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array:24 [ "pii" => "S2173579419300180" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.07.012" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1389" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:125-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669118302430" "issn" => "03656691" "doi" => "10.1016/j.oftal.2018.07.004" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1389" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:125-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 52 "formatos" => array:2 [ "HTML" => 42 "PDF" => 10 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "129" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Retinochoroidal findings and lung cancer: first report in mexican population" ] ] "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" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1066 "Ancho" => 805 "Tamanyo" => 65046 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A) Paciente con obstrucción de rama venosa. B) Paciente con retinopatía asociada a cáncer.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Moreno Páramo, M.A. Rayón Rodríguez, J.I. García Leonardo, A. Hernández Solís, P. Landa Alvarado" "autores" => array:5 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Moreno Páramo" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Rayón Rodríguez" ] 2 => array:2 [ "nombre" => "J.I." "apellidos" => "García Leonardo" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Hernández Solís" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Landa Alvarado" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579419300180" "doi" => "10.1016/j.oftale.2018.07.012" "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/S2173579419300180?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669118302430?idApp=UINPBA00004N" "url" => "/03656691/0000009400000003/v3_202201280722/S0365669118302430/v3_202201280722/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579419300106" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.11.010" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1443" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:130-3" "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">Short communication</span>" "titulo" => "Acute narrow-angle glaucoma induced by topiramate with acute myopia and macular striae: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "133" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Glaucoma agudo de ángulo cerrado inducido por topiramato con miopización aguda y estrías maculares: a propósito de un caso" ] ] "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" => 1573 "Ancho" => 2167 "Tamanyo" => 325975 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Anterior pole image showing slight conjunctival injection, conjunctival chemosis and narrow anterior chamber in BE. (B) Resolution of the condition.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Sierra-Rodríguez, L. Rodríguez-Vicente, J.J. Chavarri-García, J.L. del Río-Mayor" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Sierra-Rodríguez" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Rodríguez-Vicente" ] 2 => array:2 [ "nombre" => "J.J." "apellidos" => "Chavarri-García" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "del Río-Mayor" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118303538" "doi" => "10.1016/j.oftal.2018.11.005" "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/S0365669118303538?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579419300106?idApp=UINPBA00004N" "url" => "/21735794/0000009400000003/v1_201903010631/S2173579419300106/v1_201903010631/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579418301762" "issn" => "21735794" "doi" => "10.1016/j.oftale.2018.12.001" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "1395" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2019;94:119-24" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 9 "formatos" => array:2 [ "HTML" => 7 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Quality of life and visual function in children with glaucoma in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "124" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio de la calidad de vida y la función visual en niños con glaucoma en España" ] ] "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" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 944 "Ancho" => 1600 "Tamanyo" => 73166 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Linear correlation between visual field and mean defect and GQL-15 test results in children and caregivers. There is a positive linear correlation between the result of GQL-15 and best eye visual acuity. Both patients and caregivers reported worse scores in the quality of life test in correspondence with the increase of visual field mean defect.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.N. Moreno, L. Morales Fernández, M. Ruiz Medrano, J.M. Martínez de la Casa, R. Madrigal Sánchez, E. Hernández García, R. Gómez de Liaño, J. García Feijoo" "autores" => array:8 [ 0 => array:2 [ "nombre" => "M.N." "apellidos" => "Moreno" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Morales Fernández" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz Medrano" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Martínez de la Casa" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Madrigal Sánchez" ] 5 => array:2 [ "nombre" => "E." "apellidos" => "Hernández García" ] 6 => array:2 [ "nombre" => "R." "apellidos" => "Gómez de Liaño" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "García Feijoo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669118302727" "doi" => "10.1016/j.oftal.2018.09.001" "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/S0365669118302727?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579418301762?idApp=UINPBA00004N" "url" => "/21735794/0000009400000003/v1_201903010631/S2173579418301762/v1_201903010631/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Retinochoroidal findings and lung cancer: First report in Mexican population" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "129" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Moreno Páramo, M.A. Rayón Rodríguez, J.I. García Leonardo, A. Hernández Solís, P. Landa Alvarado" "autores" => array:5 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Moreno Páramo" "email" => array:1 [ 0 => "danomp@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M.A." "apellidos" => "Rayón Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.I." "apellidos" => "García Leonardo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Hernández Solís" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Landa Alvarado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Retina y Vítreo, Hospital General de México «Dr. Eduardo Liceaga», Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Neumología, Hospital General de México «Dr. Eduardo Liceaga», Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1066 "Ancho" => 805 "Tamanyo" => 65594 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">(A) Patient with venous branch obstruction. (B) Patient with cancer-associated retinopathy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lung cancer (LC) is the first cause of neoplasia-related mortality in the world. With the development of new diagnostic tools, the detection rate of LC has increased although the global patient survival rate of 16% at 5 years<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> has not yet been improved.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The histological classification described by the WHO<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a> classifies cancer in bronchogenic small and non-small cell cancer, the latter accounting for 75% of cases, in turn divided in 3 types: squamous cells, adenocarcinoma and undifferentiated carcinoma.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Ocular expressions associated to LC have been described only vaguely, with ocular metastases (METS) and cancer-associated retinopathy<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3,4</span></a> being most frequently evaluated and identified, mainly in a few case reports and postmortem histopathological findings secondary to various types of carcinoma.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">5–8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">At present, a high number of posterior segment ophthalmological alterations associated to neoplastic diseases have been added, including optic neuropathy, vascular alterations, pigments changes and treatment-associated retinopathy, to mention just a few. These have been attributed to antigen-antibody immunological mechanisms, direct damage to specific cell structures and pro-thrombotic states inherent to tumor conditions.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">9–13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is worthy of note that up to one third of patients without ocular symptoms exhibiting some type of malign neoplasia studied in ophthalmological practices comprise some type of retinochoroidal alterations which, in 10–30% of cases, are the first expression of the disease. After completing the study protocol, 47% of these are derived from breast cancer, 25% from lung cancer, 15% of unknown origin and the remaining percentage from other types of cancer (skin, prostate, bone and kidney, among others).</p><p id="par0030" class="elsevierStylePara elsevierViewall">At present there is no study on the Mexican population that describes in detail posterior segment alterations associated to LC that could express in the course of the disease and the relationship with the stage thereof. For this reason, 50 patients (100 eyes) with NC diagnostic were examined to determine the presence of posterior segment alterations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The importance lies in taking into account LC as a part of the diagnostic protocol of a patient with atypical posterior segment alterations as well as adjuvant ophthalmological treatment or radiotherapy after identifying the disease and improving the visual prognosis when required.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">A transversal and descriptive study carried out between March 2016 and June 2017 at the General Hospital of Mexico.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Inclusion criteria: patients of any age and sex with a diagnostic of LC in different stages.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Exclusion criteria: patients with retinochoroidal alterations secondary to causes other than LC (congenital, metabolic, rheumatologic, hematological, traumatic or surgical).</p><p id="par0055" class="elsevierStylePara elsevierViewall">All patients signed an informed consent in accordance with the general health law and the Helsinki declaration.</p><p id="par0060" class="elsevierStylePara elsevierViewall">By means of direct interviews and reviews of medical histories, the following clinic and demographic data were obtained: age, sex, histological LC type, evolution time, stage, treatment and comorbidities at the time of the interview.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The ophthalmological examination comprised visual acuity with Snellen chart and LogMAR units, anterior segment biomicroscopy under slit lamp, photographic record and evaluation of posterior pole and peripheral retina through indirect ophthalmoscopy under pharmacological midriasis (0.8% tropicamide/5% phenylephrine).</p><p id="par0070" class="elsevierStylePara elsevierViewall">All patients underwent retinal fluorescein angiography, spectral domain optical coherence tomography, Humphrey 30-2 visual field, ocular echography, electroretinogram and electrooculogram. Each patient was examined by 2 ophthalmologists.</p><p id="par0075" class="elsevierStylePara elsevierViewall">All the information was collected in a database of the SPSS application version 15.0 and a descriptive analysis was carried out.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">Overall, 50 patients (100 eyes) of the Pneumology Dept. of the General Hospital of Mexico diagnosed with LC were examined. This sample comprised 26 males (52%) and 24 females (48%) with a mean age of 65 years (49–78), of which 4 (8%) had diabetes mellitus type II and arterial hypertension without retinopathy. Mean time between NC diagnostic and ophthalmological examination was 6 months (2–12 months) and the main identified risk factor for the disease was tobacco smoking in 70% of patients.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The most frequent histological type was adenocarcinoma in 70% of patients, most of which were in stage II (50%) at the time of the examination, as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The following posterior segment alterations were identified: 10% of patients exhibited retinal metastasis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), 16% had choroidal metastasis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), while venous occlusions were identified in 4% of patients (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>A) and CAR (cancer-associated retinopathy) data were found in 6% of cases (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>B). Posterior segment examinations in the remaining 64% of patients produced normal results.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The presence of alterations related to the LC stage is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, which also evidences that 72% of patients who exhibited posterior segment alterations were in stage IV.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Ocular alterations associated to cancer have nonspecific symptomatic presentations. Up to 70% could course without symptoms and could be identified in a routine checkup while the remaining 30% usually comprise symptoms such as blurred vision, myodesopsia, scotoma and loss of vision.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3,4</span></a> In the present study, only one patient with choroidal metastasis consulted at baseline referring loss of vision and, after an ophthalmological and systemic examination, the diagnostic of LC was reached (adenocarcinoma). Chemotherapy was initiated and the patient died after 2 months. The rest of patients were asymptomatic at the time of the checkup as described above. The clinic, ecographic and angiographic characteristics of the 8 patients with choroidal METS were similar to those described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">4,14,15</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The most frequent histological type of LC in the Mexican population of the present study was adenocarcinoma in 70% of cases, similar to the percentages reported in other reviews.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">14,16,17</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The present study is the first to carry out a posterior segment ophthalmological examination of Mexican LC patients to identify alterations. Previously, Shields et al. carried out a similar evaluation in a larger group of patients of a different population, exclusively focusing on the presentation and evolution of choroidal metastasis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Chorioretinal alterations similar to those found in the present review were published as isolated cases and through case reports, with previous publications reporting that lung cancer metastasizes to the eyes in 0.2–7% of patients with clinic studies and between 6% and 7% of patients with postmortem histopathological studies. Said percentages are significantly lower when compared to the 26% of retinochoroidal metastases found in the present study. This could be due to the absence of ocular symptomatology referred by patients, which leads to the absence of ophthalmological examinations in the course of the disease, in addition to the fact that survival prognosis after diagnosing LC does not exceed 50% at 5 years.</p><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand, the incidence of CAR and vascular obstructions defined as paraneoplastic syndromes was of 10%. This incidence related to LC had not been reported in other studies.</p><p id="par0125" class="elsevierStylePara elsevierViewall">At the time of the examination, patients with CAR were in intermediate stages (II and III) and did not refer symptoms, so the diagnostic was based on electroretinographic and clinic alterations. These results are different to those reported in other studies, where loss of vision and ophthalmological alterations precede the primary tumor diagnostic in up to 50%,<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">18,19</span></a> 2 of which were in small cell LC and one in epithelial cancer.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Two asymptomatic patients in stage II without comorbidities exhibited occlusions of the venous branch at the upper temporal sector, with their angiographic studies failing to produce evidence of ischemia or neovascularization and showed only parietal staining at the level of the vascular lesion. It is likely that the prothrombotic condition inherent to the tumoral pathology was the source of said alterations.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Five patients, all in stage IV with metastases in the CNS at the time of the examination exhibited retinal metastasis, with the mean size of lesions being 200 microns. Two of these cases were associated to intra- and preretinal hemorrhages and only one was identified at the equator of the retina while the rest was found in the posterior pole. Only one referred myodesopsia and scotoma and the rest were asymptomatic at the ocular level. Due to systemic conditions, the mean life was one month.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Evolution time was not a crucial factor in the expression of ophthalmological alterations. Even though the majority of patients were diagnosed on average during evolution month 6, there was no correlation between evolution time and ophthalmological expressions, contrary to the LC presentation stage at the time of the examination where 72% of patients with alterations were in stage IV.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The present study was carried out with conventional eye fundus cameras, which in contrast with retinography and broad field angiography, does not evaluate peripheral areas of the retina. Multiple advantages could be obtained by carrying out said studies in the search for paraneoplastic syndromes at the ocular level, obtaining a single and reliable image providing a comprehensive view of the physiological and structural condition in addition to the practical value thereof which circumvents photophobia related to current studies and a relatively shorter time to obtain said studies in patients exhibiting impaired systemic conditions due to the main disease. It would be of interest to carry out new studies focused on assessing the role of retinography and broad field angiography in the ophthalmological screening of said patients.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In general, paraneoplastic syndromes can arise in the context of any tumor and consist in a broad range of signs and symptoms secondary to the distal tissue damage of any tumor or its metastasis. In most cases, ocular involvement may not be expressed through symptoms despite the existence of clinical or physiological evidence of structural damage.</p><p id="par0155" class="elsevierStylePara elsevierViewall">All oncology patients, with and without metastasis, should be referred for regular ophthalmological examinations for the early detection of associated ocular alterations in order to provide timely and comprehensive management. Equally, ophthalmologists are obliged to carry out systemic and specific evaluations to reach the etiological diagnostic of all atypical ocular alterations.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">With a sample of 100 eyes of 50 Mexican patients with lung cancer diagnostic (non-small cells, adenocarcinoma and epithelial), the present study evidences the presence of cancer-associated retinopathy, vascular occlusions and metastases in choroids and retina with a significantly higher incidence compared to that reported in the literature. Even though said alterations were more frequent in advanced stages of the disease, the expression thereof should be taken into account in early stages. Due to the absence of ocular symptomatology, said alterations are mainly found in a routine checkup of patients undergoing various medical and/or surgical treatments, and for this reason the authors recommend performing ophthalmological checkups even in the absence of visual symptoms.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0165" 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" => "xres1157243" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1084465" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1157244" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1084466" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 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" => "2018-04-26" "fechaAceptado" => "2018-07-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1084465" "palabras" => array:3 [ 0 => "Lung cancer" 1 => "Choroidal metastasis" 2 => "Retinal metastasis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1084466" "palabras" => array:3 [ 0 => "Cáncer pulmonar" 1 => "Metástasis coroidea" 2 => "Metástasis retiniana" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Lung cancer (LC) is the most common tumor, and the leading cause of cancer-related death worldwide. Although cases of choroidal metastasis and cancer-associated retinopathy have been reported in LC, no studies have been conducted on the Mexican population to describe retinochoroidal findings during the course of LC, and the relationship with its stage.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate patients with a diagnosis of LC, and to describe the posterior segment findings in relationship to the stage of LC.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional and descriptive study was conducted on 50 patients with LC (100 eyes). The demographic data included age, gender, histological type, evolution time, stage, treatment, and comorbidities. The measurement variables included visual acuity (LogMAR), anterior segment biomicroscopy, retinal photography, fluorescein retinal angiography, optical coherence tomography, and electroretinogram. All patients were evaluated by two ophthalmologists.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study included a total of 26 men and 24 women, with a mean age of 65 years, and a mean time from LC diagnosis of 6 months. The principal histological type was adenocarcinoma (70%), and most (50%) were in stage II at the time of evaluation, with 15 (30%) patients having a metastasis (stage IV). The changes in the posterior segment included choroidal metastasis (16%), retinal metastasis (10%), cancer-associated retinopathy (6%), and vascular occlusions (4%). The majority of patients who presented with posterior segment alterations were in stage IV.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Vascular occlusions, cancer-associated retinopathy, choroidal and retinal metastases may be found in LC, with an incidence higher than that reported in the literature, especially in advanced stages of LC, although they can be found from stage II in asymptomatic patients.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El cáncer pulmonar (CP) es el tumor con mayor frecuencia y mortalidad a nivel mundial. Casos de metástasis coroideas y retinopatía asociada a cáncer han sido publicados en CP, sin embargo no existen estudios en población mexicana que describan las posibles alteraciones retinocoroideas y su relación con el estadio de CP.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar a pacientes con CP para determinar la presencia de alteraciones en el segmento posterior y su relación con el estadio del mismo.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal y descriptivo de 50 pacientes (100 ojos) con CP. Datos demográficos: edad, sexo, tipo histológico, tiempo de evolución, estadio, tratamiento y comorbilidades. Variables de medición: agudeza visual (LogMAR), biomicroscopía del segmento anterior, registro fotográfico de retina, fluorangiografía retiniana, tomografía de coherencia óptica y electrorretinograma. Cada paciente fue evaluado por dos oftalmólogos.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Un total de 26 hombres y 24 mujeres fueron evaluados, el promedio de edad fue de 65 años, el tiempo medio del diagnóstico de CP fue de 6 meses siendo el adenocarcinoma el principal tipo histológico (70%), al momento de la evaluación 50% presentaban estadio II y 30% estadio IV. Las alteraciones del segmento posterior encontradas fueron: metástasis coroideas (16%), metástasis retinianas (10%), retinopatía asociada a cáncer (6%) y oclusiones vasculares (4%). La mayoría de los pacientes con alteraciones retinocoroideas se encontraban en estadio IV.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En el CP pueden encontrarse oclusiones vasculares, retinopatía asociada a cáncer y metástasis a coroides y retina con una incidencia mayor a la publicada en la literatura, siendo más frecuentes en estadios avanzados de la enfermedad aunque pueden encontrarse desde el estadio II en pacientes asintomáticos.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Moreno Páramo D, Rayón Rodríguez MA, García Leonardo JI, Hernández Solís A, Landa Alvarado P. Alteraciones retinocoroideas y cáncer pulmonar: primer reporte en población mexicana. Arch Soc Esp Oftalmol. 2019;94:125–129.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 805 "Ancho" => 805 "Tamanyo" => 59282 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients with retinal metastasis.</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" => 650 "Ancho" => 805 "Tamanyo" => 49071 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patients with choroidal metastasis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1066 "Ancho" => 805 "Tamanyo" => 65594 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">(A) Patient with venous branch obstruction. (B) Patient with cancer-associated retinopathy.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">METS: metastasis; CAR: cancer-associated retinopathy.</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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">% (Number of patients)/standard deviation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Visual acuity (LogMAR)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.20 (±0.15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left eye \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.19 (±0.09) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Histological type of LC</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Small cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Non-small cells \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">80% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">70% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>35) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Epithelial \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Indifferentiated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Stage of LC</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>15) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Posterior segment alterations</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>32) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Choroidal METS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Retinal METS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CAR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4% (<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1975943.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Clinic variables.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">METS: choroidal and/or retinal metastasis; CAR: cancer-associated retinopathy; PS: posterior segment; VO: vascular occlusion.</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="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PS alteration/stage \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">I \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">II \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">III \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">IV \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">VO \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CAR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">METS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1975942.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Posterior segment alterations per stage.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The kidney, cancer, and the eye: current concepts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. 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