TFOS DEWS II iatrogenic report.
Identifieur interne : 000296 ( PubMed/Checkpoint ); précédent : 000295; suivant : 000297TFOS DEWS II iatrogenic report.
Auteurs : José Alvaro P. Gomes [Brésil] ; Dimitri T. Azar [États-Unis] ; Christophe Baudouin [France] ; Nathan Efron [Australie] ; Masatoshi Hirayama [Japon] ; Jutta Horwath-Winter [Autriche] ; Terry Kim [États-Unis] ; Jodhbir S. Mehta [Singapour] ; Elisabeth M. Messmer [Allemagne] ; Jay S. Pepose [États-Unis] ; Virender S. Sangwan [Inde] ; Alan L. Weiner [États-Unis] ; Steven E. Wilson [États-Unis] ; James S. Wolffsohn [Royaume-Uni]Source :
- The ocular surface [ 1937-5913 ] ; 2017.
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
DOI: 10.1016/j.jtos.2017.05.004
PubMed: 28736341
Affiliations:
- Allemagne, Australie, Autriche, Brésil, France, Inde, Japon, Royaume-Uni, Singapour, États-Unis
- Angleterre, Arizona, Bavière, Caroline du Nord, District de Haute-Bavière, Illinois, Midlands de l'Ouest, Missouri (État), Ohio, Région de Kantō, État de São Paulo, Île-de-France
- Birmingham, Munich, Paris, Saint-Louis (Missouri), Tokyo
- Université Louis-et-Maximilien de Munich, École de médecine (Université Washington de Saint-Louis)
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Gomes</name><affiliation wicri:level="2"><nlm:affiliation>Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil. Electronic address: japgomes@uol.com.br.</nlm:affiliation><country xml:lang="fr">Brésil</country><wicri:regionArea>Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP</wicri:regionArea><placeName><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Azar, Dimitri T" sort="Azar, Dimitri T" uniqKey="Azar D" first="Dimitri T" last="Azar">Dimitri T. Azar</name><affiliation wicri:level="2"><nlm:affiliation>University of Illinois College of Medicine, Chicago, IL, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>University of Illinois College of Medicine, Chicago, IL</wicri:regionArea><placeName><region type="state">Illinois</region></placeName></affiliation></author><author><name sortKey="Baudouin, Christophe" sort="Baudouin, Christophe" uniqKey="Baudouin C" first="Christophe" last="Baudouin">Christophe Baudouin</name><affiliation wicri:level="3"><nlm:affiliation>Quinze-Vingts National Eye Hospital & Vision Institute, Paris, France.</nlm:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Quinze-Vingts National Eye Hospital & Vision Institute, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Efron, Nathan" sort="Efron, Nathan" uniqKey="Efron N" first="Nathan" last="Efron">Nathan Efron</name><affiliation wicri:level="1"><nlm:affiliation>School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia.</nlm:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>School of Optometry and Vision Science, Queensland University of Technology, Queensland</wicri:regionArea><wicri:noRegion>Queensland</wicri:noRegion></affiliation></author><author><name sortKey="Hirayama, Masatoshi" sort="Hirayama, Masatoshi" uniqKey="Hirayama M" first="Masatoshi" last="Hirayama">Masatoshi Hirayama</name><affiliation wicri:level="3"><nlm:affiliation>Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.</nlm:affiliation><country xml:lang="fr">Japon</country><wicri:regionArea>Department of Ophthalmology, School of Medicine, Keio University, Tokyo</wicri:regionArea><placeName><settlement type="city">Tokyo</settlement><region type="région">Région de Kantō</region></placeName></affiliation></author><author><name sortKey="Horwath Winter, Jutta" sort="Horwath Winter, Jutta" uniqKey="Horwath Winter J" first="Jutta" last="Horwath-Winter">Jutta Horwath-Winter</name><affiliation wicri:level="1"><nlm:affiliation>Department of Ophthalmology, Medical University Graz, Austria.</nlm:affiliation><country xml:lang="fr">Autriche</country><wicri:regionArea>Department of Ophthalmology, Medical University Graz</wicri:regionArea><wicri:noRegion>Medical University Graz</wicri:noRegion></affiliation></author><author><name sortKey="Kim, Terry" sort="Kim, Terry" uniqKey="Kim T" first="Terry" last="Kim">Terry Kim</name><affiliation wicri:level="2"><nlm:affiliation>Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC</wicri:regionArea><placeName><region type="state">Caroline du Nord</region></placeName></affiliation></author><author><name sortKey="Mehta, Jodhbir S" sort="Mehta, Jodhbir S" uniqKey="Mehta J" first="Jodhbir S" last="Mehta">Jodhbir S. Mehta</name><affiliation wicri:level="1"><nlm:affiliation>Singapore National Eye Centre, Singapore.</nlm:affiliation><country xml:lang="fr">Singapour</country><wicri:regionArea>Singapore National Eye Centre</wicri:regionArea></affiliation></author><author><name sortKey="Messmer, Elisabeth M" sort="Messmer, Elisabeth M" uniqKey="Messmer E" first="Elisabeth M" last="Messmer">Elisabeth M. Messmer</name><affiliation wicri:level="4"><nlm:affiliation>Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany.</nlm:affiliation><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich</wicri:regionArea><placeName><region type="land" nuts="1">Bavière</region><region type="district" nuts="2">District de Haute-Bavière</region><settlement type="city">Munich</settlement><settlement type="city">Munich</settlement></placeName><orgName type="university">Université Louis-et-Maximilien de Munich</orgName></affiliation></author><author><name sortKey="Pepose, Jay S" sort="Pepose, Jay S" uniqKey="Pepose J" first="Jay S" last="Pepose">Jay S. Pepose</name><affiliation wicri:level="4"><nlm:affiliation>Washington University School of Medicine, St. Louis, MO, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Washington University School of Medicine, St. Louis, MO</wicri:regionArea><placeName><region type="state">Missouri (État)</region><settlement type="city">Saint-Louis (Missouri)</settlement></placeName><orgName type="university">École de médecine (Université Washington de Saint-Louis)</orgName></affiliation></author><author><name sortKey="Sangwan, Virender S" sort="Sangwan, Virender S" uniqKey="Sangwan V" first="Virender S" last="Sangwan">Virender S. Sangwan</name><affiliation wicri:level="1"><nlm:affiliation>L V Prasad Eye Institute, Hyderabad, India.</nlm:affiliation><country xml:lang="fr">Inde</country><wicri:regionArea>L V Prasad Eye Institute, Hyderabad</wicri:regionArea><wicri:noRegion>Hyderabad</wicri:noRegion></affiliation></author><author><name sortKey="Weiner, Alan L" sort="Weiner, Alan L" uniqKey="Weiner A" first="Alan L" last="Weiner">Alan L. Weiner</name><affiliation wicri:level="2"><nlm:affiliation>DrugDel Consulting, LLC, Peoria, AZ, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>DrugDel Consulting, LLC, Peoria, AZ</wicri:regionArea><placeName><region type="state">Arizona</region></placeName></affiliation></author><author><name sortKey="Wilson, Steven E" sort="Wilson, Steven E" uniqKey="Wilson S" first="Steven E" last="Wilson">Steven E. Wilson</name><affiliation wicri:level="2"><nlm:affiliation>Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Cole Eye Institute, The Cleveland Clinic, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author><author><name sortKey="Wolffsohn, James S" sort="Wolffsohn, James S" uniqKey="Wolffsohn J" first="James S" last="Wolffsohn">James S. Wolffsohn</name><affiliation wicri:level="3"><nlm:affiliation>Aston University, Birmingham, UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Aston University, Birmingham</wicri:regionArea><placeName><settlement type="city">Birmingham</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Midlands de l'Ouest</region></placeName></affiliation></author></analytic><series><title level="j">The ocular surface</title><idno type="eISSN">1937-5913</idno><imprint><date when="2017" type="published">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.</div></front></TEI><pubmed><MedlineCitation Status="In-Process" Owner="NLM"><PMID Version="1">28736341</PMID><DateCreated><Year>2017</Year><Month>07</Month><Day>24</Day></DateCreated><DateRevised><Year>2017</Year><Month>07</Month><Day>25</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1937-5913</ISSN><JournalIssue CitedMedium="Internet"><Volume>15</Volume><Issue>3</Issue><PubDate><Year>2017</Year><Month>Jul</Month></PubDate></JournalIssue><Title>The ocular surface</Title><ISOAbbreviation>Ocul Surf</ISOAbbreviation></Journal><ArticleTitle>TFOS DEWS II iatrogenic report.</ArticleTitle><Pagination><MedlinePgn>511-538</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S1542-0124(17)30104-0</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.jtos.2017.05.004</ELocationID><Abstract><AbstractText>Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.</AbstractText><CopyrightInformation>Copyright © 2017 Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Gomes</LastName><ForeName>José Alvaro P</ForeName><Initials>JAP</Initials><AffiliationInfo><Affiliation>Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil. Electronic address: japgomes@uol.com.br.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Azar</LastName><ForeName>Dimitri T</ForeName><Initials>DT</Initials><AffiliationInfo><Affiliation>University of Illinois College of Medicine, Chicago, IL, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baudouin</LastName><ForeName>Christophe</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Quinze-Vingts National Eye Hospital & Vision Institute, Paris, France.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Efron</LastName><ForeName>Nathan</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hirayama</LastName><ForeName>Masatoshi</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Horwath-Winter</LastName><ForeName>Jutta</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Ophthalmology, Medical University Graz, Austria.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Terry</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mehta</LastName><ForeName>Jodhbir S</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Singapore National Eye Centre, Singapore.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Messmer</LastName><ForeName>Elisabeth M</ForeName><Initials>EM</Initials><AffiliationInfo><Affiliation>Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Pepose</LastName><ForeName>Jay S</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Washington University School of Medicine, St. Louis, MO, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sangwan</LastName><ForeName>Virender S</ForeName><Initials>VS</Initials><AffiliationInfo><Affiliation>L V Prasad Eye Institute, Hyderabad, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Weiner</LastName><ForeName>Alan L</ForeName><Initials>AL</Initials><AffiliationInfo><Affiliation>DrugDel Consulting, LLC, Peoria, AZ, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wilson</LastName><ForeName>Steven E</ForeName><Initials>SE</Initials><AffiliationInfo><Affiliation>Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wolffsohn</LastName><ForeName>James S</ForeName><Initials>JS</Initials><AffiliationInfo><Affiliation>Aston University, Birmingham, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2017</Year><Month>07</Month><Day>20</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Ocul Surf</MedlineTA><NlmUniqueID>101156063</NlmUniqueID><ISSNLinking>1542-0124</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Contact lens</Keyword><Keyword MajorTopicYN="N">Cosmetic</Keyword><Keyword MajorTopicYN="N">Drug related adverse reactions</Keyword><Keyword MajorTopicYN="N">Drug related side effects</Keyword><Keyword MajorTopicYN="N">Drug toxicity</Keyword><Keyword MajorTopicYN="N">Dry eye</Keyword><Keyword MajorTopicYN="N">Iatrogenic disease</Keyword><Keyword MajorTopicYN="N">Surgery</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2017</Year><Month>04</Month><Day>29</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2017</Year><Month>05</Month><Day>02</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2017</Year><Month>7</Month><Day>25</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">28736341</ArticleId><ArticleId IdType="pii">S1542-0124(17)30104-0</ArticleId><ArticleId IdType="doi">10.1016/j.jtos.2017.05.004</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Autriche</li><li>Brésil</li><li>France</li><li>Inde</li><li>Japon</li><li>Royaume-Uni</li><li>Singapour</li><li>États-Unis</li></country><region><li>Angleterre</li><li>Arizona</li><li>Bavière</li><li>Caroline du Nord</li><li>District de Haute-Bavière</li><li>Illinois</li><li>Midlands de l'Ouest</li><li>Missouri (État)</li><li>Ohio</li><li>Région de Kantō</li><li>État de São Paulo</li><li>Île-de-France</li></region><settlement><li>Birmingham</li><li>Munich</li><li>Paris</li><li>Saint-Louis (Missouri)</li><li>Tokyo</li></settlement><orgName><li>Université Louis-et-Maximilien de Munich</li><li>École de médecine (Université Washington de Saint-Louis)</li></orgName></list><tree><country name="Brésil"><region name="État de São Paulo"><name sortKey="Gomes, Jose Alvaro P" sort="Gomes, Jose Alvaro P" uniqKey="Gomes J" first="José Alvaro P" last="Gomes">José Alvaro P. Gomes</name></region></country><country name="États-Unis"><region name="Illinois"><name sortKey="Azar, Dimitri T" sort="Azar, Dimitri T" uniqKey="Azar D" first="Dimitri T" last="Azar">Dimitri T. Azar</name></region><name sortKey="Kim, Terry" sort="Kim, Terry" uniqKey="Kim T" first="Terry" last="Kim">Terry Kim</name><name sortKey="Pepose, Jay S" sort="Pepose, Jay S" uniqKey="Pepose J" first="Jay S" last="Pepose">Jay S. Pepose</name><name sortKey="Weiner, Alan L" sort="Weiner, Alan L" uniqKey="Weiner A" first="Alan L" last="Weiner">Alan L. Weiner</name><name sortKey="Wilson, Steven E" sort="Wilson, Steven E" uniqKey="Wilson S" first="Steven E" last="Wilson">Steven E. Wilson</name></country><country name="France"><region name="Île-de-France"><name sortKey="Baudouin, Christophe" sort="Baudouin, Christophe" uniqKey="Baudouin C" first="Christophe" last="Baudouin">Christophe Baudouin</name></region></country><country name="Australie"><noRegion><name sortKey="Efron, Nathan" sort="Efron, Nathan" uniqKey="Efron N" first="Nathan" last="Efron">Nathan Efron</name></noRegion></country><country name="Japon"><region name="Région de Kantō"><name sortKey="Hirayama, Masatoshi" sort="Hirayama, Masatoshi" uniqKey="Hirayama M" first="Masatoshi" last="Hirayama">Masatoshi Hirayama</name></region></country><country name="Autriche"><noRegion><name sortKey="Horwath Winter, Jutta" sort="Horwath Winter, Jutta" uniqKey="Horwath Winter J" first="Jutta" last="Horwath-Winter">Jutta Horwath-Winter</name></noRegion></country><country name="Singapour"><noRegion><name sortKey="Mehta, Jodhbir S" sort="Mehta, Jodhbir S" uniqKey="Mehta J" first="Jodhbir S" last="Mehta">Jodhbir S. Mehta</name></noRegion></country><country name="Allemagne"><region name="Bavière"><name sortKey="Messmer, Elisabeth M" sort="Messmer, Elisabeth M" uniqKey="Messmer E" first="Elisabeth M" last="Messmer">Elisabeth M. Messmer</name></region></country><country name="Inde"><noRegion><name sortKey="Sangwan, Virender S" sort="Sangwan, Virender S" uniqKey="Sangwan V" first="Virender S" last="Sangwan">Virender S. Sangwan</name></noRegion></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Wolffsohn, James S" sort="Wolffsohn, James S" uniqKey="Wolffsohn J" first="James S" last="Wolffsohn">James S. Wolffsohn</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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