1
|
Lin H, Zhang J, Zhang Y, Jin A, Zhang Y, Jin L, Xu Y, Xie X, Tan X, Luo L, Liu Y. Capsular Tension Ring Implantation for Intraocular Lens Decentration and Tilt in Highly Myopic Eyes: A Randomized Clinical Trial. JAMA Ophthalmol 2024:2820325. [PMID: 38935400 PMCID: PMC11211984 DOI: 10.1001/jamaophthalmol.2024.2215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/02/2024] [Indexed: 06/28/2024]
Abstract
Importance Capsular tension rings (CTRs) can support weak zonules and inhibit capsular shrinkage, thus potentially reducing intraocular lens (IOL) decentration and tilt. However, it has been debated whether CTRs can reduce IOL decentration and tilt in highly myopic eyes and whether CTR implantation is necessary for all highly myopic eyes. Objective To evaluate the influence of CTR implantation on IOL decentration and tilt in highly myopic eyes. Design, Setting, and Participants This randomized clinical trial was conducted between November 2021 and September 2023 at the Zhongshan Ophthalmic Center, Guangzhou, China. Patients with cataract and an axial length (AL) of 26 mm or longer were enrolled. Interventions Participants were stratified into 3 groups based on the AL (stratum 1, 26 mm ≤ AL <28 mm; stratum 2, 28 mm ≤ AL <30mm; stratum 3, AL ≥30 mm), and further randomly assigned to the CTR group (a C-loop IOL combined with a CTR) or the control group (only a C-loop IOL) within each stratum. Main Outcomes and Measures IOL decentration at 3 months after cataract surgery was evaluated using anterior segment optical coherence tomography. Results A total of 186 eyes of 186 participants (mean [SD] age, 57.3 [10.9] years; 118 female [63.4%]) were randomized into the CTR group (93 [50%]) or control group (93 [50%]), with 87 eyes (93.6%) and 92 eyes (98.9%) completing follow-up at 3 months, respectively. The CTR group showed smaller IOL decentration (0.19 mm vs 0.23 mm; difference, -0.04 mm; 95% CI, -0.07 to -0.01 mm; P = .02) and tilt at 3 months, and lower proportions of clinically significant IOL decentration (≥0.4 mm) and tilt (≥7°) at 3 months compared with the control group. Similar results were only found in eyes with an AL of 30 mm or longer (IOL decentration: 0.20 mm vs 0.28 mm; difference, -0.08 mm; 95% CI, -0.14 to -0.02 mm; P = .01). Additionally, the CTR group showed a smaller change in IOL decentration from 1 week to 3 months, higher prediction accuracy, and better visual quality and patient satisfaction in this stratum. No differences were observed between the CTR and control groups in eyes with an AL less than 30 mm. Conclusions and Relevance CTR implantation reduced C-loop IOL decentration and tilt, increased position stability, and improved visual quality in eyes with an AL of 30 mm or longer. These findings support use of CTR implantation in eyes with an AL of 30 mm or longer and implanted with C-loop IOLs. Trial Registration ClinicalTrials.gov Identifier: NCT05161520.
Collapse
Affiliation(s)
- Haowen Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jiaqing Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Aixia Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yifan Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaohang Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xuhua Tan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| |
Collapse
|
2
|
Liu X, Wu W, Huang Y, Fu Y, Huang Y, Li Q. Repeatability of Pentacam-derived intraocular lens decentration measurements and the level of agreement with OPD-Scan III: A prospective observational case series. PLoS One 2024; 19:e0299064. [PMID: 38517869 PMCID: PMC10959365 DOI: 10.1371/journal.pone.0299064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/03/2024] [Indexed: 03/24/2024] Open
Abstract
PURPOSE This study aimed to assess the repeatability of intraocular lens (IOL) decentration measurements obtained through Pentacam, based on corneal topographic axis (CTA) and pupillary axis (PA), and to evaluate the level of agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration. METHODS In this prospective observational case series, three measurements were performed with Pentacam to evaluate the repeatability of the measurements. The analysis included the calculation of the mean and standard deviations (SD), conducting a repeated measures analysis of variance (rANOVA), and determining an intraclass correlation coefficient (ICC) to assess the repeatability of the measurements. Moreover, Bland-Altman analysis was employed to assess the agreement between Pentacam and OPD-Scan III devices in measuring IOL decentration. IOL decentration measurements were obtained with respect to both CTA and PA. RESULTS A total of 40 eyes from 40 patients were analyzed. The rANOVA revealed no significant difference among three consecutive measurements of IOL decentration obtained with Pentacam. The mean SD of all parameters ranged from 0.04 mm to 0.07 mm. With CTA as the reference axis, the ICC values for Pentacam measurements of IOL decentration were 0.82 mm for the X-axis, 0.76 mm for the Y-axis, and 0.82 mm for spatial distance. When using PA as the reference axis, the corresponding ICC values were 0.87, 0.89, and 0.77, respectively. The 95% limits of agreement for all IOL decentration measurements were wide when comparing Pentacam and OPD-Scan III. CONCLUSIONS Pentacam demonstrated high repeatability in measuring IOL decentration with respect to both CTA and PA. However, due to poor agreement between Pentacam and OPD-Scan III measurements, caution should be exercised when using data interchangeably between the two devices.
Collapse
Affiliation(s)
- Xiaobao Liu
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
| | - Wenjie Wu
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China
| | - Yulong Huang
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
| | - Yabo Fu
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, Longyan People Hospital of Fujian, Longyan, China
| | - Yue Huang
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
| | - Qiong Li
- Shengli Clinical Medical College of Fujian Medical University; Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China
| |
Collapse
|
3
|
Liu X, Yu M, Huang Y, Li Q, Wu W. Intraocular lens tilt and decentration after cataract surgery with and without primary posterior continuous curvilinear capsulorhexis. J Cataract Refract Surg 2023; 49:492-498. [PMID: 36745843 PMCID: PMC10121364 DOI: 10.1097/j.jcrs.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate intraocular lens (IOL) tilt and decentration and their effects on higher-order aberrations (HOAs) after cataract surgery with and without primary posterior continuous curvilinear capsulorhexis (PPCCC). SETTING Fujian Provincial Hospital, Fujian, China. DESIGN Prospective, intraindividual, randomized, comparative clinical trial. METHODS 64 eyes of 32 patients with age-related cataract who underwent bilateral cataract surgery and IOL implantation were enrolled in this study. In randomized order, all patients had phacoemulsification cataract surgery with PPCCC in 1 eye (PPCCC group) and routine cataract surgery in the contralateral eye (NPCCC group). IOL decentration, tilt, HOAs, modulation transfer function, and point spread function were measured at 1 day, 1 week, 1 month, and 3 months after surgery using OPD-Scan III. RESULTS 52 eyes of 26 patients were available for analysis. The mean overall decentration in the NPCCC group was significantly higher than in the PPCCC group at 3 months (0.302 ± 0.157 mm vs 0.187 ± 0.099 mm, P < .001). Under 3 mm pupil, internal spherical aberration (SA) 1 day after surgery and coma 1 week after surgery were lower in the PPCCC group compared with the NPCCC group (0.15 ± 0.10 μm vs 0.30 ± 0.21 μm, P < .001, and 0.34 ± 0.18 μm vs 0.47 ± 0.31 μm, P = .03, respectively). IOL decentration was significantly correlated with ocular and internal coma, ocular and internal SA, and internal HOAs at 5 mm pupil ( R = 0.083 and R = 0.099, R = 0.650 and R = 0.613, and R = 0.418, respectively, all P < .01). CONCLUSIONS Less IOL decentration was observed in the PPCCC group at 3 months after surgery, indicating that PPCCC may result in better IOL centrality.
Collapse
Affiliation(s)
- Xiaobao Liu
- From the Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China (Liu, Huang, Wu); State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China (Yu); Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China (Li, Wu)
| | - Mengting Yu
- From the Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China (Liu, Huang, Wu); State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China (Yu); Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China (Li, Wu)
| | - Yue Huang
- From the Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China (Liu, Huang, Wu); State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China (Yu); Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China (Li, Wu)
| | - Qiong Li
- From the Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China (Liu, Huang, Wu); State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China (Yu); Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China (Li, Wu)
| | - Wenjie Wu
- From the Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, Fuzhou, China (Liu, Huang, Wu); State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong, China (Yu); Department of Ophthalmology, Fujian Provincial Hospital, Fuzhou, China (Li, Wu)
| |
Collapse
|
4
|
Zhang J, Han X, Zhang M, Liu Z, Chen X, Qiu X, Lin H, Li J, Liu B, Zhang C, Wei Y, Jin G, Tan X, Luo L. Predicting the risk of clinically significant intraocular lens tilt and decentration in vitrectomized eyes. J Cataract Refract Surg 2022; 48:1318-1324. [PMID: 35786811 PMCID: PMC9622369 DOI: 10.1097/j.jcrs.0000000000000997] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To identify predictors and develop a prognostic nomogram for clinically significant intraocular lens (IOL) tilt and decentration in vitrectomized eyes. SETTING Zhongshan ophthalmic center, Guangzhou, China. DESIGN Prospective observational study. METHODS Patients with previous pars plana vitrectomy who underwent phacoemulsification with IOL implantation were enrolled in this study. The tilt and decentration of the lens and IOL were assessed by a swept-source anterior segment optical coherence tomography (CASIA2). Multiple logistic regression analysis and prognostic nomogram models were used to explore factors associated with clinically significant IOL tilt and decentration (defined as tilt ≥7 degrees and decentration ≥0.4 mm). RESULTS 375 patients (375 eyes) with a mean age of 56.1 ± 9.81 years were included. Lens tilt (odds ratio [OR] = 1.44), lens decentration (OR = 1.74), lens diameter (OR = 0.49), and hydrophilic IOL (OR = 2.36) were associated with IOL tilt over 7 degrees (all P &lt; .05). Lens tilt (OR = 1.24), lens decentration (OR = 2.30), and incomplete capsulorhexis-IOL overlap (OR = 2.44) increased the risk of IOL decentration over 0.4 mm (all P &lt; .05). Preoperative lens tilt together with lens decentration was identified as the strongest predictor of incident clinically significant IOL tilt (area under the curve [AUC] = 0.82, 95% CI, 0.76-0.88) and decentration (AUC: 0.84, 95% CI, 0.78-0.89), and the nomogram was constructed accordingly. CONCLUSIONS The tilt and decentration of the crystalline lens, hydrophilic IOL, and incomplete capsulorhexis-IOL overlap were risk factors for clinically significant IOL misalignment. Clinicians could use a prognostic nomogram model based on the preoperative lens position to make a strategy for higher-risk patients.
Collapse
|
5
|
Yu M, Huang Y, Wang Y, Xiao S, Wu X, Wu W. Three-dimensional assessment of posterior capsule-intraocular lens interaction with and without primary posterior capsulorrhexis: an intraindividual randomized trial. Eye (Lond) 2021; 36:2130-2136. [PMID: 34689182 PMCID: PMC9581986 DOI: 10.1038/s41433-021-01815-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To assess the morphologic and clinical features of posterior capsule-intraocular lens (IOL) interaction following cataract surgery with and without primary posterior continuous curvilinear capsulorrhexis (PPCCC) at a three-dimensional (3-D) level using Scheimpflug imaging. METHODS This prospective intraindividual randomized comparative study comprised 56 patients (112 eyes) with age-related cataract who had bilateral cataract surgery and hydrophobic acrylic IOLs implantation. In randomized order, cataract surgery with PPCCC was performed in 1 eye (PPCCC group), and the posterior capsule was left intact in the fellow eye (NPCCC group). Scheimpflug imaging containing 25 images distributed in 360° was taken 1 day, 1 week, 1 month, and 3 months postoperatively. RESULTS 46 patients completed 3 months follow-up. Posterior capsule-IOL interaction can be morphologically classified into two types including complete adhesion and floppy shape in PPCCC group, and six types including full area wave, full area flat, concentric ring wave, concentric ring flat, sector, and complete adhesion in NPCCC group. The adhesion index (AI), defined as the proportion of complete adhesion of posterior capsule-IOL in 25 cross-section tomograms, was 0.45 ± 0.45, 0.79 ± 0.37, 0.92 ± 0.26 and 1.00 ± 0.00 in PPCCC group, while 0.05 ± 0.18, 0.41 ± 0.47, 0.87 ± 0.34, and 0.96 ± 0.21 in NPCCC group at 1 day, 1 week, 1 month and 3 months postoperatively, respectively (p = 0.001, 0.001, 0.338 and 0.151). CONCLUSIONS 3-D Scheimpflug imaging was favorable in observing of posterior capsule-IOL interaction. Faster posterior capsule adhesion to the IOL was found in PPCCC group than in NPCCC group.
Collapse
Affiliation(s)
- Mengting Yu
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yue Huang
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Yingbin Wang
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Suzhen Xiao
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Xinna Wu
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Wenjie Wu
- Department of Ophthalmology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, 350001, China.
| |
Collapse
|
6
|
Gatinel D, Debellemanière G, Saad A, Dubois M, Rampat R. Determining the Theoretical Effective Lens Position of Thick Intraocular Lenses for Machine Learning-Based IOL Power Calculation and Simulation. Transl Vis Sci Technol 2021; 10:27. [PMID: 34004006 PMCID: PMC8088222 DOI: 10.1167/tvst.10.4.27] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Purpose To describe a formula to back-calculate the theoretical position of the principal object plane of an intraocular lens (IOL), as well as the theoretical anatomic position in a thick lens eye model. A study was conducted to ascertain the impact of variations in design and IOL power, on the refractive outcomes of cataract surgery. Methods A schematic eye model was designed and manipulated to reflect changes in the anterior and posterior radii of an IOL, while keeping the central thickness and paraxial powers static. Modifications of the shape factor (X) of the IOL affects the thick lens estimated effective lens position (ELP). Corresponding postoperative spherical equivalent (SE) were computed for different IOL powers (-5 diopters [D], 5 D, 15 D, 25 D, and 35 D) with X ranging from -1 to +1 by 0.1. Results The impact of the thick lens estimated effective lens position shift on postoperative refraction was highly dependent on the optical power of the IOL and its thickness. Design modifications could theoretically induce postoperative refraction variations between approximately 0.50 and 3.0 D, for implant powers ranging from 15 D to 35 D. Conclusions This work could be of interest for researchers involved in the design of IOL power calculation formulas. The importance of IOL geometry in refractive outcomes, especially for short eyes, should challenge the fact that these data are not usually published by IOL manufacturers. Translational Relevance The back-calculation of the estimated effective lens position is central to intraocular lens calculation formulas, especially for artificial intelligence-based optical formulas, where the algorithm can be trained to predict this value.
Collapse
Affiliation(s)
- Damien Gatinel
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | | | - Alain Saad
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | - Mathieu Dubois
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| | - Radhika Rampat
- Department of Ophthalmology, Rothschild Foundation Hospital, Paris, France
| |
Collapse
|
7
|
Ashena Z, Maqsood S, Ahmed SN, Nanavaty MA. Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. Vision (Basel) 2020; 4:vision4030041. [PMID: 32937750 PMCID: PMC7559075 DOI: 10.3390/vision4030041] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 02/07/2023] Open
Abstract
Tilt and decentration of intraocular lenses (IOL) may occur secondary to a complicated cataract surgery or following an uneventful phacoemulsification. Although up to 2–3° tilt and a 0.2–0.3 mm decentration are common and clinically unnoticed for any design of IOL, larger extent of tilt and decentration has a negative impact on the optical performance and subsequently, the patients’ satisfaction. This negative impact does not affect various types of IOLs equally. In this paper we review the methods of measuring IOL tilt and decentration and focus on the effect of IOL tilt and decentration on visual function, in particular visual acuity, dysphotopsia, and wavefront aberrations. Our review found that the methods to measure the IOL displacement have significantly evolved and the available studies have employed different methods in their measurement, while comparability of these methods is questionable. There has been no universal reference point and axis to measure the IOL displacement between different studies. A remarkably high variety and brands of IOLs are used in various studies and occasionally, opposite results are noticed when two different brands of a same design were compared against another IOL design in two studies. We conclude that <5° of inferotemporal tilt is common in both crystalline lenses and IOLs with a correlation between pre- and postoperative lens tilt. IOL tilt has been noticed more frequently with scleral fixated compared with in-the-bag IOLs. IOL decentration has a greater impact than tilt on reduction of visual acuity. There was no correlation between IOL tilt and decentration and dysphotopsia. The advantages of aspheric IOLs are lost when decentration is >0.5 mm. The effect of IOL displacement on visual function is more pronounced in aberration correcting IOLs compared to spherical and standard non-aberration correcting aspherical IOLs and in multifocal versus monofocal IOLs. Internal coma has been frequently associated with IOL tilt and decentration, and this increases with pupil size. There is no correlation between spherical aberration and IOL tilt or decentration. Although IOL tilt produces significant impact on visual outcome in toric IOLs, these lenses are more sensitive to rotation compared to tilt.
Collapse
Affiliation(s)
- Zahra Ashena
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK;
| | - Sundas Maqsood
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK;
| | - Syed Naqib Ahmed
- Northampton General Hospital, Cliftonville, Northampton NN1 5BD, UK;
| | - Mayank A. Nanavaty
- Sussex Eye Hospital, Brighton & Sussex University Hospitals NHS Trust, Eastern Road, Brighton BN2 5BF, UK;
- Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PX, UK
- Correspondence: ; Tel.: +44-01273-606126
| |
Collapse
|