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Penbe A, Oklar M, Kanar HS, Bayrak MZ, Ersarı B, Talan M, Gün RD, Orçun A, Şimşek Ş. The effects of facial mask use on ocular surface parameters and tear film cytokine profile in prolonged use. Int Ophthalmol 2023; 43:2623-2632. [PMID: 36856985 PMCID: PMC9975438 DOI: 10.1007/s10792-023-02661-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To compare tear fluid levels of matrix metalloproteinase 9 (MMP-9) and IL-1ß cytokines between healthcare workers wearing facial masks and controls with correlations in clinical findings. METHODS In a prospective, controlled clinical trial tear fluid was analyzed for MMP-9 and IL-1ß levels using a commercially available test (Invitrogen; Thermo Fisher Scientific Inc. Waltham, Massachusetts, USA). Symptoms and signs of dry eye disease (DED) were evaluated using the ocular surface disease index (OSDI), noninvasive tear break-up time (NIBUT), tear meniscus height (TMH), Oxford corneal staining, meibomiography, and clinical findings of meibomian gland dysfunction (MGD). RESULTS In the 38 eyes of healthcare workers and 30 eyes of controls, there was no statistically significant difference between the groups in terms of age and sex (p > 0.05). The mean OSDI score, daily mask wear time, meibomiography degree, and rate of positive clinical findings of MGD were higher in group 1 than in group 2, and the mean NIBUT was higher in group 2. (p > 0.05). The mean values of IL-1ß and MMP-9 were higher in group 1 (p = 0.036 and p = 0.001, respectively). The TMH and Oxford score percentages were similar between the two groups (p > 0.05). CONCLUSIONS Elevated levels of IL-1ß and MMP-9 in the basal tear fluid reveal increased ocular inflammation in healthcare professionals. Lower NIBUT values with higher OSDI and meibomian gland loss scores support ocular surface disturbance depending on regular mask use.
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Affiliation(s)
- Aysegul Penbe
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Murat Oklar
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Müberra Zülal Bayrak
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Başak Ersarı
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Mustafa Talan
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Raziye Dönmez Gün
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Asuman Orçun
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
| | - Şaban Şimşek
- Department of Ophthalmology, Health Science University, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Semsi Denizer Caddesi, E-5, 34890 Kartal Istanbul, Turkey
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A Systematic Literature Review and Bibliometric Analysis of Ophthalmology and COVID-19 Research. J Ophthalmol 2022; 2022:8195228. [PMID: 35646394 PMCID: PMC9133895 DOI: 10.1155/2022/8195228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
This review is proposed to summarize the updates on COVID-19 and ophthalmology along with the bibliometric features of articles that have been published since the beginning of the COVID-19 outbreak. The databases, including PubMed, Scopus, and Web of Science, were searched using "Coronavirus," "COVID-19," "SARS-CoV-2," "pandemic," "ophthalmology," "ophthalmic," and "eye" keywords. All published articles except commentaries, errata, and corrigenda up to April 2021 were included. Titles and abstracts were screened, and ophthalmology-focused articles were collected. The bibliographic information of the articles, such as the name and country of the first author, type of study, date of publication, language, and journal name, were extracted. Included studies were assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. After systematic searching, 2,669 distinct articles were screened by title/abstract, and 1,174 ophthalmology-focused articles were selected to be reviewed. Ophthalmology-focused publications accounted for less than 0.5 percent of the total COVID-19-related articles. Most of the articles were published in the Indian Journal of Ophthalmology, and the main publication type was "original article." Almost 88% of the publications were in English. There was a decline in the publication rate during the initial months of 2021 compared with the middle and last months of 2020. Most of the publications were affiliated with the United States of America. However, Singapore and the United Kingdom were the countries with the highest number of publications after population adjustment. Furthermore, a comprehensive review on major topics including SARS-CoV-2 ocular tropism, ophthalmic manifestations, ocular complications due to COVID-19 treatment strategies, the pandemic effect on ophthalmology care and operations, myopia progression during the pandemic, and telemedicine was conducted.
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Altered Ocular Surface Health Status and Tear Film Immune Profile Due to Prolonged Daily Mask Wear in Health Care Workers. Biomedicines 2022; 10:biomedicines10051160. [PMID: 35625896 PMCID: PMC9139140 DOI: 10.3390/biomedicines10051160] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 02/06/2023] Open
Abstract
Prolonged daily face mask wearing over several months might affect health of the ocular surface and is reported to be associated with complaints of discomfort and dry-eye-like symptoms. We studied the ocular surface clinical parameters, tear soluble factors and immune cell proportions in ophthalmologists practicing within similar environmental conditions (n = 17) at two time points: pre-face-mask period (Pre-FM; end of 2019) and post-face-mask-wearing period (Post-FM; during 2020 COVID-19 pandemic), with continuous (~8 h/day) mask wear. A significant increase in ocular surface disease index (OSDI) scores without changes in tear breakup time (TBUT), Schirmer’s test 1 (ST1) and objective scatter index (OSI) was observed Post-FM. Tear soluble factors (increased—IL-1β, IL-33, IFNβ, NGF, BDNF, LIF and TSLP; decreased—IL-12, IL-13, HGF and VEGF-A) and mucins (MUC5AC) were significantly altered Post-FM. Ex vivo, human donor and corneoscleral explant cultures under elevated CO2 stress revealed that the molecular profile, particularly mucin expression, was similar to the Post-FM tear molecular profile, suggesting hypercapnia is a potential contributor to ocular surface discomfort. Among the immune cell subsets determined from ocular surface wash samples, significantly higher proportions of leukocytes and natural killer T cells were observed in Post-FM compared to Pre-FM. Therefore, it is important to note that the clinical parameters, tear film quality, tear molecular factors and immune cells profile observed in prolonged mask-wear-associated ocular surface discomfort were distinct from dry eye disease or other common ocular surface conditions. These observations are important for differential diagnosis as well as selection of appropriate ocular surface treatment in such subjects.
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Lalgudi VG, Shetty R, Nischal KK, Ziai S, Koaik M, Sethu S. Biochemical and molecular alterations and potential clinical applications of biomarkers in keratoconus. Saudi J Ophthalmol 2022; 36:7-16. [PMID: 35971485 PMCID: PMC9375466 DOI: 10.4103/sjopt.sjopt_203_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 12/05/2021] [Accepted: 02/19/2022] [Indexed: 11/06/2022] Open
Abstract
Keratoconus (KC) is a complex multifactorial corneal ectatic disorder, with disease onset commonly in the second-third decades significantly affecting quantity, quality of vision, and quality of life. Several pathways and factors such as eye rubbing, inflammatory, oxidative, metabolic, genetic, and hormonal among others have been studied in the last two decades. However, the management of KC is still based on a few "one-size fits all" approaches and is predominantly guided by topo/tomographic parameters. Consideration of the several novel factors which have the potential to be biomarkers in addressing several unanswered questions in the disease process could help in the better predictive ability of progression or vision loss and customization of treatment options. This article delves into the understanding of these novel factors or biomarkers based on the pathogenesis of KC and features a special focus on their potential clinical applications and their future role in personalized medicine.
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Affiliation(s)
- Vaitheeswaran G. Lalgudi
- Department of Cornea, External Disease and Refractive Surgery, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON, Canada,Address for correspondence: Dr. Vaitheeswaran G. Lalgudi, Department of Cornea, External Disease and Refractive Surgery, University of Ottawa Eye Institute, The Ottawa Hospital, 501, Smyth Road, Ottawa, ON, Canada. E-mail:
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Kanwal K. Nischal
- UPMC Eye Centre, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Pediatric Ophthalmology and Strabismus, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Setareh Ziai
- Department of Cornea, External Disease and Refractive Surgery, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON, Canada,Department of Ophthalmology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Mona Koaik
- Department of Cornea, External Disease and Refractive Surgery, University of Ottawa Eye Institute, The Ottawa Hospital, Ottawa, ON, Canada,Department of Ophthalmology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Swaminathan Sethu
- Molecular and Genetic Research, GROW Laboratories, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
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Li Y, Liu Y, Yao B, Narasimalu S, Dong Z. Rapid preparation and antimicrobial activity of polyurea coatings with RE-Doped nano-ZnO. Microb Biotechnol 2021; 15:548-560. [PMID: 34676986 PMCID: PMC8867993 DOI: 10.1111/1751-7915.13891] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/22/2021] [Accepted: 07/02/2021] [Indexed: 12/04/2022] Open
Abstract
The recent COVID‐19 virus has led to a rising interest in antimicrobial and antiviral coatings for frequently touched surfaces in public and healthcare settings. Such coatings may have the ability to kill a variety of microorganisms and bio‐structures and reduce the risk of virus transmission. This paper proposes an extremely rapid method to introduce rare‐earth doping nano‐ZnO in polyamines for the preparation of the anti‐microbial polyurea coatings. The nano‐ZnO is prepared by wet chemical method, and the RE‐doped nano‐ZnO was obtained by mixing nano ZnO and RE‐dopants with an appropriate amount of nitric acid. This rapidly fabricated polyurea coating can effectively reduce bacteria from enriching on the surface. Comparing with pure nano‐ZnO group, all the polyurea coatings with four different rare‐earth elements (La, Ce, Pr and Gd) doped nano‐ZnO. The La‐doped nano‐ZnO formula group indicates the highest bactericidal rate over 85% to Escherichia coli (E. coli) and Pseudomonas aeruginosa (Pseudomonas). Followed by Ce/ZnO, the bactericidal rate may still remain as high as 83% at room temperature after 25‐min UV‐exposure. It is believed that the RE‐doping process may greatly improve the photocatalytic response to UV light as well as environmental temperature due to its thermal catalytic enhancement. Through the surface characterizations and bioassays, the coatings have a durably high bactericidal rate even after repeated usage. As polyurea coating itself has high mechanical strength and adhesive force with most substrate materials without peel‐off found, this rapid preparation method will also provide good prospects in practical applications.
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Affiliation(s)
- Yuanzhe Li
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Yang Liu
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore.,School of Mechanical Engineering & Key Laboratory of Materials Design and Preparation Technology of Hunan Province, Xiangtan University, Xiangtan, 411105, China
| | - Bingqing Yao
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore
| | - Srikanth Narasimalu
- Energy Research Institute @ NTU (ERI@N), CleanTech One, Singapore, 637141, Singapore
| | - ZhiLi Dong
- School of Materials Science & Engineering, Nanyang Technological University, Singapore, 639798, Singapore
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Pajokh M, Pourfridoni M. Proposing a nasal trehalose-induced autophagy approach against SARS-CoV 2. Health Sci Rep 2021; 4:e375. [PMID: 34604543 PMCID: PMC8474006 DOI: 10.1002/hsr2.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/08/2021] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Mojde Pajokh
- Department of Anatomical Sciences, School of Medicine Jiroft University of Medical Sciences Jiroft Iran
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Petrillo F, Chianese A, De Bernardo M, Zannella C, Galdiero M, Reibaldi M, Avitabile T, Boccia G, Galdiero M, Rosa N, Franci G. Inhibitory Effect of Ophthalmic Solutions against SARS-CoV-2: A Preventive Action to Block the Viral Transmission? Microorganisms 2021; 9:microorganisms9081550. [PMID: 34442628 PMCID: PMC8401441 DOI: 10.3390/microorganisms9081550] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 12/21/2022] Open
Abstract
In 2020, a global pandemic was declared following the spread of SARS-CoV-2, the pathogen responsible for COVID-19. The risk of infection is high due to the ease of transmission, which can occur orally, through droplets, or via contact with contaminated surfaces and objects. It has also been demonstrated that the ocular surface can constitute a transmission route, especially in hospital settings, where health care workers can become a dangerous source of infection. In order to increase prevention and reduce the spread of the virus on the ocular surface, the antiviral activity of already-marketed eye drops against SARS-CoV-2 was evaluated. Iodim, Ozodrop, Septavis, and Dropsept were tested against SARS-CoV-2 in plaque-assay experiments at different stimulation times. Furthermore, the expression levels of early and late genes were evaluated through molecular assays. Results indicated that three of the four ophthalmic solutions showed a considerable dose-dependent inhibition of viral replication, highlighting their use as potential antiviral drugs against SARS-CoV-2 and preventing other ocular infections.
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Affiliation(s)
- Francesco Petrillo
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (F.P.); (T.A.)
| | - Annalisa Chianese
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (C.Z.); (M.G.); (M.G.)
| | - Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.B.)
| | - Carla Zannella
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (C.Z.); (M.G.); (M.G.)
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (C.Z.); (M.G.); (M.G.)
| | - Michele Reibaldi
- Department of Surgical Science, Eye Clinic, University of Turin, 10124 Turin, Italy;
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy; (F.P.); (T.A.)
| | - Giovanni Boccia
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.B.)
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (A.C.); (C.Z.); (M.G.); (M.G.)
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.B.)
- Correspondence: (N.R.); (G.F.)
| | - Gianluigi Franci
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy; (M.D.B.); (G.B.)
- Correspondence: (N.R.); (G.F.)
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Barabino S. A Narrative Review of Current Understanding and Classification of Dry Eye Disease with New Insights on the Impact of Dry Eye during the COVID-19 Pandemic. Ophthalmol Ther 2021; 10:495-507. [PMID: 34275088 PMCID: PMC8286160 DOI: 10.1007/s40123-021-00373-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/01/2021] [Indexed: 01/18/2023] Open
Abstract
Dry eye disease (DED) is a complex, progressive and multifactorial condition that is commonly seen in clinical practice and can be challenging to accurately diagnose. Untreated or suboptimally managed dry eye can progress to severe, chronic disease which may become resistant to treatment. Symptoms include ocular irritation and visual impairment. Patients frequently report negative consequences regarding quality of life (QoL), productivity and psychological wellbeing. Certain lifestyle factors (e.g. use of screen-based devices, air conditioning) can induce or exacerbate symptoms of DED, leading to progressive and debilitating complications. Exposures to such triggers are likely to have increased significantly during the ongoing COVID-19 pandemic with people across the globe living with heightened levels of stress/anxiety while being forced to adapt most aspects of their daily lives (from work and education through to social activities) to accommodate social distancing, primarily through the use digital technologies. This review aims to provide a concise and practical overview of current understanding regarding DED, highlighting proposals for refined diagnostic categories and therapeutic terminologies that are designed to improve identification and management of dry eye as well as reduce or slow disease progression. Finally, the findings of a European survey are shared to illustrate the impact of the COVID-19 pandemic on the lives of people with DED. The survey was conducted during the first lockdown period (March–September 2020) and explored issues relating to psychological wellbeing, QoL and engagement with healthcare services. The results demonstrate the ways in which the pandemic amplified the impact of dry eye on daily life and may be valuable in enhancing understanding among clinicians of the challenges faced by people with DED, which extend beyond the signs and symptoms of disease.
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Affiliation(s)
- Stefano Barabino
- Centro Superficie Oculare e Occhio Secco, ASST Fatebenefratelli-Sacco, Ospedale L. Sacco, Università di Milano, via G.B. Grassi 74, 20157, Milan, Italy.
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Gurnani B, Kaur K. Publication trend of COVID-19 and non-COVID-19 articles in the Indian Journal of Ophthalmology during the pandemic. Indian J Ophthalmol 2021; 69:1241-1248. [PMID: 33913868 PMCID: PMC8186616 DOI: 10.4103/ijo.ijo_117_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose To analyze the trend of COVID-19-related and non-COVID-19-related articles published in the Indian Journal of Ophthalmology (IJO) during the COVID-19 pandemic. Methods A retrospective analysis of all COVID-19 and non-COVID-19-related articles published in all the issues of IJO from January 2020 to March 2021 was performed. The data were obtained from the official website of IJO, Editor IJO monthly email, and PubMed. The monthly data were analyzed and a comparative analysis was done. The articles were segregated as Original, Review, Case Report/Series, Letter to the Editor/Commentary, Guest Editorial, Research methodology, Point-Counterpoint, Consensus Criteria, Ophthalmic Images, Photo Essay, Surgical Techniques, and AIOS Meeting Papers. Results Out of 1343 articles published in IJO during the pandemic, 182 (13.55%) were COVID-19-related and 1161 (86.45%) were non-COVID-19-related articles. Among COVID-19 articles (182), majority were letter to the editors 66 (36.26%), followed by original articles 39 (21.42%), commentaries 24 (13.18%), editorials 18 (9.89%), and preferred practices 13 (7.14%). The least were case reports five (2.74%), current ophthalmology and innovation three (1.64%) each, and one (0.54%) each of consensus criteria, images, and photo assays. In the non-COVID-19-related articles (1161), maximum were original articles 276 (23.77%), followed by case reports 179 (15.41%), photo assays 157 (13.52%), and commentaries 141 (12.14%). The least were three (0.25%) consensus criteria and two (0.17%) each of current ophthalmology and innovations. The lockdown issue with 223 articles, postlockdown phase 1 had 267, postlockdown phase 2 had 321, and postlockdown phase 3 with 316 (1127 articles) articles in IJO showed a rising trend in a number of published articles compared with the prelockdown issues (216 articles). Conclusion The quality and quantity of articles published in IJO increased and improved significantly. The results were seen with progressive improvement in citations and impact factors of the journal.
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Affiliation(s)
- Bharat Gurnani
- Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Kirandeep Kaur
- Pediatric and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
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Marinova E, Dabov D, Zdravkov Y. Ophthalmic complaints in face-mask wearing: prevalence, treatment, and prevention with a potential protective effect against SARS-CoV-2. BIOTECHNOL BIOTEC EQ 2020. [DOI: 10.1080/13102818.2020.1838323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Evelina Marinova
- Department of Ophthalmology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Dimitar Dabov
- Department of Ophthalmology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Yani Zdravkov
- Department of Ophthalmology, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
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