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Wan KH, Lin TPH, Lai KHW, Liu S, Lam DSC. Options and results in managing suction loss during small-incision lenticule extraction. J Cataract Refract Surg 2021; 47:933-941. [PMID: 33315737 DOI: 10.1097/j.jcrs.0000000000000546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
Suction loss is an intraoperative complication in small-incision lenticule extraction (SMILE) that presents a management challenge for the refractive surgeon. The purpose of this review is to evaluate the visual, refractive, and wavefront outcomes after suction loss across the different stages of SMILE with various respective surgical treatments. Surgical management options include immediate re-SMILE by redocking or delayed re-SMILE, with or without adjustment of the laser parameters, conversion to femtosecond laser in situ keratomileusis, transepithelial photorefractive keratectomy, refractive lenticule extraction, or pseudo-SMILE. The restart treatment module on VisuMax provides appropriate retreatment recommendation. Most retreatment options for suction loss, immediate or delayed, resulted in effective, safe, and predictable outcomes, and patients were satisfied with their outcomes. Based on available level II evidence, immediate re-SMILE with or without adjustment to the laser settings achieve favorable visual and refractive outcomes in handling this intraoperative complication across all stages of SMILE.
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Affiliation(s)
- Kelvin H Wan
- From the Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong (Wan, Lam); Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong (Lin); C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong (Lai, Liu, Lam); International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China (Lam); C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China (Lam)
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Kim JY, Lee H, Joo CK, Hyon JY, Kim TI, Kim JH, Kim JK, Cho EY, Choi JE, Lee NR, Tchah HW. Three-Year Follow-Up of Laser In Situ Keratomileusis Treatments for Myopia: Multi-Center Cohort Study in Korean Population. J Pers Med 2021; 11:jpm11050419. [PMID: 34065718 PMCID: PMC8156820 DOI: 10.3390/jpm11050419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/03/2021] [Accepted: 05/08/2021] [Indexed: 11/16/2022] Open
Abstract
This multi-center cohort study included 3401 myopic laser in situ keratomileusis (LASIK) procedures conducted in 1756 myopia patients between 2002 and 2005. Pre- and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction spherical equivalent (SE) were recorded. Factors predicting low postoperative efficacy (defined as a postoperative UCVA < 0.5) were identified using univariate and multivariate logistic regression analysis. Compared with 1 month postoperatively, logMAR UCVA at 3 months postoperatively was significantly decreased (p = 0.002) and that at 2 and 3 years was significantly increased (p < 0.001). LogMAR BCVA at 2 years postoperatively was significantly decreased compared with 1 month postoperatively (p = 0.008). Over the 3-year postoperative period, overall refractive predictability within ±1.00 D and ±0.50 D ranged from 69.0% to 86.2% and from 43.3% to 67.8%, respectively. This also decreased from 1 month to 6 months postoperatively (p < 0.005). Multivariate logistic regression analysis using generalized estimating equations, revealed that higher preoperative SE (odds ratio [OR], 2.58 and 7.23; p < 0.001) and lower preoperative BCVA (OR, 2.44; p = 0.003) were predictive of a low postoperative efficacy. In summary, myopic LASIK can be effective and safe with a high refractive predictability in a Korean population, but myopic regression occurs over time. Higher preoperative SE and lower preoperative BCVA are predictive of a low postoperative efficacy.
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Affiliation(s)
- Jae-Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
| | - Choun-Ki Joo
- Department of Ophthalmology and Visual Science, Kangnam St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;
| | - Joon-Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea;
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Jin-Hyoung Kim
- Department of Ophthalmology, Ilsan Paik Hospital, Inje University of Korea, Koyang 10380, Korea;
| | - Jin-Kuk Kim
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Eun-Young Cho
- B&VIIT Eye Center, Seoul 06615, Korea; (J.-K.K.); (E.-Y.C.)
| | - Ji-Eun Choi
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Na-Rae Lee
- National Evidence-Based Healthcare Collaborating Agency, Seoul 04554, Korea; (J.-E.C.); (N.-R.L.)
| | - Hung-Won Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (J.-Y.K.); (H.L.)
- Correspondence:
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Albietz JM, Lenton LM, McLennan SG. Dry eye after LASIK: Comparison of outcomes for Asian and Caucasian eyes. Clin Exp Optom 2021; 88:89-96. [PMID: 15807640 DOI: 10.1111/j.1444-0938.2005.tb06673.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2004] [Revised: 11/29/2004] [Accepted: 12/01/2004] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dry eye is a common complication of LASIK surgery. Our clinical impression was that post-LASIK dry eye was more problematic for our Asian patients. The aim of this study was to determine if dry eye after LASIK is more prevalent, more sustained and more severe in Asian eyes compared with Caucasian eyes. METHODS This study was based on a retrospective analysis of a clinical database. Data (n = 932 eyes, 932 patients) was collected before and after (week 2 and months 1, 3 and 6) LASIK surgery. Patients were defined as Asian if both parents were of East Asian ethic origin. Assessments included dry eye symptoms, ocular surface staining, tear volume, tear secretion, tear film stability and corneal sensation. RESULTS Asian eyes had greater ocular surface staining, poorer tear film stability and lower tear volume before LASIK and at all times after LASIK. Dry eye symptoms occurring 'often or constantly' were more prevalent at all time points after LASIK in Asian eyes. Chronic dry eye persisting six months or more after LASIK was diagnosed in 28 per cent of Asian eyes and 5 per cent of Caucasian eyes (p < 0.001). Asian patients with chronic dry eye were predominantly female, reported dry eye symptoms, had greater ocular surface staining and lower tear secretion, stability and volume before surgery. After LASIK, Asian eyes had a slower return to pre-operative values for ocular surface staining, tear volume and corneal sensation. DISCUSSION The risk of chronic dry eye after LASIK was significantly higher in Asian eyes. Contributing factors could include racial differences in eyelid and orbital anatomy, tear film parameters and blinking dynamics and higher attempted refractive corrections in Asian eyes.
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Safety and reliability of femtosecond laser-assisted cataract surgery for Japanese eyes. Jpn J Ophthalmol 2017; 62:226-230. [DOI: 10.1007/s10384-017-0553-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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Liu M, Wang J, Zhong W, Wang D, Zhou Y, Liu Q. Impact of Suction Loss During Small Incision Lenticule Extraction (SMILE). J Refract Surg 2016; 32:686-692. [DOI: 10.3928/1081597x-20160608-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 05/19/2016] [Indexed: 11/20/2022]
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Bali SJ, Hodge C, Lawless M, Roberts TV, Sutton G. Early Experience with the Femtosecond Laser for Cataract Surgery. Ophthalmology 2012; 119:891-9. [PMID: 22361311 DOI: 10.1016/j.ophtha.2011.12.025] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 12/16/2011] [Accepted: 12/16/2011] [Indexed: 11/19/2022] Open
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Bromley JG, Albright TD, Kharod-Dholakia B, Kim JY. Intraoperative and postoperative complications of laser in situkeratomileusis. EXPERT REVIEW OF OPHTHALMOLOGY 2012. [DOI: 10.1586/eop.12.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Muñoz G, Albarrán-Diego C, Ferrer-Blasco T, Javaloy J, García-Lázaro S. Single versus double femtosecond laser pass for incomplete laser in situ keratomileusis flap in contralateral eyes: Visual and optical outcomes. J Cataract Refract Surg 2012; 38:8-15. [DOI: 10.1016/j.jcrs.2011.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 06/19/2011] [Accepted: 06/22/2011] [Indexed: 10/14/2022]
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Tomita M, Watabe M, Nakamura T, Nakamura N, Tsuru T, Waring GO. Management and Outcomes of Suction Loss During LASIK Flap Creation With a Femtosecond Laser. J Refract Surg 2012; 28:32-6. [DOI: 10.3928/1081597x-20111122-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Accepted: 10/11/2011] [Indexed: 11/20/2022]
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Jung HJ, Kim SW, Lee TH, Lee KH. The Analysis of Epithelial Ingrowth after LASIK Using a Femtosecond Laser. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Davison JA, Johnson SC. Intraoperative Complications of LASIK Flaps Using the Intralase Femtosecond Laser in 3009 Cases. J Refract Surg 2010; 26:851-7. [DOI: 10.3928/1081597x-20100114-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 11/25/2009] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW Complications from laser in-situ keratomileusis surgery are extremely rare. However, most of the complications involve construction of the corneal flap, which is fashioned using various mechanical or femtosecond laser microkeratomes. Here, we review and discuss complications of microkeratome flaps. RECENT FINDINGS Several large studies of microkeratome laser in-situ keratomileusis cases report a similar set of complications: partial or irregular flaps, buttonholes, and free flaps. Risk factors for these complications include increased age, preoperative hyperopia, and years of contact lens wear. Numerous animal and clinical studies have shown that the femtosecond platform produces flaps with greater stability with more consistent and accurate dimensions than the mechanical microkeratome. However, there is no significant difference in final visual outcome. SUMMARY The aim of this review is to report complications associated with mechanical microkeratomes in the construction of laser in-situ keratomileusis flaps and to see whether there is a significant disadvantage compared with the femtosecond laser.
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Kato N, Toda I, Hori-Komai Y, Sakai C, Tsubota K. Five-Year Outcome of LASIK for Myopia. Ophthalmology 2008; 115:839-844.e2. [PMID: 17900692 DOI: 10.1016/j.ophtha.2007.07.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/18/2007] [Accepted: 07/09/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of LASIK over a 5-year postoperative period. DESIGN Observational case series. PARTICIPANTS We examined 779 eyes in 402 patients with myopia or myopic astigmatism who underwent LASIK to correct their refractive errors and received regular postoperative assessments for 5 years. METHODS Postoperative examinations were performed 1 day; 1 week; 1, 3, and 6 months; and 1, 2, 3, 4, and 5 years after LASIK surgery. MAIN OUTCOME MEASURES We evaluated changes in uncorrected visual acuity (UCVA) (logarithm of the minimum angle of resolution [logMAR]), manifest refraction, best-corrected visual acuity (BCVA) (logMAR), intraocular pressure, corneal thickness, corneal endothelial cell counts, and complications. RESULTS Preoperative UCVA of 1.27 improved to -0.03 at 1 day after surgery and -0.08 at 1 month and revealed minimal but significant decreases thereafter. Postoperative manifest refraction was also improved by surgery, showing minimal but significant regression after 1 year. Final BCVA loss was seen in 10 eyes of 7 patients; in 7 cases, there were obvious reasons such as the progression of cataracts in 3 eyes, epithelial disintegrity due to dry eye in 2 eyes, irregular astigmatism due to flap striae in 1 eye, and age-related macular dystrophy in 1 eye. Intraocular pressure and corneal thickness decreased by 4.0 mmHg and 76.9 microm, respectively, due to surgery, but remained stable throughout the follow-up period. Corneal endothelial cell counts (2689.0+/-232.9 cells/mm(2) before surgery) showed a statistically significant decrease at 5 years after surgery (2658.0+/-183.1 cells/mm(2); 1.2% loss for 5 years), likely within the range due to physiological age-related loss. No serious, vision-threatening, irreversible complication such as keratectasia or progressive endothelial cell loss was observed. CONCLUSION LASIK surgery is an effective and safe procedure for correcting myopia/myopic astigmatism as long as inclusion and exclusion criteria are strictly respected. However, minimal regression occurred during the 5-year investigative period.
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Affiliation(s)
- Naoko Kato
- Minamiaoyama Eye Clinic, Tokyo, Japan.; Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.
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Aslanides IM, Tsiklis NS, Astyrakakis NI, Pallikaris IG, Jankov MR. LASIK Flap Characteristics Using the Moria M2 Microkeratome With the 90-µm Single Use Head. J Refract Surg 2007; 23:45-9. [PMID: 17269243 DOI: 10.3928/1081-597x-20070101-08] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the accuracy and consistency of corneal flap thickness, horizontal diameter, and hinge size with the Moria M2 90-microm single use head. METHODS Fifty-two myopic patients (104 eyes), mean age 32.6 years, underwent bilateral LASIK with a superior hinged flap using the Moria M2 microkeratome (90-microm single use head). Prospective evaluation included flap thickness (subtraction method), diameter, hinge size, interface particles, intraoperative complications, and visual recovery. RESULTS The mean preoperative spherical equivalent refraction was -5.72 +/- 2.59 diopters (D) (range: -2.88 to -10.75 D) and -5.84 +/- 2.73 D (range: -3.13 to -9.38 D) for right and left eyes, respectively. The mean preoperative central corneal thickness was 548 +/- 24 microm and 547 +/- 25 microm for right and left eyes, respectively. The mean preoperative steepest K was 44.12 +/- 1.28 D and 44.41 +/- 1.27 D for right and left eyes, respectively. Corneal diameter (white-to-white) was 12 +/- 0.4 mm and 11.9 +/- 0.4 mm for right and left eyes, respectively. The mean postoperative flap thickness was 109 +/- 18 microm (range: 67 to 152 microm) and 103 +/- 15 microm (range: 65 to 151 microm) for right and left eyes, respectively. The mean postoperative flap diameter was 9.4 +/- 0.3 mm (expected mean according to the nomogram given by the company was 9.5 mm). The mean postoperative hinge chord was 4.4 +/- 0.4 mm (expected mean 4.2 mm). No interface particles were detected on slit-lamp examination. CONCLUSIONS The Moria M2 90-microm single use head is safe with reasonable predictability for LASIK flap creation.
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Affiliation(s)
- Ioannis M Aslanides
- VEIC - Vardinoyannion Eye Institute of Crete, School of Medicine, University of Crete, Greece
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Affiliation(s)
- Marcelo V Netto
- The Cole Eye Institute, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Ito M, Hori-Komai Y, Toda I, Tsubota K. Risk factors and retreatment results of intraoperative flap complications in LASIK. J Cataract Refract Surg 2004; 30:1240-7. [PMID: 15177598 DOI: 10.1016/j.jcrs.2003.10.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2003] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the incidence, type, and risk factors of intraoperative complications leading to abandonment of laser in situ keratomileusis (LASIK), and to compare the safety and efficacy of retreated LASIK with uncomplicated primary LASIK. SETTING Refractive surgery centers in Tokyo, Yokohama, Nagoya, Osaka, and Fukuoka, Japan. METHODS A total of 3751 eyes of 2033 patients who were followed for 6 months after primary LASIK, of which 15 eyes were retreated after intraoperative flap complications, were reviewed. In most of the cases, retreatments were performed by recutting a new flap. RESULTS Intraoperative flap complications occurred in 25 eyes, of which 15 eyes had retreatment at a later date. The overall incidence of complications was independent of the surgeons' experience, although incomplete flaps, in particular, occurred at a higher rate in the hands of inexperienced surgeons. No patient profile was detected as a risk factor for intraoperative flap complications. No flap-related complications occurred at retreatment. Refractive and visual outcomes were comparable to those in the uncomplicated cases within 6 months postoperatively. CONCLUSIONS Retreatment after microkeratome flap complications by recutting the cornea is safe and effective.
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Affiliation(s)
- Mitsutoshi Ito
- Minamiaoyama Eye Clinic, Keio University of Medicine, Tokyo, Japan.
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Jabbur NS, Myrowitz E, Wexler JL, O'Brien TP. Outcome of second surgery in LASIK cases aborted due to flap complications. J Cataract Refract Surg 2004; 30:993-9. [PMID: 15130634 DOI: 10.1016/j.jcrs.2003.09.067] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2003] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the technique and timing of second refractive surgery after aborted laser in situ keratomileusis (LASIK) due to intraoperative flap complication and determine the final visual outcome. SETTING Outpatient ambulatory laser vision correction centers. METHODS This retrospective noncomparative case series included 16 patients (16 eyes) who had a second refractive surgery after initial LASIK surgery was aborted because of a flap complication. Charts were reviewed with attention to initial preoperative data, intraoperative details of the aborted LASIK, postoperative examination, possible causes of the flap complication, timing and technique of second refractive surgery, and final visual outcome. RESULTS Causes of the aborted LASIK were identified in 13 of 16 eyes (81.2%) and included eye squeezing (5 eyes), loss of suction or machine failure (5 eyes), steep corneas (2 eyes), and learning curve of the surgeon (1 eye). The mean time until the second surgery was 135 days (range 49 to 372 days). Repeat flaps were created deeper and larger than the initially attempted flaps when possible. No patient had a final uncorrected visual acuity (UCVA) worse than 20/30 after the second surgery. Two eyes (12.5%) lost 1 line of best spectacle-corrected visual acuity. CONCLUSION A planned delayed reoperation after sufficient corneal healing following an intraoperative flap complication can result in satisfactory recovery of UCVA.
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Affiliation(s)
- Nada S Jabbur
- Refractive Surgery Center, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Affiliation(s)
- Christopher Yo
- Department of Ophthalmology, Kaiser Permanente Hospital, Baldwin Park, CA 91706, USA
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