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To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India

Received: 1 June 2021     Accepted: 15 June 2021     Published: 22 June 2021
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Abstract

Aim: To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. Materials and methods: This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. Results: Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. Conclusion: Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 2)
DOI 10.11648/j.ijovs.20210602.21
Page(s) 128-143
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Albendazole, Cysticercosis, Corticosteroids, ELISA, Magnetic Resonance Imaging, USG Bscan, Parsplana Vitrectomy

References
[1] Duke-Elder S, Perkins ES. Diseases of the uveal tract. In: Duke-Elder S [Ed]. System of Ophthalmology, Vol. 9. St. Louis: CV Mosby; 1966. p. 478.
[2] Santos R, Dalma A, Ortiz E, et al. Management of subretinal and vitreous cysticercosis: role of photocoagulation and surgery. Ophthalmology. 1979; 86: 1501-7.
[3] Franken S. Intraocular cysticercus. Ophthalmologica. 1975; 171: 7-10.
[4] King CH. Cestodes [Tapeworms]. In: Mandell G, Bennett JE, Dolin R [Eds]. Principles and Practice of Infectious Diseases, Vol. 2. New York: Churchill-Livingstone; 1995. p. 2544.
[5] Sorvillo F, Wilkins P, Shafir S, Eberhard M. Public health implications of cysticercosis acquired in the United States. Emerg Infect Dis. 2011 Jan; 17 (1): 1-6.
[6] Rajshekhar V, Joshi DD, Doanh NQ, van De N, Xiaonong Z. Taenia solium taeniosis/cysticercosis in Asia: epidemiology, impact and issues. Acta Trop. 2003 Jun; 87 (1): 53-60.
[7] Malik SR, Gupta AK, Choudhry S. Ocular cysticercosis. Am J Ophthalmol. 1968 Dec; 66 (6): 1168-71.
[8] Bartholomew RS. Subretinal cysticercosis. Am J Ophthalmol 1975; 79: 670–3.
[9] Madigubba S, Vishwanath K, Reddy GBKJ, et al. Changing trends in ocular cysticercosis over two decades: an analysis of 118 surgically excised cysts. Indian J Med Microbiol. 2007; 25 (3): 214–219.
[10] Rath S, Honavar SG, Naik M, et al. Orbital cysticercosis: clinical manifestations, diagnosis, management and outcome. Ophthalmology. 2010; 117 (3): 600–605.
[11] Wender JD, Rathinam SR, Shaw RE, Cunningham ET Jr. Intraocular cysticercosis: case series and comprehensive review of the literature. Ocul Immunol Inflamm. 2011 Aug; 19 (4): 240-5.
[12] Kruger-Leite E, Jalkh AE, Quiroz H, et al. Intraocular cysticercosis. Am J Ophthalmol. 1985; 99: 252-7.
[13] Topilow HW, Yimoyines DJ, Freeman HM, et al. Bilateral multifocal intraocular cysticercosis. Ophthalmology. 1981; 88: 1166.
[14] Wittig EO. Ocular cysticercosis: an epidemiological study. Arq Neuropsiquiatr. 2001; 59: 696-701.
[15] David S, Mathai E. Ocular cysticercosis-a review of 25 cases. J Assoc Physicians India. 2000; 48: 704-7.
[16] Chowdhary A, Bansal R, Singh K, et al. Ocular cysticercosis-a profile. Trop Doct. 2003; 33: 185-8.
[17] Mahajan R C 1982 Geographical distribution human cyticercosis; in Cysticercosis present state of knowledge and perspectives [eds]. A Flisser, K Willms, C Laclette, C Larrolde, C Ridaura and F Beltran [New York: Academic Press] pp 39-46.
[18] Sekhar GC, Honavar SG. Myocysticercosis: experience with imaging and therapy. Ophthalmology. 1999; 106: 2336-40.
[19] Puri P, Grover AK. Medical management of orbital myocysticercosis: a pilot study. Eye [Lond]. 1998; 12: 795-9.
[20] Raoot A. Lacrimal sac cysticercosis: a rare site for manifestation. Case Rep Ophthalmol Med. 2014: 961815.
[21] Sundaram PM, Jayakumar N, Noronha V. Extraocular muscle cysticercosis-a clinical challenge to the ophthalmologists. Orbit. 2004; 23 (4): 255–262.
[22] Verma R, Jaiswal A. Multiple brain parenchymal neurocysticercosis with extraocular muscle cysticercosis affecting levator palpebral superioris and superior rectus complex: an unusual association. BMJ Case Rep. 2013; 2013.
[23] Murthy H, Kumar A, Verma L. Orbital cysticercosis – an ultrasonic diagnosis. Acta Ophthalmologica 1990; 68: 612-4.
[24] Gulani AC. Sonographic diagnosis of orbital cysticercus cyst: 'hanging drop sign'. J Diagn Med Sonogr. 1998; 14: 122-4.
[25] Nijjar IBS, Singh JP, Arora V, et al. MRI in intraocular cysticercosis—a case report. Ind J Radiol Imaging. 2005; 15 (3): 309–10.
[26] Rahalkar MD, Shetty DD, Kelkar AB, et al. The many faces of cysticercosis. Clin Radiol. 2000; 55: 668-74.
[27] Rangdal SS, Prabakar S, Dhatt SS, et al. Isolated muscular cysticercosis: a rare pseudotumor and diagnostic challenge, can it be treated nonoperatively? A report of two cases and review of literature. J Postgrad Med Educ Res. 2012; 46: 43–8. 60.
[28] Topilow HW. Cysticercosis. In: Fraunfelder FT, Roy FH [Eds]. Current Ocular Therapy, 4th edition. Philadelphia: WB Saunders; 1995. p. 121.
[29] Ursekar MA, Dastur DK, Manghani DK, et al. Isolated cysticercal. infestation of extraocular muscles: CT and MR findings. AJNR Am J Neuroradiol. 1998; 19: 109-13.
[30] Escobar A, Aruffo C, Cruz-Sánchez F, Cervos-Navarro J. Neuropathologic findings in neurocysticercosis. Arch Neurobiol (Madr). 1985; 48 (3): 151–6.
[31] Nash TE, Garcia HH. Diagnosis and treatment of neurocysticercosis. Nat Rev Neurol. 2011; 7: 584–94.
[32] Garcia HH, O'Neal SE, Noh J, Handali S; Cysticercosis Working Group in Peru. Laboratory Diagnosis of Neurocysticercosis (Taenia solium). J Clin Microbiol. 2018 Aug 27; 56 (9): e00424-18.
[33] Rodriguez S, Wilkins P, Dorny P. Immunological and molecular diagnosis of cysticercosis. Pathog Glob Health. 2012 Sep; 106 (5): 286–298.
[34] Proaño-Narvaez JV, Meza-Lucas A, Mata-Ruiz O, García-Jerónimo RC, Correa D. Laboratory diagnosis of human neurocysticercosis: double-blind comparison of enzyme-linked immunosorbent assay and electroimmunotransfer blot assay. J Clin Microbiol. 2002 Jun; 40 (6): 2115-8.
[35] Biswas R, Parija SC, Narayan SK. Dot-ELISA for the diagnosis of neurocysticercosis. Rev Inst Med Trop Sao Paulo. 2004 Sep-Oct; 46 (5): 249-52.
[36] Sekhar GC, Lemke BN. Orbital cysticercosis. Ophthalmology 1997; 104: 1599-1604.
[37] Menon V, Kumar G, Prakash P. Cysticercosis of extraocular muscle. J Pediatr Ophthalmol Strabismus 1994; 31: 126-129.
[38] Sihota R, Honavar SG. Oral albendazole in the management of extraocular muscle cysticercosis. Br J Ophthalmol 1994; 78: 621-623.
[39] Rosenthal PJ. Clinical Pharmacology of the Antihelminthic Drugs. Katzung. Basic and clinical pharmacology, Edition-12. McGraw Hill Lange; 2012. p-937-47.
[40] Jung H, Hurtado M, Medina MT, Sanchez M, Sotelo J. Dexamethasone increases plasma levels of albendazole. J Neurol 1990; 237: 279-280.
[41] Takayanagui OM, Jardim E. Therapy for neurocysticercoosis. Camparison between albendazole and praziquantel. Arch Neurol. 1992: 49: 290-4.
[42] Raina UK, Taneja S, Lamba PA, Bansal RL. Spontaneous extrusion of extraocular cysticercus cysts. Am J Ophthalmol 1996; 121: 438-441.
[43] Cardenas F, Quiroz H, Plancarte A, et al. Taenia solium ocular cysticercosis: findings in 30 cases. Ann Ophthalmol 1992; 24: 25–8.
[44] Madan VS, Dhamija RM, Gill HS, Boparai MS, Souza PD, Sanchete PC, Bhardwaj JR. Optic nerve cysticercosis: a case report. J Neurol Neurosurg Psychiatry. 1991 May; 54 (5): 470-1.
[45] Lombardo J. Subretinal cysticercosis. Optom Vis Sci. 2001 Apr; 78 (4): 188-94.
[46] Gurha N, Sood A, Dhar J, Gupta S. Optic nerve cysticercosis in the optic canal. Acta Ophthalmol Scand. 1999 Feb; 77 (1): 107-9.
[47] Kumar V, Surve A, Kumar P, Sharma A, Azad S. Submacular cysticercosis. Eur J Ophthalmol. 2020 Sep; 30 (5): NP58-NP61.
[48] Sharma T, Sinha S, Shah N, et al. Intraocular Cysticercosis: Clinical Characteristics and Visual Outcome after Vitreoretinal Surgery. Ophthalmology 2003; 110 (5): 996-1004.
[49] Hutton WL, Vaiser A, Snyder WB. Pars plana vitrectomy for removal of intravitreous cysticercus. Am J Ophthalmol 1976; 81: 571–3.
[50] Segal P, Mrzyglod S, Smolarz-Dudarewicz J. Subretinal cysticercosis in the macular region. Am J Ophthalmol 1964; 57: 655–64.
[51] Zinn KM, Guillory SL, Friedman AH. Removal of intravitreous cysticerci from the surface of the optic nervehead. A pars plana approach. Arch Ophthalmol 1980; 98: 714–6.
[52] Natarajan S, Malpani A, Kumar Nirmalan P, Dutta B. Management of intraocular cysticercosis. Graefes Arch Clin Exp Ophthalmol 1999; 237: 812–4.
[53] Luger MH, Stilma JS, Ringens PJ, van Baarlen J. In-toto removal of subretinal Cysticercus cellulosae by pars plana vitrectomy. Br J Ophthalmol 1991; 75: 561–3.
[54] Pantaleão GR, Borges de Souza AD, Rodrigues EB, Coelho AI. The use of systemic and intravitreous steroid in inflammation secondary to intraocular cysticercosis: case report. Arq Bras Oftalmol. 2007 Nov-Dec; 70 (6): 1006-9.
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    Deepesh Arora, Anuj Sharma, Ratish Raman, Ankit Parasher, Chinky Sharma, et al. (2021). To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India. International Journal of Ophthalmology & Visual Science, 6(2), 128-143. https://doi.org/10.11648/j.ijovs.20210602.21

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    Deepesh Arora; Anuj Sharma; Ratish Raman; Ankit Parasher; Chinky Sharma, et al. To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India. Int. J. Ophthalmol. Vis. Sci. 2021, 6(2), 128-143. doi: 10.11648/j.ijovs.20210602.21

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    AMA Style

    Deepesh Arora, Anuj Sharma, Ratish Raman, Ankit Parasher, Chinky Sharma, et al. To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India. Int J Ophthalmol Vis Sci. 2021;6(2):128-143. doi: 10.11648/j.ijovs.20210602.21

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  • @article{10.11648/j.ijovs.20210602.21,
      author = {Deepesh Arora and Anuj Sharma and Ratish Raman and Ankit Parasher and Chinky Sharma and Devesh Sharma and Bhawna Tiwari and Himanshu Arora and Abhishek Kumar and Kanika Gupta and Niyaaz Ahmad and Sulekha Nautiyal and Surbhi Verma and Deepak Anthwal and Dinesh Sharma},
      title = {To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {6},
      number = {2},
      pages = {128-143},
      doi = {10.11648/j.ijovs.20210602.21},
      url = {https://doi.org/10.11648/j.ijovs.20210602.21},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210602.21},
      abstract = {Aim: To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. Materials and methods: This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. Results: Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. Conclusion: Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India
    AU  - Deepesh Arora
    AU  - Anuj Sharma
    AU  - Ratish Raman
    AU  - Ankit Parasher
    AU  - Chinky Sharma
    AU  - Devesh Sharma
    AU  - Bhawna Tiwari
    AU  - Himanshu Arora
    AU  - Abhishek Kumar
    AU  - Kanika Gupta
    AU  - Niyaaz Ahmad
    AU  - Sulekha Nautiyal
    AU  - Surbhi Verma
    AU  - Deepak Anthwal
    AU  - Dinesh Sharma
    Y1  - 2021/06/22
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijovs.20210602.21
    DO  - 10.11648/j.ijovs.20210602.21
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
    SP  - 128
    EP  - 143
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20210602.21
    AB  - Aim: To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. Materials and methods: This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. Results: Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. Conclusion: Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.
    VL  - 6
    IS  - 2
    ER  - 

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Author Information
  • Department of Vitreo-Retina, Amritsar Eye Clinic, Dehradun, India

  • Department of Vitreo-Retina, Amritsar Eye Clinic, Dehradun, India

  • Department of Radiodiagnosis, Teerthankar Mahaveer Medical College and Research Centre, Moradabad, India

  • Department of Radiodiagnosis, Parashers Pathology and Imaging Centre, Dehradun, India

  • Department of General Medicine, Teerthankar Mahaveer Medical College and Research Centre, Moradabad, India

  • Department of Cornea and Refractive Surgery, Amritsar Eye clinic, Dehradun, India

  • Department of Oculoplasty and Reconstructive Surgery, Amritsar Eye clinic, Dehradun, India

  • Department of Glaucoma, Amritsar Eye clinic, Dehradun, India

  • Department of Cataract and Microsurgery, Amritsar Eye clinic, Dehradun, India

  • Department of Paediatric Ophthalmology, Amritsar Eye clinic, Dehradun, India

  • Department of Medicine, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India

  • Department of Microbiology, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India

  • Department of Cornea and Refractive Surgery, Sadguru Netra Chikitsalaya, Chirakoot, India

  • Department of Retina-Vitreous, Aravind Eye Hospital, Coimbatore, India

  • Department of Cataract and Refractive Surgery, Amritsar Eye clinic, Dehradun, India

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