1
|
Chen J, Bai T, Su J, Cong X, Lv L, Tong L, Yu H, Feng Y, Yu G. Salivary Gland Transplantation as a Promising Approach for Tear Film Restoration in Severe Dry Eye Disease. J Clin Med 2024; 13:521. [PMID: 38256655 PMCID: PMC10816601 DOI: 10.3390/jcm13020521] [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: 11/14/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
With increased awareness of dry eye disease (DED), a multitude of therapeutic options have become available. Nevertheless, the treatment of severe DED remains difficult. In a patient whose DED is related to the loss of lacrimal function without severe destruction of the salivary glands, autologous transplantation of the latter as functioning exocrine tissue to rebuild a stable tear film is an attractive idea. All three major and minor salivary glands have been used for such transplantation. Due to the complications associated with and unfavorable prognosis of parotid duct and sublingual gland transplantation, surgeons now prefer to use the submandibular gland (SMG) for such procedures. The transplantation of the SMG not only has a high survival rate, but also improves dry eye symptoms and signs for more than 20 years post-surgery. The regulation of the secretion of the transplanted SMG is critical because the denervated SMG changes its mechanism of secretion. Innovative procedures have been developed to stimulate secretion in order to prevent the obstruction of the Wharton's duct and to decrease secretion when postoperative "epiphora" occurs. Among the minor salivary glands, the transplantation of the labial salivary glands is the most successful in the long-term. The measurement of the flow rates of minor salivary glands and donor-site selection are critical steps before surgery.
Collapse
Affiliation(s)
- Jiayi Chen
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Tianyi Bai
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Jiazeng Su
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Xin Cong
- Key Laboratory of Molecular Cardiovascular Sciences, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, Ministry of Education, Beijing 100191, China;
| | - Lan Lv
- Department of Ophthalmology, Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing 100730, China
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore 168751, Singapore;
- Ocular Surface Research Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Eye-Academic Clinical Program, Duke-National University of Singapore, Singapore 169857, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
| | - Haozhe Yu
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Yun Feng
- Beijing Key Laboratory of Damaged Ocular Nerve, Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China (H.Y.)
| | - Guangyan Yu
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
| |
Collapse
|
2
|
[Beyond esthetics-Regenerative medicine for severe diseases of the adnexa oculi]. DIE OPHTHALMOLOGIE 2022; 119:878-890. [PMID: 35925347 DOI: 10.1007/s00347-022-01643-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Restoration of eyelid and lacrimal functions are important steps on the way to an intact ocular surface. Clinically available substitute tissues or therapeutic options for eyelid reconstruction and lacrimal gland regeneration often reach their limits in patients with severe diseases of the adnexa oculi. Several approaches in regenerative medicine have been intensively researched and clinically tested in recent years. These range from reconstructive approaches with novel tissue matrices in the field of eyelid surgery to stem cell therapies to regenerate lacrimal gland function. MATERIAL AND METHODS The state of the art in the current literature is presented and an overview of clinically applied or currently researched tissues for eyelid reconstruction is given. Furthermore, approaches in stem cell therapy of the lacrimal gland as well as own results are presented. RESULTS Acellular dermis has been successfully used for eyelid reconstruction and represents a viable option in cases of limited availability of autologous tissue. In vitro grown cellular constructs or tissues with genetically modified cells have already been successfully applied in dermatology for the treatment of burns or severe genodermatoses. First studies on stem cell therapy for severe dry eye in Sjögren syndrome showed a safe and effective application of mesenchymal stem cells by injection into the lacrimal gland. CONCLUSION Due to the limitations of currently available replacement tissues, there is a clinical need for the development of new materials for adnexa oculi reconstruction. Constructs grown in vitro with allogeneic and/or genetically engineered cells are slowly making their way into clinical practice. The efficacy and mode of action of stem cells in severe dry eye are subject matters of current clinical trials.
Collapse
|
3
|
Singh S, Basu S, Geerling G. Salivary gland transplantation for dry eye disease: Indications, techniques, and outcomes. Ocul Surf 2022; 26:53-62. [DOI: 10.1016/j.jtos.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/29/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
|
4
|
Zhang L, Su JZ, Cai ZG, Lv L, Zou LH, Liu XJ, Wu J, Zhu ZH, Mao C, Wang Y, Peng X, Song B, Li XX, Yu GY. Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease. Int J Oral Maxillofac Surg 2019; 48:40-47. [PMID: 30057239 DOI: 10.1016/j.ijom.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/04/2018] [Accepted: 07/11/2018] [Indexed: 12/13/2022]
Affiliation(s)
- L Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - J-Z Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Z-G Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - L Lv
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - L-H Zou
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - X-J Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - J Wu
- Department of Ophthalmology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China; Department of Ophthalmology, Affiliated Beijing Bo Ai Hospital, Capital University of Medical Science, Beijing, 100068, China
| | - Z-H Zhu
- Department of Stomatology, Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, China
| | - C Mao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Y Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - B Song
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - X-X Li
- Clinical Laboratory, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - G-Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| |
Collapse
|
5
|
Zhang X, Yang N, Liu X, Su J, Cong X, Wu L, Zhang Y, Yu G. Autonomic reinnervation and functional regeneration in autologous transplanted submandibular glands in patients with severe keratoconjunctivitis sicca. Int J Oral Sci 2018; 10:14. [PMID: 29695713 PMCID: PMC5944256 DOI: 10.1038/s41368-018-0014-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 12/25/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
Autologous submandibular gland (SMG) transplantation has been proved to ameliorate the discomforts in patients with severe keratoconjunctivitis sicca. The transplanted glands underwent a hypofunctional period and then restored secretion spontaneously. This study aims to investigate whether autonomic nerves reinnervate the grafts and contribute to the functional recovery, and further determine the origin of these nerves. Parts of the transplanted SMGs were collected from the epiphora patients, and a rabbit SMG transplantation model was established to fulfill the serial observation on the transplanted glands with time. The results showed that autonomic nerves distributed in the transplanted SMGs and parasympathetic ganglionic cells were observed in the stroma of the glands. Low-dense and unevenly distributed cholinergic axons, severe acinar atrophy and fibrosis were visible in the patients’ glands 4–6 months post-transplantation, whereas the cholinergic axon density and acinar area were increased with time. The acinar area or the secretory flow rate of the transplanted glands was statistically correlated with the cholinergic axon density in the rabbit model, respectively. Meanwhile, large cholinergic nerve trunks were found to locate in the temporal fascia lower to the gland, and sympathetic plexus concomitant with the arteries was observed both in the adjacent fascia and in the stroma of the glands. In summary, the transplanted SMGs are reinnervated by autonomic nerves and the cholinergic nerves play a role in the morphological and functional restoration of the glands. Moreover, these autonomic nerves might originate from the auriculotemporal nerve and the sympathetic plexus around the supplying arteries. Regenerated nerves play a role in restoring the function of transplanted submandibular glands (SMGs) in treating dry eye syndrome. Dry eye syndrome, or keratoconjunctivitis sicca (KCS), is a leading cause of patients visiting ophthalmologists, and one effective treatment in severe cases is transplanting SMGs (to the temporal area). Autonomic nerves have an important function in maintaining the secretory function of salivary glands, and a team headed by Yan Zhang and Guang-Yan Yu at Peking University, China investigated whether those nerves underwent reinnervation (restoration of nerve control) with transplanted SMGs in KCS patients and in a rabbit model. The authors found that in both the patients and rabbit model, the transplanted SMGs were reinnervated and the regenerated nerves played a role in restoring the glands’ function. The findings offer new insights into managing SMG transplantation.
Collapse
Affiliation(s)
- Xueming Zhang
- Center for Salivary Gland Diseases and Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ningyan Yang
- Center for Salivary Gland Diseases and Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.,Department of Pediatric Dentistry, Beijing Stomatological Hospital and School of Stomatology, Capital Medical University, Beijing, China
| | - Xiaojing Liu
- Center for Salivary Gland Diseases and Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jiazeng Su
- Center for Salivary Gland Diseases and Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xin Cong
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Liling Wu
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China
| | - Yan Zhang
- Department of Physiology and Pathophysiology, Peking University School of Basic Medical Sciences, and Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing, China.
| | - Guangyan Yu
- Center for Salivary Gland Diseases and Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| |
Collapse
|
6
|
Su JZ, Cai ZG, Liu XJ, Lv L, Yu GY. Management of duct obstruction in transplanted submandibular glands. J Craniomaxillofac Surg 2018; 46:825-830. [PMID: 29606544 DOI: 10.1016/j.jcms.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/08/2018] [Accepted: 03/07/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Submandibular gland (SMG) transplantation is a successful treatment approach for patients with severe dry eye. However, duct obstruction can occur post-transplant. METHODS We studied nineteen patients with duct obstruction of transplanted SMGs, including five interventional modalities: stone removal; secretory stimulation (to mimic "internal irrigation" with substantial secretory flow); irrigation; surgical opening of stenosis and orifice reconstruction; cephalic vein bypass and Wharton's duct reconstruction. RESULTS A solitary stone was found and removed in one patient. Duct blockages like mucus plug were cleared by secretory stimulation in three patients, and by normal saline irrigation in two grafts. In the remaining 13 patients, irrigation failed and surgical opening was performed. Orifice reconstruction succeeded in six of the eight patients, whose stenosis was near the orifice. Wharton's duct reconstruction was successful in two of the five cases where stenosis was located in the middle segment of the duct. CONCLUSION Transplanted SMGs obstruct for various reasons. Stone, which is easy to diagnose and treat, should be excluded first. Non-organic blockage and stenosis were semblable in clinic. Therefore, subsequent steps should be a diagnostic/therapeutic trial of secretory stimulation, followed by irrigation; failure of these interventions suggests the diagnosis of duct stenosis, necessitating surgical recanalization.
Collapse
Affiliation(s)
- Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery (Head of the department, Professor Yi Zhang), Peking University School and Hospital of Stomatology, PR China; National Engineering Laboratory for Digital and Material Technology of Stomatology (Head of the laboratory, Professor Chuan-Bin Guo), Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, PR China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery (Head of the department, Professor Yi Zhang), Peking University School and Hospital of Stomatology, PR China; National Engineering Laboratory for Digital and Material Technology of Stomatology (Head of the laboratory, Professor Chuan-Bin Guo), Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, PR China
| | - Xiao-Jing Liu
- Department of Oral and Maxillofacial Surgery (Head of the department, Professor Yi Zhang), Peking University School and Hospital of Stomatology, PR China; National Engineering Laboratory for Digital and Material Technology of Stomatology (Head of the laboratory, Professor Chuan-Bin Guo), Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, PR China
| | - Lan Lv
- Department of Ophthalmology (Head of the department, Professor Wen-Bin Wei), Affiliated Beijing Tong Ren Hospital, Capital University of Medical Science, Beijing, 100730, PR China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery (Head of the department, Professor Yi Zhang), Peking University School and Hospital of Stomatology, PR China; National Engineering Laboratory for Digital and Material Technology of Stomatology (Head of the laboratory, Professor Chuan-Bin Guo), Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, PR China.
| |
Collapse
|
7
|
Liu S, Niu K, Da Y, Liu Y, Zhang J, Wang W, Zhang Y, Jiang H, Wang K, Bai W, Qin L, Jia J. Effects of standardized isopropanolic black cohosh and estrogen on salivary function in ovariectomized rats. Biomed Pharmacother 2018; 97:1438-1444. [DOI: 10.1016/j.biopha.2017.11.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/18/2017] [Accepted: 11/03/2017] [Indexed: 02/04/2023] Open
|
8
|
|
9
|
Liu XJ, Li M, Su JZ, Wang Z, Xie Z, Yu GY. Carbachol improves the secretion of transplanted submandibular glands during the latent period after microvascular autologous transplantation for severe keratoconjunctivitis sicca. Int J Oral Maxillofac Surg 2016; 45:1273-9. [DOI: 10.1016/j.ijom.2016.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 02/07/2016] [Accepted: 03/22/2016] [Indexed: 11/28/2022]
|
10
|
Review: The Lacrimal Gland and Its Role in Dry Eye. J Ophthalmol 2016; 2016:7542929. [PMID: 27042343 PMCID: PMC4793137 DOI: 10.1155/2016/7542929] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 02/04/2016] [Indexed: 01/15/2023] Open
Abstract
The human tear film is a 3-layered coating of the surface of the eye and a loss, or reduction, in any layer of this film may result in a syndrome of blurry vision and burning pain of the eyes known as dry eye. The lacrimal gland and accessory glands provide multiple components to the tear film, most notably the aqueous. Dysfunction of these glands results in the loss of aqueous and other products required in ocular surface maintenance and health resulting in dry eye and the potential for significant surface pathology. In this paper, we have reviewed products of the lacrimal gland, diseases known to affect the gland, and historical and emerging dry eye therapies targeting lacrimal gland dysfunction.
Collapse
|
11
|
Effects of Capsaicin and Carbachol on Secretion From Transplanted Submandibular Glands and Prevention of Duct Obstruction. Cornea 2016; 35:494-500. [PMID: 26807899 DOI: 10.1097/ico.0000000000000752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate whether capsaicin and carbachol promote secretion from and prevent duct obstruction in transplanted submandibular glands (SMGs). METHODS This retrospective cohort study included consecutive patients with severe keratoconjunctivitis sicca and successful SMG transplantation. Patients were divided into 2 groups: an exposed group receiving both capsaicin and carbachol after surgery and an unexposed group receiving neither. Secretion changes in response to capsaicin and carbachol administration were recorded in the exposed group. The main outcome measures were the secretory flow rate and duct obstruction rate in the transplanted SMGs. RESULTS Forty-four patients (44 eyes) in the unexposed group and 115 patients (128 eyes) in the exposed group were followed up for more than 3 months postoperatively. The baseline characteristics were similar between the groups. The secretory flow rate before and 5, 25, 55 minutes after administration was 1 mm (0-2 mm) (median with interquartile range), 3 mm (1-5 mm), 4 mm (2-5 mm), 1 mm (0-2.5 mm), respectively, for capsaicin and 1 mm (0-3 mm), 1050 mm (450-1500 mm), 375 mm (150-600 mm), 0 mm (0-150 mm), respectively, for carbachol (P < 0.001 for both). In the exposed group, 6.2% of eyes had duct obstruction, whereas 18.2% of eyes in the unexposed group had duct obstruction (P = 0.031) (odds ratio = 0.3, 95% confidence interval, 0.105-0.856). CONCLUSIONS This study provides evidence that capsaicin and carbachol effectively promote secretion from and prevent duct obstruction in transplanted SMGs during at least 3 months after transplantation.
Collapse
|
12
|
Su JZ, Cai ZG, Yu GY. Microvascular autologous submandibular gland transplantation in severe cases of keratoconjunctivitis sicca. Maxillofac Plast Reconstr Surg 2015; 37:5. [PMID: 25664315 PMCID: PMC4317526 DOI: 10.1186/s40902-015-0006-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/17/2022] Open
Abstract
Dry eye syndrome is a relatively common disease of the tears and ocular surfaces that results in discomfort, visual disturbance, and tear film instability with possible damage to the ocular surfaces. Microvascular submandibular gland (SMG) transfer offers a surgical alternative for a permanent autologous substitution of tears using the basal secretion of a transplanted SMG. Long-term follow-up reveals that this technique is a lasting and effective solution for patients with severe dry eye syndrome. The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced. Objective examination showed significant improvement in tear film and some features of ocular surface such as breakup time of tear film and corneal staining. Patients may suffer from obstruction of Wharton's duct or epiphora after surgery. Activation of secretion-related receptors could improve the early hypofunction of the denervated SMG and prevent the duct obstruction. Reduction surgery, partial SMG transplantation, uses of atropine gel or Botulinum toxin A could be the choices of treatment for epiphora.
Collapse
Affiliation(s)
- Jia-Zeng Su
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| | - Zhi-Gang Cai
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| | - Guang-Yan Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, No. 22, South Avenue Zhongguancun, Haidian District, Beijing, 100081 P.R. China
| |
Collapse
|
13
|
Highlights from this issue. Br J Ophthalmol 2014. [DOI: 10.1136/bjophthalmol-2014-306321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|