{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:54:10Z","timestamp":1787169250234,"version":"build-2736575974"},"reference-count":57,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,20]],"date-time":"2022-07-20T00:00:00Z","timestamp":1658275200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 \u00b1 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 \u00b1 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was \u22129.59 \u00b1 2.36 D. At the final follow-up, the mean astigmatism decreased to \u22125.38 \u00b1 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.<\/jats:p>","DOI":"10.3390\/jcm11144221","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T03:34:40Z","timestamp":1658374480000},"page":"4221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3682-0225","authenticated-orcid":false,"given":"Nadav","family":"Levinger","sequence":"first","affiliation":[{"name":"Hadassah Medical Center, Jerusalem 9574409, Israel"},{"name":"Enaim Medical Center Jerusalem, Tel Aviv 9438307, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shmuel","family":"Levinger","sequence":"additional","affiliation":[{"name":"Enaim Medical Center Jerusalem, Tel Aviv 9438307, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nir","family":"Erdinest","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Jerusalem 9574409, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6315-6908","authenticated-orcid":false,"given":"Asaf","family":"Achiron","sequence":"additional","affiliation":[{"name":"Enaim Medical Center Jerusalem, Tel Aviv 9438307, Israel"},{"name":"Department of Ophthalmology, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6935-3275","authenticated-orcid":false,"given":"Naomi","family":"London","sequence":"additional","affiliation":[{"name":"Private Practice, Jerusalem 9422805, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Trivizki","sequence":"additional","affiliation":[{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliya","family":"Levinger","sequence":"additional","affiliation":[{"name":"Enaim Medical Center Jerusalem, Tel Aviv 9438307, Israel"},{"name":"Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1144-0226","authenticated-orcid":false,"given":"Irina S.","family":"Barequet","sequence":"additional","affiliation":[{"name":"Enaim Medical Center Jerusalem, Tel Aviv 9438307, Israel"},{"name":"Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer 5262000, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,20]]},"reference":[{"key":"ref_1","first-page":"415","article-title":"Femtosecond laser-assisted astigmatic keratotomy","volume":"117","author":"Mirshahi","year":"2020","journal-title":"Der Ophthalmol. Z. Der Dtsch. Ophthalmol. Ges."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jcrs.2017.11.018","article-title":"Astigmatic correction by intrastromal astigmatic keratotomy during femtosecond laser\u2013assisted cataract surgery: Factors in outcomes","volume":"44","author":"Byun","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1016\/S0161-6420(91)32238-3","article-title":"Long-term outcome after corneal transplantation: Visual result and patient perception of success","volume":"98","author":"Williams","year":"1991","journal-title":"Ophthalmology"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Hjortdal, J. (2016). Post-keratoplasty Astigmatism. Corneal Transplantation, Springer International Publishing.","DOI":"10.1007\/978-3-319-24052-7"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7340","DOI":"10.1038\/s41598-021-86763-5","article-title":"Comparison of penetrating femtosecond laser-assisted astigmatic keratotomy and toric intraocular lens implantation for correction of astigmatism in cataract surgery","volume":"11","author":"Noh","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, J., Zhao, J., Xu, J., and Zhang, J. (2018). Evaluation of the effectiveness of combined femtosecond laser-assisted cataract surgery and femtosecond laser astigmatic keratotomy in improving post-operative visual outcomes. BMC Ophthalmol., 18.","DOI":"10.1186\/s12886-018-0823-1"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40662-018-0099-9","article-title":"Femtosecond laser-assisted astigmatic keratotomy: A review","volume":"5","author":"Chang","year":"2018","journal-title":"Eye Vis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/IIO.0b013e31820f26cd","article-title":"Femtosecond-assisted astigmatic keratotomy","volume":"51","author":"Wu","year":"2011","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10792-017-0803-0","article-title":"Vector analysis of femtosecond laser-assisted astigmatic keratotomy after deep anterior lamellar keratoplasty and penetrating keratoplasty","volume":"39","author":"AnNakhli","year":"2019","journal-title":"Int. Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"697","DOI":"10.2147\/OPTH.S99741","article-title":"Advances in femtosecond laser technology","volume":"10","author":"Callou","year":"2016","journal-title":"Clin. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"152","DOI":"10.3928\/1081597X-20160204-01","article-title":"Stability of keratometric astigmatism after non-penetrating femtosecond laser intrastromal astigmatic keratotomy performed during laser cataract surgery","volume":"32","author":"Day","year":"2016","journal-title":"J. Refract. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1016\/j.jcrs.2019.08.002","article-title":"Femtosecond laser\u2013assisted arcuate keratotomy at the time of cataract surgery for the management of preexisting astigmatism","volume":"45","author":"Visco","year":"2019","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.jcrs.2007.01.031","article-title":"Mechanized astigmatic arcuate keratotomy with the Hanna arcitome for astigmatism after keratoplasty","volume":"33","author":"Hoffart","year":"2007","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/j.jcrs.2015.09.028","article-title":"Predictors of femtosecond laser intrastromal astigmatic keratotomy efficacy for astigmatism management in cataract surgery","volume":"42","author":"Day","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.jcrs.2015.12.053","article-title":"Development of a nomogram for femtosecond laser astigmatic keratotomy for astigmatism after keratoplasty","volume":"42","author":"Clair","year":"2016","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.ajo.2017.05.015","article-title":"Tomographic analysis of anterior and posterior and total corneal refractive power changes after femtosecond laser\u2013assisted keratotomy","volume":"180","author":"Herzog","year":"2017","journal-title":"Am. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.jcrs.2018.05.027","article-title":"Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery","volume":"44","author":"Roberts","year":"2018","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1159\/000499859","article-title":"Vector analysis of femtosecond laser-assisted arcuate keratotomy for post-keratoplasty astigmatic correction","volume":"62","author":"Elzarga","year":"2019","journal-title":"Ophthalmic Res."},{"key":"ref_19","first-page":"1","article-title":"Cataract surgery astigmatism incisional management. Manual relaxing incision versus femtosecond laser-assisted arcuate keratotomy. A systematic review","volume":"261","year":"2022","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.ophtha.2009.01.013","article-title":"Femtosecond laser arcuate keratotomy for the correction of high astigmatism after keratoplasty","volume":"116","author":"Nubile","year":"2009","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"378","DOI":"10.3928\/1081597X-20130515-01","article-title":"Treatment of post-operative keratoplasty astigmatism using femtosecond laser-assisted intrastromal relaxing incisions","volume":"29","author":"Wetterstrand","year":"2013","journal-title":"J. Refract. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.ophtha.2009.10.041","article-title":"IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: On-axis vector analysis","volume":"117","author":"Kumar","year":"2010","journal-title":"Ophthalmology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/j.jcrs.2015.10.011","article-title":"Correction ratio and vector analysis of femtosecond laser arcuate keratotomy for the correction of post-mushroom profile keratoplasty astigmatism","volume":"41","author":"Trivizki","year":"2015","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_24","first-page":"249","article-title":"Ocular Surface Preparation Before Keratoprosthesis Implantation","volume":"11","author":"Krysik","year":"2022","journal-title":"Ophthalmology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.ajo.2008.12.017","article-title":"Correction of postkeratoplasty astigmatism by femtosecond laser compared with mechanized astigmatic keratotomy","volume":"147","author":"Hoffart","year":"2009","journal-title":"Am. J. Ophthalmol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40662-017-0093-7","article-title":"Post-keratoplasty astigmatism management by relaxing incisions: A systematic review","volume":"4","author":"Hoffart","year":"2017","journal-title":"Eye Vis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1097\/ICU.0000000000000267","article-title":"Femtosecond laser-assisted keratotomy","volume":"27","author":"Vickers","year":"2016","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.1016\/j.survophthal.2021.11.005","article-title":"Post-penetrating keratoplasty astigmatism","volume":"67","author":"Deshmukh","year":"2021","journal-title":"Surv. Ophthalmol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4103\/DJO.DJO_63_20","article-title":"Femtosecond laser-assisted arcuate keratotomy for correction of postkeratoplasty astigmatism","volume":"22","author":"Anis","year":"2021","journal-title":"Delta J. Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1039\/c9pp00039a","article-title":"Femtosecond laser in refractive corneal surgery","volume":"18","author":"Moussa","year":"2019","journal-title":"Photochem. Photobiol. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.jfo.2021.09.010","article-title":"Vector analysis of astigmatism correction in femtosecond laser-assisted arcuate keratotomy for extreme astigmatism after penetrating keratoplasty","volume":"45","author":"Mainguy","year":"2022","journal-title":"J. Fr. D\u2019ophtalmologie"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1097\/ICO.0000000000002840","article-title":"Deep Anterior Lamellar Keratoplasty: Current Status and Future Directions","volume":"41","author":"Yu","year":"2022","journal-title":"Cornea"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1038\/s41433-019-0686-6","article-title":"A novel blunt dissection technique to treat modified deep anterior lamellar keratoplasty (DALK)-associated high astigmatism","volume":"34","author":"Elkadim","year":"2020","journal-title":"Eye"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1186\/s12886-018-0920-1","article-title":"AstigMATIC: An automatic tool for standard astigmatism vector analysis","volume":"18","author":"Gauvin","year":"2018","journal-title":"BMC Ophthalmol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/S0161-6420(03)00463-9","article-title":"Long-term graft survival after penetrating keratoplasty","volume":"110","author":"Thompson","year":"2003","journal-title":"Ophthalmology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1097\/ICO.0000000000001420","article-title":"Reconsidering sequential double running suture removal after penetrating keratoplasty: A prospective randomized study comparing excimer laser and motor trephination","volume":"37","author":"Seitz","year":"2018","journal-title":"Cornea"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1097\/ICO.0000000000002758","article-title":"Long-term results and refractive error after cataract surgery with a scleral incision in eyes with deep anterior lamellar keratoplasty","volume":"40","author":"Tourabaly","year":"2021","journal-title":"Cornea"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/ICO.0000000000002175","article-title":"Astigmatism orientation after deep anterior lamellar keratoplasty for keratoconus and its correlation with preoperative peripheral corneal astigmatism","volume":"39","author":"Elkadim","year":"2020","journal-title":"Cornea"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/ICO.0000000000001896","article-title":"Corneal tomography changes and refractive outcomes after Descemet stripping without endothelial keratoplasty","volume":"38","author":"Davies","year":"2019","journal-title":"Cornea"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3175","DOI":"10.1007\/s00417-021-05114-2","article-title":"Influence of rebubbling on anterior segment parameters and refractive outcomes in eyes with DMEK for Fuchs endothelial dystrophy","volume":"259","author":"Agha","year":"2021","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/ICO.0000000000000080","article-title":"Outcome of \u201cmushroom\u201d pattern femtosecond laser-assisted keratoplasty versus conventional penetrating keratoplasty in patients with keratoconus","volume":"33","author":"Levinger","year":"2014","journal-title":"Cornea"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1097\/ICO.0000000000001688","article-title":"Refractive Stability After Deep Anterior Lamellar Keratoplasty for Keratoconus","volume":"37","author":"Javadi","year":"2018","journal-title":"Cornea"},{"key":"ref_43","first-page":"78","article-title":"Clinical outcomes after femtosecond laser\u2013assisted implantation of an intrastromal corneal ring segment with a 340-degree arc length in postkeratoplasty patients: 12-month follow-up","volume":"46","author":"Tzelikis","year":"2020","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Janiszewska-Bil, D., Czarnota-Nowakowska, B., Krysik, K., Lyssek-Boron, A., Dobrowolski, D., Grabarek, B.O., and Wylegala, E. (2021). Comparison of Long-Term Outcomes of the Lamellar and Penetrating Keratoplasty Approaches in Patients with Keratoconus. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112421"},{"key":"ref_45","first-page":"691","article-title":"Femtosecond Laser-assisted Allogenic Additive Stromal Keratoplasty With or Without Excimer Laser Donor Keratomileusis for Management of Keratoconus","volume":"16","author":"Jafarinasab","year":"2021","journal-title":"J. Ophthalmic Vis. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1016\/j.jcrs.2006.01.103","article-title":"Astigmatic keratotomy for post-keratoplasty astigmatism","volume":"32","author":"Poole","year":"2006","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4103\/1735-1995.200267","article-title":"Femtosecond laser arcuate keratotomy for the correction of postkeratoplasty high astigmatism in keratoconus","volume":"22","author":"Hashemian","year":"2017","journal-title":"J. Res. Med. Sci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1016\/j.jcrs.2014.08.046","article-title":"Safety and efficacy of femtosecond laser-assisted arcuate keratotomy to treat irregular astigmatism after penetrating keratoplasty","volume":"41","author":"Fadlallah","year":"2015","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_49","first-page":"485","article-title":"Astigmatism control","volume":"19","author":"Nichamin","year":"2006","journal-title":"Ophthalmol. Clin. N. Am."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1034\/j.1600-0420.1998.760202.x","article-title":"Paired arcuate keratotomy for congenital and post-keratoplasty astigmatism","volume":"76","author":"Hjortdal","year":"1998","journal-title":"Acta Ophthalmol. Scand."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/j.1755-3768.1994.tb02798.x","article-title":"Transverse keratotomy in postkeratoplasty astigmatism","volume":"72","author":"Hovding","year":"1994","journal-title":"Acta Ophthalmol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"709","DOI":"10.3928\/1081597X-20090707-05","article-title":"Arcuate keratotomy for high postoperative keratoplasty astigmatism performed with the intralase femtosecond laser","volume":"25","author":"Buzzonetti","year":"2009","journal-title":"J. Refract. Surg."},{"key":"ref_53","first-page":"e607","article-title":"Long-term follow-up of astigmatic keratotomy for corneal astigmatism after penetrating keratoplasty","volume":"94","author":"Dineva","year":"2016","journal-title":"Acta Ophthalmol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3928\/1081597X-20100224-05","article-title":"Femtosecond thin-flap LASIK for the correction of ametropia after penetrating keratoplasty","volume":"26","author":"Barequet","year":"2010","journal-title":"J. Refract. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.ophtha.2013.10.011","article-title":"Results of toric intraocular lenses for post-penetrating keratoplasty astigmatism","volume":"121","author":"Wade","year":"2014","journal-title":"Ophthalmology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/j.jcrs.0000000000000774","article-title":"Astigmatic change as a predictor of intrastromal corneal ring segment late extrusion","volume":"48","author":"Alio","year":"2022","journal-title":"J. Cataract Refract. Surg."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.ajo.2020.09.041","article-title":"Incidence and Reasons for Intrastromal Corneal Ring Segment Explantation","volume":"222","author":"Abdelghany","year":"2021","journal-title":"Am. J. Ophthalmol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:55:04Z","timestamp":1760140504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,20]]},"references-count":57,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11144221"],"URL":"https:\/\/doi.org\/10.3390\/jcm11144221","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,20]]}}}