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Herxes are caused by treating the disease with medications and antimicrobials and the sickness that follows is from pathogen die off

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Alterations in acylcarnitine metabolism in the retina and retinal pigment epithelium/choroid tissue, especially decreased concentrations of short-chain or medium-chain odd-numbered acylcarnitine, may play a key role in accelerating the development of choroidal neovascularization and age-related macular degeneration [316]