.E.L.); (M.S.H.)
| | - Michael S. Hansen
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (J.M.E.L.); (M.S.H.)
| | - Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, DK-2600 Glostrup, Denmark; (J.M.E.L.); (M.S.H.)
- Department of Clinical Research, University of Southern Denmark, DK-5230 Odense, Denmark
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Merle H, Béral L, Rocher M, Pierre M, Jean-Charles A, Béra O, Rosamont LA, Robert PY, Lézin A. Class II Human Leukocyte Antigen (HLA) and Susceptibility to Polypoidal Choroidal Vasculopathy in Afro-Caribbean Descent. Clin Ophthalmol 2022; 16:1047-1053. [PMID: 35418742 PMCID: PMC8995864 DOI: 10.2147/opth.s337084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate how the HLA genotype is associated to the polypoidal choroidal vasculopathy (PCV) in a population of patients of Afro-Caribbean descent. Methods Forty-seven patients were diagnosed with PCV. The number of control patients was 457. All affected patients and control patients were of Afro-Caribbean descent and natives to Martinique. HLA typing was based on blood sample, using the polymerase chain reaction technique. Comparison of HLA alleles between the 2 groups was done using chi-2 test, odds ratio (OR) and confidence interval using Woolf’s method. The Bonferroni correction was considered significant when p-value ≤0.05. Alleles frequency was analyzed for DRB1 and DQB1 locus. Results HLA-DRB1*13 allele was significantly associated to PCV (OR = 2.02, CI = [1.3; 3.13], p = 0.003). In group DRB1, the Bonferroni correction significance threshold was <0.004. HLA-DQB1*04 allele was significantly associated to PCV (OR = 3.5, CI = [1.48; 8.3], p = 0.006). In group DQB1, the Bonferroni correction significance threshold was <0.006. Conclusion Two HLA alleles are positively associated to PCV. The possible association between PCV and certain alleles suggest HLA implication in PCV pathogeny, most likely by modeling the immune system response.
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Affiliation(s)
- Harold Merle
- Department of Ophthalmology, University Hospital of Martinique, Fort de France, French West Indies, France
- Correspondence: Harold Merle, Department of Ophthalmology, University Hospital of Martinique, Hôpital Pierre Zobda Quitman, BP 632, Martinique, Fort de France, 97261 Cedex, French West Indies, France, Tel +596 596 552 251, Fax +596 596 758 447, Email
| | - Laurence Béral
- Department of Ophthalmology, University Hospital of Guadeloupe, Pointe à Pitre, French West Indies, France
| | - Maxime Rocher
- Department of Ophthalmology, University Hospital of Limoges, France
| | - Mitta Pierre
- Department of Ophthalmology, University Hospital of Martinique, Fort de France, French West Indies, France
| | - Albert Jean-Charles
- Department of Ophthalmology, University Hospital of Martinique, Fort de France, French West Indies, France
| | - Odile Béra
- Department of Genetics, University Hospital of Martinique, Fort de France, French West Indies, France
| | - Laurie-Anne Rosamont
- Department of Genetics, University Hospital of Martinique, Fort de France, French West Indies, France
| | | | - Agnes Lézin
- Department of Genetics, University Hospital of Martinique, Fort de France, French West Indies, France
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Li H, Li J, Huang Y, Sui R. Clinical and genetic study of a pseudo-dominant retinoschisis pedigree: the first female patient reported in Chinese population. Ophthalmic Genet 2022; 43:433-437. [PMID: 35189768 DOI: 10.1080/13816810.2022.2042702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The inheritance pattern of genetically confirmed hereditary juvenile retinoschisis reported so far is X-linked recessive with limited number of female cases. We identified a female patient with retinoschisis, and this study reports the clinical features as well as the underlying genetic defect of this family. MATERIALS AND METHODS Detailed family history and pedigree analysis were performed. All affected subjects underwent detailed ophthalmic examinations, including best corrected visual acuity (BCVA), dilated fundoscopy, optical coherent tomography (OCT) and fundus autofluorescence (FAF). DNA sample of the proband was sequenced by next-generation sequencing (NGS). Sanger sequencing was performed for validation and segregation. RESULTS Three affected subjects including one female and two males were confirmed in this consanguineous family. The BCVA ranged from 20/50 to hand motion. Foveoschisis, hyperopia, subcapsular cataracts, vitreous opacity, retinal pigmentation, and macular atrophy were present in all three patients, with variable severity. Nystagmus, esotropia, and retinal vessels transposition were noted in the female patient. Retinal detachment occurred in the female patient and her affected brother. A small deletion in RS1 gene c.97delT (p.W33Gfs*93) (NM_000330.3) was found, which was co-segregated in the pedigree. CONCLUSIONS Consanguineous family having XLRS female patient could manifest as pseudo-dominant inheritance. Significant intrafamilial phenotypic variation was revealed.
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Affiliation(s)
- Huajin Li
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jing Li
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yanfeng Huang
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ruifang Sui
- Department of Ophthalmology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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