The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia
Background/aims Levobupivacaine, the S(–)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess...
Gespeichert in:
| Veröffentlicht in: | Eye (London) 2003-03, Vol.17 (2), p.200-206 |
|---|---|
| Hauptverfasser: | , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 206 |
|---|---|
| container_issue | 2 |
| container_start_page | 200 |
| container_title | Eye (London) |
| container_volume | 17 |
| creator | Birt, D J Cummings, G C |
| description | Background/aims
Levobupivacaine, the S(–)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine
vs
0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia.
Methods
A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and
orbicularis oculi
function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block.
Results
The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (
P
=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration
vs
time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group).
Conclusions
Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects. |
| doi_str_mv | 10.1038/sj.eye.6700313 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_18769535</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>18769535</sourcerecordid><originalsourceid>FETCH-LOGICAL-c484t-45b35fc242fd40df8c10d4bc587a687b428bd5401a33d5132afb3d5fe5e05c53</originalsourceid><addsrcrecordid>eNp1kM1r20AQxZeS0jhprzkGEUhuUma_tPKxhPQDAr340Nt2djXbyMiSs2sZ_N9ngwUOhZ5mmPebN8Nj7IpDxUE292ld0YGq2gBILj-wBVemLrXS6owtYKmhFEL8PmcXKa0BsmjgEzvnolagwCzYn9UzFRRC59EfChzaImGg3aEYQwGV0bdFT_vRTdtujx67gYp9moX3wzDGYkuxc1PvMGYfpLR7ptThZ_YxYJ_oy1wv2erb4-rhR_n06_vPh69PpVeN2pVKO6mDF0qEVkEbGs-hVc7rxmDdGKdE41qtgKOUreZSYHC5CaQJtNfykt0dbbdxfJnycbvpkqe-x4HGKVnemHqp5Rt48w-4Hqc45Nes4I1UYgkiQ9UR8nFMKVKw29htMB4sB_uWu01rm3O3c-554Xp2ndyG2hM-B52B2xnA5LEPEQffpROnDGgpeObuj1zK0vCX4um9_5x-BSE8mhk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>218342902</pqid></control><display><type>article</type><title>The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Birt, D J ; Cummings, G C</creator><creatorcontrib>Birt, D J ; Cummings, G C</creatorcontrib><description>Background/aims
Levobupivacaine, the S(–)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine
vs
0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia.
Methods
A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and
orbicularis oculi
function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block.
Results
The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (
P
=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration
vs
time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group).
Conclusions
Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects.</description><identifier>ISSN: 0950-222X</identifier><identifier>EISSN: 1476-5454</identifier><identifier>DOI: 10.1038/sj.eye.6700313</identifier><identifier>PMID: 12640407</identifier><identifier>CODEN: EYEEEC</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia depending on type of surgery ; Anesthesia, Conduction - methods ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Anesthetics, Local - adverse effects ; Anesthetics, Local - blood ; Biological and medical sciences ; Bupivacaine - adverse effects ; Bupivacaine - blood ; clinical-study ; Double-Blind Method ; Eye Diseases - surgery ; Female ; Humans ; Hyaluronoglucosaminidase ; Injections ; Laboratory Medicine ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Middle Aged ; Oculomotor Muscles - drug effects ; Ophthalmology ; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics ; Pharmaceutical Sciences/Technology ; Prospective Studies ; Stereoisomerism ; Surgery ; Surgical Oncology ; Time Factors</subject><ispartof>Eye (London), 2003-03, Vol.17 (2), p.200-206</ispartof><rights>Royal College of Ophthalmologists 2003</rights><rights>2003 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Mar 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c484t-45b35fc242fd40df8c10d4bc587a687b428bd5401a33d5132afb3d5fe5e05c53</citedby><cites>FETCH-LOGICAL-c484t-45b35fc242fd40df8c10d4bc587a687b428bd5401a33d5132afb3d5fe5e05c53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sj.eye.6700313$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sj.eye.6700313$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14705321$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12640407$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Birt, D J</creatorcontrib><creatorcontrib>Cummings, G C</creatorcontrib><title>The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia</title><title>Eye (London)</title><addtitle>Eye</addtitle><addtitle>Eye (Lond)</addtitle><description>Background/aims
Levobupivacaine, the S(–)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine
vs
0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia.
Methods
A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and
orbicularis oculi
function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block.
Results
The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (
P
=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration
vs
time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group).
Conclusions
Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Anesthesia depending on type of surgery</subject><subject>Anesthesia, Conduction - methods</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Anesthetics, Local - adverse effects</subject><subject>Anesthetics, Local - blood</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine - adverse effects</subject><subject>Bupivacaine - blood</subject><subject>clinical-study</subject><subject>Double-Blind Method</subject><subject>Eye Diseases - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Hyaluronoglucosaminidase</subject><subject>Injections</subject><subject>Laboratory Medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oculomotor Muscles - drug effects</subject><subject>Ophthalmology</subject><subject>Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics</subject><subject>Pharmaceutical Sciences/Technology</subject><subject>Prospective Studies</subject><subject>Stereoisomerism</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Time Factors</subject><issn>0950-222X</issn><issn>1476-5454</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp1kM1r20AQxZeS0jhprzkGEUhuUma_tPKxhPQDAr340Nt2djXbyMiSs2sZ_N9ngwUOhZ5mmPebN8Nj7IpDxUE292ld0YGq2gBILj-wBVemLrXS6owtYKmhFEL8PmcXKa0BsmjgEzvnolagwCzYn9UzFRRC59EfChzaImGg3aEYQwGV0bdFT_vRTdtujx67gYp9moX3wzDGYkuxc1PvMGYfpLR7ptThZ_YxYJ_oy1wv2erb4-rhR_n06_vPh69PpVeN2pVKO6mDF0qEVkEbGs-hVc7rxmDdGKdE41qtgKOUreZSYHC5CaQJtNfykt0dbbdxfJnycbvpkqe-x4HGKVnemHqp5Rt48w-4Hqc45Nes4I1UYgkiQ9UR8nFMKVKw29htMB4sB_uWu01rm3O3c-554Xp2ndyG2hM-B52B2xnA5LEPEQffpROnDGgpeObuj1zK0vCX4um9_5x-BSE8mhk</recordid><startdate>20030301</startdate><enddate>20030301</enddate><creator>Birt, D J</creator><creator>Cummings, G C</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7T2</scope><scope>7U2</scope><scope>C1K</scope></search><sort><creationdate>20030301</creationdate><title>The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia</title><author>Birt, D J ; Cummings, G C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c484t-45b35fc242fd40df8c10d4bc587a687b428bd5401a33d5132afb3d5fe5e05c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Anesthesia depending on type of surgery</topic><topic>Anesthesia, Conduction - methods</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Anesthetics, Local - adverse effects</topic><topic>Anesthetics, Local - blood</topic><topic>Biological and medical sciences</topic><topic>Bupivacaine - adverse effects</topic><topic>Bupivacaine - blood</topic><topic>clinical-study</topic><topic>Double-Blind Method</topic><topic>Eye Diseases - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Hyaluronoglucosaminidase</topic><topic>Injections</topic><topic>Laboratory Medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oculomotor Muscles - drug effects</topic><topic>Ophthalmology</topic><topic>Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics</topic><topic>Pharmaceutical Sciences/Technology</topic><topic>Prospective Studies</topic><topic>Stereoisomerism</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Birt, D J</creatorcontrib><creatorcontrib>Cummings, G C</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</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 UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science 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>Health and Safety Science Abstracts (Full archive)</collection><collection>Safety Science and Risk</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Eye (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Birt, D J</au><au>Cummings, G C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia</atitle><jtitle>Eye (London)</jtitle><stitle>Eye</stitle><addtitle>Eye (Lond)</addtitle><date>2003-03-01</date><risdate>2003</risdate><volume>17</volume><issue>2</issue><spage>200</spage><epage>206</epage><pages>200-206</pages><issn>0950-222X</issn><eissn>1476-5454</eissn><coden>EYEEEC</coden><abstract>Background/aims
Levobupivacaine, the S(–)-enantiomer of racemic bupivacaine, is associated with a similar efficacy but a reduced potential for cardiovascular and central nervous system toxicity than racemic bupivacaine. Thus, this prospective, randomised, double-masked study was undertaken to assess the efficacy and safety of 0.75% levobupivacaine
vs
0.75% bupivacaine, each with hyaluronidase, for peribulbar anaesthesia.
Methods
A total of 60 patients undergoing elective anterior segment surgery were randomly allocated to receive either agent by a single, inferotemporal peribulbar injection technique, supplemented with a medial canthus injection if necessary. Ocular akinesia and
orbicularis oculi
function were assessed by scoring systems at 2 min intervals until satisfactory akinesia was achieved, and movements were reassessed on the day after surgery to confirm regression of the block.
Results
The time taken to reach a state of satisfactory anaesthesia and akinesia was deemed to be the primary measure of efficacy. Both agents achieved this in a similar median time of 2 min after receiving 5 ml of the injectate, and the treatment difference was not statistically significant (
P
=0.24). Blood samples from the first 20 patients were taken at intervals up to 4 h. These were analysed for plasma levels and confirmed similar plasma concentration
vs
time profiles for the two agents. Seven patients in each group (23%) complained of pain on injection but the technique was generally well tolerated. Two patients in the levobupivacaine group experienced serious adverse events, but neither was considered related to the study medication. The most common minor post-operative adverse event was prolongation of the local anaesthetic block, which was reported by nine patients (four in the levobupivacaine group and five in the bupivacaine group).
Conclusions
Levobupivacaine and bupivacaine are equally successful in achieving clinically satisfactory peribulbar anaesthesia with few adverse effects.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>12640407</pmid><doi>10.1038/sj.eye.6700313</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0950-222X |
| ispartof | Eye (London), 2003-03, Vol.17 (2), p.200-206 |
| issn | 0950-222X 1476-5454 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_18769535 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; SpringerLink Journals - AutoHoldings |
| subjects | Aged Aged, 80 and over Anesthesia Anesthesia depending on type of surgery Anesthesia, Conduction - methods Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Anesthetics, Local - adverse effects Anesthetics, Local - blood Biological and medical sciences Bupivacaine - adverse effects Bupivacaine - blood clinical-study Double-Blind Method Eye Diseases - surgery Female Humans Hyaluronoglucosaminidase Injections Laboratory Medicine Male Medical sciences Medicine Medicine & Public Health Middle Aged Oculomotor Muscles - drug effects Ophthalmology Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics Pharmaceutical Sciences/Technology Prospective Studies Stereoisomerism Surgery Surgical Oncology Time Factors |
| title | The efficacy and safety of 0.75% levobupivacaine vs 0.75% bupivacaine for peribulbar anaesthesia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-10T09%3A16%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=The%20efficacy%20and%20safety%20of%200.75%25%20levobupivacaine%20vs%200.75%25%20bupivacaine%20for%20peribulbar%20anaesthesia&rft.jtitle=Eye%20(London)&rft.au=Birt,%20D%20J&rft.date=2003-03-01&rft.volume=17&rft.issue=2&rft.spage=200&rft.epage=206&rft.pages=200-206&rft.issn=0950-222X&rft.eissn=1476-5454&rft.coden=EYEEEC&rft_id=info:doi/10.1038/sj.eye.6700313&rft_dat=%3Cproquest_cross%3E18769535%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=218342902&rft_id=info:pmid/12640407&rfr_iscdi=true |