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array:24 [ "pii" => "S2173579420300384" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.01.009" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1625" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:164-70" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120300332" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.01.006" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1625" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:164-70" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Nuevo abordaje anestésico en la cirugía de glaucoma: anestesia subtenoniana ampular y su influencia en el resultado a medio plazo" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "164" "paginaFinal" => "170" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "New anesthetic approach in glaucoma surgery: “Underbleb” subtenonian anesthesia and its influence in medium term outcome" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1675 "Ancho" => 2218 "Tamanyo" => 130378 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">PIO media pre y posquirúrgicas a lo largo de 24 meses en ambos grupos: anestesia subtenoniana (ASA) y peribulbar (AP).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Martínez Díaz, F. González López, N. Puerto Amorós, A. Moreno Valladares" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Martínez Díaz" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "González López" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Puerto Amorós" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Moreno Valladares" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579420300384" "doi" => "10.1016/j.oftale.2020.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420300384?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120300332?idApp=UINPBA00004N" "url" => "/03656691/0000009500000004/v2_202108150633/S0365669120300332/v2_202108150633/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579420300359" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.12.007" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1616" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:171-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Agreement in retinal nerve fiber layer values and comparison in children using two optical coherence tomography devices" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "171" "paginaFinal" => "177" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Grado de concordancia y diferencias entre los valores de capa de fibras nerviosas de la retina peripapilar en niños mediante dos tipos de tomografía de coherencia óptica espectral" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1784 "Ancho" => 2170 "Tamanyo" => 208539 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bland–Altman graph for establishing match between RNFLm of OCT Spectralis against OCT Cirrus. Values shown in micrometers (μm). Typical deviation: 5.01 μm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Ruiz Caro Larrea, L. Cabrejas Martínez, I. Mahíllo Fernández, M.A. Alonso Peralta, I. Jiménez-Alfaro Morote" "autores" => array:5 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Ruiz Caro Larrea" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Cabrejas Martínez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Mahíllo Fernández" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Alonso Peralta" ] 4 => array:2 [ "nombre" => "I." "apellidos" => "Jiménez-Alfaro Morote" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120300083" "doi" => "10.1016/j.oftal.2019.12.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120300083?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420300359?idApp=UINPBA00004N" "url" => "/21735794/0000009500000004/v1_202004240656/S2173579420300359/v1_202004240656/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579420300347" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.01.007" "estado" => "S300" "fechaPublicacion" => "2020-04-01" "aid" => "1627" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2020;95:159-63" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prevalence of <span class="elsevierStyleItalic">Demodex</span> spp. in eyelashes of a university’s population in Santiago, Chile" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "163" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de <span class="elsevierStyleItalic">Demodex</span> spp. en pestañas de una población universitaria en Santiago, Chile" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 775 "Ancho" => 1348 "Tamanyo" => 56050 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0090" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Presence of signs and/or symptoms of volunteers who tested positive for <span class="elsevierStyleItalic">Demodex</span> spp.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Correa Fontt, M. Mena Oliva, C. Pérez Campos, C. Alburquenque Ossandón" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Correa Fontt" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Mena Oliva" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Pérez Campos" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Alburquenque Ossandón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120300356" "doi" => "10.1016/j.oftal.2020.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120300356?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420300347?idApp=UINPBA00004N" "url" => "/21735794/0000009500000004/v1_202004240656/S2173579420300347/v1_202004240656/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "New anesthetic approach in glaucoma surgery: “Underbleb” subtenonian anesthesia and its influence in medium term outcome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "164" "paginaFinal" => "170" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Martínez Díaz, F. González López, N. Puerto Amorós, A. Moreno Valladares" "autores" => array:4 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Martínez Díaz" "email" => array:1 [ 0 => "monitxa10@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "F." "apellidos" => "González López" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Puerto Amorós" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Moreno Valladares" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevo abordaje anestésico en la cirugía de glaucoma: anestesia subtenoniana ampular y su influencia en el resultado a medio plazo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 891 "Ancho" => 1505 "Tamanyo" => 282100 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ampoule subtenon anesthesia (ASA). a) topical lidocaine. b) limbar conjunctival opening. c) subtenon injection of 1–2 ml 2% lidocaine in the direction of the superior rectus. d) Fornix-based conjunctival dissection, showing slight pharmacological midriasis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">At present, most ocular surgeries are performed with local anesthesia in order to minimize vital risk. Anesthesia techniques can be subdivided in posterior (retrobulbar, peribulbar and posterior subtenon) and anterior (topical, subconjunctival and anterior subtenon), each having its advantages and disadvantages associated to different types of anesthesia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Subtenon anesthesia (SA) is utilized at present in glaucoma surgery as a safe and effective option. SA was first proposed by Ritch and Liebmann in 1992 and supported by several studies that found similar efficacy and patient satisfaction compared to other types of anesthesia such as retrobulbar or subconjunctival.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to the risk of ocular perforation or orbital hemorrhage, posterior techniques in glaucoma surgery could increase intra-surgery intraocular pressure (IOP), facilitate neurotoxicity and the feared «wipe-out» in terminal glaucoma cases. On the other hand, even though anterior anesthesia techniques produce lower akinesia, they have demonstrated acceptable analgesia levels in utilizing smaller volumes of anesthetic without increasing IOP and exhibiting lower neurotoxicity.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In the group of anterior techniques, anterior subtenon exhibits the highest degree of akinesia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Even though topical anesthesia (TA) has also demonstrated to be an efficient and safe alternative for trabeculectomy, it is not always adequate because it does not produce akinesia, particularly in patients with poor cooperation and in long operations such as non-perforating deep sclerectomy (NPDS)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and could contribute to higher rates of intrasurgery complications.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A new variant of anterior SA technique devised in the Dept. of the authors is presented. This technique has been establishedthe anesthetic technique of choice in patients undergoing glaucoma surgery or combined cataract-glaucoma surgery. It has been defined as|as «ampular SA» (ASA) because it is applied from the limbar conjunctiva in the area of the filtration bleb to be, inserted (ASA), depositing the anesthetic in the subtenon space next to the insertion of the superior rectus muscle. The possible advantages thereof are presented below together with an evaluation of its repercussion on medium-term surgical success in NPDS filtrating surgery.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Design</span>: a retrospective and randomized case and control study.</p><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Study population</span>: a review of patients who underwent glaucoma surgery in the 2013–2015 period in the Glaucoma Unit of the Ophthalmology Department of the Albacete University Hospital Complex. Out of 190 surgeries, the study selected 128 patients diagnosed with simple chronic glaucoma who underwent NPDS or PHACO-NPDS surgery.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sample selection</span>: in order to diminish bias, groups were formed through a random selection of cases based on the type of anesthesia, creating 2 groups with comparable sizes, i.e., one that underwent ASA (n = 59) and a control group with peribulbar anesthesia (PA) (n = 38). The surgeries were performed by 3 surgeons specialized in glaucoma (NPA, AMV and FGL) utilizing the 2 types of anesthesia to the extent that they included the technique in their daily practice.</p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Anesthetic technique</span>: all patients received topical anesthetic comprising tetracaine and oxybuprocaine, in addition to 5% topical lidocaine (3 instillations every 5 min) during the preparation of the surgery. Similarly, all patients were administered slight sedation with remifentanil, controlled by the surgery and surgery anesthesia. Both the PA and the ASA technique were applied by the same surgeon who conducted the glaucoma operation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The PA technique was administered after disinfecting the skin with 10% iodine povidone on the inferotemporal quadrant utilizing a 23 gauge (G) retrobulbar needle at the join of the middle and lateral third of the inferior orbital edge, parallel to the orbital floor and tangential to the ocular globe in primary gaze position, with a mixture of 2% mepivacaine and 0.75% bupivacaine in equal proportions. In all cases a volume under 6 ml was applied followed by rubbing without using the honan balloon to avoid compressing of the ocular globe and waiting 15–20 min to prepare the surgical field.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">For the ASA technique, after preparing the surgical field with 5% iodine povidone and corneal fixation points with vicryl 7/0 s, contact TA was applied with a surgical sponge impregnated in 5% lidocaine on the superior limboconjunctival area. Subsequently, a minimum 1 mm incision was performed in the superior quadrants, either at 10 or 2 o’clock on the limbar conjunctiva, to locate the subtenon space (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A cannula was introduced (Abocath® 20 G flexible by Becton Dickinson Infusion Therapy Systems Inc. or a rigid 19 G curved anterior vitrectomy cannula), following the curvature of the ocular globe in the direction of the equator in the subtenon space, administering between 1−2 ml of 2% lidocaine and avoiding excessive conjunctival chemosis. The anesthetic effect was immediate, following which the conjunctival dissection was performed from the injection point.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The present nonperforating deep sclerectomy (NPDS) technique consists in a fornix based conjunctival dissection, application of 0.02% mitomycin C with 2 min of contact, performing a superficial 5 × 5 mm scleral flap and a deep 4 × 4 mm scleral flap, peeling the inner wall of Schlemm canal, placing the ESNOPER V-2000 (AJL Ophthalmic S.A.) scleral implant, suturing to the sclera and proceeding to conjunctival closure with vicryl 7/0 s.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Variables</span> and <span class="elsevierStyleItalic">statistical analysis</span>: the study analyzed the IOP variables and the drugs prior to surgery after 1 day, 1 week, 1 and 2. 3. 6. 12. 18 and 24 months after surgery. Intrasurgery complications and the need of rescue maneuvers were recorded. Complete surgical success was regarded as IOP ≤19 mmHg without medication, while IOP ≤19 mmHg with antiglaucoma medicaments was considered to be a partial success. Data collection and analysis were conducted with SPSS PASW Statistics 18 for Windows (SPSS Inc., Chicago, Illinois, USA). Mean values of each variable and standard deviation as dispersion measure are described. To determine the existence of statistically significant differences, the T for student test was applied for quantitative variables and the Chi square test for qualitative variables. Statistical significance was given to a value of p < 0.05.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study was conducted in accordance with the ethical standards set forth in the Helsinki declaration. All patients signed an informed consent prior to surgical treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">No significant differences were found for age, sex, type of surgery, laterality and number of previous medicaments between the 2 compared groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). Overall, 38 surgeries were performed with PA and 59 with ASA. In addition, 22 surgeries were performed by a surgeon with the initials of NPA, 52 by AMV and 23 by FGL, maintaining the same percentage of distribution in both groups. As regards gender, 52 patients were males and 45 were females, with a slightly higher percentage of males in the PA group (57%). Out of all patients, 26 underwent surgery with NPDS (26.8%) and 71 underwent PHACO-NPDS (73.2%). During the follow-up period, 5 patients were lost due to demise and 1 dropped out.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Presurgery IOP was slightly higher in the group of cases when compared to the control group: 23.69 <span class="elsevierStyleBold">±</span> 5.29 vs. 21.18 ± 4.23. However no significant differences were found between both groups (p = 0.112). Similarly, significant differences were not found in the number of presurgery medicaments (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). In what concerns complications derived from the anesthetic technique, none of the cases exhibited ocular perforation although one orbital hemorrhage occurred in the PA group that was resolved with canthotomy which did not prevent the execution of the surgery. Intra-op complications for ASA were 0%, whereas 10.5% of intra-surgery complications were observed in the PA group (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">As regards IOP reduction, in the surgery with ASA it diminished similarly to the reduction in the control group, without exhibiting significant differences up to month 24. when IOP was 2 mm lower in the ASA group, with the difference being statistically significant (p = 0.009) (14.83 ± 2.87 vs. 17.61 ± 4.27) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). These differences were maintained in the NPDS (13.33 ± 3.05 vs. 18.78 ± 3.45. with p = 0.036) as well as in the PHACO-NPDS (15.5 ± 2.85 vs. 17.14 ± 4.5. p = 0.086) groups, without differences observed for surgery type.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The number of postoperative medicaments was slightly lower in the ASA group at 3. 6. and 18 months, and slightly higher at 24 months, without reaching statistical significance in any of the above described periods (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In what concerns complete and partial success at 24 months, the results were similar for both groups, with a slightly higher number for the cases group which reached 62.5% vs. 51.6% of complete success (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) and partial success of 100% in the cases group vs. 71% in the control group.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">According to the study by Guijarro-Oria et al., SA achieved adequate analgesia in filtrating surgery associated or not to cataract surgery, with little or no pain at administration as well as during the surgery and in the postoperative period. Satisfaction rates of patients as well as surgeons were very high.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Specifically, the modified ASA technique of the authors provides this type of anesthesia and the added advantage that it produces a nontraumatic dissection because a slight edema arises in the conjunctiva, protecting it from possible tears in the area of the future filtration bleb, making it particularly advantageous in fragile conjunctivas. The cases group of this study did not exhibit any severe complication related to the anesthesia apart from a few cases of chemosis and some subconjunctival hemorrhage which were not an obstacle for the execution of the scheduled operation.</p><p id="par0100" class="elsevierStylePara elsevierViewall">An additional significant advantage when compared to PA is the low injected volume. With the modified ASA technique described herein, only 1 or 2 ml of 2% lidocaine are sufficient to produce akinesia of the superior rectus muscle, which is one third of the anesthesia required for the PA technique. This reduction diminishes neurotoxicity risks in patients affected by glaucomatous optic neuropathy. In addition, it does not produce modifications of IOP nor alter vascular flow. Another advantage is that the period of analgesia is longer, constituting a safe and effective option.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">It should also be emphasized that the complications profile with AS is very low. Retrobulbar hemorrhage and ocular globe perforations, related to the injection applied in the peri-and retrobulbar anesthesia<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5,7</span></a> are an exceptional occurrence, involving low risk of hemorrhage which the authors consider to be even lower in their ASA variant.</p><p id="par0110" class="elsevierStylePara elsevierViewall">A drawback associated to PA is that, as in retrobulbar anesthesia, it tends to increase IOP and decrease ocular blood flow. This could give rise to complications such as retinal and choroidal vascular occlusions as well as optical atrophy.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This does not occur in the techniques described above.</p><p id="par0115" class="elsevierStylePara elsevierViewall">An additional possible advantage is that, in the case of reoperations, the application of the ASA technique involves administering the fluid directly into the subtenon space in the surgical area, and this can assist in separating the conjunctiva and Tenon’s capsule from the episclera, thus facilitating conjunctival dissection and raising the area with less adherence.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,8</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In what concerns the influence of the anesthetic technique in the success of filtrating surgery, the present study has evidence that the ASA technique did not have a negative influence, exhibiting post-surgery pressure control similar to that of PA, which exhibited even better control at 24 months. The hypothesis we propose is that the direct administration of lidocaine in the surgical area facilitates Tenon capsule dissection, a crucial step for the surgical success of filtrating surgery. In addition, the atraumatic cannula establishes direct communication between the filtration bleb with the posterior subtenon space, increasing the diffusion surface as confirmed by the fact that the ASA group exhibited 2 cases of post-surgery hypotonia which resolved spontaneously.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The deleterious effect of the subconjunctival administration of lidocaine in the area of the filtration bleb is controversial. On the one hand, the literature describes increased risk of surgery failure due to stimulating the migration and proliferation of fibroblasts associated to the risk of bleeding during administration when applied subconjunctivally with a needle,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> whereas on the other it has been reported that the subconjunctival administration could slow down fibroblast migration<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and thus contribute to long-term success.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The present efficacy results would confirm the second hypothesis, with the peculiarity that as the anesthetic is administered with a blunt-tipped cannula, the risk of added subconjunctival bleeding in the surgical area is very small.</p><p id="par0130" class="elsevierStylePara elsevierViewall">As regards the type of cannula utilized for SA, a study by Riad et al. confirmed that a flexible as well as a rigid posterior cannulae produced similar anesthetic effectiveness.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In the present case, surgeons NPA and FGL utilized the flexible Abocath type while AMV utilized the 19 G rigid curved cannula without producing statistically significant differences.</p><p id="par0135" class="elsevierStylePara elsevierViewall">TA is a widely used additional option in ophthalmological surgery as it provides adequate analgesia and a number of advantages including early visual recovery and the absence of complications related to the injection. In addition, it does not modify the IOP, demonstrates similar controls in the medium-term and can be specially useful in patients with highly reduced visual fields or poor visual acuity. However, TA is not widespread in glaucoma surgery due to its longer duration and because it requires sufficient surgeon experience.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,13–16</span></a> Another significant disadvantage is that TA does not produce akinesia, which limits its use to cooperative patients and could facilitate the appearance of complications due to unexpected movements in addition to increasing operative surgeon stress.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Very few published articles have studied SA in comparison with peribulbar in patients who underwent NPDS, due to the fact that most have been conducted on trabeculectomy and cataract surgery, which emphasizes the originality of the present study. The limitations of this study include its retrospective and observational design which diminishes scientific evidence due to not being a randomized clinic trial.</p><p id="par0145" class="elsevierStylePara elsevierViewall">To end, an additional advantage observed in relation to PA is surgery time. The present ASA variant allows the surgeon to begin operating just after its administration due to being applied in the surgical area. This in some cases involves up to 15–20 min less surgery time compared to the standard procedure.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0150" class="elsevierStylePara elsevierViewall">The present ASA variant allows the execution of NPDS filtrating glaucoma surgery in a safe manner, diminishing the volume of anesthetic and shortening surgery time. This technique does not have a negative influence in midterm pressure control in nonperforating surgery and could contribute to longer term surgical success. Additional studies should be conducted to confirm and expand on the present results.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1328688" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1224520" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1328689" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1224521" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-19" "fechaAceptado" => "2020-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1224520" "palabras" => array:4 [ 0 => "Peribulbar" 1 => "Anesthesia" 2 => "Deep sclerectomy" 3 => "Glaucoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1224521" "palabras" => array:4 [ 0 => "Peribulbar" 1 => "Anestesia" 2 => "Esclerectomía profunda" 3 => "Glaucoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To present a new anterior subtenonian anesthesia approach in the area of the future filtration bleb and its influence on medium term surgical success.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of 97 surgeries, deep sclerectomy (DS) or phaco-deep sclerectomy (PHACO-DS), were performed in patients with open angle glaucoma (OAG) comparing our modified “underbleb” subtenonian anesthesia (USA) (n = 58) versus a control group under peribulbar anesthesia (PA) (n = 38). Main outcomes were intraocular pressure (IOP), number of antiglaucomatous drugs and total and qualificated success, compared during 1, 3, 6, 12, 18 and 24 months follow up after glaucoma surgery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Both groups were comparable in terms of age, gender, surgical technique, number of antiglaucoma drugs and preoperative IOP. The IOP in the USA group decreased as in PA control group without statistical significant differences except at 24 months, where the IOP was 2 mm lower (14.83 ± 2.87 vs. 17.61 ± 4.27 (p = 0.009). This happened for both, DS and PHACO-DS surgeries. The number of postoperative drugs was lower at 3, 6, and 18 months but without statistically significant diferences. Tottal success at 24 months was higher in the ASA group respect AP control group (62.5% vs. 51.6) as well as partial success (100% vs. 71%).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Our new USA anesthetic technique doesn`t have a negative impact in deep sclerectomy medium-term surgical success, even it could contribute to it´s longer-term improvement.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">presentar una nueva variante de anestesia subtenoniana, en el área quirúrgica de la futura ampolla de filtración y su influencia en el éxito quirúrgico a medio plazo.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">estudio retrospectivo de 97 cirugías (EPNP o FACO-EPNP) realizadas en pacientes con glaucoma crónico simple (GCS) comparando aquellas realizadas bajo nuestra técnica de anestesia subtenoniana anterior modificada “subampular” (ASA) frente a otro grupo control bajo anestesia peribulbar (AP) (n = 58 vs 38). Se contrastaron la PIO, número de fármacos antiglaucomatosos y porcentaje de éxito total y parcial a 1, 3, 6, 12, 18 y 24 meses tras la cirugía.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">ambos grupos fueron comparables en términos de edad, sexo, tipo de cirugía, numero de fármacos y PIO preoperatoria. La PIO en el grupo intervenido bajo ASA descendió de forma similar respecto al grupo control sin diferencias significativas salvo en los 24 meses, donde la PIO fue 2 mm menor 14,83 +/- 2,87 vs 17,61+/-4,27 p = 0,009. Esto sucedió tanto para EPNP como para la FACO-EPNP. El número de fármacos postoperatorios fue algo menor a los 3, 6, y 18 meses pero no estadísticamente significativo. El éxito total a los 24 meses fue mayor en el grupo de ASA respecto al control AP (62,5 % vs 51,6) al igual que el éxito parcial (100% vs 71%)</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Nuestra nueva técnica anestésica ASA no influye negativamente en el control tensional a medio plazo de la cirugía no perforante, sino que incluso podría contribuir al éxito quirúrgico a más largo plazo.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez Díaz M, González López F, Puerto Amorós N, Moreno Valladares A. Nuevo abordaje anestésico en la cirugía de glaucoma: anestesia subtenoniana ampular y su influencia en el resultado a medio plazo. Arch Soc Esp Oftalmol. 2020;95:164–170.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 891 "Ancho" => 1505 "Tamanyo" => 282100 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ampoule subtenon anesthesia (ASA). a) topical lidocaine. b) limbar conjunctival opening. c) subtenon injection of 1–2 ml 2% lidocaine in the direction of the superior rectus. d) Fornix-based conjunctival dissection, showing slight pharmacological midriasis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1681 "Ancho" => 2173 "Tamanyo" => 154351 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mean preop and postop IOP values through 24 months in both groups: subtenon (ASA) and peribulbar anesthesia (PA).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1548 "Ancho" => 2111 "Tamanyo" => 123553 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mean number of pre-op and postop drugs through 24 months in both groups: subtenon ampular (ASA) and peribulbar anesthesia (PA).</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1554 "Ancho" => 2156 "Tamanyo" => 179200 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Percentage of surgeries with complete success in both groups: peribulbar (PA) vs. subtenon ampoule anestesia (ASA) up to 24 months follow-up.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Data shown as mean± standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cases (n = 59) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controls (n = 38) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Significance \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.2 ± 9.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.03 ± 7.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.112 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preop IOP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.69 ± 5.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.18 ± 4.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.143 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IOP 2 years after surgery (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.83 ± 2.871 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.61 ± 4.271 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Preop drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.59 ± 0.812 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.55 ± 0.760 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.806 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Drugs 2 years after surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.67 ± 0.963 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.56 ± 0.983 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.694 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2277509.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparison in case and control groups for age, pre-op and postop IOP, pre-op and postop drugs.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cases (n = 59) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controls (n = 38) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Anesthetic technique complications</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ocular perforation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Orbital hemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Intraop complications</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (89.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Microperforation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Perforation + iridectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Anterior chamber bleeding \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Postop complications</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No complications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (94.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 (94.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Seidel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypotonic maculopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hypotony after goniopuncture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2277508.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Intraop and postop complications in both groups: cases (ampular subtenon) and controls (peribulbar).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:16 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessing the quality of ophthalmic anesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. 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