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  1. Article ; Online: Inter and intradevice assessment of microperimetry testing in aging eyes.

    Coulibaly, Leonard M / Mohamed, Hamza / Fuchs, Philipp / Schmidt-Erfurth, Ursula / Reiter, Gregor S

    Scientific reports

    2024  Volume 14, Issue 1, Page(s) 1049

    Abstract: Microperimetry (MP) is a psychometric examination combining retinal imaging and functional sensitivity testing with an increasing importance due to its potential use as clinical study outcome. We investigated the repeatability of pointwise retinal ... ...

    Abstract Microperimetry (MP) is a psychometric examination combining retinal imaging and functional sensitivity testing with an increasing importance due to its potential use as clinical study outcome. We investigated the repeatability of pointwise retinal sensitivity (PWS) on the most advanced commercially available MP devices under their standard setting in a healthy aging population. Two successive MP examinations on both MP-3 (NIDEK CO., Ltd., Gamagori, Japan) and MAIA (CenterVue S.p.A. (iCare), Padova, Italy) were performed on healthy aging subjects in a randomized order. PWS repeatability was analysed for different macular regions and age groups using Bland-Altmann coefficients of repeatability (CoR). A total of 3600 stimuli from 20 healthy individuals with a mean age of 70 (11) years were included. Mean CoR in dB were ±4.61 for MAIA and ±4.55 for MP-3 examinations. A lower repeatability (p=0.005) was detected in the central millimetre on MAIA examinations. Higher subject age was associated with a lower repeatability of PWS on both devices (both p=0.003). Intra-device correlation was good (MAIA: 0.79 [0.76-0.81]; MP-3: 0.72 [0.68-0.76]) whereas a moderate mean inter-device correlation (0.6 [0.55-0.65]) could be detected. In conclusion, older subjects and the foveal region are associated with a worse pointwise repeatability.
    MeSH term(s) Humans ; Aged ; Visual Field Tests ; Retina ; Aging ; Fovea Centralis ; Health Status
    Language English
    Publishing date 2024-01-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-024-51539-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Inter and intradevice assessment of microperimetry testing in aging eyes

    Leonard M. Coulibaly / Hamza Mohamed / Philipp Fuchs / Ursula Schmidt-Erfurth / Gregor S. Reiter

    Scientific Reports, Vol 14, Iss 1, Pp 1-

    2024  Volume 9

    Abstract: Abstract Microperimetry (MP) is a psychometric examination combining retinal imaging and functional sensitivity testing with an increasing importance due to its potential use as clinical study outcome. We investigated the repeatability of pointwise ... ...

    Abstract Abstract Microperimetry (MP) is a psychometric examination combining retinal imaging and functional sensitivity testing with an increasing importance due to its potential use as clinical study outcome. We investigated the repeatability of pointwise retinal sensitivity (PWS) on the most advanced commercially available MP devices under their standard setting in a healthy aging population. Two successive MP examinations on both MP-3 (NIDEK CO., Ltd., Gamagori, Japan) and MAIA (CenterVue S.p.A. (iCare), Padova, Italy) were performed on healthy aging subjects in a randomized order. PWS repeatability was analysed for different macular regions and age groups using Bland-Altmann coefficients of repeatability (CoR). A total of 3600 stimuli from 20 healthy individuals with a mean age of 70 (11) years were included. Mean CoR in dB were ±4.61 for MAIA and ±4.55 for MP-3 examinations. A lower repeatability (p=0.005) was detected in the central millimetre on MAIA examinations. Higher subject age was associated with a lower repeatability of PWS on both devices (both p=0.003). Intra-device correlation was good (MAIA: 0.79 [0.76–0.81]; MP-3: 0.72 [0.68–0.76]) whereas a moderate mean inter-device correlation (0.6 [0.55–0.65]) could be detected. In conclusion, older subjects and the foveal region are associated with a worse pointwise repeatability.
    Keywords Medicine ; R ; Science ; Q
    Language English
    Publishing date 2024-01-01T00:00:00Z
    Publisher Nature Portfolio
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Anomaly guided segmentation: Introducing semantic context for lesion segmentation in retinal OCT using weak context supervision from anomaly detection.

    Seeböck, Philipp / Orlando, José Ignacio / Michl, Martin / Mai, Julia / Schmidt-Erfurth, Ursula / Bogunović, Hrvoje

    Medical image analysis

    2024  Volume 93, Page(s) 103104

    Abstract: Automated lesion detection in retinal optical coherence tomography (OCT) scans has shown promise for several clinical applications, including diagnosis, monitoring and guidance of treatment decisions. However, segmentation models still struggle to ... ...

    Abstract Automated lesion detection in retinal optical coherence tomography (OCT) scans has shown promise for several clinical applications, including diagnosis, monitoring and guidance of treatment decisions. However, segmentation models still struggle to achieve the desired results for some complex lesions or datasets that commonly occur in real-world, e.g. due to variability of lesion phenotypes, image quality or disease appearance. While several techniques have been proposed to improve them, one line of research that has not yet been investigated is the incorporation of additional semantic context through the application of anomaly detection models. In this study we experimentally show that incorporating weak anomaly labels to standard segmentation models consistently improves lesion segmentation results. This can be done relatively easy by detecting anomalies with a separate model and then adding these output masks as an extra class for training the segmentation model. This provides additional semantic context without requiring extra manual labels. We empirically validated this strategy using two in-house and two publicly available retinal OCT datasets for multiple lesion targets, demonstrating the potential of this generic anomaly guided segmentation approach to be used as an extra tool for improving lesion detection models.
    MeSH term(s) Humans ; Semantics ; Tomography, Optical Coherence ; Phenotype ; Retina/diagnostic imaging
    Language English
    Publishing date 2024-02-08
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1356436-5
    ISSN 1361-8423 ; 1361-8431 ; 1361-8415
    ISSN (online) 1361-8423 ; 1361-8431
    ISSN 1361-8415
    DOI 10.1016/j.media.2024.103104
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Clinical Practice Settings vs Clinical Trials: Is Artificial Intelligence the Answer?

    Jampol, Lee Merrill / Schmidt-Erfurth, Ursula M

    JAMA ophthalmology

    2020  Volume 138, Issue 1, Page(s) 5–6

    MeSH term(s) Artificial Intelligence ; Clinical Trials as Topic/statistics & numerical data ; Diagnosis, Computer-Assisted ; Humans ; Machine Learning ; Professional Practice/statistics & numerical data
    Language English
    Publishing date 2020-01-06
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2701705-9
    ISSN 2168-6173 ; 2168-6165
    ISSN (online) 2168-6173
    ISSN 2168-6165
    DOI 10.1001/jamaophthalmol.2019.4782
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Influence of drusenoid pigment epithelial detachments on the progression of age-related macular degeneration and visual acuity.

    Hollaus, Marlene / Iby, Johannes / Brugger, Jonas / Leingang, Oliver / Reiter, Gregor S / Schmidt-Erfurth, Ursula / Sacu, Stefan

    Canadian journal of ophthalmology. Journal canadien d'ophtalmologie

    2024  

    Abstract: Objective: To analyze the presence and morphologic characteristics of drusenoid pigment epithelial detachments (DPEDs) in spectral-domain optical coherence tomography (SD-OCT) in Caucasian patients with early and intermediate age-related macular ... ...

    Abstract Objective: To analyze the presence and morphologic characteristics of drusenoid pigment epithelial detachments (DPEDs) in spectral-domain optical coherence tomography (SD-OCT) in Caucasian patients with early and intermediate age-related macular degeneration (AMD) as well as the influence of these characteristics on best-corrected visual acuity (BCVA) and disease progression.
    Design: Prospective observational cohort study.
    Participants: 89 eyes of 56 patients with early and intermediate AMD.
    Methods: Examinations consisted of BCVA, SD-OCT, and indocyanine green angiography. Evaluated parameters included drusen type, mean drusen height and -volume, the presence of DPED, DPED maximum height, -maximum diameter, -volume, topographic location, the rate of DPED collapse, and the development of macular neovascularization (MNV) or geographic atrophy (GA).
    Results: DPED maximum height (162.34 µm ± 75.70 μm, p = 0.019) was significantly associated with the development of GA and MNV. For each additional 100 μm in maximum height, the odds of developing any late AMD (GA or MNV) increased by 2.23 (95% CI = 1.14-4.35). The presence of DPED (44 eyes, p = 0.01), its volume (0.20 mm ± 0.20 mm, p = 0.01), maximum diameter (1860.87 μm ± 880.74 μm, p = 0.03), maximum height (p < 0.001) and topographical location in the central millimetre (p = 0.004) of the Early Treatment Diabetic Retinopathy Study (ETDRS)-Grid were significantly correlated with BCVA at the last follow-up (0.15logMAR ± 0.20logMAR; Snellen equivalent approximately 20/28). DPEDs occurred significantly less in the outer quadrants than in the central millimetre and inner quadrants of ETDRS-Grid (all p values < 0.001).
    Conclusions: The height of drusen and DPEDs is a biomarker that is significantly associated with the development of late AMD and visual loss. DPEDs affect predominantly the center and inner quadrants of the ETDRS-Grid.
    Language English
    Publishing date 2024-01-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 80091-0
    ISSN 1715-3360 ; 0008-4182
    ISSN (online) 1715-3360
    ISSN 0008-4182
    DOI 10.1016/j.jcjo.2023.12.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Performance of retinal fluid monitoring in OCT imaging by automated deep learning versus human expert grading in neovascular AMD.

    Pawloff, Maximilian / Gerendas, Bianca S / Deak, Gabor / Bogunovic, Hrvoje / Gruber, Anastasiia / Schmidt-Erfurth, Ursula

    Eye (London, England)

    2023  Volume 37, Issue 18, Page(s) 3793–3800

    Abstract: Purpose: To evaluate the reliability of automated fluid detection in identifying retinal fluid activity in OCT scans of patients treated with anti-VEGF therapy for neovascular age-related macular degeneration by correlating human expert and automated ... ...

    Abstract Purpose: To evaluate the reliability of automated fluid detection in identifying retinal fluid activity in OCT scans of patients treated with anti-VEGF therapy for neovascular age-related macular degeneration by correlating human expert and automated measurements with central retinal subfield thickness (CSFT) and fluid volume values.
    Methods: We utilized an automated deep learning approach to quantify macular fluid in SD-OCT volumes (Cirrus, Spectralis, Topcon) from patients of HAWK and HARRIER Studies. Three-dimensional volumes for IRF and SRF were measured at baseline and under therapy in the central millimeter and compared to fluid gradings, CSFT and foveal centerpoint thickness (CPT) values measured by the Vienna Reading Center.
    Results: 41.906 SD-OCT volume scans were included into the analysis. Concordance between human expert grading and automated algorithm performance reached AUC values of 0.93/0.85 for IRF and 0.87 for SRF in HARRIER/HAWK in the central millimeter. IRF volumes showed a moderate correlation with CSFT at baseline (HAWK: r = 0.54; HARRIER: r = 0.62) and weaker correlation under therapy (HAWK: r = 0.44; HARRIER: r = 0.34). SRF and CSFT correlations were low at baseline (HAWK: r = 0.29; HARRIER: r = 0.22) and under therapy (HAWK: r = 0.38; HARRIER: r = 0.45). The residual standard error (IRF: 75.90 µm; SRF: 95.26 µm) and marginal residual standard deviations (IRF: 46.35 µm; SRF: 44.19 µm) of fluid volume were high compared to the range of CSFT values.
    Conclusion: Deep learning-based segmentation of retinal fluid performs reliably on OCT images. CSFT values are weak indicators for fluid activity in nAMD. Automated quantification of fluid types, highlight the potential of deep learning-based approaches to objectively monitor anti-VEGF therapy.
    MeSH term(s) Humans ; Angiogenesis Inhibitors/therapeutic use ; Tomography, Optical Coherence/methods ; Deep Learning ; Reproducibility of Results ; Vascular Endothelial Growth Factor A ; Visual Acuity ; Wet Macular Degeneration/diagnosis ; Wet Macular Degeneration/drug therapy ; Intravitreal Injections ; Subretinal Fluid/diagnostic imaging
    Chemical Substances Angiogenesis Inhibitors ; Vascular Endothelial Growth Factor A
    Language English
    Publishing date 2023-06-13
    Publishing country England
    Document type Journal Article
    ZDB-ID 91001-6
    ISSN 1476-5454 ; 0950-222X
    ISSN (online) 1476-5454
    ISSN 0950-222X
    DOI 10.1038/s41433-023-02615-8
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Progression Dynamics of Early versus Later Stage Atrophic Lesions in Nonneovascular Age-Related Macular Degeneration Using Quantitative OCT Biomarker Segmentation.

    Coulibaly, Leonard M / Reiter, Gregor S / Fuchs, Philipp / Lachinov, Dmitrii / Leingang, Oliver / Vogl, Wolf-Dieter / Bogunovic, Hrvoje / Schmidt-Erfurth, Ursula

    Ophthalmology. Retina

    2023  Volume 7, Issue 9, Page(s) 762–770

    Abstract: Purpose: To investigate the progression of geographic atrophy secondary to nonneovascular age-related macular degeneration in early and later stage lesions using artificial intelligence-based precision tools.: Design: Retrospective analysis of an ... ...

    Abstract Purpose: To investigate the progression of geographic atrophy secondary to nonneovascular age-related macular degeneration in early and later stage lesions using artificial intelligence-based precision tools.
    Design: Retrospective analysis of an observational cohort study.
    Subjects: Seventy-four eyes of 49 patients with ≥ 1 complete retinal pigment epithelial and outer retinal atrophy (cRORA) lesion secondary to age-related macular degeneration were included. Patients were divided between recently developed cRORA and lesions with advanced disease status.
    Methods: Patients were prospectively imaged by spectral-domain OCT volume scans. The study period encompassed 18 months with scheduled visits every 6 months. Growth rates of recent cRORA-converted lesions were compared with lesions in an advanced disease status using mixed effect models.
    Main outcome measures: The progression of retinal pigment epithelial loss (RPEL) was considered the primary end point. Secondary end points consisted of external limiting membrane disruption and ellipsoid zone loss. These pathognomonic imaging biomarkers were quantified using validated deep-learning algorithms. Further, the ellipsoid zone/RPEL ratio was analyzed in both study cohorts.
    Results: Mean (95% confidence interval [CI]) square root progression of recently converted lesions was 79.68 (95% CI, -77.14 to 236.49), 68.22 (95% CI, -101.21 to 237.65), and 84.825 (95% CI, -124.82 to 294.47) mm/half year for RPEL, external limiting membrane loss, and ellipsoid zone loss respectively. Mean square root progression of advanced lesions was 131.74 (95% CI, -22.57 to 286.05), 129.96 (95% CI, -36.67 to 296.59), and 116.84 (95% CI, -90.56 to 324.3) mm/half year for RPEL, external limiting membrane loss, and ellipsoid zone loss, respectively. RPEL (P = 0.038) and external limiting membrane disruption (P = 0.026) progression showed significant differences between the 2 study cohorts. Further recent converters had significantly (P < 0.001) higher ellipsoid zone/RPEL ratios at all time points compared with patients in an advanced disease status (1.71 95% CI, 1.12-2.28 vs. 1.14; 95% CI, 0.56-1.71).
    Conclusion: Early cRORA lesions have slower growth rates in comparison to atrophic lesions in advanced disease stages. Differences in growth dynamics may play a crucial role in understanding the pathophysiology of nonneovascular age-related macular degeneration and for the interpretation of clinical trials in geographic atrophy. Individual disease monitoring using artificial intelligence-based quantification paves the way toward optimized geographic atrophy management.
    Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    MeSH term(s) Humans ; Geographic Atrophy/complications ; Retrospective Studies ; Artificial Intelligence ; Tomography, Optical Coherence/methods ; Disease Progression ; Retinal Pigment Epithelium/pathology ; Macular Degeneration/complications ; Biomarkers ; Atrophy
    Chemical Substances Biomarkers
    Language English
    Publishing date 2023-05-09
    Publishing country United States
    Document type Observational Study ; Journal Article
    ISSN 2468-6530
    ISSN (online) 2468-6530
    DOI 10.1016/j.oret.2023.05.004
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Disorganization of Retinal Inner Layers and the Importance of Setting Boundaries.

    Schmidt-Erfurth, Ursula / Michl, Martin

    JAMA ophthalmology

    2018  Volume 137, Issue 1, Page(s) 46–47

    MeSH term(s) Endothelial Growth Factors ; Humans ; Macular Edema ; Retina ; Retinal Vein Occlusion ; Visual Acuity
    Chemical Substances Endothelial Growth Factors
    Language English
    Publishing date 2018-10-24
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2701705-9
    ISSN 2168-6173 ; 2168-6165
    ISSN (online) 2168-6173
    ISSN 2168-6165
    DOI 10.1001/jamaophthalmol.2018.4516
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Spatio-temporal alterations in retinal and choroidal layers in the progression of age-related macular degeneration (AMD) in optical coherence tomography.

    Vogl, Wolf-Dieter / Bogunović, Hrvoje / Waldstein, Sebastian M / Riedl, Sophie / Schmidt-Erfurth, Ursula

    Scientific reports

    2021  Volume 11, Issue 1, Page(s) 5743

    Abstract: Age-related macular degeneration (AMD) is the predominant cause of vision loss in the elderly with a major impact on ageing societies and healthcare systems. A major challenge in AMD management is the difficulty to determine the disease stage, the highly ...

    Abstract Age-related macular degeneration (AMD) is the predominant cause of vision loss in the elderly with a major impact on ageing societies and healthcare systems. A major challenge in AMD management is the difficulty to determine the disease stage, the highly variable progression speed and the risk of conversion to advanced AMD, where irreversible functional loss occurs. In this study we developed an optical coherence tomography (OCT) imaging based spatio-temporal reference frame to characterize the morphologic progression of intermediate age-related macular degeneration (AMD) and to identify distinctive patterns of conversion to the advanced stages macular neovascularization (MNV) and macular atrophy (MA). We included 10,040 OCT volumes of 518 eyes with intermediate AMD acquired according to a standardized protocol in monthly intervals over two years. Two independent masked retina specialists determined the time of conversion to MNV or MA. All scans were aligned to a common reference frame by intra-patient and inter-patient registration. Automated segmentations of retinal layers and the choroid were computed and en-face maps were transformed into the common reference frame. Population maps were constructed in the subgroups converting to MNV (n=135), MA (n=50) and in non-progressors (n=333). Topographically resolved maps of changes were computed and tested for statistical significant differences. The development over time was analysed by a joint model accounting for longitudinal and right-censoring aspect. Significantly enhanced thinning of the outer nuclear layer (ONL) and retinal pigment epithelium (RPE)-photoreceptorinner segment/outer segment (PR-IS/OS) layers within the central 3 mm and a faster thinning speed preceding conversion was documented for MA progressors. Converters to MNV presented an accelerated thinning of the choroid and appearance changes in the choroid prior to MNV onset. The large-scale automated image analysis allowed us to distinctly assess the progression of morphologic changes in intermediate AMD based on conventional OCT imaging. Distinct topographic and temporal patterns allow to prospectively determine eyes with risk of progression and thereby greatly improving early detection, prevention and development of novel therapeutic strategies.
    MeSH term(s) Aged ; Aged, 80 and over ; Choroid/diagnostic imaging ; Choroid/pathology ; Disease Progression ; Female ; Humans ; Macular Degeneration/diagnostic imaging ; Male ; Regression Analysis ; Retina/diagnostic imaging ; Retina/pathology ; Time Factors ; Tomography, Optical Coherence
    Language English
    Publishing date 2021-03-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-021-85110-y
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  10. Article ; Online: Impact of Intra- and Subretinal Fluid on Vision Based on Volume Quantification in the HARBOR Trial.

    Riedl, Sophie / Vogl, Wolf-Dieter / Waldstein, Sebastian M / Schmidt-Erfurth, Ursula / Bogunović, Hrvoje

    Ophthalmology. Retina

    2021  Volume 6, Issue 4, Page(s) 291–297

    Abstract: Purpose: To investigate the functional associations of intraretinal fluid (IRF) and subretinal fluid (SRF) volumes at baseline and after the loading dose as well as fluid change after the first injection with best-corrected visual acuity (BCVA) in ... ...

    Abstract Purpose: To investigate the functional associations of intraretinal fluid (IRF) and subretinal fluid (SRF) volumes at baseline and after the loading dose as well as fluid change after the first injection with best-corrected visual acuity (BCVA) in patients with neovascular age-related macular degeneration (nAMD) who received an anti-VEGF treatment over 24 months.
    Design: Post hoc analysis of a phase III, randomized, multicenter trial in which ranibizumab was administered monthly or in a pro re nata regimen (HARBOR).
    Participants: Study eyes of 1094 treatment-naïve patients with nAMD.
    Methods: IRF and SRF volumes were segmented automatically on monthly spectral domain OCT images. Fluid volumes and changes thereof were included as covariates into longitudinal mixed-effects models, which modeled BCVA trajectories.
    Main outcome measures: BCVA estimates corresponding to baseline, follow-up, and persistent IRF/SRF volumes after the loading dose; BCVA estimates of change in fluid volumes after the first injection; and marginal and conditional R
    Results: Analysis of 22 494 volumetric scans revealed that foveal IRF consistently shows a negative correlation with BCVA at baseline and subsequent visits (-3.23 and -4.32 letters/100 nL, respectively). After the first injection, BCVA increased by +2.13 letters/100 nL decrease in foveal IRF. Persistent IRF was associated with lower baseline BCVA and less improvement. Foveal SRF correlated with better BCVA at baseline and subsequent visits (+6.52 and +1.42 letters/100 nL, respectively). After the first injection, SRF decrease was associated with significant vision gain (+5.88 letters/100 nL). Foveal fluid correlated more with BCVA than parafoveal IRF/SRF.
    Conclusions: Although IRF consistently correlates with decreased function and recovery throughout therapy, SRF is associated with a more pronounced functional improvement. Moreover, SRF resolution provides increased benefit. Fluid-function correlation represents an essential base for the development of personalized treatment regimens, optimizing functional outcomes, and reducing treatment burden.
    MeSH term(s) Child, Preschool ; Humans ; Intravitreal Injections ; Subretinal Fluid/diagnostic imaging ; Tomography, Optical Coherence ; Vascular Endothelial Growth Factor A ; Visual Acuity
    Chemical Substances Vascular Endothelial Growth Factor A
    Language English
    Publishing date 2021-12-16
    Publishing country United States
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ISSN 2468-6530
    ISSN (online) 2468-6530
    DOI 10.1016/j.oret.2021.12.007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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