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   Table of Contents - Current issue
January-March 2018
Volume 13 | Issue 1
Page Nos. 1-89

Online since Thursday, January 11, 2018

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Importance of posterior corneal astigmatism in eyes with keratoconus Highly accessed article p. 1
Majid Moshirfar
DOI:10.4103/jovr.jovr_271_17  PMID:29403581
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Characteristics of posterior corneal astigmatism in different stages of keratoconus p. 3
Fereshteh Aslani, Masoud Khorrami-Nejad, Mohammad Aghazadeh Amiri, Hesam Hashemian, Farshad Askarizadeh, Bahram Khosravi
DOI:10.4103/jovr.jovr_217_16  PMID:29403582
Purpose: To evaluate the magnitudes and axis orientation of anterior corneal astigmatism (ACA) and posterior corneal astigmatism (PCA), the ratio of ACA to PCA, and the correlation between ACA and PCA in the different stages of keratoconus (KCN). Methods: This retrospective case series comprised 161 eyes of 161 patients with KCN (104 men, 57 women; mean age, 22.35 ± 6.10 years). The participants were divided into four subgroups according to the Amsler-Krumeich classification. A Scheimpflug imaging system was used to measure the magnitude and axis orientation of ACA and PCA. The posterior-anterior corneal astigmatism ratio was also calculated. The results were compared among different subgroups. Results: The average amounts of anterior, posterior, and total corneal astigmatism were 4.08 ± 2.21 diopters (D), 0.86 ± 0.46 D, and 3.50 ± 1.94 D, respectively. With-the-rule, against-the-rule, and oblique astigmatisms of the posterior surface of the cornea were found in 61 eyes (37.9%), 67 eyes (41.6%), and 33 eyes (20.5%), respectively; corresponding figures in the anterior corneal surface were 55 eyes (32.4%), 56 eyes (34.8%), and 50 eyes (31.1%), respectively. A strong correlation (P ≤ 0.001, r = 0.839) was found between ACA and PCA in the different stages of KCN; the correlation was weaker in eyes with grade 3 (P ≤ 0.001, r = 0.711) and grade 4 (P ≤ 0.001, r = 0.717) KCN. The maximum posterior-anterior corneal astigmatism ratio (PCA/ACA, 0.246) was found in patients with stage 1 KCN. Conclusion: Corneal astigmatism in anterior surface was more affected than posterior surface by increasing in the KCN severity, although PCA was more affected than ACA in an early stage of KCN.
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Factors influencing graft endothelial cell density after descemet stripping automated endothelial keratoplasty p. 10
Mohammad Ali Javadi, Sepehr Feizi, Roya Jafari, Seyed Bagher Hosseini, Sharareh Safapour
DOI:10.4103/jovr.jovr_213_16  PMID:29403583
Purpose: To determine the factors that influence the endothelial cell density (ECD) of donor grafts after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: This retrospective, interventional case series comprised 77 eyes of 64 patients who underwent DSAEK. Confocal microscopy was performed at the final follow-up examination to evaluate the endothelial cell count, cell morphology, and graft thickness. Univariate and multiple linear regression analyses were used to investigate recipient-, donor-, surgical-, and postoperative related variables capable of influencing graft endothelial cell counts after DSAEK. Results: The mean patient age was 62.3 ± 15.6 years; patients were followed-up for 26.2 ± 20.9 months postoperatively. Forty-six eyes (59.7%) underwent stand-alone DSAEK; 31 eyes (40.3%) underwent DSAEK combined with cataract surgery. The donor trephination size was 8.0 ± 0.21 mm. The mean donor age was 30.4 ± 11.2 years, and the mean preoperative endothelial cell density was 3127.4 ± 315.1 cells/mm2, which decreased to 1788.6 ± 716.5 cells/mm2 postoperatively (P < 0.001). The mean postoperative central graft thickness was 102.4 ± 31.6 μm. Univariate analysis revealed that postoperative ECD was significantly associated with death to preservation time (P = 0.046), graft thickness (P = 0.016), follow-up duration (P = 0.005), and graft non-attachment (P = 0.049). Multiple regression analyses identified graft thickness (β = 10.62, P = 0.003) and follow-up duration (β = -22.09, P = 0.001) as the significant characteristics influencing postoperative ECD. Conclusion: The primary predictors of ECD after DSAEK were graft thickness and duration of follow-up. Surgeons' requests for ultrathin DSAEK donor grafts to improve visual outcomes might not have the desired postoperative outcome with respect to ECD.
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Visual outcomes and refractive status after combined silicone oil removal/cataract surgery with intraocular lens implantation p. 17
Hussain F Al-Habboubi, Waseem Al-Zamil, Ali A Al-Habboubi, Rajiv Khandekar
DOI:10.4103/jovr.jovr_252_16  PMID:29403584
Purpose: To evaluate refractive status and identify predictors of surgical success following a combined silicone oil removal/cataract surgery with intraocular lens (IOL) implantation procedure. Methods: In this single-armed, retrospective study, we reviewed patients who underwent vitreoretinal surgery followed by a combined silicone oil removal/cataract surgery procedure between 2009 and 2013. Preoperative data included patient demographics, refractive status, IOL power, and axial length (measured with the IOL Master). Postoperative data were obtained from the 8-week follow-up visit and from the last follow-up visit attended that included refractive error (RE) evaluation (e.g., myopic, hyperopic, and astigmatic). Associations between variables and refractive status were examined. Blindness was defined as a best-corrected visual acuity (BCVA) worse than 3/60. Results: Nighty-eight eyes were ultimately included in analyses. Following surgery, 37.0% of eyes achieved BCVA better than 6/18. The incidence of blindness (BCVA worse than 3/60) was reduced from 47.0% before surgery to 17.3% after surgery. Additionally, 33.7% of eyes did not require refractive correction. Forty-two percent of eyes were under-corrected (>0.5 D hyperopia) following surgery. Age, gender, silicone oil viscosity, axial length, IOL type, initial vitreoretinal pathology, surgeon, and IOL calculation formula were not significantly associated with surgical outcomes (all P > 0.05). Conclusion: A combined silicone oil removal/cataract surgery with IOL implantation procedure restored functional vision in approximately one-third of cases. However, nearly half of patients were under-corrected. Unfortunately, we did not identify any factors that predicted surgical success.
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Effects of dexamethasone implant on multifocal electroretinography in central retinal vein occlusion p. 23
Muhammed Nurullah Bulut, Umit Çallı, Güzide Akçay, Ulviye Kıvrak, Kezban Bulut, Yusuf Özertürk
DOI:10.4103/jovr.jovr_118_16  PMID:29403585
Purpose: To investigate the effect of Ozurdex (dexamethasone intravitreal implant) on multifocal electroretinography (mfERG) findings during the treatment of macular edema secondary to the central retinal vein occlusion (CRVO). Methods: Fifteen eyes of 15 patients who were treated with Ozurdex implant due to CRVO-related macular edema were included in this study. Best corrected visual acuity (BCVA), central macular thickness (CMT), and mfERG evaluations were performed for all patients before injection of Ozurdex. After the injection, BCVA and CMT were measured at months 3 and 6 and mfERG test was performed at month 6 for all patients. Results: Pre-implantation mfERG P wave amplitude values of r1, r2, r3, r4 and r5 were 57.8 ± 14.8, 25.1 ± 10.6, 17.2 ± 7.3, 12.0 ± 5.0 and 7.1 ± 3.6 nV/deg2, respectively. They increased to 72.9 ± 33.2, 31.2 ± 9.3, 22.6 ± 7.6, 15.6 ± 7.1 and 10.9 ± 5.7 nV/deg2, respectively, at month 6. However, these increases were not statistically significant (all P > 0.05). Pre-implantation mfERG r1, r2, r3, r4 and r5 P wave implicit times were 40.1 ± 10.9, 39.4 ± 3, 38.4 ± 3.4, 38.2 ± 3.1 and 39.3 ± 2.2 ms, respectively and these values were measured as 38.9 ± 8.2, 38.4 ± 4.7, 37 ± 3.8, 37.5 ± 4.6 and 37.7 ± 4.7 ms at 6 months. Although there were reductions in P wave implicit times in all rings, they were not statistically significant (all P > 0.05). Conclusion: In this prospective study, we found that the Ozurdex implant had no effect on mfERG findings 6 months after insertion for treatment of CRVO-related macular edema.
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Efficacy of intravitreal bevacizumab for the treatment of Zone I Type 1 retinopathy of prematurity p. 29
Reza Karkhaneh, Hamidreza Torabi, Alireza Khodabande, Ramak Roohipoor, Mohammad Riazi-Esfahani
DOI:10.4103/jovr.jovr_198_16  PMID:29403586
Purpose: To describe the efficacy of intravitreal bevacizumab for the treatment of type 1 retinopathy of prematurity (ROP) in zone I. Methods: Preterm infants with type 1 ROP in zone I (zone I ROP, any stage with plus disease or zone I ROP, stage 3 without plus disease) were enrolled in this prospective study. Intravitreal bevacizumab (0.625 mg/0.025 ml) was injected under topical anesthesia. Patients were followed weekly for 4 weeks and then biweekly till 90 weeks gestational age. Results: Seventy eyes of 35 patients with type 1 ROP in zone I were enrolled. At a gestational age of 90 weeks, ROP regressed with complete or near-complete peripheral retinal vascularization, in 82.9% of eyes after a single injection and in 92.9% of eyes after up to two injections. In five eyes (7.1%), ROP progressed to stage 4B or 5, so surgical management was required. There were no major complications such as endophthalmitis, cataract, or vitreous hemorrhage after injection. Conclusion: Intravitreal bevacizumab injection is an effective method for the management of patients with Zone I ROP requiring treatment; however, some cases may progress to more advanced stages and require surgical management. Close monitoring for recurrence or progression is necessary. Eyes with persistent zone I ROP may progress to advanced stages when treated with intravitreal bevacizumab injection and re-treatment may be needed.
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Ophthalmologic findings in patients with neuro-metabolic disorders p. 34
Narjes Jafari, Karl Golnik, Mansoor Shahriari, Parvaneh Karimzadeh, Sayena Jabbehdari
DOI:10.4103/jovr.jovr_242_16  PMID:29403587
Purpose: We aimed to present the ophthalmic manifestations of neuro-metabolic disorders. Methods: Patients who were diagnosed with neuro-metabolic disorders in the Neurology Department of Mofid Pediatric Hospital in Tehran, Iran, between 2004 and 2014 were included in this study. Disorders were confirmed using clinical findings, neuroimaging, laboratory data, and genomic analyses. All enrolled patients were assessed for ophthalmological abnormalities. Results: A total of 213 patients with 34 different neuro-metabolic disorders were included. Ophthalmological abnormalities were observed in 33.5% of patients. Abnormal findings in the anterior segment included Kayser–Fleischer rings, congenital or secondary cataracts, and lens dislocation into the anterior chamber. Posterior segment (i.e., retina, vitreous body, and optic nerve) evaluation revealed retinitis pigmentosa, cherry-red spots, and optic atrophy. In addition, strabismus, nystagmus, and lack of fixation were noted during external examination. Conclusion: Ophthalmological examination and assessment is essential in patients that may exhibit neuro-metabolic disorders.
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Choroidal thickness in healthy subjects p. 39
Morteza Entezari, Saeed Karimi, Alireza Ramezani, Homayoun Nikkhah, Yousef Fekri, Bahareh Kheiri
DOI:10.4103/jovr.jovr_148_16  PMID:29403588
Purpose: To measure the choroidal thickness by enhanced depth imaging optical coherence tomography (EDI-OCT) in normal eyes. Methods: In a prospective case series, 208 eyes of 104 normal Iranian subjects were enrolled. Complete ophthalmic examination was performed. Inclusion criteria were best corrected visual acuity (BCVA) ≥20/20, ≤ ±1 diopter of refractive error in either spherical or cylindrical components, normal intraocular pressure (IOP) and no systemic or ocular diseases. The choroidal thickness was measured by EDI-OCT subfoveally, and 1500 μm and 3000 μm nasal and temporal to the fovea. Results: Mean age was 34.6 ± 9.8 years (range, 18–57 years). Mean subfoveal choroidal thickness was 363 ± 84 μm. Choroidal thickness was 292 ± 76 and 194 ± 58 μm at 1500 and 3000 μm nasal to the fovea, respectively, and 314 ± 77 and 268 ± 66 μm at 1500 and 3000 μm temporal to the fovea, respectively. There was no statistically significant difference in the choroidal thickness between sexes and laterality of the eyes. Choroidal thickness at fovea (P < 0.001) and at all extrafoveal locations decreased significantly for every 10 years increase in age. Conclusion: In normal Iranian subjects participating in this study, mean choroidal thickness was comparable with other reports.
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Effect of different illumination sources on reading and visual performance p. 44
Male Shiva Ram, Rishi Bhardwaj
DOI:10.4103/jovr.jovr_50_17  PMID:29403589
Purpose: To investigate visual performance during reading under different illumination sources. Methods: This experimental quantitative study included 40 (20 females and 20 males) emmetropic participants with no history of ocular pathology. The participants were randomly assigned to read a near visual task under four different illuminations (400-lux constant): compact fluorescent light (CFL), tungsten light (TUNG), fluorescent tube light (FLUO), and light emitting diode (LED). Subsequently, we evaluated the participants' experiences of eight symptoms of visual comfort. Results: The mean age of the participants was 19.86 ± 1.09 (range: 18–21) years. There was no statistically significant difference between the reading rates of males and females under the different illuminations (P = 0.99); however, the reading rate was fastest among males under CFL, and among females under FLUO. One way analysis of variance (ANOVA) revealed a strong significant difference (P = 0.001) between males and females (P = 0.002) regarding the visual performance and illuminations. Conclusion: This study demonstrates the influence of illumination on reading rate; there were no significant differences between males and females under different illuminations, however, males preferred CFL and females preferred FLUO for faster reading and visual comfort. Interestingly, neither preferred LED or TUNG. Although energy-efficient, visual performance under LED is poor; it is uncomfortable for prolonged reading and causes early symptoms of fatigue.
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Visual impairment registry of patients from North Kolkata, Eastern India: A hospital-based study p. 50
Sabyasachi Bandyopadhyay, Samir Kumar Bandyopadhyay, Jaya Biswas, Mita Saha, Asim Kumar Dey, Asim Chakrabarti
DOI:10.4103/jovr.jovr_164_16  PMID:29403590
Purpose: To study the demographic profile, severity and causes of visual impairment among registered patients in a tertiary care hospital in north Kolkata, eastern India, and to assess the magnitude of under-registration in that population. Methods: This is a retrospective analytical study. A review of all visually impaired patients registered at our tertiary care hospital during a ten-year period from January 2005 to December 2014, which is entitled for certification of people of north Kolkata, eastern India (with a population denominator of 1.1 million), was performed. Overall, 2472 eyes of 1236 patients were analyzed in terms of demographic characteristics, cause of visual impairment, and percentage of visual disability as per the guidelines established by the government of India. Results: Male patients (844, 68.28%; 95% confidence interval [CI], 65.69-70.87) registered more often than female patients (392; 31.72%, P = 0.0004). The registration rate for visual impairment was 11.24 per 100,000 per annum; this is not the true incidence rate, as both new patients and those visiting for renewal of certification were included in the study. Optic atrophy was the most common cause of visual impairment (384 eyes, 15.53%; 95% CI, 14.1-16.96). Conclusion: Commonest cause of visual impairment was optic atrophy followed by microphthalmos. Under-registration is a prevalent problem as the registration system is voluntary rather than mandatory, and female patients are more likely to be unregistered in this area.
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Evolution of cyclophotocoagulation p. 55
Jideofor K Ndulue, Kamran Rahmatnejad, Carina Sanvicente, Sheryl S Wizov, Marlene R Moster
DOI:10.4103/jovr.jovr_190_17  PMID:29403591
Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma.
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Management of retinal diseases in pregnant patients p. 62
Julie M Rosenthal, Mark W Johnson
DOI:10.4103/jovr.jovr_195_17  PMID:29403592
Pregnancy leads to significant changes in the body, which potentially affect the retina. Pregnancy can induce disease, such as that seen in hypertensive retinopathy and choroidopathy. It can cause exudative retinal detachments in the HELLP syndrome (hemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation (DIC), and thrombotic thrombocytopenic purpura (TTP), and provoke arterial and venous retinal occlusive disease. Pregnancy may also exacerbate pre-existing retinal disease, such as idiopathic central serous chorioretinopathy (ICSC) and diabetic retinopathy. Special consideration needs to be exercised when treating pregnant patients in choosing medications, as well as in selecting diagnostic modalities and surgical methods.
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Upcoming methods and specifications of continuous intraocular pressure monitoring systems for glaucoma p. 66
Amir Molaei, Vahid Karamzadeh, Sare Safi, Hamed Esfandiari, Javad Dargahi, Mohammad Azam Khosravi
DOI:10.4103/jovr.jovr_208_17  PMID:29403593
Glaucoma is the leading cause of irreversible blindness and vision loss in the world. Although intraocular pressure (IOP) is no longer considered the only risk factor for glaucoma, it is still the most important one. In most cases, high IOP is secondary to trabecular meshwork dysfunction. High IOP leads to compaction of the lamina cribrosa and subsequent damage to retinal ganglion cell axons. Damage to the optic nerve head is evident on funduscopy as posterior bowing of the lamina cribrosa and increased cupping. Currently, the only documented method to slow or halt the progression of this disease is to decrease the IOP; hence, accurate IOP measurement is crucial not only for diagnosis, but also for the management. Due to the dynamic nature and fluctuation of the IOP, a single clinical measurement is not a reliable indicator of diurnal IOP; it requires 24-hour monitoring methods. Technological advances in microelectromechanical systems and microfluidics provide a promising solution for the effective measurement of IOP. This paper provides a broad overview of the upcoming technologies to be used for continuous IOP monitoring.
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Possible Role of Descemet–Stroma Interface for Descemet's Membrane Detachment after Penetrating Keratoplasty p. 72
Vivian W.M Ho, Vito Romano, Bernhard Steger, Stephen B Kaye
DOI:10.4103/jovr.jovr_40_16  PMID:29403594
Purpose: To report two cases of spontaneous Descemet's membrane detachment (DMD) and dehiscence following penetrating keratoplasty (PK). Case Reports: Spontaneous DMD or Descemet's membrane (DM) dehiscence following PK is a rare occurrence. Here, we describe two cases of such an occurrence following PK arising from the graft–host interface. A possible causative relation between DMD/dehiscence and DM–stromal interface attachment is suggested. Conclusion: DMD and dehiscence after PK can be explained by the peripheral thinning of DM and possible changes to the recently characterized anchoring zone of interwoven collagen fibers and proteoglycans at the Descemet–stroma interface.
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Visibility of blood flow on optical coherence tomography angiography in a case of branch retinal artery occlusion p. 75
Sophie Bonnin, Valérie Krivosic, Emmanuel Cognat, Ramin Tadayoni
DOI:10.4103/jovr.jovr_13_17  PMID:29403595
Purpose: We report the variability in flow angiogram during the course of branch retinal artery occlusion (BRAO) in a case imaged by optical coherence tomography angiography (OCTA). Case Report: OCTA was performed in a patient with BRAO at initial examination and 6 hours later. Initially, the occluded retinal artery and its branches were not detected on OCTA whereas a slow perfusion was present on fluorescein angiography. Six hours after initial examination, flow was detected on OCTA image in the previously occluded artery. Conclusion: This case confirmed the relevance of using OCTA in monitoring BRAO and showed that capillaries with a very slow flow are not visible on OCTA angiograms. It emphasizes that non-perfusion on OCTA should be interpreted with caution.
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Primary atypical lipomatous tumor of the orbit: A case report p. 78
Douglas P Dworak, Shyam A Patel, Rohini Chennuri, Daniel Falco
DOI:10.4103/jovr.jovr_208_15  PMID:29403596
Purpose: To describe a case of primary atypical orbital lipomatous tumor (ALT). Case Report: A 35-year-old man presented with a two-month history of left eye proptosis and vertical diplopia. His visual acuity was 20/30 OD and 20/60 OS. External examination showed proptosis and downward displacement of the left eye with mild lid erythema. Extraocular movements were reduced in the left eye, with 10% and 70% motility in upgaze and abduction/adduction, respectively. Imaging showed a mass (22 × 16 × 46 mm) in the superior left orbit that infiltrated the orbital fat and the superior rectus muscle. A biopsy of the mass showed mature adipose tissue intermingled with fibrous zones of hyperchromatic stromal cells with nuclear atypia. Fluorescence in situ hybridization analysis demonstrated positive amplification for MDM2/CEP12. The MDM2 to CEP12 ratio was 5:7. A diagnosis of ALT was confirmed. An orbital exenteration was recommended, which the patient declined. Conclusion: Although rare, the differential for unilateral proptosis with or without diplopia should include orbital liposarcomas including the ALT subtype. Imaging, biopsy, staining, and/or FISH analysis for proto-oncogenes can assist with diagnosis and staging, while the standard treatment is exenteration.
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Compound nevus simulating a conjunctival melanoma p. 81
Parul Chawla Gupta, Jagat Ram, Madhuri Akella, Jitender Jinagal
DOI:10.4103/jovr.jovr_167_16  PMID:29403597
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Sub-internal limiting membrane cavity following valsalva retinopathy resembling central serous chorioretinopathy p. 83
Koushik Tripathy, Rohan Chawla, Laxman Vekaria, Yog Raj Sharma
DOI:10.4103/jovr.jovr_192_16  PMID:29403598
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Conjunctival rhinosporidiosis with lateral rectus muscle involvement p. 85
Rajesh Subhash Joshi
DOI:10.4103/jovr.jovr_53_17  PMID:29403599
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Unilateral myelinated retinal nerve fibers p. 87
Amit Mohan
DOI:10.4103/jovr.jovr_78_17  PMID:29403600
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Author's Reply p. 89
Georgios D Panos, Zisis Gatzioufas
DOI:10.4103/jovr.jovr_232_17  PMID:29403601
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