Advertisement

Factors Regulating the Blood Flow in the Optic Nerve Head

  • Sohan Singh Hayreh

Abstract

Ischemic disorders of the optic nerve head (ONH) constitute an important cause of blindness or seriously impaired vision. Acute ONH ischemia results in anterior ischemic optic neuropathy (AION) - a seriously blinding disease. There is overwhelming evidence that glaucomatous optic neuropathy is a chronic ischemic disorder of the ONH. Glaucomatous optic neuropathy is seen in primary open angle glaucoma and low (or normal) tension glaucoma. Both AION and glaucomatous optic neuropathy are common disorders, seen more commonly in middle aged and older than in young persons. For a proper understanding of the pathogenesis and management of these important and highly prevalent ischemic disorders of the ONH, it is imperative to know its blood supply and various factors which regulate the blood flow in the ONH.

Keywords

Optic Nerve Optic Neuropathy Optic Nerve Head Primary Open Angle Glaucoma Ocular Blood Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alderman, M.H., Ooi, W.L., Madhavan, S. and Cohen, H. (1988) Treatment-induced blood pressure reduction and the risk of myocardial infarction, JAMA 262:920–924.CrossRefGoogle Scholar
  2. Alm, A. and Bill A. (1972) The oxygen supply to the retina. II. Effects of high intraocular pressure and of increased arterial carbon dioxide tension on uveal and retinal blood flow in cats; a study with radioactively labeled microspheres including flow determinations in brain and some other tissues, Acta Physiol. Scand. 84:306–319.PubMedCrossRefGoogle Scholar
  3. Alm, A. and Bill, A. (1973) Ocular and optic nerve blood flow at normal and increased intraocular pressures in monkeys (Macaca irus): a study with radioactively labeled microspheres including flow determinations in brain and some other tissues, Exp. Eye Res. 15:15–29.PubMedCrossRefGoogle Scholar
  4. Bill, A. (1974) Effects of acetazolamide and carotid occlusion on the ocular blood flow in unanesthetized rabbits, Invest. Ophthalmol. Vis. Sci. 13:954–958.Google Scholar
  5. Bill, A. (1985) Some aspects of the ocular circulation, Invest. Ophthalmol. Vis. Sci. 26:410–424.Google Scholar
  6. Bill, A. and Linder, J. (1976) Sympathetic control of cerebral blood flow in acute arterial hypertension, Acta Physiol. Scand. 96:114–121.PubMedCrossRefGoogle Scholar
  7. Bill, A. and Sperber, G.O. (1987) Blood flow and glucose consumption in the optic nerve: Effects of high intraocular pressure. In: Krieglstein GK, editor. Glaucoma Update III. Berlin Heidelberg: Springer, pp 51–57.CrossRefGoogle Scholar
  8. Boisvert, D.J.P., Jones, J.V. and Harper, A.M. (1977) Cerebral blood flow autoregulation to acutely increasing blood pressure during sympathetic stimulation, Acta Neurol. Scand. 56 Suppl. 64:48–49.Google Scholar
  9. Caplan, L.R. and Stein, RW. (1986) Stroke: A Clinical Approach. Boston: Butterworths, pp 11.Google Scholar
  10. Connor, R.C. (1962) Complicated migraine: a study of permanent neurological and visual defects caused by migraine, Lancet 2:1072–1075.PubMedCrossRefGoogle Scholar
  11. Cove, D.H., Seddon, M., Fletcher, R.F. and Dukes. D.C. (1979) Blindness after treatment for malignant hypertension, Br. Med. J. 2:245–246.PubMedCrossRefGoogle Scholar
  12. Dollery, C.T., Hill, D.W. and Hodge, J.V. (1963) The response of normal retinal blood vessels to angiotensin and noradrenaline, J Physiol 165:500–507.PubMedGoogle Scholar
  13. Dorfman, L.J., Marshall, W.H. and Deiter, E.R. (1979) Cerebral infarction and migraine: clinical and radiological correlations, Neurology 29:317–322.PubMedCrossRefGoogle Scholar
  14. Drance, S.M., Douglas, G.R., Wijsman, K., Chulzer, M. and Britton, R.J. (1988) Response of blood flow to warm and cold in normal and low-tension glaucoma patients, Am. J. Ophthalmol. 105:35–39.PubMedGoogle Scholar
  15. Drayer, Weber, M.A. and Chard, E.R. (1984) Non-invasive automated blood pressure monitoring in ambulatory normotensive men. In: Weber, M.A. and Drayer, J.I.M., editors. Ambulatory Blood Pressure Monitoring. Darmstadt: Steinkopff Verlag, pp:129–135.CrossRefGoogle Scholar
  16. Dukes, H.T. and Vieth, H.G. (1964) Cerebral arteriography during migraine prodrome and headache, Neurology 14:636–639.PubMedCrossRefGoogle Scholar
  17. Edmeads, J. (1977) Cerebral blood flow in migraine, Headache 17:148–152.PubMedCrossRefGoogle Scholar
  18. Edvinsson, L., Owman, C. and Siesjo, B. (1976) Physiological role of cerebrovascular sympathetic nerves in the autoregulation of cerebral blood flow, Brain Res. 117:519–523.PubMedCrossRefGoogle Scholar
  19. Ernest, J.T. (1974) Autoregulation of optic-disk oxygen tension, Invest. Ophthalmol. Vis. Sci. 13:101–106.Google Scholar
  20. Ernest, J.T. (1976) Optic disc blood flow, Trans. Ophthalmol Soc. UK. 96:348–351.PubMedGoogle Scholar
  21. Ernest, J.T. (1977) Optic disk oxygen tension, Exp. Eye Res. 24:271–278.PubMedCrossRefGoogle Scholar
  22. Ernest, J.T. (1979) Autoregulation of blood flow in the distal segment of the optic nerve. In: Krieglstein, G.K., Leydhecker, W, eds. Glaucoma Update. Heidelberg: Springer, pp 93–100.CrossRefGoogle Scholar
  23. Fitch, W., MacKenzie, E.T. and Harper, A.M. (1975) Effects of decreasing arterial blood pressure on cerebral blood flow in the baboon; influence of the sympathetic nervous system, Circ. Res. 37:550–557.PubMedCrossRefGoogle Scholar
  24. Floras, J.S. (1988) Antihypertensive treatment, myocardial infraction, and nocturnal myocardial ischaemia, Lancet 2:994–996.PubMedCrossRefGoogle Scholar
  25. Floras, J. and Sleight, P. (1983) Ambulatory monitoring of blood pressure. In: Sleight, P. and Jones, J.V., eds. Scientific foundations of cardiology. London: Heinemann, pp 155–164.Google Scholar
  26. Geijer, C. and Bill, A. (1979) Effects of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys, Invest. Ophthalmol Vis. Sci. 18:1030–1042.PubMedGoogle Scholar
  27. Graveson, G.S. (1949) Retinal arterial occlusion in migraine, Br. Med. J. 2:838–840.PubMedCrossRefGoogle Scholar
  28. Grunwald, J.E., Riva, C.E., Stone, R.A., Keates, E.U. and Petrig, B.L. (1984) Retinal autoregulation in open-angle glaucoma, Ophthalmology 91:1690–1694.PubMedGoogle Scholar
  29. Hayreh, S.S. (1958) A study of the central artery of the retina in human beings. [Master of Surgery Thesis]. India: Panjab University.Google Scholar
  30. Hayreh, S.S. (1962) The ophthalmic artery. III. Branches, Br. J. Ophthalmol 46:212–247.PubMedCrossRefGoogle Scholar
  31. Hayreh, S.S. (1963a) The central artery of the retina-its role in the blood supply of the optic nerve, Br. J. Ophthalmol. 47:651–663.PubMedCrossRefGoogle Scholar
  32. Hayreh, S.S. (1963b) Blood supply and vascular disorders of the optic nerve, Anal Inst. Barraquer 4:7–109.Google Scholar
  33. Hayreh, S.S. (1964) The orbital vessels of rhesus monkeys, Exp. Eye. Res. 3:16–30.PubMedGoogle Scholar
  34. Hayreh, S.S. (1969) Blood supply of the optic nerve head and its role in optic atrophy, glaucoma and oedema of the optic disc, Br. J. Ophthalmol. 53:721–748.PubMedCrossRefGoogle Scholar
  35. Hayreh, S.S. (1970) Pathogenesis of visual field defects-role of the ciliary circulation, Br. J. Ophthalmol. 54:289–311.PubMedCrossRefGoogle Scholar
  36. Hayreh, S.S. (1974a) The choriocapillaris, Graefe’s Arch. Clin. Exp. Ophthalmol. 192:165–179.CrossRefGoogle Scholar
  37. Hayreh, S.S. (1974b) Submacular choroidal vascular pattern-experimental fluorescein fundus angiographic studies, Graefe’s Arch. Clin. Exp. Ophthalmol 192:181–196.CrossRefGoogle Scholar
  38. Hayreh, S.S. (1974c) The long posterior ciliary arteries-an experimental study, Graefe’s Arch. Clin. Exp. Ophthalmol. 192:197–213.CrossRefGoogle Scholar
  39. Hayreh, S.S. (1974d) Anterior ischaemic optic neuropathy-I. Terminology and pathogenesis, Br. J. Ophthalmol. 58:955–963.PubMedCrossRefGoogle Scholar
  40. Hayreh, S.S. (1974e) Anterior ischaemic optic neuropathy-II. Fundus on ophthalmoscopy and fluorescein angiography, Br. J. Ophthalmol. 58:964–980.PubMedCrossRefGoogle Scholar
  41. Hayreh, S.S. (1975a) Segmental nature of the choroidal vasculature, Br. J. Ophthalmol. 59:631–648.PubMedCrossRefGoogle Scholar
  42. Hayreh, S.S. (1975b) Anterior Ischemic Optic Neuropathy. New York: Springer-Verlag.CrossRefGoogle Scholar
  43. Hayreh, S.S. (1978) Structure and blood supply of the optic nerve. In: Heilmann K, Richardson KT, editor. Glaucoma: Conceptions of a disease. Stuttgart: Thieme, pp78–96.Google Scholar
  44. Hayreh, S.S. (1981) Anterior ischemic optic neuropathy, Arch. Neurol 38:675–678.PubMedCrossRefGoogle Scholar
  45. Hayreh, S.S. (1985) Inter-individual variation in blood supply of the optic nerve head. Its importance in various ischemic disorders of the optic nerve head, and glaucoma, low-tension glaucoma and allied disorders, Doc. Ophthalmol. 59:217–246.PubMedCrossRefGoogle Scholar
  46. Hayreh, S.S. (1987) Factors determining the glaucomatous optic nerve head damage. In: Krieglstein GK, editor. Glaucoma Update-III. Heidelberg: Springer-Verlag, pp 40–46.CrossRefGoogle Scholar
  47. Hayreh, S.S. (1989) Blood supply of the optic nerve head in health and disease. In: Lambrou GN, Greve EL, editors. Ocular blood flow in glaucoma: Means, methods and measurements. Amstelveen: Kugler & Ghedini, pp 3–54.Google Scholar
  48. Hayreh, S.S. (1990) In vivo choroidal circulation and its watershed zones, Eye 4:273–289.PubMedCrossRefGoogle Scholar
  49. Hayreh, S.S. and Baines, J.A.B. (1972a) Occlusion of the posterior ciliary artery I. Effects on choroidal circulation, Br. J. Ophthalmol. 56:719–735.PubMedCrossRefGoogle Scholar
  50. Hayreh, S.S and Baines, J.A.B. (1972b) Occlusion of the posterior ciliary artery III. Effects on the optic nerve head, Br. J. Ophthalmol. 56:754–764.PubMedCrossRefGoogle Scholar
  51. Hayreh, S.S and Baines, J.A.B. (1973) Occlusion of the vortex veins, Br. J. Ophthalmol. 57:217–238.PubMedCrossRefGoogle Scholar
  52. Hayreh, S.S., Bill, A. and Sperber, G.O. (1991) Metabolic effects of high intraocular pressure in old arteriosclerotic monkeys, Invest. Ophthalmol. Vis. Sci. 32:810.Google Scholar
  53. Hayreh, S.S and Chopdar, A. (1982) Occlusion of the posterior ciliary artery-V. Protective influence of simultaneous vortex vein occlusion, Arch. Ophthalmol. 100:1481–1491.PubMedCrossRefGoogle Scholar
  54. Hayreh, S.S and Perkins, E.S. (1968) Clinical and experimental studies on the circulation at the optic nerve head. In: Cant JS, editor. The William MacKenzie Centenary Symposium on the Ocular Circulation in Health and Disease. Kimpton: London, pp 71–86.Google Scholar
  55. Hayreh, S.S. and Perkins, E.S. (1971) The effects of raised intraocular pressure on the blood vessels of the retina and optic disc. In: Amalric P, editor. Proceedings of the International Symposium on Fluorescein Angiography; 1969 Albi. Karger: Basel, pp 323–328.Google Scholar
  56. Hayreh, S.S., Revie, I.H.S. and Edwards, J. (1970) Vasogenic origin of visual field defects and optic nerve changes in glaucoma, Br. J. Ophthalmol. 54:461–472.PubMedCrossRefGoogle Scholar
  57. Hayreh, S.S., Servais, G.E. and Virdi, PS. (1986a) Fundus lesions in malignant hypertension-V. Hypertensive optic neuropathy, Ophthalmology 93:74–87.PubMedGoogle Scholar
  58. Hayreh, S.S., Servais, G.E. and Virdi, P.S. (1986b) Fundus lesions in malignant hypertension-VI. Hypertensive choroidopathy, Ophthalmology 93:1383–1400.PubMedGoogle Scholar
  59. Hayreh, S.S. and Walker, W.M. (1967) Fluorescent fundus photography in glaucoma, Am. J. Ophthalmol. 63:982–989.PubMedGoogle Scholar
  60. Hayreh, S.S. and Weingeist, T.A. (1980) Experimental occlusion of the central artery of the retina-I. Ophthalmoscopic and fluorescein fundus angiographic studies, Br. J. Ophthalmol. 64:896–912.PubMedCrossRefGoogle Scholar
  61. Hayreh, S.S., Zimmerman, M.B., Podhajsky, P. and Alward, W.L. (1994) Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders, Am. J. Ophthalmol. 117:603–624.PubMedGoogle Scholar
  62. Hulse, J.A., Taylor, D.S.I. and Dillion, M.J. (1979) Blindness and paraplegia in severe childhood hypertension, Lancet 2:553–556.PubMedCrossRefGoogle Scholar
  63. Jones, J.V., Fitch, W., MacKenzie, E.T., Strandgaard, S. and Harper, A.M. (1976) Lower limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon, Circ. Res. 39:555–557.PubMedCrossRefGoogle Scholar
  64. Kennedy, H.L., Horan, M.J., Sprague, M.K., Padgett, N.E. and Shriver, K.K. (1983) Ambulatory blood pressure in healthy normotensive males, Am. Heart J. 106:717–722.PubMedCrossRefGoogle Scholar
  65. Kishi, S., Tso, M.O.M. and Hayreh, S.S. (1985) Fundus lesions in malignant hypertension-II. A pathologic study of experimental hypertensive optic neuropathy, Arch. Ophthalmol. 103:1198–1206.PubMedCrossRefGoogle Scholar
  66. Kitazawa, Y., Shirai, H. and Go, F.J. (1989) The effect of Ca2+-antagonist on visual field in low-tension glaucoma, Graefe’s Arch. Clin. Exp. Ophthalmol. 227:408–412.CrossRefGoogle Scholar
  67. Kleiman, N., Goodman, D., Schechtman, K. and Roberts, R. (1988) (Diltiazem Reinfarction Study.) Lack of diurnal variation in the occurrence of non-Q-wave myocardial infarction: results of a prospective study, J. Am. Coll. Cardiol. 11:27A.CrossRefGoogle Scholar
  68. Langham, M.E., Tomey, K.F. and Preziosi, T.J. (1981) Carotid occlusive disease: effect of complete occlusion of internal carotid artery on intraocular pulse/pressure relation and on ophthalmic arterial pressure, Stroke 12:759–765.PubMedCrossRefGoogle Scholar
  69. Langham, M.E. (1987) Ocular blood flow and visual loss in glaucomatous eyes. In: Krieglstein GK, editor. Glaucoma Update III. Heidelberg: Springer, pp 58–66.CrossRefGoogle Scholar
  70. Lauritzen, M., Olsen, T.S. and Paulson, O.B. (1982) Regional cerebral blood flow in classic migraine: a possible relationship to the spreading depression of Leao? In: Rose FC, editor. Advances in migraine research and therapy. New York: Raven Press, pp 105–115.Google Scholar
  71. Lauritzen, M., Olsen, T.S., Larsen, N.A. and Paulson, O.B. (1983) Changes in the regional cerebral blood flow during the course of classic migraine attacks, Ann. Neurol. 13:633–641.PubMedCrossRefGoogle Scholar
  72. MacKenzie, E.T., McGerorge, A.P., Graham, D.I., Fitch, W., Edvinsson, L. and Harper, A.M. (1977) Breakthrough of cerebral autoregulation and the sympathetic nervous system, Acta. Neurol. Scand. 56 Suppl 64:48–49.Google Scholar
  73. Marsh, E.E., Bille, J., Adams, H.P., Marier, J.R., Hulbert, J.R., Love, B.B., et al. (1990) Circadian variation in onset of acute ischemic stroke, Arch. Neurol. 47:1178–1180.PubMedCrossRefGoogle Scholar
  74. McDonald, W.I. and Sanders, M.D. (1971) Migraine complicated by ischaemic papillopathy, Lancet 2:521–523.PubMedCrossRefGoogle Scholar
  75. Novack, R.L., Stefansson, E., Hatchell, D.L. (1990) Intraocular pressure effects on optic nerve-head oxidative metabolism measured in vivo, Graefe’s Arch. Clin. Exp. Ophthalmol. 228:128–133.Google Scholar
  76. Olver, J.M., Splaton, D.J. and McCartney, A.C.E. (1990) Microvascular study of the retrolaminar optic nerve in man: the possible significance in anterior ischaemic optic neuropathy, Eye 4:7–24.PubMedCrossRefGoogle Scholar
  77. Pasteur, V.R., Blamoutier, P., Mawas, L. and Hamburger, J. (1937) Acces de migraine ophtalmique suivis d’une hemorragie retinienne, Ann. Med. 42:132–137.Google Scholar
  78. Pearce, J.M.S. and Foster, J.B. (1965) An investigation of complicated migraine, Neurology 15:333–340.PubMedCrossRefGoogle Scholar
  79. Phelps, C.D. and Corbett, J.S. (1985) Migraine and low-tension glaucoma: A case control study, Invest. Ophthalmol. Vis. Sci. 26:1105–1108.PubMedGoogle Scholar
  80. Pillunat, L.E., Stodtmeister, R,. Wilmanns, I. and Christ, Th. (1985a) Autoregulation of ocular blood flow during changes in intraocular pressure-Preliminary results, Graefe’s Arch. Clin. Exp. Ophthalmol. 223:219–223.CrossRefGoogle Scholar
  81. Pillunat, L.E., Stodtmeister, R., Wilmanns, I. and Christ, Th. (1985b) New aspects in pressure tolerance of the optic nerve head, Invest. Ophthalmol. Vis. Sci. 26 ARVO suppl 223.Google Scholar
  82. Pillunat, L.E., Stodtmeister, R., Wilmanns, I. and Metzner, D. (1986a) Effect of timolol on optic nerve head autoregulation, Ophthalmologica 193:146–153.PubMedCrossRefGoogle Scholar
  83. Pillunat, L.E., Stodtmeister, R., Wilmanns, I. and Christ, Th. (1986b) Drucktoleranztest des sehnervenkopfes bei okulaerer hypertension, Klin. Monatsbl. Augenheilkd. 186:39–44.CrossRefGoogle Scholar
  84. Pillunat, L.E., Stodtmeister, R. and Wilmanns, I. (1987) Pressure compliance of the optic nerve head in low tension glaucoma, Br. J. Ophthalmol. 71:181–187.PubMedCrossRefGoogle Scholar
  85. Porsaa, K. (1941) Experimental studies on the vasomotor innervation of the retinal arteries, Acta Ophthalmol. Suppl. 18.Google Scholar
  86. Pryor, J.S., Davies, P.D. and Hamilton, D.V. (1979) Blindness and malignant hypertension, Lancet 2:803.PubMedCrossRefGoogle Scholar
  87. Robert, Y. and Maurer, W. (1984) Pallor of the optic disc in glaucoma patients with artificial hypertension, Doc. Ophthalmol. 57:203–214.PubMedCrossRefGoogle Scholar
  88. Robert, Y., Grauwiller, T., Hendrickson, P.H. and Brunner, H.R. (1988) Die autoregulation der papillengefaesse under ihre verhalten unter halothan, Klin. Monatsbl. Augenheilkd. 192:117–121.PubMedCrossRefGoogle Scholar
  89. Robert, Y., Steiner. D. and Hendrickson, P. (1989) Papillary circulation dynamics in glaucoma, Graefe’s Arch. Clin. Exp. Ophthalmol. 227:436–439.CrossRefGoogle Scholar
  90. Russell, R.W.R. (1963) Observations on intracerebral aneurysms, Brain 86:425–442.CrossRefGoogle Scholar
  91. Singh, S. and Dass, R. (1960a) The central artery of the retina I. Origin and course, Br. J. Ophthalmol. 44:193–212.PubMedCrossRefGoogle Scholar
  92. Singh, S. and Dass, R. (1960b) The central artery of the retina II. Distribution and anastomoses, Br. J. Ophthalmol. 44:280–299.PubMedCrossRefGoogle Scholar
  93. Sossi, N. and Anderson, D.R. (1983) Effect of elevated intraocular pressure on blood flow: occurrence in cat optic nerve head studies with iodantipyrine I 125, Arch. Ophthalmol. 101:98–101.PubMedCrossRefGoogle Scholar
  94. Sperber, G.O. and Bill, A. (1985) Blood flow and glucose consumption in optic nerve, retina and brain: effects of high intraocular pressure, Exp. Eye Res. 41:639–653.PubMedCrossRefGoogle Scholar
  95. Strandgaard, S. (1976) Autoregulation of cerebral blood flow in hypertensive patients: the modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension, Circulation 53:720–727.PubMedCrossRefGoogle Scholar
  96. Strandgaard, S., Jones, J.V., MacKenzie, E.T. and Harper, A.M. (1975) Upper limit of cerebral blood flow autoregulation in experimental renovascular hypertension in the baboon, Circ. Res. 37:164–167.PubMedCrossRefGoogle Scholar
  97. Strandgaard, S., Olesen, J., Skinhoj, E. and Lassen, N.A. (1973) Autoregulation of brain circulation in severe arterial hypertension, Br. Med. J. 1:507–510.PubMedCrossRefGoogle Scholar
  98. Taylor, D., Ramsay, J., Day, S., Dillion, M. (1981) Infarction of the optic nerve head in children with accelerated hypertension, Br. J. Ophthalmol. 65:153–160.PubMedCrossRefGoogle Scholar
  99. Ujiie, K. and Takahashi, M. (1987) Angioarchitecture of anterior segment of the optic nerve. In: Tsuchiya M, Asano M, Mishima Y, Oda M, editors. Microcirculation;-An Update. Proceedings of the Fourth World Congress for Microcirculation, Tokyo, Amsterdam: Excerpta. Medica., 2:85–87.Google Scholar
  100. Wallace, J.M., Thornton, W.E., Kennedy, H.L., Pickering, T.G., Harshfield, G.A., Frohlich, E.D., et al. (1984) Ambulatory blood pressure in 199 normal subjects, a collaborative study. In: Weber MA, Drayer JIM, editors. Ambulatory Blood Pressure Monitoring. Darmstadt: Steinkopff Verlag, pp 117–127.CrossRefGoogle Scholar
  101. Weinstein, J.M., Duckrow, R.B., Beard, D. and Brennan, RW. (1983) Regional optic nerve blood flow and its autoregulation, Invest. Ophthalmol. Vis. Sci. 24:1559–1565.PubMedGoogle Scholar
  102. Weinstein, J.M. and Feman, S.S. (1982) Ischemic optic neuropathy in migraine, Arch. Ophthalmol. 100:1097–1100.PubMedCrossRefGoogle Scholar
  103. Wetherill, J.H. (1979) Blindness after treatment for malignant hypertension, Br. Med. J. 2:550.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Sohan Singh Hayreh
    • 1
  1. 1.Department of OphthalmologyUniversity of IowaIowa CityUSA

Personalised recommendations