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array:24 [ "pii" => "S2173579419300726" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.02.002" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1479" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:343-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669119300620" "issn" => "03656691" "doi" => "10.1016/j.oftal.2019.02.001" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1479" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:343-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 38 "formatos" => array:2 [ "HTML" => 12 "PDF" => 26 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Permanencia de la membrana de Descemet y del endotelio receptor tras queratoplastia penetrante. A propósito de un caso clínico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "346" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Persistence of Descemet membrane and recipient-type endothelium after keratoplasty. A case report" ] ] "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" => 861 "Ancho" => 905 "Tamanyo" => 80898 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Visualización con lámpara de hendidura tras endoteliotomía YAG. OCT de segmento anterior tras endoteliotomía YAG.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Tabuenca-del Barrio, O. Iturralde-Errea, M. Mozo-Cuadrado, A. Zubicoa-Enériz, P. Plaza-Ramos" "autores" => array:5 [ 0 => array:2 [ "nombre" => "L." "apellidos" => "Tabuenca-del Barrio" ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Iturralde-Errea" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Mozo-Cuadrado" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zubicoa-Enériz" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Plaza-Ramos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579419300726" "doi" => "10.1016/j.oftale.2019.02.002" "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/S2173579419300726?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669119300620?idApp=UINPBA00004N" "url" => "/03656691/0000009400000007/v2_202201280816/S0365669119300620/v2_202201280816/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579419300544" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.01.007" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1474" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:347-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Combined intrastromal injection of ganciclovir and depot betamethasone for the management of nummular keratitis: Case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "347" "paginaFinal" => "351" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Inyección intraestromal combinada con ganciclovir y betametasona de depósito para el manejo de la queratitis numular: serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 909 "Ancho" => 805 "Tamanyo" => 84997 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cornea of an eye with nummular keratitis. (A) Before treatment. (B) After treatment with intra-stromal application of depot betamethasone and ganciclovir. Complete resolution of lesions can be observed</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Arenas, A. Mieth, D. Muñoz" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Arenas" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Mieth" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Muñoz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119300413" "doi" => "10.1016/j.oftal.2019.01.009" "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/S0365669119300413?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300544?idApp=UINPBA00004N" "url" => "/21735794/0000009400000007/v1_201907010945/S2173579419300544/v1_201907010945/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579419300738" "issn" => "21735794" "doi" => "10.1016/j.oftale.2019.03.002" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1489" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:337-42" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "342" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El ojo seco está relacionado a un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Cartes, D. López, D. Salinas, C. Segovia, C. Ahumada, N. Pérez, F. Valenzuela, N. Lanza, R.O. López Solís, V.L. Perez, P. Zegers, A. Fuentes, C. Alarcón, L. Traipe" "autores" => array:14 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Cartes" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "López" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Salinas" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Segovia" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Ahumada" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Pérez" ] 6 => array:2 [ "nombre" => "F." "apellidos" => "Valenzuela" ] 7 => array:2 [ "nombre" => "N." "apellidos" => "Lanza" ] 8 => array:2 [ "nombre" => "R.O." "apellidos" => "López Solís" ] 9 => array:2 [ "nombre" => "V.L." "apellidos" => "Perez" ] 10 => array:2 [ "nombre" => "P." "apellidos" => "Zegers" ] 11 => array:2 [ "nombre" => "A." "apellidos" => "Fuentes" ] 12 => array:2 [ "nombre" => "C." "apellidos" => "Alarcón" ] 13 => array:2 [ "nombre" => "L." "apellidos" => "Traipe" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669119300887" "doi" => "10.1016/j.oftal.2019.03.007" "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/S0365669119300887?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300738?idApp=UINPBA00004N" "url" => "/21735794/0000009400000007/v1_201907010945/S2173579419300738/v1_201907010945/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Persistence of Descemet membrane and recipient-type endothelium after keratoplasty. A case report" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "343" "paginaFinal" => "346" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Tabuenca-del Barrio, O. Iturralde-Errea, M. Mozo-Cuadrado, A. Zubicoa-Enériz, P. Plaza-Ramos" "autores" => array:5 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Tabuenca-del Barrio" "email" => array:1 [ 0 => "lauratabuillueca@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "O." "apellidos" => "Iturralde-Errea" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Mozo-Cuadrado" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Zubicoa-Enériz" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Plaza-Ramos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Complejo Hospitalario de Navarra, Pamplona, Navarra, 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" => "Permanencia de la membrana de Descemet y del endotelio receptor tras queratoplastia penetrante. A propósito de un caso clínico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 870 "Ancho" => 905 "Tamanyo" => 81003 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Persistence of receptor endothelium after penetrating keratoplasty under slit lamp. Anterior segment OCT showing endothelium persistence.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Penetrating keratoplasty is a corneal transplant type consisting in the substitution of all pathological corneal layers by those of a healthy donor in a single surgical operation. Indications for penetrating keratoplasty can be summarized in 4 large groups:</p><p id="par0010" class="elsevierStylePara elsevierViewall">1) Tectonic: applied in order to restore the corneal anatomy and resolve structural problems that could lead to corneal architecture disorders, either secondary to infections, traumatism, severe caustication or other diseases<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,2</span></a>; 2) therapeutic: when the aim is to alleviate pain. This is the case of corneal decompensation in which the imbalance between corneal layers leads to alterations in the more superficial layers with sensitive innervation, as occurs in bullous keratopathy<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>; 3) optical, for restoring corneal transparency and refractive stability through the substitution of an impaired cornea in order to improve visual acuity<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a>; and 4) cosmetic: for example, for improving the esthetics of a blind eye with poor appearance due to corneal opacification.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">1,3</span></a> As can be seen, there can be multiple indications for penetrating keratoplasty. The case presented herein is an example.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The possible complications of said technique in the post-surgery period include those related to the dehiscence of sutures, poor graft epithelization, rejection at various stages and increased astigmatism.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> However, the most feared complication is expensive hemorrhage that can occur during surgery and involve severe results for the eye. An additional infrequent complication discussed herein is the appearance of a retrocorneal membrane after said surgery. Different types of retrocorneal membranes could emerge after penetrating keratoplasty. The present article emphasizes the importance of adequate diagnostic and treatment of said complication.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinic case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">Male, 88, who consulted due to pain in the right eye with 3 months evolution. History included cataract surgery in both eyes 20 years ago, rhegmatogenous retinal detachment surgery in the right eye 14 years ago and epiretinal membrane surgery in the same eye 3 years ago.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Visual acuity is perception of light with +15 diopters in the right eye and 7/10 with −0.5 to 155° +15 diopters in the left eye. Right eye biomicroscopy shows advanced bullous keratopathy with band keratopathy and aphakia. Left eye was aphakic with operational cornea. Intraocular pressure was 14<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg in both eyes. Right eye fundus exhibited chorioretinal scars secondary to past retinal surgery, with normal results for the rest of the examination.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Considering the corneal decompensation and corresponding symptoms, it was decided to perform a conventional penetrating corneal transplant in the right eye in order to restore optical and esthetic function and to resolve the painful clinic. Symptomatic treatment with 5% sodium chloride was prescribed until surgery.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Surgery took place without complications, with the patient exhibiting very positive postop evolution with absence of pain and apparently correct apposition and suture of the graft. The checkup at month 4 revealed hand motion visual acuity, with biomicroscopy showing transparent graft with a separate opalescent membrane behind it (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). This arose the suspicion of persistence in receptor Descemet membrane and endothelium. Anterior segment OCT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) confirmed said membrane and revealed lack of contact with the donor endothelium, thus confirming the diagnostic. Regular checkups were maintained in the course of one year, during which the membrane gradually opacified. One year after surgery, sutures were removed without complications and it was decided to carry out YAG endotheliotomy due to the fact that the patient referred diminished visual acuity. Subsequently, the patient was checked up every month, with the graft remaining transparent and the endotheliotomy exhibiting stability (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), with visual acuity below 1/10. One year after endotheliotomy the patient remains stable, painless, with the remains of the receptor endothelium exhibiting whitish appearance, with free visual axis and graft endothelium count of 1253<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">2</span>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Various types of retrocorneal membranes can appear for different reasons after corneal transplant surgery, including: (1) membranes due to epithelial growth, due to an invasion of the anterior chamber by corneal and/or conjunctival epithelial cells, and to a proliferation thereof; (2) membranes due to fibrous growth caused by the release of fibroblanst products in the anterior chamber; (3) inflammatory membranes, where postop inflammation generates a thin retrocorneal layer; (4) persistence of the receiving Descemet membrane, a rare complication that appears after incomplete elimination of the receiving cornea; (5) donor Descemet membrane detachment, a more frequent complication after phacoemulsification surgery in which ocular manipulation could be aggressive for the graft.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The development of anterior segment optical coherence tomography (OCT) has significantly facilitated differential diagnostics between the various types of retrocorneal membranes. In the present case, said diagnostic test revealed the presence of a membrane anchored to the receptor bed, separated by a space of donor bed, which confirmed the diagnostic (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0050" class="elsevierStylePara elsevierViewall">As discussed above, the persistence of Descemet membrane and the receiving endothelium is an infrequent condition which could appear after penetrating keratoplasty. Said surgery involves complete trephination of the receptor cornea to create a bed on which the donor graft can be sutured.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The exact reason for which the patient endothelial layer remained intact after trephination is not known. Several causes have been proposed, including incomplete trephination of the cornea despite subsequent cutting with scissors, severe corneal edema causing the Descemet membrane to lose adhesion from the rest of layers, significant ocular globe hypotony and lastly cicatricial bed fibrosis in re-transplants.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> In the present case, after analyzing other mechanisms, viscodissection of the inner layers of the receiving cornea has been proposed to explain said occurrence. After non-perforating trephination, viscoelastic is injected in the anterior chamber before completing trephination with scissors. At this point, viscoelastic may not penetrate the interior chamber adequately, giving rise to a separation of said internal layers from the rest of the corneal thickness. This assumption has also been proposed by other authors.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Complications secondary to Descemet and endothelium persistence include optic complications due to the opacification of said membrane as well as increased graft failure risk due to contact of the receiving membrane with the endothelial cells of the donor cornea.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> Said complications can be approached in different manners, including observation to identify the appearance of possible opacity of the persisting membrane, Nd:YAG laser membranotomy when said opacity diminishes visual acuity, and surgical resection thereof, reserved for cases involving contact between both endothelium, in monocular diplopia or pharmacologically uncontrollable ocular hypertension.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In the present case involving opacity, it was decided to treat with Nd:YAG laser membranotomy using low energy and a small amount of light pulses. In addition, the literature describes cases in which the amount of endothelial cells in the donor bed and the graft ends in rejection after this technique. Accordingly, these cases require close follow-up.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">7,8</span></a> However, the present case did not cause rejection and one year after said membranotomy the graft maintains an adequate amount of endothelial cells (1253<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">2</span>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="par0070" class="elsevierStylePara elsevierViewall">The persistence of Descemet membrane and endothelium is an infrequent complication secondary to penetrating keratoplasty surgery. Even though it has been described in a range of publications, the experience of the authors provides a further case to the literature in which inadvertent viscodissection of receptor Descemet or endothelium appears to be the mechanism in play. In order to prevent said complication, trephination must be carried out meticulously together with manual retention of the iris during the operation to ensure that the full thickness is sectioned.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1213846" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1129522" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1213847" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1129521" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conclusions" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-31" "fechaAceptado" => "2019-02-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1129522" "palabras" => array:6 [ 0 => "Keratoplasty" 1 => "Corneal transplant" 2 => "Endothelium persistence" 3 => "Corneal surgery" 4 => "Descemet" 5 => "YAG" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1129521" "palabras" => array:6 [ 0 => "Queratoplastia" 1 => "Trasplante corneal" 2 => "Persistencia endotelial" 3 => "Cirugía corneal" 4 => "Descemet" 5 => "YAG" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A case is presented of a retained Descemet's membrane after penetrating keratoplasty, highlighting the importance of the anterior segment optical coherence tomography (OCT) in the diagnosis and treatment planning of keratoplasty complications.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A review of literature is also presented.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An 88 year-old man underwent penetrating keratoplasty for bullous keratopathy.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A retained host Descemet's membrane was detected. The retained membrane went unnoticed until the visual acuity decreased. The ophthalmological examination showed the presence of an opalescent membrane located below the endothelium, and was identified as the Descemet membrane of the receptor. Nd:YAG laser membranotomy was performed after the diagnosis.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To conclude, it is noted that the inadvertent retention of the host Descemet membrane is a rare complication in penetrating keratoplasty. The anterior segment OCT was used to determine the diagnosis, and Nd:YAG laser membranotomy is an indicated treatment in these cases.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El objetivo es describir un caso de persistencia de membrana de Descemet tras una queratoplastia penetrante, así como la importancia de la tomografía de coherencia óptica de segmento anterior para su diagnóstico y las posibles opciones terapéuticas.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se presenta un caso clínico y se hace una revisión bibliográfica.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se trata de un varón de 88 años que se sometió a una queratoplastia penetrante debido a una queratopatía bullosa avanzada, tras la cual se produjo una persistencia de la membrana de Descemet receptora. La persistencia pasó inadvertida hasta que el paciente comenzó con disminución de su agudeza visual, y en la exploración oftalmológica se observó la presencia de una membrana opalescente posicionada debajo del endotelio, que fue identificada como la membrana de Descemet del receptor. El tratamiento se llevó a cabo mediante membranotomía Nd:YAG, acorde a lo consultado en la literatura con éxito.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Como conclusión se establece que la persistencia inadvertida de la membrana de Descemet es una complicación muy poco frecuente de la queratoplastia penetrante. La tomografía de coherencia óptica de segmento anterior permite un diagnóstico de certeza, y la membranotomía con láser Nd:YAG es uno de los tratamientos indicados.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Tabuenca-del Barrio L, Iturralde-Errea O, Mozo-Cuadrado M, Zubicoa-Enériz A, Plaza-Ramos P. Permanencia de la membrana de Descemet y del endotelio receptor tras queratoplastia penetrante. A propósito de un caso clínico. Arch Soc Esp Oftalmol. 2019;94:343–346.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 870 "Ancho" => 905 "Tamanyo" => 81003 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Persistence of receptor endothelium after penetrating keratoplasty under slit lamp. Anterior segment OCT showing endothelium persistence.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 861 "Ancho" => 905 "Tamanyo" => 80898 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Visualization with slit lamp after YAG endotheliotomy. 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