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Published in: International Ophthalmology 1/2024

01-12-2024 | Rheumatoid Arthritis | Original Paper

Choroidal, retinal, and optic nerve changes in rheumatoid arthritis and primary sjogren’s syndrome patients: comparıson with each other and healthy subjects

Authors: Pelin Kiyat, Omer Karti, Önay Gercik, Tuncer Şak

Published in: International Ophthalmology | Issue 1/2024

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Abstract

Purpose

The present study aims to evaluate the optic nerve, macula, and choroidal changes in both rheumatoid arthritis (RA) and primary Sjögren’s syndrome (SjS) patients, and to compare these findings with age-matched healthy volunteers.

Methods

This study included 46 RA patients, 33 primary SjS patients, and 37 age-matched healthy volunteers. All of the patients underwent a thorough ophthalmological examination, during which measurements of the retinal nerve fiber layer (RNFL), ganglion cell layer(GCL), and subfoveal choroidal thickness (CT) were taken using OCT (optical coherence tomography). The measurements taken from the right eye of each patient were used to compare among the groups.

Results

RNFL thickness in superior quadrant was found to be statistically significantly thinner in the eyes with RA when compared to the control group (p = 0.022). In the nasal quadrant, the RNFL thickness was significantly thinner in patients with primary SjS compared to healthy individuals (p = 0.036). Also, the temporal quadrant RNFL was significantly thinner in RA patients than in the primary SjS patients (p = 0.033). GCL thickness was observed to be thinner in all quadrants of both RA and primary SjS groups compared to the control group. However, the difference was not found to be statistically significant. Subfoveal CT was observed to be thicker in RA and SjS groups compared to the control group, but this difference was also not statistically significant.

Conclusion

Systemic autoimmune diseases like RA and primary SjS can lead to a decrease in RNLF and GCL thickness, which can impair visual acuity even in the absence of ocular symptoms. Therefore, monitoring changes in the optic nerve, retina, and choroid layer are crucial in these patients.
Literature
2.
go back to reference Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A (2021) Rheumatoid arthritis: extra-articular manifestations and comorbidities. Autoimmun Rev 20(4):102776PubMedCrossRef Figus FA, Piga M, Azzolin I, McConnell R, Iagnocco A (2021) Rheumatoid arthritis: extra-articular manifestations and comorbidities. Autoimmun Rev 20(4):102776PubMedCrossRef
3.
go back to reference Silman AJ, Pearson JE (2002) Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 4:265–272CrossRef Silman AJ, Pearson JE (2002) Epidemiology and genetics of rheumatoid arthritis. Arthritis Res 4:265–272CrossRef
4.
go back to reference Dammacco R, Guerriero S, Alessio G, Dammacco F (2022) Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review. Int Ophthalmol 42(2):689–711PubMedCrossRef Dammacco R, Guerriero S, Alessio G, Dammacco F (2022) Natural and iatrogenic ocular manifestations of rheumatoid arthritis: a systematic review. Int Ophthalmol 42(2):689–711PubMedCrossRef
5.
go back to reference Zlatanovic G, Veselinovic D, Cekic S, Zivković M, Dorđević-Jocić J, Zlatanović M (2010) Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci 10:323–327PubMedPubMedCentralCrossRef Zlatanovic G, Veselinovic D, Cekic S, Zivković M, Dorđević-Jocić J, Zlatanović M (2010) Ocular manifestation of rheumatoid arthritis-different forms and frequency. Bosn J Basic Med Sci 10:323–327PubMedPubMedCentralCrossRef
6.
go back to reference Turk MA, Hayworth JL, Nevskaya T, Pope JE (2021) Ocular manifestations in rheumatoid arthritis, connective tissue disease, and vasculitis: a systematic review and metaanalysis. J Rheumatol 48(1):25–34PubMedCrossRef Turk MA, Hayworth JL, Nevskaya T, Pope JE (2021) Ocular manifestations in rheumatoid arthritis, connective tissue disease, and vasculitis: a systematic review and metaanalysis. J Rheumatol 48(1):25–34PubMedCrossRef
7.
go back to reference Negrini S, Emmi G, Greco M, Borro M, Sardanelli F, Murdaca G, Indiveri F, Puppo F (2022) Sjögren’s syndrome: a systemic autoimmune disease. Clin Exp Med 22(1):9–25PubMedCrossRef Negrini S, Emmi G, Greco M, Borro M, Sardanelli F, Murdaca G, Indiveri F, Puppo F (2022) Sjögren’s syndrome: a systemic autoimmune disease. Clin Exp Med 22(1):9–25PubMedCrossRef
8.
go back to reference Tauqeer Z, Bunya VY, Macchi I, Massaro-Giordano M (2021) Ocular pathophysiology of Sjögren’s syndrome. Ocul Immunol Inflamm 29(4):796–802PubMedCrossRef Tauqeer Z, Bunya VY, Macchi I, Massaro-Giordano M (2021) Ocular pathophysiology of Sjögren’s syndrome. Ocul Immunol Inflamm 29(4):796–802PubMedCrossRef
9.
go back to reference Liew M, Shiao H, Zhang M, Kim E, Akpek EK (2012) Prevalence and predictors of Sjögren’s syndrome in a prospective cohort of patients with aqueous-deficient dry eye. Br J Ophthalmol 96(12):1498–1503PubMedCrossRef Liew M, Shiao H, Zhang M, Kim E, Akpek EK (2012) Prevalence and predictors of Sjögren’s syndrome in a prospective cohort of patients with aqueous-deficient dry eye. Br J Ophthalmol 96(12):1498–1503PubMedCrossRef
10.
go back to reference Ogawa Y, Takeuchi T, Tsubota K (2021) Autoimmune Epithelitis and chronic inflammation in Sjögren’s syndrome-related dry eye disease. Int J Mol Sci 22(21):11820PubMedPubMedCentralCrossRef Ogawa Y, Takeuchi T, Tsubota K (2021) Autoimmune Epithelitis and chronic inflammation in Sjögren’s syndrome-related dry eye disease. Int J Mol Sci 22(21):11820PubMedPubMedCentralCrossRef
11.
go back to reference Akpek EK, Mathews P, Hahn S, Hessen M, Kim J, Grader-Beck T, Birnbaum J, Baer AN et al (2015) Ocular and systemic morbidity in a longitudinal cohort of Sjögren’s syndrome. Ophthalmology 122:56–61PubMedCrossRef Akpek EK, Mathews P, Hahn S, Hessen M, Kim J, Grader-Beck T, Birnbaum J, Baer AN et al (2015) Ocular and systemic morbidity in a longitudinal cohort of Sjögren’s syndrome. Ophthalmology 122:56–61PubMedCrossRef
12.
13.
go back to reference Hajiabbasi A, Shenavar Masooleh I, Alizadeh Y, Banikarimi AS, Ghavidel PP (2016) Secondary sjogren’s syndrome in 83 patients with rheumatoid arthritis. Acta Med Iran 54(7):448–453PubMed Hajiabbasi A, Shenavar Masooleh I, Alizadeh Y, Banikarimi AS, Ghavidel PP (2016) Secondary sjogren’s syndrome in 83 patients with rheumatoid arthritis. Acta Med Iran 54(7):448–453PubMed
14.
go back to reference Brown LE, Frits ML, Iannaccone CK, Weinblatt ME, Shadick NA, Liao KP (2015) Clinical characteristics of RA patients with secondary SS and association with joint damage. Rheumatology (Oxford) 54(5):816–820PubMedCrossRef Brown LE, Frits ML, Iannaccone CK, Weinblatt ME, Shadick NA, Liao KP (2015) Clinical characteristics of RA patients with secondary SS and association with joint damage. Rheumatology (Oxford) 54(5):816–820PubMedCrossRef
15.
go back to reference He J, Ding Y, Feng M, Guo J, Sun X, Zhao J et al (2013) Characteristics of Sjögren’s syndrome in rheumatoid arthritis. Rheumatology 52(6):1084–1089PubMedCrossRef He J, Ding Y, Feng M, Guo J, Sun X, Zhao J et al (2013) Characteristics of Sjögren’s syndrome in rheumatoid arthritis. Rheumatology 52(6):1084–1089PubMedCrossRef
16.
go back to reference Kim H, Cho SK, Kim HW, Han J, Kim Y, Hwang KG, Sung YK (2020) The prevalence of Sjögren’s syndrome in rheumatoid arthritis patients and their clinical features. J Korean Med Sci 35(45):e369PubMedPubMedCentralCrossRef Kim H, Cho SK, Kim HW, Han J, Kim Y, Hwang KG, Sung YK (2020) The prevalence of Sjögren’s syndrome in rheumatoid arthritis patients and their clinical features. J Korean Med Sci 35(45):e369PubMedPubMedCentralCrossRef
17.
go back to reference Wang Y, Xie X, Zhang C, Su M, Gao S, Wang J, Lu C, Lin Q, Lin J, Matucci-Cerinic M, Furst DE, Zhang G (2022) Rheumatoid artritis. Systemic lupus erythematosus and primary Sjögren’s syndrome shared megakaryocyte expansion in peripheral blood. Ann Rheum Dis 81(3):379–385PubMedCrossRef Wang Y, Xie X, Zhang C, Su M, Gao S, Wang J, Lu C, Lin Q, Lin J, Matucci-Cerinic M, Furst DE, Zhang G (2022) Rheumatoid artritis. Systemic lupus erythematosus and primary Sjögren’s syndrome shared megakaryocyte expansion in peripheral blood. Ann Rheum Dis 81(3):379–385PubMedCrossRef
18.
go back to reference Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S (2019) Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: a review. Surv Ophthalmol 64:757–769PubMedCrossRef Steiner M, Esteban-Ortega MDM, Muñoz-Fernández S (2019) Choroidal and retinal thickness in systemic autoimmune and inflammatory diseases: a review. Surv Ophthalmol 64:757–769PubMedCrossRef
19.
go back to reference Minakaran N, de Carvalho ER, Petzold A, Wong SH (2021) Optical coherence tomography (OCT) in neuro-ophthalmology. Eye (Lond) 35(1):17–32PubMedCrossRef Minakaran N, de Carvalho ER, Petzold A, Wong SH (2021) Optical coherence tomography (OCT) in neuro-ophthalmology. Eye (Lond) 35(1):17–32PubMedCrossRef
20.
go back to reference Renard JP, Fénolland JR, Giraud JM (2019) Glaucoma progression analysis by spectral domain optical coherence tomography (SD-OCT). J Fr Ophtalmol 42(5):499–516PubMedCrossRef Renard JP, Fénolland JR, Giraud JM (2019) Glaucoma progression analysis by spectral domain optical coherence tomography (SD-OCT). J Fr Ophtalmol 42(5):499–516PubMedCrossRef
21.
go back to reference Karimi Y, Yang H, Liu J, Park BH, Chamanzar M (2022) Enhanced spectral-domain optical coherence tomography (SD-OCT) using in situ ultrasonic virtual tunable optical waveguides. Opt Express 30(19):34256–34275ADSPubMedCrossRef Karimi Y, Yang H, Liu J, Park BH, Chamanzar M (2022) Enhanced spectral-domain optical coherence tomography (SD-OCT) using in situ ultrasonic virtual tunable optical waveguides. Opt Express 30(19):34256–34275ADSPubMedCrossRef
22.
go back to reference Aletaha D, Neogi T, Silman A et al (2010) Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581PubMedCrossRef Aletaha D, Neogi T, Silman A et al (2010) Rheumatoid arthritis classification criteria: an American college of rheumatology/European league against rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581PubMedCrossRef
24.
go back to reference Yang JM, Heo H, Park SW (2014) Relationship between retinal morphological findings and autoantibody profile in primary Sjögren’s syndrome. Jpn J Ophthalmol 58:359–368PubMedCrossRef Yang JM, Heo H, Park SW (2014) Relationship between retinal morphological findings and autoantibody profile in primary Sjögren’s syndrome. Jpn J Ophthalmol 58:359–368PubMedCrossRef
25.
go back to reference Yang JM, Sung MS, Ji YS, Heo H, Park SW (2016) Analysis of clinical factors associated with retinal morphological changes in patients with primary sjögren’s syndrome. PLoS ONE 11(6):e0157995PubMedPubMedCentralCrossRef Yang JM, Sung MS, Ji YS, Heo H, Park SW (2016) Analysis of clinical factors associated with retinal morphological changes in patients with primary sjögren’s syndrome. PLoS ONE 11(6):e0157995PubMedPubMedCentralCrossRef
26.
go back to reference Rosen A, Casciola-Rosen L, Ahearn J (1995) Novel packages of viral and self-antigens are generated during apoptosis. J Exp Med 181:1557–1561PubMedCrossRef Rosen A, Casciola-Rosen L, Ahearn J (1995) Novel packages of viral and self-antigens are generated during apoptosis. J Exp Med 181:1557–1561PubMedCrossRef
27.
go back to reference Lucas M, Stuart LM, Savill J, Lacy-Hulbert A (2003) Apoptotic cells and innate immune stimuli combine to regulate macrophage cytokine secretion. J Immunol 171:2610–2615PubMedCrossRef Lucas M, Stuart LM, Savill J, Lacy-Hulbert A (2003) Apoptotic cells and innate immune stimuli combine to regulate macrophage cytokine secretion. J Immunol 171:2610–2615PubMedCrossRef
28.
go back to reference Gaipl US, Munoz LE, Grossmayer G, Lauber K, Franz S, Sarter K, Voll RE, Winkler T, Kuhn A, Kalden J, Kern P, Herrmann M (2007) Clearance deficiency and systemic lupus erythematosus (SLE). J Autoimmun 28:114–121PubMedCrossRef Gaipl US, Munoz LE, Grossmayer G, Lauber K, Franz S, Sarter K, Voll RE, Winkler T, Kuhn A, Kalden J, Kern P, Herrmann M (2007) Clearance deficiency and systemic lupus erythematosus (SLE). J Autoimmun 28:114–121PubMedCrossRef
29.
go back to reference Cartwright MJ, Grajewski AL, Friedberg ML, Anderson DR, Richards DW (1992) Immune-related disease and normal-tension glaucoma. A case-control study Arch Ophthalmol 110:500–502PubMedCrossRef Cartwright MJ, Grajewski AL, Friedberg ML, Anderson DR, Richards DW (1992) Immune-related disease and normal-tension glaucoma. A case-control study Arch Ophthalmol 110:500–502PubMedCrossRef
30.
go back to reference Laspas P, Gramlich OW, Muller HD, Cuny CS, Gottschling PF, Pfeiffer N, Dick HB, Joachim SC, Grus FH (2011) Autoreactive antibodies and loss of retinal ganglion cells in rats induced by immunization with ocular antigens. Invest Ophthalmol Vis Sci 52:8835–8848PubMedCrossRef Laspas P, Gramlich OW, Muller HD, Cuny CS, Gottschling PF, Pfeiffer N, Dick HB, Joachim SC, Grus FH (2011) Autoreactive antibodies and loss of retinal ganglion cells in rats induced by immunization with ocular antigens. Invest Ophthalmol Vis Sci 52:8835–8848PubMedCrossRef
31.
go back to reference Wax MB, Tezel G, Yang J, Peng G, Patil RV, Agarwal N, Sappington RM, Calkins DJ (2008) Induced autoimmunity to heat shock proteins elicits glaucomatous loss of retinal ganglion cell neurons via activated T-cell derived fas-ligand. J Neurosci 28:12085–12096PubMedPubMedCentralCrossRef Wax MB, Tezel G, Yang J, Peng G, Patil RV, Agarwal N, Sappington RM, Calkins DJ (2008) Induced autoimmunity to heat shock proteins elicits glaucomatous loss of retinal ganglion cell neurons via activated T-cell derived fas-ligand. J Neurosci 28:12085–12096PubMedPubMedCentralCrossRef
32.
go back to reference Gramlich OW, Beck S, von Thun Und Hohenstein-Blaul N, Boehm N, Ziegler A, Vetter JM, Pfeiffer N, Grus FH (2013) Enhanced insight into the autoimmune component of glaucoma: IgG autoantibody accumulation and pro-inflammatory conditions in human glaucomatous retina. PLoS ONE 8:e57557ADSPubMedPubMedCentralCrossRef Gramlich OW, Beck S, von Thun Und Hohenstein-Blaul N, Boehm N, Ziegler A, Vetter JM, Pfeiffer N, Grus FH (2013) Enhanced insight into the autoimmune component of glaucoma: IgG autoantibody accumulation and pro-inflammatory conditions in human glaucomatous retina. PLoS ONE 8:e57557ADSPubMedPubMedCentralCrossRef
33.
go back to reference Martel C, Jauberteau MO, Vidal E, Fauchais AL (2014) Pathophysiology of primary Sjögren’s syndrome. Rev Med Interne 35(8):524–530PubMedCrossRef Martel C, Jauberteau MO, Vidal E, Fauchais AL (2014) Pathophysiology of primary Sjögren’s syndrome. Rev Med Interne 35(8):524–530PubMedCrossRef
34.
go back to reference Kroese FG, Abdulahad WH, Haacke E, Bos NA, Vissink A, Bootsma H (2014) B-cell hyperactivity in primary Sjögren’s syndrome. Expert Rev Clin Immunol 10(4):483–499PubMedCrossRef Kroese FG, Abdulahad WH, Haacke E, Bos NA, Vissink A, Bootsma H (2014) B-cell hyperactivity in primary Sjögren’s syndrome. Expert Rev Clin Immunol 10(4):483–499PubMedCrossRef
35.
go back to reference Wang H, Wang K, Zhong X, Qiu W, Dai Y, Wu A, Hu X (2012) Cerebrospinal fluid BAFF and APRIL levels in neuromyelitis optica and multiple sclerosis patients during relapse. J Clin Immunol 32(5):1007–1011PubMedCrossRef Wang H, Wang K, Zhong X, Qiu W, Dai Y, Wu A, Hu X (2012) Cerebrospinal fluid BAFF and APRIL levels in neuromyelitis optica and multiple sclerosis patients during relapse. J Clin Immunol 32(5):1007–1011PubMedCrossRef
36.
go back to reference Nakashima I, Takahashi T, Cree BA, Kim HJ, Suzuki C, Genain CP, Vincent T, Fujihara K, Itoyama Y, Bar-Or A (2011) Transient increases in anti-aquaporin-4 antibody titers following rituximab treatment in neuromyelitis optica, in association with elevated serum BAFF levels. J Clin Neurosci 18(7):997–998PubMedCrossRef Nakashima I, Takahashi T, Cree BA, Kim HJ, Suzuki C, Genain CP, Vincent T, Fujihara K, Itoyama Y, Bar-Or A (2011) Transient increases in anti-aquaporin-4 antibody titers following rituximab treatment in neuromyelitis optica, in association with elevated serum BAFF levels. J Clin Neurosci 18(7):997–998PubMedCrossRef
37.
38.
go back to reference Kal A, Duman E, Sezenöz AS, Ulusoy MO, Kal Ö (2018) Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis. Int Ophthalmol 38(5):1825–1831PubMedCrossRef Kal A, Duman E, Sezenöz AS, Ulusoy MO, Kal Ö (2018) Evaluation of retrobulbar blood flow and choroidal thickness in patients with rheumatoid arthritis. Int Ophthalmol 38(5):1825–1831PubMedCrossRef
39.
go back to reference Androudi S, Dastiridou A, Symeonidis C, Kump L, Praidou A, Brazitikos P (2013) Retinal vasculitis in rheumatic diseases: an unseen burden. Clin Rheumatol 32:7–13PubMedCrossRef Androudi S, Dastiridou A, Symeonidis C, Kump L, Praidou A, Brazitikos P (2013) Retinal vasculitis in rheumatic diseases: an unseen burden. Clin Rheumatol 32:7–13PubMedCrossRef
40.
go back to reference Karti O, Ayhan Z, Zengin MO, Kaya M, Kusbeci T (2018) Choroidal thickness changes in rheumatoid arthritis and the effects of short-term hydroxychloroquine treatment. Ocul Immunol Inflamm 26(5):770–775PubMedCrossRef Karti O, Ayhan Z, Zengin MO, Kaya M, Kusbeci T (2018) Choroidal thickness changes in rheumatoid arthritis and the effects of short-term hydroxychloroquine treatment. Ocul Immunol Inflamm 26(5):770–775PubMedCrossRef
41.
go back to reference Hysa E, Cutolo CA, Gotelli E, Paolino S, Cimmino MA, Pacini G, Pizzorni C, Sulli A, Smith V, Cutolo M (2021) Ocular microvascular damage in autoimmune rheumatic diseases: the pathophysiological role of the immune system. Autoimmun Rev 20(5):102796PubMedCrossRef Hysa E, Cutolo CA, Gotelli E, Paolino S, Cimmino MA, Pacini G, Pizzorni C, Sulli A, Smith V, Cutolo M (2021) Ocular microvascular damage in autoimmune rheumatic diseases: the pathophysiological role of the immune system. Autoimmun Rev 20(5):102796PubMedCrossRef
42.
go back to reference Duru N, Altinkaynak H, Erten S, Can ME, Duru Z, Ugurlu FG (2016) Thinning of choroidal thickness in patients with rheumatoid arthritis unrelated to disease activity. Ocul Immunol Inflamm 24:246–253PubMedCrossRef Duru N, Altinkaynak H, Erten S, Can ME, Duru Z, Ugurlu FG (2016) Thinning of choroidal thickness in patients with rheumatoid arthritis unrelated to disease activity. Ocul Immunol Inflamm 24:246–253PubMedCrossRef
43.
go back to reference Tetikoglu M, Temizturk F, Sagdik HM, Aktas S, Ozcura F, Ozkan Y, Temizturk S (2015) Evaluation of the choroid, fovea, and retinal nerve fiber layer in patients with rheumatoid arthritis. Ocul Immunol Inflamm 30:1–5 Tetikoglu M, Temizturk F, Sagdik HM, Aktas S, Ozcura F, Ozkan Y, Temizturk S (2015) Evaluation of the choroid, fovea, and retinal nerve fiber layer in patients with rheumatoid arthritis. Ocul Immunol Inflamm 30:1–5
44.
go back to reference Koutkia P, Mylonakis E, Rounds S, Erickson A (2001) Leucocytoclastic vasculitis: an update for the clinician. Scand J Rheumatol 30:315–322PubMedCrossRef Koutkia P, Mylonakis E, Rounds S, Erickson A (2001) Leucocytoclastic vasculitis: an update for the clinician. Scand J Rheumatol 30:315–322PubMedCrossRef
45.
go back to reference Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P (2021) Ophthalmologic Manifestations of Primary Sjögren’s Syndrome. Genes 12(3):365PubMedPubMedCentralCrossRef Roszkowska AM, Oliverio GW, Aragona E, Inferrera L, Severo AA, Alessandrello F, Spinella R, Postorino EI, Aragona P (2021) Ophthalmologic Manifestations of Primary Sjögren’s Syndrome. Genes 12(3):365PubMedPubMedCentralCrossRef
46.
go back to reference Liu R, Wang Y, Li Q, Xia Q, Xu T, Han T, Cai S, Luo S, Wu R, Shao Y (2022) Optical coherence tomography angiography biomarkers of retinal thickness and microvascular alterations in sjogren’s syndrome. Front Neurol 8(13):853930CrossRef Liu R, Wang Y, Li Q, Xia Q, Xu T, Han T, Cai S, Luo S, Wu R, Shao Y (2022) Optical coherence tomography angiography biomarkers of retinal thickness and microvascular alterations in sjogren’s syndrome. Front Neurol 8(13):853930CrossRef
Metadata
Title
Choroidal, retinal, and optic nerve changes in rheumatoid arthritis and primary sjogren’s syndrome patients: comparıson with each other and healthy subjects
Authors
Pelin Kiyat
Omer Karti
Önay Gercik
Tuncer Şak
Publication date
01-12-2024
Publisher
Springer Netherlands
Published in
International Ophthalmology / Issue 1/2024
Print ISSN: 0165-5701
Electronic ISSN: 1573-2630
DOI
https://doi.org/10.1007/s10792-024-02970-9

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