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   Table of Contents - Current issue
October-December 2017
Volume 12 | Issue 4
Page Nos. 357-452

Online since Tuesday, October 10, 2017

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Use of photorefractive keratectomy treated donor corneas for endothelial keratoplasty Highly accessed article p. 357
Neslihan Dilruba Koseoglu, Ricardo M Nosé, Pedram Hamrah
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Optical coherence tomography angiography as an imaging modality for evaluation of diabetic macular edema Highly accessed article p. 359
Gautam Vangipuram, Kasra A Rezaei
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Distribution of different sized ocular surface vessels in diabetics and normal individuals Highly accessed article p. 361
Touka Banaee, Hamidreza Pourreza, Hassan Doosti, Mojtaba Abrishami, Asieh Ehsaei, Mohsen Basiry, Reza Pourreza
Purpose: To compare the distribution of different sized vessels using digital photographs of the ocular surface of diabetic and normal individuals. Methods: In this cross-sectional study, red-free conjunctival photographs of diabetic and normal individuals, aged 30-60 years, were taken under defined conditions and analyzed using a Radon transform-based algorithm for vascular segmentation. The image areas occupied by vessels (AOV) of different diameters were calculated. The main outcome measure was the distribution curve of mean AOV of different sized vessels. Secondary outcome measures included total AOV and standard deviation (SD) of AOV of different sized vessels. Results: Two hundred and sixty-eight diabetic patients and 297 normal (control) individuals were included, differing in age (45.50 ± 5.19 vs. 40.38 ± 6.19 years, P < 0.001), systolic (126.37 ± 20.25 vs. 119.21 ± 15.81 mmHg, P < 0.001) and diastolic (78.14 ± 14.21 vs. 67.54 ± 11.46 mmHg, P < 0.001) blood pressures. The distribution curves of mean AOV differed between patients and controls (smaller AOV for larger vessels in patients; P < 0.001) as well as between patients without retinopathy and those with non-proliferative diabetic retinopathy (NPDR); with larger AOV for smaller vessels in NPDR (P < 0.001). Controlling for the effect of confounders, patients had a smaller total AOV, larger total SD of AOV, and a more skewed distribution curve of vessels compared to controls. Conclusion: Presence of diabetes mellitus is associated with contraction of larger vessels in the conjunctiva. Smaller vessels dilate with diabetic retinopathy. These findings may be useful in the photographic screening of diabetes mellitus and retinopathy.
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Temporal and spatial flap variability in laser in-situ keratomileusis by optical coherence tomography p. 368
Yousif Farhan Dawood, Usama Al Hassany, Ammar F Issa
Purpose: To study changes in flap thickness made with two different microkeratome heads across different corneal locations using anterior segment optical coherence tomography (OCT). Methods: In this prospective, non-randomized, consecutive case series, subjects who had their laser in-situ keratomileusis (LASIK) flaps made using 90 μm (MSU90) or 130 μm (MSU130) disposable M2 microkeratome heads were examined using OCT. The measurements were performed at three locations (central and 2.5 mm to either side) at 1 day, 1 week, and 1 month postoperatively. Results: The central flap thickness was 123 ± 15, 130 ± 14, and 127 ± 13 μm, respectively, at 1 day, 1 week, and 1 month postoperatively in the MSU90 group (41 eyes) and 142 ± 20, 147 ± 19, and 143 ± 15 μm, respectively, in the MSU130 group (47 eyes). At 1 month, peripheral flap thickness was 161 ± 17 and 159 ± 13 μm, respectively, at 2.5 mm to the right and left of corneal center in the MSU90 group. The corresponding figures were 170 ± 14 and 167 ± 13 μm, respectively, in the MSU130 group. There was a statistically significant difference between the two groups at all locations (P < 0.001). No statistically significant change in flap thickness was detected in either group at any assessment time. There was a partial positive correlation (after controlling for preoperative manifest refractive spherical equivalent) between central flap thickness and preoperative ultrasound central pachymetry (r = 0.739, P = 0.036) in the MSU90 group but not in the MSU130 group. Conclusion: Using OCT, changes in flap thickness were minimal in the first month after LASIK. Flap thickness correlated strongly with central corneal thickness if a 90 μm head was used.
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Comparison between Pentacam HR and Orbscan II after hyperopic photorefractive keratectomy p. 374
Mahmoud Jabbarvand, Farshad Askarizadeh, Mohamad Reza Sedaghat, Hadi Ghadimi, Bahram Khosravi, Mohammad Aghazadeh Amiri, Foroozan Narooie-Noori
Purpose: The aim of this study was to determine the agreement between Pentacam HR (Scheimpflug imaging, Oculus) and Orbscan II (scanning slit topography, Bausch and Lomb) in measuring corneal parameters after photorefractive keratectomy (PRK) for hyperopia. Methods: In this prospective cross-sectional study, 38 hyperopic eyes undergoing PRK were examined before refractive surgery and 8 to 10 months postoperatively using Pentacam HR and Orbscan II. Ultrasound (US) pachymetry was also used to measure central corneal thickness (CCT). The radius of anterior (A-) and posterior (P-) best-fit sphere size (BFS), central elevation (CE), and anterior maximum tangential power in 3 mm (TG3) and 3-5 mm (TG5) zones, anterior chamber depth (ACD), and central corneal thickness (CCT) were collected and used in the analyses. To study the agreement between the measurements made by the two devices, the method described by Bland and Altman was used and the 95% limits of agreement were calculated. Results: The 95% limits of agreement show reasonable agreement between the measurements by Pentacam HR and Orbscan II for A-BFS, P-BFS, A-TG3, and CCT, but not for A-CE, P-CE, A-TG5, or ACD. CCT values obtained by both Pentacam HR and Orbscan II correlated well with the values determined by US pachymetry. Conclusion: Pentacam HR and Orbscan II after PRK for hyperopia show reasonable agreement for determining A-BFS, P-BFS, A-TG3, and CCT, but not for A-CE, P-CE, A-TG5, or ACD. CCT measurements with Pentacam HR have reasonable agreement with US pachymetry.
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Preparation and thickness profile of endothelial keratoplasty lenticules from donated whole eyes with previous photorefractive keratectomy p. 380
Mozhgan Rezaei Kanavi, Pejman Fahim, Mohsen Rahmanian, Tahereh Chamani, Bahar Kheiri, Sahar Balagholi, Mohammad Ali Javadi
Purpose: To describe the preparation and thickness profiles of endothelial keratoplasty lenticules harvested from eyes with previous photorefractive keratectomy (PRK). Methods: Donor whole eyes that underwent PRK were subjected to microkeratome-assisted dissection for Descemet stripping automated endothelial keratoplasty. Specular microscopy and Visante optical coherence tomography were performed on precut corneas. Endothelial cell indices and thickness profiles of endothelial keratoplasty lenticules were statistically analyzed. Postoperative reports for transplanted lenticules were recorded. Results: Over a 6-month period, 2,929 whole eyes from 1,471 donors were screened for PRK. Twenty-five (0.85%) eyes from 14 donors were diagnosed with disciform haziness due to prior PRK and were used uneventfully for preparation of endothelial keratoplasty lenticules. Mean endothelial cell count was 3164.6 ± 311.0/mm2 and mean central posterior lenticule thickness was 128 ± 34 μm. Posterior lenticules revealed an increase in thickness from the central to peripheral cornea (mean increase of 26.2 μm at pericentral and 90.4 μm at peripheral locations). Mean increase in thickness was statistically different between two peripheral locations (74.5 μm vs. 108.1 μm, P = 0.047). Postoperative reports of transplanted lenticules revealed no posterior flap detachment or loss of clarity at least three months after the surgery. Conclusion: PRK donor whole eyes are potential sources for preparation of microkeratome-assisted thin endothelial keratoplasty lenticules with a high endothelial cell count. Although an asymmetric and significant increase in thickness was present at the peripheral cornea, neither attachment nor clarity of transplanted lenticules was affected by variations in thickness of precut corneas.
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Accuracy of various intraocular lens power calculation formulas in steep corneas p. 385
Amir Faramarzi, Ali Aghajani, Leila Ghiasian
Purpose: To compare the accuracy of four different intraocular lens (IOL) power calculation formulas for eyes with mean keratometry values greater than 46 diopters (D). Methods: Forty five eyes from 45 patients who were candidates for senile cataract surgery with mean keratometry values greater than 46 D were included. Calculation of the IOL power was performed by the Lenstar. The implanted IOL in all cases was Acrysof SA60AT. The average absolute value of the differences between the actual and predicted spherical equivalent (SE) of the postoperative refractive error (mean absolute error: MAE) was calculated using 4 formulas (Haigis, Holladay 1, Hoffer Q, and SRK/T) with optical IOL constants from the User Group for Laser Interference Biometry constants. Results: The MAE was smallest in the SRK/T formula (0.39 D ± 0.35) followed by those of the Holladay 1 (0.44 D ± 0.32), Haigis (0.45 D ± 0.35) and Hoffer Q (0.5 D ± 0.38) formulas. However, there was no statistically significant difference between the MAE among different formulas. The SRK/T formula predicted more eyes within ± 0.5 D of the SE (77.8%) compared to other formulas. Conclusion: In eyes with steep corneas, there were no statistically significant differences among the accuracies of the four common IOL power calculation formulas.
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Water drinking test: Intraocular pressure changes after tube surgery and trabeculectomy p. 390
Mohammad Reza Razeghinejad, Zahra Tajbakhsh, Mohammad Hossein Nowroozzadeh, Masoumeh Masoumpour
Purpose: To study the effects of filtration surgeries (tube and trabeculectomy) on changes in intraocular pressure after a water-drinking test. Methods: In this prospective, non-randomized, comparative clinical study, 30 patients who had tube surgery and 30 age- and sex-matched trabeculectomy patients underwent a water-drinking test. Only one eye of each patient was included. The baseline intraocular pressure was ≤21 mmHg in all enrolled eyes with or without adjunctive topical medications. After the water-drinking test, the intraocular pressure was measured and recorded at 15, 30, 45, and 60 minutes and the results were compared between the two groups. Results: In both groups, intraocular pressure significantly increased from baseline at all measured time-points (P < 0.001). In the trabeculectomy group, the average intraocular pressure increased from 14.8 ± 2.9 to 18.8 ± 4.7 mmHg at 30 minutes, but decreased at 60 min (18.0 ± 5.2 mmHg). In the Tube group, intraocular pressure increased incrementally until the last measurement (14.2 ± 3.9, 18.8 ± 5.6, and 19.7 ± 6.0 mmHg at baseline, 30, and 60 minutes, respectively). The end-pressure difference (intraocular pressure at 60 minutes vs. baseline) was significantly greater in the tube group (5.6 ± 3.6 mmHg; 41% change) than in the trabeculectomy group (3.2 ± 4.7; 23% change; P = 0.03). Conclusion: Intraocular pressure significantly increased after the water-drinking test in both the groups. Intraocular pressure started to decline 30 minutes after the water-drinking test in the trabeculectomy group, while it continued to increase up to 60 minutes in the Tube group. This finding may have implications regarding the efficacy or safety of the procedures in advanced glaucoma patients.
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Orbital volume augmentation with calcium hydroxyapatite filler in anophthalmic enophthalmos p. 397
Maryam Aletaha, Hossein Salour, Saied Yadegary, Yousef Fekri, Mehdi Tavakoli
Purpose: To report the long-term results of orbital volume augmentation using calcium hydroxyapatite filler injections in patients with anophthalmic sockets. Methods: Twelve eligible patients with post-enucleation socket syndrome (PESS) and small orbital volumes were included in our study. In this investigation, 1.5 mL injectable calcium hydroxyapatite (Radiesse) was utilized in an off-label application under local anesthesia. We evaluated the effect of orbital volume augmentation for correction of enophthalmos. Results: Five women and seven men with a mean age of 35 years (range, 21-72 years) were included in the study. The mean follow-up was 19.5 months (range, 16-27 months). Enophthalmos and deep superior sulcus were reduced in all patients during all follow-up visits postoperatively. The mean improvement of enophthalmos was 2.58 mm (range, 1-5 mm) and the improvement in deformity grading of superior sulcus was 0.83 (range, 0-4 grade). The mean marginal reflex distance increased by 0.6 mm (range of -1 to 3 mm). Complications included increase in ptosis in two cases and extrusion of the filler accompanied by discoloration of the skin in one case. Conclusion: The use of injectable calcium hydroxyapatite for orbital volume restoration in anophthalmic sockets is a simple, fast, and minimally invasive method with considerable long-term effects and low complications.
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Pattern visual evoked potentials in dyslexic children p. 402
Javad Heravian Shandiz, Mohsen Heyrani, Davood Sobhani-Rad, Zeinab Salehinejad, Shirin Shojaei, Mohamad Javad Khoshsima, Abbas Azimi, Abbas Ali Yekta, Seyed Hosein Hoseini Yazdi
Purpose: This study aimed to compare pattern visual evoked potential (PVEP) components in dyslexic and normal children. Methods: This cross-sectional analytic study recruited 72 children, including 36 dyslexic and 36 normal participants aged 8-12 years. Visual examinations included measurement of distance visual acuity, refraction, and PVEP components of amplitudes and latencies with two different check sizes of 15 and 60 minutes (min) of arc at two contrast levels of 25% and 100%. Results: Our results demonstrated significant differences between dyslexic and normal children in terms of P100 latency and amplitude of PVEP at 25% contrast, with check sizes of 15 and 60 min of arc. However, there were no significant differences between the two groups regarding P100 latency and amplitude at 100% contrast with check sizes of both 15 and 60 min of arc. Conclusion: Dyslexic participants showed reduced amplitude and prolonged latency in most PVEP components at low-contrast levels. These findings may support the magnocellular deficit hypothesis in dyslexic participants, even though the parvocellular pathway remains intact.
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FMNL2 with functions related to the cytoskeleton is partially regulated by PAX6 p. 407
Elham Ghorbanpour, Parvin Pasalar, Shahin Yazdani, Hamidreza Moazzeni, Elahe Elahi
Purpose: We aimed to assess whether the transcription factor PAX6 affects transcription of FMNL2. PAX6 is a transcription factor with significant roles in development of the eye and eye-related functions. FMNL2 encodes a member of the formin family of proteins and has roles in polymerization of actin and features of the cytoskeleton. The state of the cytoskeleton affects the flow of aqueous humor, disruption of which is a cornerstone of glaucoma pathology. Methods: Initially, bioinformatics were used extensively to identify FMNL2 as an appropriate candidate gene for possible targeting by PAX6. Subsequently, direct targeting of the promoter of FMNL2 by PAX6 was tested using the dual luciferase assay. The experiment was performed by cloning a promoter region of FMNL2 that contains PAX6 binding sitesupstream of a firefly luciferase gene and comparison of expression of luciferase in the presence and absence of PAX6 expression vectors in the HEK293T cell line. The effect of PAX6 on endogenous expression of FMNL2 in primary trabecular meshwork (TM) cells was assessed by real-time polymerase chain reaction. Results: Dual luciferase assays in HEK293T cells clearly demonstrated that PAX6 directly affects the FMNL2 promoter to increase expression of downstream sequences. However, overexpression of PAX6 in TM cells caused mild but statistically significant downregulation of endogenous FMNL2 as assessed by real-time polymerase chain reaction. Conclusion: It is concluded that PAX6 can indeed directly affect transcription of FMNL2. However, regulation of FMNL2 expression in TM cells is complicated and not limited to the direct effects of PAX6.
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Review of static approaches to surgical correction of presbyopia p. 413
Mohammad Ali Zare Mehrjerdi, Masomeh Mohebbi, Mehdi Zandian
Presbyopia is the primary cause of reduction in the quality of life of people in their 40s, due to dependence on spectacles. Therefore, presbyopia correction has become an evolving and rapidly progressive field in refractive surgery. There are two primary options for presbyopia correction: the dynamic approach uses the residual accommodative capacity of the eye, and the static approach attempts to enhance the depth of focus of the optical system. The dynamic approach attempts to reverse suspected pathophysiologic changes. Dynamic approaches such as accommodative intraocular lenses (IOLs), scleral expansion techniques, refilling, and photodisruption of the crystalline lens have attracted less clinical interest due to inconsistent results and the complexity of the techniques. We have reviewed the most popular static techniques in presbyopia surgery, including multifocal IOLs, PresbyLASIK, and corneal inlays, but we should emphasize that these techniques are very different from the physiologic status of an untouched eye. A systematic PubMed search for the keywords “presbylasik”, “multifocal IOL”, and “presbyopic corneal inlay” revealed 634 articles; 124 were controlled clinical trials, 95 were published in the previous 10 years, and 78 were English with available full text. We reviewed the abstracts and rejected the unrelated articles; other references were included as needed. This narrative review compares different treatments according to available information on the optical basis of each treatment modality, including the clinical outcomes such as near, intermediate, and far visual acuity, spectacles independence, quality of vision, and dysphotopic phenomena.
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Pneumatic vitreolysis for management of symptomatic focal vitreomacular traction p. 419
Clement K Chan, Calvin E Mein, Jason N Crosson
Pneumatic vitreolysis (PVL) is the intravitreal injection of a small quantity of expansile gas for the purpose of achieving focal vitreomacular traction (VMT) release for eyes with symptomatic VMT, or inducing VMT release and closure of the macular defect for eyes with a small stage-2 macular hole (MH). Initially, there was limited interest in this technique upon its introduction for clinical treatment in human eyes in 1993. With the advent of optical coherence tomography allowing detailed observation of vitreomacular interface changes and rising importance of medical economics in recent years, there has been increasing interest in PVL, a low-cost procedure for managing symptomatic VMT. The success rates of VMT release in the literature have ranged from 60% to 100% and the rates of closure of small macular holes have ranged from 50% to 80% following PVL. In a recent retrospective consecutive series of 56 eyes in two centers undergoing C3F8 gas injection, Chan and Mein reported an overall success of 86% in VMT release and 60% closure of small macular holes with few adverse events (7% with retinal breaks, retinal detachment, or progression of VMT). Multiple recent studies have shown superior outcome utilizing C3F8 gas compared with SF6 gas for PVL. In conclusion, PVL is a promising, low-cost therapeutic option, with the potential for managing symptomatic focal VMT on a global scale.
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The role of mitochondria in AMD: Current knowledge and future applications p. 424
Mohammad Riazi-Esfahani, Baruch D Kuppermann, M Cristina Kenney
Mitochondria are organelles which comprise the main respiratory machinery in the eukaryotic cells. In addition to their crucial role in energy production, they have profound effects on apoptosis and retrograde signaling to nucleus. Mitochondria have their own DNA, which codes for different proteins mostly involved in oxidative phosphorylation. Significant changes in the mitochondria of retinal pigment epithelium have been reported in age-related macular degeneration (AMD), which is correlated with the severity of the disease. Cybrid cell lines that have identical nuclei but mitochondria from different individuals can provide a unique means for studying the relationship between mitochondria and AMD. Different approaches for protection of mitochondria have been introduced which can be considered as potential future treatments for AMD and other age- related disorders.
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Severe rosacea: A case report p. 429
Ebrahim Shirzadeh, Abbas Bagheri, Mojtaba Fattahi Abdizadeh, Mozhgan Rezaei Kanavi
Purpose: To describe a case of severe rosacea with ocular involvement. Case Report: A 28-year-old female patient presented with extensive facial and ocular eruptions. She had a history of treatment with oral prednisolone due to the clinical diagnosis of lupus erythematosus (LE), which had resulted in transient improvement of the lesions, but was followed by exacerbation of the lesions. With the clinical diagnosis of severe oculofacial rosacea, she was successfully treated with oral doxycycline, steroid eye drops, and ocular lubricants. Histopathological features of skin biopsy were consistent with rosacea in the context of infection with Demodexfolliculorum. After four years, a relapse of the oculofacial lesions occurred, for which retreatment with oral tetracycline, steroid eye drops, and ocular lubricants was administered. Conclusion: Rosacea can be extremely severe and disfiguring, and it can be misdiagnosed as the pathognomonic butterfly rash of LE. Demodex carriage in rosacea is consistent and may play a significant role in the severe forms.
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Oseltamivir (Tamiflu)-induced bilateral ciliochoroidal effusion and angle closure glaucoma: What type of idiosyncratic reaction? p. 434
Shahin Yazdani, Hamed Esfandiari, Sare Safi, Alireza Fatemi
Purpose: To report a case of bilateral acute angle closure glaucoma after one dose of oseltamivir 75 mg. Case Report: A 37-year-old man with a history of influenza developed high intraocular pressure and uniformly shallow anterior chamber in both eyes, 5 hours after the first dose of oseltamivir 75 mg. The condition was managed successfully with topical cycloplegic and systemic/topical antiglaucoma medications. Conclusion: Since a presumed idiosyncratic reaction developed right after the first dose of the medication, it challenges the common concept of adaptive immune system involvement in this type of reaction in medication-related ciliochoroidal effusion.
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Leprosy presenting with iridocyclitis: A diagnostic dilemma p. 437
Jaya Kaushik, Vaibhav Kumar Jain, Jitendra Kumar Singh Parihar, Sanjay Dhar, Savita Agarwal
Purpose: To report a case of lepromatous iridocyclitis that posed a diagnostic challenge. Case Report: A 50-yeasr-old male developed profound loss of vision in the right eye, while he was in the hospital with septicemia presenting with fever, dysuria, and abdominal swelling. He also developed erythema nodosum on the legs. Skin incisional biopsy section, upon dermatology consultation, showed a granulomatous nodule in the dermis. The anterior chamber aspirate demonstrated lepra bacilli, which confirmed the diagnosis of lepromatous leprosy with type II reaction. The patient was treated with multidrug therapy and oral and topical steroids. Conclusion: This case highlights that the lepromatous iridocyclitis, a serious vision-threatening disorder requires a high index of suspicion for prompt diagnosis in atypical cases particularly in endemic areas. Examination of the aqueous humor can also be helpful in diagnosis.
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Central retinal vein occlusion-like appearance: A precursor stage in evolution of frosted branch angiitis p. 440
Babulal Kumawat, Koushik Tripathy, Pradeep Venkatesh, Rohan Chawla, Yog Raj Sharma
Purpose: To report a young man with a central retinal vein occlusion (CRVO)-like appearance which later evolved to frosted branch angiitis (FBA). Case Report: As 28-year-old Indian man presented with optic disc swelling, hyperemia, peripapillary hemorrhages, and dilated tortuous veins in the left eye, 6 months after being diagnosed with idiopathic FBA in the right eye. Within 3 days of presentation, the left eye developed FBA, which was promptly and successfully treated with oral steroids. Conclusion: A CRVO-like picture may be the first stage of FBA. Young patients with CRVO and intraocular inflammation should be followed closely for early detection of FBA. Early initiation of oral steroids may preserve visual acuity in such cases.
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Successful treatment of corneal larva migrans by Nd:YAG laser photodisruption p. 443
Jisha Kamalakshy, Krishna Babu, Padmasree Kamala Madhavan, Seshadrinathan Subrahmaniam
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Inflammatory precipitates in an air bubble in the aqueous humor p. 445
Saeed Shokoohi-Rad, Ghodsieh Zamani, Mohammad-Reza Doosti
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Use of the smart phone as a diagnostic interface for detecting severe retinopathy of prematurity: A pilot study p. 447
Sucheta Kulkarni, Nilesh Kakade, Rajiv Khandekar, Pravin Narwadkar, M Deshpande
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Barriers to attending eye appointments among underserved adults p. 449
Maria A Woodward, Swetha E Jeganathan, Weixia Guo, Jean Cederna, Paula Anne Newman-Casey
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Vision disorders in drivers involved in traffic accidents p. 451
Hasan Behboudi, Reza Soltani Moghadam, Najmollah Tiefeh, Morteza Fallah Karkan
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