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Axial CT scan. Hyperdense mass in RE with defined borders that do not exceed the globe. B. Histopathology macroscopic imaging correlation with ultrasound imaging. C. Histopathology macroscopic imaging. D. Histopathology microscopic imaging reports the presence of polygonal cells with an epithelioid appearance with moderate cytoplasm, round or oval nucleus and vesiculosus nucleolus with prominent eosinophils. There is abundant mitosis (7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>40). There are nests of neoplastic cells that are mixed with necrosis zones.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Corzo-Camberos, D. Alvarez-Ascencio, D. Martinez-Trujillo, C. Becerra-Revollo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Corzo-Camberos" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Alvarez-Ascencio" ] 2 => array:2 [ "nombre" => "D." 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"apellidos" => "Pérez-López" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123001612" "doi" => "10.1016/j.oftal.2023.07.014" "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/S0365669123001612?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001433?idApp=UINPBA00004N" "url" => "/21735794/0000009900000001/v1_202401090457/S2173579423001433/v1_202401090457/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Ocular involvement secondary to Monkeypox virus infection" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "33" "paginaFinal" => "37" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Trawally Flores, I.I. Guedes Guedes, J.P. Espinoza González, E. Jerez Olivera, L. Siguero Martín, J. Pérez Álvarez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Trawally Flores" "email" => array:1 [ 0 => "abu_telde7@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I.I." "apellidos" => "Guedes Guedes" ] 2 => array:2 [ "nombre" => "J.P." "apellidos" => "Espinoza González" ] 3 => array:2 [ "nombre" => "E." "apellidos" => "Jerez Olivera" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Siguero Martín" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Pérez Álvarez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, 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" => "Afectación ocular secundaria a la infección por Monkeypox virus" ] ] "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" => 418 "Ancho" => 1674 "Tamanyo" => 75638 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy (BMC) after positive PCR for Monkeypox virus: hyperemia, symblepharon, corneal ulcers and membranes with fibrin remnants were observed at a conjunctival level.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Monkeypox virus is a zoonotic disease caused by a double-stranded DNA virus belonging to the genus Orthopoxvirus, from the Poxviridae family. It is endemic to West and Central Africa, but the exact animal reservoir is unknown. Two variants from these endemic areas have been described; the less virulent and deadly Western variant was the one that caused the 2022 outbreak.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Animal-to-human transmission occurs through direct contact with body fluids, blood or cutaneous-mucosal lesions of infected animals. Human-to-human transmission occurs through close contact with respiratory secretions (droplets), mucosal skin lesions of infected people, or freshly contaminated fomites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The disease manifests with general symptoms such as fever, myalgia or lymphadenopathy. The most characteristic findings are skin rash with sequential evolution from macules to papules, vesicles and pustules. These are more frequent on the face (95%), palms of the hands and soles of the feet (75%) and oral (70%), genital (30%) or ocular (20%) mucous membranes. The condition is usually self-limiting, lasting around 2–4 weeks, and complications are rare. Ocular involvement is generally mild and occurs in 20–30% of those affected, with no significant visual impairment. Diagnosis can be difficult, as the clinical presentation may mimic common ophthalmic diseases such as preseptal cellulitis and conjunctivitis. It can cause severe ocular lesions when corneal involvement is present, which can gravely affect the patient's visual prognosis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Monkeypox virus diagnosis is difficult. Therefore, upon suspicion of the disease, it is important to collect an adequate sample. The main method for early identification is by conventional polymerase chain reaction (PCR) of skin or mucous samples.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The cornerstone of ophthalmological treatment consists of lubrication with artificial tears, removal of mucous membranes, as well as corticosteroids and broad-spectrum topical antibiotics if necessary. Other treatments described include: topical antiseptics such as Povidone-Iodine, topical Trifluridine 1% if there is corneal involvement, and the oral antiviral agent Tecovirimat, which acts by inhibiting the p37 protein located in the viral envelope, important in Orthopoxviruses since it facilitates their invasion of cells, thus preventing and reducing viral replication.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">We present the case of a male that developed unilateral keratoconjunctivitis due to Monkeypox virus diagnosed by PCR of conjunctival exudate, which advanced into various ocular complications requiring hospital admission for systemic treatment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0035" class="elsevierStylePara elsevierViewall">A 37-year-old Caucasian male, with no personal or ophthalmological history of interest arrived at the hospital emergency department with a 5-day history of eyelid oedema, hyperemia and secretions in the left eye (LE), without visual acuity (VA) alterations, associated with pain and preauricular adenopathy. Ophthalmological examination revealed a VA of 0.9 in both eyes, hyperemia and membranes adhered to the inferior tarsal conjunctiva of the left eye. Given the high suspicion of viral conjunctivitis, treatment with Tobramycin and topical Dexamethasone every 3 h (Tobradex®), artificial tears, hygienic measures and mucous pseudomembranes removal every 24 h was started. Two days after beginning treatment, the patient went for a check-up to continue with the pseudomembranes removal, and a marked clinical decline was observed despite good treatment compliance. Therefore, a conjunctival exudate study was performed, and the PCR was positive for Monkeypox virus. Vesicular lesions were also observed on the hands, feet and chest, compatible with the infection demonstrated by PCR (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">There was another clinical decline 24 h later with a decrease in VA to 0.6, associated with inflammatory corneal ulcers, symblepharon and fibrin remnants in the fornix. Fibrinous material was again removed from the inferior conjunctival fornix under topical anesthesia and washed with 5% Povidone-Iodine. Topical Ozonised Oil 0.5% (Ozonest®) was prescribed every 4 h and topical Ofloxacin (Exocin®) every 8 h due to the torpid symptom evolution.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Due to poor response to treatment, the patient continued to be monitored daily. During evolution the condition deteriorated even more, presenting a peripheral thinning halo with peripheral ulcerative keratitis. Since the patient's evolution was not as expected despite optimal treatment and compliance, the decision to repeat the PCR analysis was made, which was positive once again.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In view of the second positive PCR and the torpid evolution, the infectious diseases unit (<span class="elsevierStyleItalic">Unidad de Enfermedades Infecciosas</span>, UEI) was consulted and the decision to admit the patient to start topical and systemic antiviral treatment and to monitor treatment compliance was reached. General laboratory tests on admission were normal; in addition to the previous treatment, Ganciclovir 0.15% (Virgan®) in ophthalmic ointment 5 times a day and Tecovirimat (Tpoxx®) 600 mg oral (three 200 mg capsules) every 12 h for 14 days were prescribed.</p><p id="par0055" class="elsevierStylePara elsevierViewall">During admission the patient began to exhibit a marked improvement in the inflammatory keratoconjunctival symptoms, although symblepharon, epithelial irregularity with superficial punctate keratitis and residual leukoma in the mid-periphery persisted (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">One week after discharge a new PCR was performed, which was still positive. Therefore, the same topical treatment was maintained and the conjunctival exudate study was repeated one week later, with negative results. Following the favorable clinical evolution and negative test results, it was decided to withdraw the prescribed treatment and the patient was started on 20% Autologous Serum eye drops every 2 h, Fluorometholone eye drops (FML®) every 8 h and artificial tears every 3 h, which was maintained as home treatment for 2 months, with good evolution.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After discharge, the patient was checked on weekly, with a positive evolution over the months. The last exam showed a VA of 1.0 in both eyes, with a faint central leukoma with small stromal vessels at the temporal limbus level and symblepharon (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and thus it was decided to continue topical treatment with Fluorometholone eye drops (FML®) once a day and artificial tears on demand until definitive discharge once clinical stability had been confirmed.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Ocular involvement by Monkeypox virus is usually mild and self-limiting. In our case, the patient presented a severe conjunctivitis with corneal involvement leading to a reduction in VA, although a final value of 1 was found in the affected eye. The main method for early identification of Monkeypox virus is by PCR of skin or mucosal samples; in this case, diagnosis was made by PCR of conjunctival exudate obtained with a swab.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The cornerstone of ophthalmological treatment consists of general measures such as lubrication and removal of membranes adhering to the tarsus. If bacterial co-infection is suspected, broad-spectrum topical antibiotics should be prescribed. The use of topical corticosteroids decreases inflammatory reactions, but they should not be applied without a simultaneous topical antiviral therapy, since it could favor the persistence of the virus and increase the complications derived from the infectious process. Other treatments described include topical antiseptics such as Povidone-Iodine.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The current consensus in literature for the treatment of systemic and ophthalmic lesions is Tecovirimat. Based on available studies, treatment with oral Tecovirimat 600 mg every 12 h for 14 days is useful in cases with severe systemic involvement, persistent infection, or when there is significant ocular involvement. This drug acts by inhibiting the p37 protein located in the viral envelope that allows Orthopoxviruses to invade host cells.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a> In this case, given the poor evolution of the condition, the PCR test was repeated and remained persistently positive. A multidisciplinary approach was determined, and clinical management was discussed with the UEI to optimize treatment strategies. Systemic antiviral treatment was started with Tecovirimat (Tpoxx®) and topical treatment with Ganciclovir (Virgan®), with evident clinical improvement after starting the systemic treatment.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Topical Trifluridine 1% could be used as a specific treatment for ocular involvement, it has been shown to be useful in cases of corneal involvement by Orthopoxvirus and is only available in Spain through a foreign drug application to the Spanish Agency for Medicines and Health Products (Agencia Española de Medicamentos y Productos Sanitarios, AEMPS). The World Health Organization (WHO) recommends its use as a treatment against Monkeypox virus and some studies have already demonstrated its efficacy. It is recommended to avoid continuous administration for more than 21 days due to ocular surface toxicity.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–10</span></a> Our patient did not need to use this drug.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In summary, we report a case of ocular involvement by Monkeypox virus that was diagnosed by PCR and treated with 5% Povidone-Iodine, topical Ofloxacin (Exocin®), as well as topical Ganciclovir 0.15% (Virgan®) and systemic treatment with oral Tecovirimat (Tpoxx®) similar to the case documented by Ly-Yang et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Unlike the latter, in our case topical Ozonised Oil 0.5% (Ozonest®) was added, and it was not necessary to use intravenous Acyclovir or topical Chlorhexidine 0.2%, thus avoiding the side effects associated with these drugs. The improvement our patient showed after starting systemic treatment with oral Tecovirimat (Tpoxx®) and topical Ganciclovir 0.15% (Virgan®) was particularly relevant; in addition, 20% Autologous Serum eye drops were used to treat residual corneal lesions. On the other hand, Fluorometholone eye drops were used as a follow-up treatment in both patients, with a favorable evolution.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Ocular involvement by Monkeypox virus is usually mild, self-limiting and typically presents with non-specific signs and symptoms such as preseptal cellulitis, conjunctival hyperemia, photosensitivity and secretions, without relevant visual involvement. In more severe cases it can cause corneal involvement leading to leukomas and loss of vision.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The main treatment consists of general measures such as the use of artificial tears and removal of mucous membranes. The use of topical corticosteroids decreases the immune reaction but should not be applied without simultaneous topical antiviral therapy as it may increase the risk of complications. The current consensus for treatment of Monkeypox virus is oral Tecovirimat, 600 mg every 12 h for 14 days in severe cases, persistent infection, or in case of ocular involvement.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Rapid recognition and diagnosis by PCR of skin or mucosal samples is essential to prevent transmission and early initiation of treatment to avoid ocular complications.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0110" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0115" class="elsevierStylePara elsevierViewall">No conflicts of interests were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2070136" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1766290" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2070137" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1766291" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-08-06" "fechaAceptado" => "2023-10-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1766290" "palabras" => array:4 [ 0 => "Monkeypox virus" 1 => "Conjunctivitis" 2 => "Keratitis" 3 => "Tecovirimat" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1766291" "palabras" => array:4 [ 0 => "Monkeypox virus" 1 => "Conjuntivitis" 2 => "Queratitis" 3 => "Tecovirimat" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 37-year-old male patient with symptoms compatible with adenoviral conjunctivitis of 5 days' evolution. Topical corticosteroids, lubricants and removal of pseudomembranes were prescribed. PCR analysis of conjunctival exudate was positive for Monkeypox virus. During follow-up, the patient developed corneal ulcers with a torpid course, requiring admission for treatment with Tecovirimat. Ocular involvement by Monkeypox virus is usually mild and self-limiting. Cases with severe visual involvement have been described when there is corneal damage, as exemplified in this case. After admission to hospital for systemic treatment, the patient progressed favourably.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de paciente varón de 37 años con cuadro compatible con conjuntivitis adenovírica de 5 días de evolución. Se pautó corticoides tópicos, lubricantes y retirada de pseudomembranas. El análisis mediante PCR del exudado conjuntival resultó positivo para Monkeypox virus. Durante el seguimiento presentó úlceras corneales de evolución tórpida, por lo que precisó ingreso para instaurar tratamiento con Tecovirimat. La afectación ocular por Monkeypox virus suele ser leve y autolimitada. Se han descrito casos con afectación visual severa cuando hay daño corneal, tal y como se ejemplifica en este caso. Tras el ingreso hospitalario para tratamiento sistémico, presentó evolución favorable.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 418 "Ancho" => 1674 "Tamanyo" => 75638 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Biomicroscopy (BMC) after positive PCR for Monkeypox virus: hyperemia, symblepharon, corneal ulcers and membranes with fibrin remnants were observed at a conjunctival level.</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" => 1153 "Ancho" => 2240 "Tamanyo" => 273255 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BMC after admission and treatment with Tecovirimat: an improvement of the corneal ulcers can be observed, with peripheral halo without thinning persistence (A and B) during the first week of admission. After completing the treatment, the evolution was favorable, although residual symblepharon (C), epithelial irregularity with superficial punctate keratitis (D and E) and residual leukoma measuring 1.5 × 1 mm (F) persisted.</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" => 914 "Ancho" => 1207 "Tamanyo" => 143209 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CMB at discharge: the cornea shows no epithelial involvement (A) with stromal vessels at the inferior temporal level (B), inferior fornix symblepharon (C) and central leukoma (D).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monkeypox virus: a re-emergent threat to humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Q. 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Ocular involvement secondary to Monkeypox virus infection
Afectación ocular secundaria a la infección por Monkeypox virus
A. Trawally Flores
, I.I. Guedes Guedes, J.P. Espinoza González, E. Jerez Olivera, L. Siguero Martín, J. Pérez Álvarez
Corresponding author
Servicio de Oftalmología, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain