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Munnerlyn CR, Arnoldussen ME, Munnerlyn AL, Logan BA. Theory concerning the ablation of corneal tissue with large-area, 193-nm excimer laser beams. JOURNAL OF BIOMEDICAL OPTICS 2006; 11:064032. [PMID: 17212555 DOI: 10.1117/1.2399091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Excimer laser beams (193 nm) of uniform fluence were studied to find out why they produce corneal ablations deeper at the edge than the center. Ablation depth profiles were taken of porcine corneas, including five dehydrated samples. Hydrated corneas and polymethyl methacrylate were ablated with and without central masks. Ablation plumes were photographed. Hydrated porcine corneas showed patterns of central underablation. As the incident beam increased, the crater exhibited increasingly shallower central ablation while maintaining nearly constant depth at the edges. Dehydrated corneas did not vary significantly. Masks did not alter the depth or shape of craters near ablation edges, but depth adjacent to the images of the masks was more than twice that with no mask. Depth adjacent to the mask image was nearly the same as at the edge of the zone. The rate of change in depth with position was nearly equal in both areas. Maximum plume density was centered over the entire ablation with and without the mask. Redeposition of plume particles is not the major cause of central underablation. Propagating transverse energy from the absorption of photons by peptide bonds increases pressure on excited components within the irradiated area, increasing recombination, which raises the ablation threshold.
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Affiliation(s)
- Charles R Munnerlyn
- Advanced Medical Optics, Incorporated, 3400 Central Expressway, Santa Clara, California 95050, USA
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Fisher BT, Hahn DW. Determination of Excimer Laser Ablation Rates of Corneal Tissue Using Wax Impressions of Ablation Craters and White-Light Interferometry. Ophthalmic Surg Lasers Imaging Retina 2004. [DOI: 10.3928/1542-8877-20040101-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Alfred Vogel
- Medical Laser Center Lübeck, Peter-Monnik-Weg 4, D-23562 Lübeck, Germany.
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Huang D, Arif M. Spot size and quality of scanning laser correction of higher-order wavefront aberrations. J Cataract Refract Surg 2002; 28:407-16. [PMID: 11973085 DOI: 10.1016/s0886-3350(01)01163-4] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To investigate the effect of laser spot size on the outcome of aberration correction with scanning laser corneal ablation. SETTING Cleveland Clinic Foundation, Cleveland, Ohio, USA. METHODS Corrections of wavefront aberrations of Zernike modes from the second to eighth order were simulated. Gaussian and top-hat beams of 0.6 to 2.0 mm full-width-half-maximum diameters were modeled. The fractional correction and secondary aberration (distortion) were evaluated. RESULTS Using a distortion/correction ratio of less than 0.5 as a cutoff for adequate performance, a 2.0 mm or smaller beam was adequate for spherocylindrical correction (Zernike second order), a 1.0 mm or smaller beam was adequate for correction of up to fourth-order Zernike modes, and a 0.6 mm or smaller beam was adequate for correction of up to sixth-order Zernike modes. CONCLUSIONS Since ocular aberrations above the Zernike fourth order are relatively insignificant in normal eyes, current scanning lasers with a beam diameter of 1.0 mm or less are theoretically capable of eliminating most higher-order aberrations.
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Affiliation(s)
- David Huang
- Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Hauge E, Naroo SA, Charman WN. Poly(methyl methacrylate) model study of optical surface quality after excimer laser photorefractive keratectomy. J Cataract Refract Surg 2001; 27:2026-35. [PMID: 11738921 DOI: 10.1016/s0886-3350(01)01130-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate lenses produced by excimer laser ablation of poly(methyl methacrylate) (PMMA) plates. SETTING University research laboratory. METHODS Two Nidek EC-5000 scanning-slit excimer laser systems were used to ablate plane-parallel plates of PMMA. The ablated lenses were examined by focimetry, interferometry, and mechanical surface profiling. RESULTS The spherical optical powers of the lenses matched the expected values, but the cylindrical powers were generally lower than intended. Interferometry revealed marked irregularity in the surface of negative corrections, which often had a positive "island" at their center. Positive corrections were generally smoother. These findings were supported by the results of mechanical profiling. Contrast sensitivity measurements carried out when observing through ablated lenses whose power had been neutralized with a suitable spectacle lens of opposite sign confirmed that the surface irregularities of the ablated lenses markedly reduced contrast sensitivity over a range of spatial frequencies. CONCLUSION Improvements in beam delivery systems seem desirable.
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Affiliation(s)
- E Hauge
- Department of Optometry and Neuroscience, UMIST, Manchester, United Kingdom
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Fiore T, Carones F, Brancato R. Broad Beam vs. Flying Spot Excimer Laser: Refractive and Videokeratographic Outcomes of Two Different Ablation Profiles After Photorefractive Keratectomy. J Refract Surg 2001; 17:534-41. [PMID: 11583223 DOI: 10.3928/1081-597x-20010901-06] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the refractive outcomes and videokeratographic patterns in photorefractive keratectomy (PRK) of two last-generation excimer lasers: broad beam and flying spot lasers. METHODS Forty eyes were treated for a mean myopic correction of -5.59+/-2.17 D with a Ladarvision excimer laser (Autonomous Technology Corp). We compared the refractive outcomes and the videokeratographic patterns with those of 40 eyes treated with the Summit Apex Plus laser (Summit Technology Inc) for a mean myopic correction of -5.60+/-2.24 D. RESULTS During the 6-month follow-up, we found no significant difference in uncorrected and spectacle-corrected visual acuity, haze grade, regularity index, or decentration. The eyes treated by Ladarvision showed a lower refractive error at 1 month (P = .04), a lower incidence of central islands at 1 (P = .003) and 3 months (P = .04), a wider mean effective ablation area at 1 (P = .0004), 3 (P = .0000009), and 6 months (P = .0000000004), a less steep ablation edge at 1 (P = .0026), 3 (P = .015), and 6 months (P = .011). CONCLUSIONS The small beam excimer laser provides better videokeratographic outcomes, which lead to quicker refractive stability and better visual performance.
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Affiliation(s)
- T Fiore
- Department of Ophthalmology & Visual Sciences, San Raffaele Hospital, University of Milan, Italy
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Huang D, Arif M. Spot Size and Quality of Scanning Laser Correction of Higher Order Wavefront Aberrations. J Refract Surg 2001; 17:S588-91. [PMID: 11583236 DOI: 10.3928/1081-597x-20010901-16] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effect of laser spot size on the outcome of aberration correction with scanning laser corneal ablation. METHODS Numerical simulation of ablation outcome. RESULTS Correction of wavefront aberrations of Zernike modes from second to eighth order were simulated. Gaussian and top-hat beams of 0.6 to 2.0-mm full-width-half-maximum diameters were modeled. The fractional correction and secondary aberration (distortion) were evaluated. Using a distortion/correction ratio of less than 0.5 as a cutoff for adequate performance, we found that a 2 mm or smaller beam is adequate for spherocylindrical correction (Zernike second order), a 1 mm or smaller beam is adequate for correction of up to fourth order Zernike modes, and a 0.6 mm or smaller beam is adequate for correction of up to sixth order Zernike modes. CONCLUSIONS Since ocular aberrations above Zernike fourth order are relatively insignificant, current scanning lasers with a beam diameter of 1 mm or less are theoretically capable of eliminating most of the higher order aberrations of the eye.
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Affiliation(s)
- D Huang
- Cleveland Clinic Foundation, OH 44195, USA.
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Affiliation(s)
- R J Duffey
- Premier Medical Eye Group, Mobile, AL 36606, USA
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Abstract
PURPOSE To prospectively evaluate the safety and efficacy of the new large-zone (6.5 mm) photoablation technology using the VISX S2 Smoothscan excimer laser. SETTING University-based hospital, Stanford, California, USA. METHODS Forty-two eyes of 21 patients with a mean preoperative spherical equivalent (SE) of-5.55 diopters (D)+/- 2.24 (SD) (range-2.13 to-10.75 D) had laser in situ keratomileusis (LASIK) using the VISX Smoothscan S2 excimer laser for simple myopia or compound myopic astigmatism. A 6.5 mm optical zone was used in all eyes. Patients were prospectively followed 1 day and 1 and 3 months postoperatively. RESULTS At 3 months, the mean SE was reduced 94% to-0. 31+/- 0.55 D. Ninety-one percent of eyes had an uncorrected visual acuity of 20/40 or better. Eighty-eight percent were within+/-1.00 D of attempted correction and 84%, within +/-0.50 D. Stability within+/-0.50 D occurred after the first postoperative month. Vector analysis of eyes that had toric ablations demonstrated a difference vector within+/-1.00 D in 100% of eyes. The mean angle of error was-0.04+/- 6.37 degrees. Visually significant steep central islands associated with loss of best spectacle-corrected visual acuity was observed in 7.5% of eyes at 1 month. No eyes experienced significant glare or halos. CONCLUSIONS The new large-zone (6.5 mm) photoablation technology with the VISX S2 Smoothscan resulted in effective reduction of simple myopia and compound myopic astigmatism. However, with the 6.5 mm zone, there may be an increased risk of developing symptomatic steep central islands in the early post-LASIK period compared with the standard 6.0 mm treatment zone.
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Affiliation(s)
- W W Haw
- Stanford University School of Medicine, Department of Ophthalmology, Stanford, California, USA
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Affiliation(s)
- R R Krueger
- Dept of Refractive Surgery, Cole Eye Institute, Cleveland Clinic Foundation, OH 44195, USA
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Chen WL, Hu FR, Wang IJ, Chang HW. Surgical results of photorefractive keratectomy with different operative modes. J Cataract Refract Surg 2000; 26:879-86. [PMID: 10889435 DOI: 10.1016/s0886-3350(00)00371-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the predictability, efficacy, and safety of photorefractive keratectomy (PRK) using different operative modes. SETTING National Taiwan University Hospital, Taipei, Taiwan. METHODS One hundred fifty-three eyes of 80 patients who had PRK for myopia with a follow-up of at least 6 months were studied. All patients were sequentially assigned to 1 of the following surgical modes: mode 1: PRK with the Summit OmniMed excimer laser; mode 2: PRK with the Summit Apex Plus laser; mode 3: PRK with the Summit Apex Plus laser with anti-central-island pretreatment. RESULTS Six months after treatment, a homogeneous topographic pattern was seen in 76% of mode 1 eyes, 70% of mode 2 eyes, and 88% of mode 3 eyes. In the low myopia group (< or =-6.0 diopters [D]), the mean residual refractive error was -0.79 D +/- 0.59 (SD) in mode 1, -0.94 +/- 1.02 D in mode 2, and -0.31 +/- 0.42 D in mode 3. In the high myopia group (>-6.0 D), it was -1.93 +/- 1.51 D, -1.54 +/- 0.88 D, and -0.70 +/- 0.81 D, respectively. Uncorrected visual acuity of 20/25 or better was achieved in 81% of mode 1 eyes, 56% of mode 2 eyes, and 89% of mode 3 eyes in the low myopia group, and in 48%, 28%, and 72%, respectively, in the high myopia group. CONCLUSIONS Photorefractive keratectomy appears to be a predictable and effective procedure. The best results were achieved with the Summit Apex Plus laser with anti-central-island pretreatment, followed by the Summit OmniMed laser. The Summit Apex Plus laser without anti-central-island pretreatment produced less satisfactory results.
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Affiliation(s)
- W L Chen
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Kang SW, Chung ES, Kim WJ. Clinical analysis of central islands after laser in situ keratomileusis. J Cataract Refract Surg 2000; 26:536-42. [PMID: 10771226 DOI: 10.1016/s0886-3350(99)00458-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To analyze the incidence and clinical characteristics of central islands after laser in situ keratomileusis (LASIK) and to elucidate factors associated with their formation. SETTING Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. METHODS Laser in situ keratomileusis was performed in 103 eyes of 61 patients with myopia ranging from -4.0 to -13.5 diopters (D) using the Hansatome (Chiron) and SVS Apex Plus (version 3.2.1) excimer laser (Summit Technology) in which the anti-central-island program was implemented. After 1 week, corneal topography (Orbscan, Orbtek) was done and manifest refraction and visual acuity were measured. RESULTS Postoperatively, the mean uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were 0.12 and 0.06 (logMAR scale), respectively, and the mean refractive error (spherical equivalent) was 0.07 D +/- 0.76 (SD). On topographic examination, a central island was defined as an area of higher refractive power of more than 1.5 D and 2.5 mm or more in diameter. Budding or isolated central islands were observed in 12 eyes of 12 patients (11.7%). The peak, height, and area of the islands were 41.5 +/- 3.1 D, 5.6 +/- 1. 9 D, and 3.5 +/- 1.1 mm(2), respectively. In the eyes with central islands, there were statistically significant differences in the postoperative change in UCVA and BCVA (P <.05). There was no significant correlation between the occurrence of a central island and preoperative refractive error, corneal thickness, age, or in sex and correction of astigmatism (P >.05). CONCLUSION Despite use of the anti-central-island pretreatment program, the occurrence of central islands after LASIK was significant, as in photorefractive keratectomy. Further studies of the effect of central islands on surgical results and clinical progress and measures to prevent the occurrence are needed.
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Affiliation(s)
- S W Kang
- Department of Ophthalmology, Samsung Medical Center School of Medicine, Sungkyunkwan University, Seoul, South Korea
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Reviglio VE, Luna JD, Rodríguez ML, García FE, Juárez CP. Laser in situ keratomileus using the LaserSight 200 laser: results of 950 consecutive cases. J Cataract Refract Surg 1999; 25:1062-8. [PMID: 10445191 DOI: 10.1016/s0886-3350(99)00121-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the refractive outcome in 950 consecutive eyes having laser in situ keratomileusis (LASIK) by 1 surgeon with experience in keratomileusis. SETTING Outpatient excimer laser surgical facility. METHODS This study comprised 950 consecutive eyes of 475 patients having LASIK as a primary procedure with a LaserSight 200 excimer laser (8.51 software). A nasal hinged flap and a Chiron microkeratome were used. Preoperative cycloplegic refraction was done only in patients younger than 25 years and in all hyperopic cases. Subjective preoperative and postoperative manifest refractions were done after autorefractometry in all cases. In cases of hyperopia, the software was modified by adding 30% to the refractive error. Enhancement results are not included. RESULTS Of the 950 eyes, 893 (94.00%) were myopic and 57 (6.00%), hyperopic. In the low myopia group (1.00 to 3.99 D) of 223 eyes (24.97%), mean spherical equivalents (SEs) were -2.90 D +/- 0.56 (SD) preoperatively, -0.46 +/- 0.6 D 3 months postoperatively, and -0.41 +/- 0.5 D 6 months postoperatively. In the moderate myopia group (4.00 to 5.99 D) of 205 eyes (22.96%), respective mean SEs were -4.90 +/- 0.7 D, -0.90 D +/- 0.9 D, and -0.67 +/- 0.7 D. In the high myopia group (6.00 to 9.99) of 266 eyes (25.30%), the respective means were -7.70 +/- 1.3 D, -0.76 +/- 0.99 D, and -0.60 +/- 0.8 D. In the extreme myopia group (10.21 to 30.00) of 199 eyes (22.28%), the respective means were -13.30 +/- 2.9 D, -1.30 +/- 1.4 D, and -1.13 +/- 1.3 D. For the entire myopic group, the mean astigmatism was +1.55 +/- 1.38 D, +1.09 +/- 0.92 D, and +0.87 +/- 0.77 D, respectively. The low hyperopia group (1.00 to 2.99 D) of 39 eyes (68.42%) had a mean preoperative SE of +1.80 +/- 0.59 D and mean postoperative SEs of +1.00 +/- 0.76 D at 3 months and +1.16 +/- 0.52 D at 6 months. The respective means in the moderate hyperopia group (3.00 to 6.00) of 18 eyes (31.57%) were +4.62 +/- 1.19 D, +3.71 +/- 1.12 D, and +4.00 +/- 1.07 D. CONCLUSIONS Laser in situ keratomileus for myopia using the LaserSight 200 excimer laser was stable with time and safe for the correction of different degrees of myopia. In the hyperopic group, marked regression occurred in a large percentage of patients. Thus, we will not perform LASIK for hyperopia until the software improves.
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Oshika T, Klyce SD, Smolek MK, McDonald MB. Corneal hydration and central islands after excimer laser photorefractive keratectomy. J Cataract Refract Surg 1998; 24:1575-80. [PMID: 9850893 DOI: 10.1016/s0886-3350(98)80345-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE To determine whether uneven corneal surface hydration during excimer laser photorefractive keratectomy (PRK) is related to postoperative occurrence of central islands. SETTING LSU Eye Center, New Orleans, Louisiana, USA. METHODS A retrospective study reviewed intraoperative videotapes and postoperative videokeratography of 49 eyes of 49 patients who had excimer laser PRK for myopia. The uniformity of corneal hydration within the photoablation zone, particularly the frosty appearance of the ablated zone, was characterized. The presence or absence of a topographic central island (steepening of at least 3.0 diopters and 1.5 mm in diameter) was determined from the 1 month postoperative videokeratographs. RESULTS Twelve eyes (24.5%) developed central islands postoperatively. A statistically significant association was observed between the uneven surface hydration (central accumulation of fluid) within the ablation zone intraoperatively and the formation of central islands postoperatively (P < .001, Kruskal-Wallis test; Kendall tau rank correlation = 0.534; P < .001). CONCLUSION Nonuniform fluid distribution during photoablation was a risk factor for central island formation after PRK. Intraoperatively, the presence of excess fluid in the central cornea appeared as a shiny area. This mirror-like surface layer may reduce the rate of central ablation by reflecting and absorbing a significant amount of the incident excimer laser light.
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Affiliation(s)
- T Oshika
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
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Förster W, Clemens S, Magnago T, Elsner C, Krueger R. Steep central islands after myopic photorefractive keratectomy. J Cataract Refract Surg 1998; 24:899-904. [PMID: 9682107 DOI: 10.1016/s0886-3350(98)80040-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To investigate the formation of steep central islands and their reduction under modified experimental conditions. SETTING University Eye Hospital Münster and Schwind Co., Kleinostheim, Germany. METHODS Corneas of enucleated intact bovine eyes were treated with the Schwind Keratom. All experimental conditions were repeated six times in six different corneas. Eight experimental groups were looked at. Fluence was 180 to 200 mJ/cm2. Ablation mode (phototherapeutic keratectomy ([PTK] and standard myopic photorefractive keratectomy [PRK]), internal repetition rate (3 to 30 Hz), and ablation diameter (5 to 8 mm) and depth (4 to 15 diopters [D] in PRK) were varied. Modifications to reduce or avoid steep central islands included blowing nitrogen gas and aerosol over the cornea, cleaning the cornea of fluid, and using an anti-central-island software program. RESULTS In PTK, an increase in the internal repetition rate resulted in a decrease in the height of the steep central island. In standard PRK, increasing refractive correction up to -8.0 D and increasing the ablation diameter resulted in an increase in steep central island power. The anti-central-island program, blowing aerosol, and cleaning the cornea reduced the formation of steep central islands and blowing nitrogen gas eliminated them. CONCLUSION Steep central islands are created by a wide-field ablation process and are probably caused by many factors. Both software and hardware modifications can be used to reduce their formation.
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Affiliation(s)
- W Förster
- University Eye Hospital Münster, Germany
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Refractive Surgical Problem. J Cataract Refract Surg 1997. [DOI: 10.1016/s0886-3350(97)80102-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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