Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus

Purpose: To evaluate the visual, refractive, and tomography changes after femtosecond laser-assisted intrastromal corneal ring segment (ICRS; Intacs® SK) implantation in patients with keratoconus. Methods: In this prospective interventional case series, Intacs SK ICRSs were inserted using a femtosec...

Full description

Saved in:
Bibliographic Details
Published in:Journal of ophthalmic & vision research 2018-10, Vol.13 (4), p.376-382
Main Authors: Hashemian, Seyed, Farshchian, Nooshin, Foroutam-Jazi, Alireza, Jafari, Mohammad, Hashemian, Mahsa
Format: Article
Language:English
Subjects:
Astigmatism
Care and treatment
Complications and side effects
Contact lenses
Cornea
Femtosecond lasers
Icrs
Intacs-SK
Intrastromal Corneal Ring Segment
Keratoconus
Iodine
Keratoconus
Lasers
Medical research
Original
Patient outcomes
Patients
Studies
Surgeons
Surgery
Topography
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c623i-5c4b5d00306993fd2ff9508cc6c3de2f189f06ab1881b37a44a974eea55379e53
cites
container_end_page 382
container_issue 4
container_start_page 376
container_title Journal of ophthalmic & vision research
container_volume 13
creator Hashemian, Seyed
Farshchian, Nooshin
Foroutam-Jazi, Alireza
Jafari, Mohammad
Hashemian, Mahsa
Hashemian, Seyed
description Purpose: To evaluate the visual, refractive, and tomography changes after femtosecond laser-assisted intrastromal corneal ring segment (ICRS; Intacs® SK) implantation in patients with keratoconus. Methods: In this prospective interventional case series, Intacs SK ICRSs were inserted using a femtosecond laser into eyes with stage I-IV keratoconus. Visual, refractive, and corneal tomography changes, along with surgical complications, were analyzed 1 week, 2 months, and 6 months postoperatively. Results: The study evaluated 71 eyes of 52 patients (mean age: 27.5 years). Six months postoperatively, the spherical equivalent, mean sphere, and mean cylinder were decreased by 2.07, 1.47, and 1.13 diopters (D), respectively. The mean preoperative uncorrected distance visual acuity (UDVA) increased from 0.87 ± 0.26 to 0.46 ± 0.19 LogMAR and the mean preoperative corrected distance visual acuity (CDVA) increased from 0.55 ± 0.21 to 0.28 ± 0.17 LogMAR (P < 0.001). Flat and steep keratometry decreased by a mean corneal power in the 3-mm zone, and mean anterior elevation decreased by 0.91 D, 2.52 D, and 1.03 microns (P < 0.001), respectively. Among all eyes, 93.0% gained one or more lines of CDVA. Mean internal anterior chamber depth decreased from 3.25 ± 0.33 to 3.14 ± 0.45 mm (P = 0.001), and mean irregularity in the 3-mm zone decreased from 5.63 ± 1.71 to 5.24 ± 1.82 (P = 0.006). However, mean posterior elevation and irregularity in the 5-mm zone did not change significantly. Conclusion: Implantation of one or two Intacs SK segments is safe and effective to treat keratoconus, leading to significant improvement in UDVA, CDVA, and refractive error.
doi_str_mv 10.4103/jovr.jovr_42_17
format article
fullrecord <record><control><sourceid>gale_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_f86d9181cdb34094af1d16b56cb5ac6d</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A560296328</galeid><doaj_id>oai_doaj_org_article_f86d9181cdb34094af1d16b56cb5ac6d</doaj_id><sourcerecordid>A560296328</sourcerecordid><originalsourceid>FETCH-LOGICAL-c623i-5c4b5d00306993fd2ff9508cc6c3de2f189f06ab1881b37a44a974eea55379e53</originalsourceid><addsrcrecordid>eNp1kkuP0zAUhSMEYoaBNTsUiQ2bdvxInGSDNBrxGKkSG0DsLMe5Tt0mdrGdVvwe_ii37byKQJFs6-S7x_b1ybLXlMwLSvjlym_DfD_IgklaPcnOGSH1jDP24-mj9Vn2IsYVIUKIon6enXFSVE1FyvPs93cbJzXkynV5ABOUTnYLuZ-S9iPEg5786PugNkurc71Urt_rJkHIDYzJR9AeqUFFCDMVo40Juty6FFRMwY_orn1wgHOwrs8j9CO4lNtxMyiXVLLeIZ5vcIV6zHc2LfM1BJU8Ok_xZfbMqCHCq9v5Ivv28cPX68-zxZdPN9dXi5kWjNtZqYu27AjhRDQNNx0zpilJrbXQvANmaN0YIlRL65q2vFJFoZqqAFBlyasGSn6R3Rx9O69WchPsqMIv6ZWVB8GHXqqQrB5Amlp0Da2p7lpekKZQhnZUtKXQbam06NDr_dFrM7UjdBr27RhOTE__OLuUvd9KwSjBA6LBu1uD4H9OEJMcbdQwYMvAT1EyymvBa8IEom__Qld-Cg5bhRQTJcXHLh-oXuEFrDMe99V7U3lVCsIawVmN1PwfFH4djBZfA4xF_aTg8ligg48RI3R_R0rkPqPyEM-HjGLFm8etuefvQonA4gjs_IApi-th2kGQyK6d3_3PV_JKyGOaJaZW3qWZ_wHptwWh</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2126514795</pqid></control><display><type>article</type><title>Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus</title><source>Publicly Available Content Database</source><source>PubMed Central</source><creator>Hashemian, Seyed ; Farshchian, Nooshin ; Foroutam-Jazi, Alireza ; Jafari, Mohammad ; Hashemian, Mahsa ; Hashemian, Seyed</creator><creatorcontrib>Hashemian, Seyed ; Farshchian, Nooshin ; Foroutam-Jazi, Alireza ; Jafari, Mohammad ; Hashemian, Mahsa ; Hashemian, Seyed</creatorcontrib><description>Purpose: To evaluate the visual, refractive, and tomography changes after femtosecond laser-assisted intrastromal corneal ring segment (ICRS; Intacs® SK) implantation in patients with keratoconus. Methods: In this prospective interventional case series, Intacs SK ICRSs were inserted using a femtosecond laser into eyes with stage I-IV keratoconus. Visual, refractive, and corneal tomography changes, along with surgical complications, were analyzed 1 week, 2 months, and 6 months postoperatively. Results: The study evaluated 71 eyes of 52 patients (mean age: 27.5 years). Six months postoperatively, the spherical equivalent, mean sphere, and mean cylinder were decreased by 2.07, 1.47, and 1.13 diopters (D), respectively. The mean preoperative uncorrected distance visual acuity (UDVA) increased from 0.87 ± 0.26 to 0.46 ± 0.19 LogMAR and the mean preoperative corrected distance visual acuity (CDVA) increased from 0.55 ± 0.21 to 0.28 ± 0.17 LogMAR (P &lt; 0.001). Flat and steep keratometry decreased by a mean corneal power in the 3-mm zone, and mean anterior elevation decreased by 0.91 D, 2.52 D, and 1.03 microns (P &lt; 0.001), respectively. Among all eyes, 93.0% gained one or more lines of CDVA. Mean internal anterior chamber depth decreased from 3.25 ± 0.33 to 3.14 ± 0.45 mm (P = 0.001), and mean irregularity in the 3-mm zone decreased from 5.63 ± 1.71 to 5.24 ± 1.82 (P = 0.006). However, mean posterior elevation and irregularity in the 5-mm zone did not change significantly. Conclusion: Implantation of one or two Intacs SK segments is safe and effective to treat keratoconus, leading to significant improvement in UDVA, CDVA, and refractive error.</description><identifier>ISSN: 2008-322X</identifier><identifier>ISSN: 2008-2010</identifier><identifier>EISSN: 2008-322X</identifier><identifier>DOI: 10.4103/jovr.jovr_42_17</identifier><identifier>PMID: 30479705</identifier><language>eng</language><publisher>India: Wolters Kluwer India Pvt. Ltd</publisher><subject>Astigmatism ; Care and treatment ; Complications and side effects ; Contact lenses ; Cornea ; Femtosecond lasers ; Icrs; Intacs-SK; Intrastromal Corneal Ring Segment; Keratoconus ; Iodine ; Keratoconus ; Lasers ; Medical research ; Original ; Patient outcomes ; Patients ; Studies ; Surgeons ; Surgery ; Topography</subject><ispartof>Journal of ophthalmic &amp; vision research, 2018-10, Vol.13 (4), p.376-382</ispartof><rights>COPYRIGHT 2018 Medknow Publications and Media Pvt. Ltd.</rights><rights>2018. This work is published under https://creativecommons.org/licenses/by-nc-sa/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright: © 2018 Journal of Ophthalmic and Vision Research 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c623i-5c4b5d00306993fd2ff9508cc6c3de2f189f06ab1881b37a44a974eea55379e53</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210881/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2126514795?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30479705$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hashemian, Seyed</creatorcontrib><creatorcontrib>Farshchian, Nooshin</creatorcontrib><creatorcontrib>Foroutam-Jazi, Alireza</creatorcontrib><creatorcontrib>Jafari, Mohammad</creatorcontrib><creatorcontrib>Hashemian, Mahsa</creatorcontrib><creatorcontrib>Hashemian, Seyed</creatorcontrib><title>Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus</title><title>Journal of ophthalmic &amp; vision research</title><addtitle>J Ophthalmic Vis Res</addtitle><description>Purpose: To evaluate the visual, refractive, and tomography changes after femtosecond laser-assisted intrastromal corneal ring segment (ICRS; Intacs® SK) implantation in patients with keratoconus. Methods: In this prospective interventional case series, Intacs SK ICRSs were inserted using a femtosecond laser into eyes with stage I-IV keratoconus. Visual, refractive, and corneal tomography changes, along with surgical complications, were analyzed 1 week, 2 months, and 6 months postoperatively. Results: The study evaluated 71 eyes of 52 patients (mean age: 27.5 years). Six months postoperatively, the spherical equivalent, mean sphere, and mean cylinder were decreased by 2.07, 1.47, and 1.13 diopters (D), respectively. The mean preoperative uncorrected distance visual acuity (UDVA) increased from 0.87 ± 0.26 to 0.46 ± 0.19 LogMAR and the mean preoperative corrected distance visual acuity (CDVA) increased from 0.55 ± 0.21 to 0.28 ± 0.17 LogMAR (P &lt; 0.001). Flat and steep keratometry decreased by a mean corneal power in the 3-mm zone, and mean anterior elevation decreased by 0.91 D, 2.52 D, and 1.03 microns (P &lt; 0.001), respectively. Among all eyes, 93.0% gained one or more lines of CDVA. Mean internal anterior chamber depth decreased from 3.25 ± 0.33 to 3.14 ± 0.45 mm (P = 0.001), and mean irregularity in the 3-mm zone decreased from 5.63 ± 1.71 to 5.24 ± 1.82 (P = 0.006). However, mean posterior elevation and irregularity in the 5-mm zone did not change significantly. Conclusion: Implantation of one or two Intacs SK segments is safe and effective to treat keratoconus, leading to significant improvement in UDVA, CDVA, and refractive error.</description><subject>Astigmatism</subject><subject>Care and treatment</subject><subject>Complications and side effects</subject><subject>Contact lenses</subject><subject>Cornea</subject><subject>Femtosecond lasers</subject><subject>Icrs; Intacs-SK; Intrastromal Corneal Ring Segment; Keratoconus</subject><subject>Iodine</subject><subject>Keratoconus</subject><subject>Lasers</subject><subject>Medical research</subject><subject>Original</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Topography</subject><issn>2008-322X</issn><issn>2008-2010</issn><issn>2008-322X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNp1kkuP0zAUhSMEYoaBNTsUiQ2bdvxInGSDNBrxGKkSG0DsLMe5Tt0mdrGdVvwe_ii37byKQJFs6-S7x_b1ybLXlMwLSvjlym_DfD_IgklaPcnOGSH1jDP24-mj9Vn2IsYVIUKIon6enXFSVE1FyvPs93cbJzXkynV5ABOUTnYLuZ-S9iPEg5786PugNkurc71Urt_rJkHIDYzJR9AeqUFFCDMVo40Juty6FFRMwY_orn1wgHOwrs8j9CO4lNtxMyiXVLLeIZ5vcIV6zHc2LfM1BJU8Ok_xZfbMqCHCq9v5Ivv28cPX68-zxZdPN9dXi5kWjNtZqYu27AjhRDQNNx0zpilJrbXQvANmaN0YIlRL65q2vFJFoZqqAFBlyasGSn6R3Rx9O69WchPsqMIv6ZWVB8GHXqqQrB5Amlp0Da2p7lpekKZQhnZUtKXQbam06NDr_dFrM7UjdBr27RhOTE__OLuUvd9KwSjBA6LBu1uD4H9OEJMcbdQwYMvAT1EyymvBa8IEom__Qld-Cg5bhRQTJcXHLh-oXuEFrDMe99V7U3lVCsIawVmN1PwfFH4djBZfA4xF_aTg8ligg48RI3R_R0rkPqPyEM-HjGLFm8etuefvQonA4gjs_IApi-th2kGQyK6d3_3PV_JKyGOaJaZW3qWZ_wHptwWh</recordid><startdate>20181001</startdate><enddate>20181001</enddate><creator>Hashemian, Seyed</creator><creator>Farshchian, Nooshin</creator><creator>Foroutam-Jazi, Alireza</creator><creator>Jafari, Mohammad</creator><creator>Hashemian, Mahsa</creator><creator>Hashemian, Seyed</creator><general>Wolters Kluwer India Pvt. Ltd</general><general>Medknow Publications and Media Pvt. Ltd</general><general>Medknow Publications &amp; Media Pvt. Ltd</general><general>Medknow Publications &amp; Media Pvt Ltd</general><general>Knowledge E</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20181001</creationdate><title>Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus</title><author>Hashemian, Seyed ; Farshchian, Nooshin ; Foroutam-Jazi, Alireza ; Jafari, Mohammad ; Hashemian, Mahsa ; Hashemian, Seyed</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c623i-5c4b5d00306993fd2ff9508cc6c3de2f189f06ab1881b37a44a974eea55379e53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Astigmatism</topic><topic>Care and treatment</topic><topic>Complications and side effects</topic><topic>Contact lenses</topic><topic>Cornea</topic><topic>Femtosecond lasers</topic><topic>Icrs; Intacs-SK; Intrastromal Corneal Ring Segment; Keratoconus</topic><topic>Iodine</topic><topic>Keratoconus</topic><topic>Lasers</topic><topic>Medical research</topic><topic>Original</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Topography</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hashemian, Seyed</creatorcontrib><creatorcontrib>Farshchian, Nooshin</creatorcontrib><creatorcontrib>Foroutam-Jazi, Alireza</creatorcontrib><creatorcontrib>Jafari, Mohammad</creatorcontrib><creatorcontrib>Hashemian, Mahsa</creatorcontrib><creatorcontrib>Hashemian, Seyed</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Databases</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Directory of Open Access Journals</collection><jtitle>Journal of ophthalmic &amp; vision research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hashemian, Seyed</au><au>Farshchian, Nooshin</au><au>Foroutam-Jazi, Alireza</au><au>Jafari, Mohammad</au><au>Hashemian, Mahsa</au><au>Hashemian, Seyed</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus</atitle><jtitle>Journal of ophthalmic &amp; vision research</jtitle><addtitle>J Ophthalmic Vis Res</addtitle><date>2018-10-01</date><risdate>2018</risdate><volume>13</volume><issue>4</issue><spage>376</spage><epage>382</epage><pages>376-382</pages><issn>2008-322X</issn><issn>2008-2010</issn><eissn>2008-322X</eissn><abstract>Purpose: To evaluate the visual, refractive, and tomography changes after femtosecond laser-assisted intrastromal corneal ring segment (ICRS; Intacs® SK) implantation in patients with keratoconus. Methods: In this prospective interventional case series, Intacs SK ICRSs were inserted using a femtosecond laser into eyes with stage I-IV keratoconus. Visual, refractive, and corneal tomography changes, along with surgical complications, were analyzed 1 week, 2 months, and 6 months postoperatively. Results: The study evaluated 71 eyes of 52 patients (mean age: 27.5 years). Six months postoperatively, the spherical equivalent, mean sphere, and mean cylinder were decreased by 2.07, 1.47, and 1.13 diopters (D), respectively. The mean preoperative uncorrected distance visual acuity (UDVA) increased from 0.87 ± 0.26 to 0.46 ± 0.19 LogMAR and the mean preoperative corrected distance visual acuity (CDVA) increased from 0.55 ± 0.21 to 0.28 ± 0.17 LogMAR (P &lt; 0.001). Flat and steep keratometry decreased by a mean corneal power in the 3-mm zone, and mean anterior elevation decreased by 0.91 D, 2.52 D, and 1.03 microns (P &lt; 0.001), respectively. Among all eyes, 93.0% gained one or more lines of CDVA. Mean internal anterior chamber depth decreased from 3.25 ± 0.33 to 3.14 ± 0.45 mm (P = 0.001), and mean irregularity in the 3-mm zone decreased from 5.63 ± 1.71 to 5.24 ± 1.82 (P = 0.006). However, mean posterior elevation and irregularity in the 5-mm zone did not change significantly. Conclusion: Implantation of one or two Intacs SK segments is safe and effective to treat keratoconus, leading to significant improvement in UDVA, CDVA, and refractive error.</abstract><cop>India</cop><pub>Wolters Kluwer India Pvt. Ltd</pub><pmid>30479705</pmid><doi>10.4103/jovr.jovr_42_17</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2008-322X
ispartof Journal of ophthalmic & vision research, 2018-10, Vol.13 (4), p.376-382
issn 2008-322X
2008-2010
2008-322X
language eng
recordid cdi_doaj_primary_oai_doaj_org_article_f86d9181cdb34094af1d16b56cb5ac6d
source Publicly Available Content Database; PubMed Central
subjects Astigmatism
Care and treatment
Complications and side effects
Contact lenses
Cornea
Femtosecond lasers
Icrs
Intacs-SK
Intrastromal Corneal Ring Segment
Keratoconus
Iodine
Keratoconus
Lasers
Medical research
Original
Patient outcomes
Patients
Studies
Surgeons
Surgery
Topography
title Visual and refractive outcomes and tomographic changes after femtosecond laser-assisted intrastromal corneal ring segment implantation in patients with keratoconus
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-08T11%3A08%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Visual%20and%20refractive%20outcomes%20and%20tomographic%20changes%20after%20femtosecond%20laser-assisted%20intrastromal%20corneal%20ring%20segment%20implantation%20in%20patients%20with%20keratoconus&rft.jtitle=Journal%20of%20ophthalmic%20&%20vision%20research&rft.au=Hashemian,%20Seyed&rft.date=2018-10-01&rft.volume=13&rft.issue=4&rft.spage=376&rft.epage=382&rft.pages=376-382&rft.issn=2008-322X&rft.eissn=2008-322X&rft_id=info:doi/10.4103/jovr.jovr_42_17&rft_dat=%3Cgale_doaj_%3EA560296328%3C/gale_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c623i-5c4b5d00306993fd2ff9508cc6c3de2f189f06ab1881b37a44a974eea55379e53%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2126514795&rft_id=info:pmid/30479705&rft_galeid=A560296328&rfr_iscdi=true