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array:24 [ "pii" => "S2173579421000244" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.09.014" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1833" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2021;96:195-201" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669120303841" "issn" => "03656691" "doi" => "10.1016/j.oftal.2020.09.009" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1833" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2021;96:195-201" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "195" "paginaFinal" => "201" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Spurectomy: A novel modification of non-penetrating deep sclerectomy" ] ] "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" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3007 "Ancho" => 2508 "Tamanyo" => 640766 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Diagrama de la espolonectomía. A)<span class="elsevierStyleHsp" style=""></span>Muestra las estructuras que el cirujano debe identificar para realizar la cirugía. (C: conjuntiva; S: canal de Schlemm; L: línea de Schwalbe; T: malla trabecular; EE: espolón escleral; CC: cuerpo ciliar; I: iris). B)<span class="elsevierStyleHsp" style=""></span>Peritomía base fórnix y disección intraoperatoria del tapete escleral superficial. C)<span class="elsevierStyleHsp" style=""></span>Escisión intraoperatoria del tapete escleral profundo. D)<span class="elsevierStyleHsp" style=""></span>Muestra las estructuras debajo del tapete escleral profundo eliminado. E)<span class="elsevierStyleHsp" style=""></span>El espacio supracoroideo abierto después de la extirpación del espolón escleral. F)<span class="elsevierStyleHsp" style=""></span>Visión esquemática de la finalización de la cirugía con el implante Esnoper en el espacio supracoroideo.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Vila-Mascarell, J. 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"apellidos" => "Fons Moreno" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579421000244" "doi" => "10.1016/j.oftale.2020.09.014" "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/S2173579421000244?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669120303841?idApp=UINPBA00004N" "url" => "/03656691/0000009600000004/v1_202103300800/S0365669120303841/v1_202103300800/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579421000086" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.09.007" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1848" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2021;96:202-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "202" "paginaFinal" => "209" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1124 "Ancho" => 1500 "Tamanyo" => 87605 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mean number of medications trend.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Gil-Carrasco, D. Alvarez-Ascencio, P. Tolosa-Tort, M. Alvarez-Padilla, J. Jimenez-Roman, A. Castillejos-Chevez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Gil-Carrasco" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Alvarez-Ascencio" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Tolosa-Tort" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Alvarez-Padilla" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Jimenez-Roman" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Castillejos-Chevez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120304202" "doi" => "10.1016/j.oftal.2020.09.018" "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/S0365669120304202?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421000086?idApp=UINPBA00004N" "url" => "/21735794/0000009600000004/v1_202103300746/S2173579421000086/v1_202103300746/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579420301249" "issn" => "21735794" "doi" => "10.1016/j.oftale.2020.05.007" "estado" => "S300" "fechaPublicacion" => "2021-04-01" "aid" => "1756" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2021;96:189-94" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The outcome of surgical treatment in advanced glaucoma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "194" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. el Afrit, D. Saadouli, G. Hachicha, K. ben Mansour, N. el Afrit, S. Yahyaoui" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "el Afrit" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Saadouli" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Hachicha" ] 3 => array:2 [ "nombre" => "K." "apellidos" => "ben Mansour" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "el Afrit" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Yahyaoui" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669120302422" "doi" => "10.1016/j.oftal.2020.05.041" "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/S0365669120302422?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579420301249?idApp=UINPBA00004N" "url" => "/21735794/0000009600000004/v1_202103300746/S2173579420301249/v1_202103300746/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Spurectomy: A novel modification of non-penetrating deep sclerectomy" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "195" "paginaFinal" => "201" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "E. Vila-Mascarell, J. Vila-Arteaga, M.M. Suriano, A. Fons Moreno" "autores" => array:4 [ 0 => array:3 [ "nombre" => "E." "apellidos" => "Vila-Mascarell" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Vila-Arteaga" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "M.M." "apellidos" => "Suriano" "email" => array:1 [ 0 => "mayerlingsuriano@yahoo.it" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Fons Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Clínica Oftalmológica Vila-Innova Ocular, Valencia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital La Fe, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital General de Castellón, Castellón, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Medicina, Universidad Jaime I, Castellón, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Facultad de Medicina, Universidad de Valencia, Valencia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante" ] ] "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" => 3002 "Ancho" => 2500 "Tamanyo" => 607298 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spurectomy diagram. A) shows the structures that the surgeon must identify to perform the surgery (C: conjunctiva; S: Schlemm’s channel; L: Schwalbe’s line; T: trabecular meshwork; EE: scleral spur; CC: ciliary body; I: iris). B) Peritomy of the base of the fornix and intraoperative dissection of the superficial scleral mat. C) Intraoperative excision of the deep scleral mat. D) Showing the structures underneath the removed deep scleral mat. E) The open suprachoroidal space after the removal of the scleral spur F) Schematic view of the completion of surgery with the Esnoper implant in the suprachoroidal space.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Glaucoma is one of the leading causes of blindness in the world.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its current treatment focuses on reducing intraocular pressure (IOP), which, secondarily, prevents the worsening of the visual field.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This is achieved through medical or surgical treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most glaucoma surgical techniques are aimed at lowering intraocular pressure by increasing the drainage of aqueous humor.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The surgical drainage routes are subconjunctival, trabecular and supracoroidal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Both <span class="elsevierStyleItalic">external ab</span> surgery and minimally invasive glaucoma surgery (MIGS) seek one of these three drainage routes<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Trabeculectomy and non-perforating deep sclerectomy (NPDS) are examples of subconjunctival drainage, obtaining similar tension results, although NPDS decreases the number of complications.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Surgeries that use the trabecular approach and supracoroid approach endeavour to decrease intraocular pressure without relying on a filtration bleb.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">NPDS also enables access to the supracoroid space to search for that drainage path. This can be done through spurectomy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The scleral spur is a band of fibrous tissue where the longitudinal fibers of the ciliary body are inserted. A spurectomy consists of the excision of the scleral spur portion located in the NPDS area, which facilitates the drainage of the aqueous humor and the opening of the suprachoroidal space. The objective of the present study was to analyze the medium-term results and complications of this novel technique for the treatment of glaucoma in comparison with classic NPDS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">A retrospective and non-randomized observational study comparing two groups. Group A included 98 glaucoma eyes from 76 patients operated on with our modified NPDS technique, which we call spurectomy. Group B included 53 glaucoma eyes from 43 patients operated on with the classic NPDS technique. All patients received and signed an informed consent form stating their willingness to participate in the study for at least 12 months. The study complied with the principles declared in Helsinki by the World Medical Association.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The inclusion criteria comprised patients with uncontrolled primary or secondary glaucoma (poor IOP control with maximum medical treatment with signs of progression) and over 18 years of age. Exclusion criteria were unwillingness to participate in the study, previous eye surgery for glaucoma, narrow angle, closed or neovascular glaucoma, poorly controlled diabetes mellitus with a diagnosis of diabetic retinopathy at any stage, macular degeneration and inflammatory eye diseases.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pre-operative evaluation</span><p id="par0045" class="elsevierStylePara elsevierViewall">Previous ophthalmic medical-surgical history. Complete ophthalmological examination including visual acuity, refraction, study of the anterior segment with slit lamp, gonioscopy, intraocular pressure with Goldmann tonometer, pachymetry, fundoscopy, optical nerve coherence tomography and visual field.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Surgical technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">All surgeries (NPDS and spurectomy) were performed under peribulbar anesthesia by four experienced surgeons from two eye centers using the same surgical team between 2008 and 2012. In group A, before performing the spurectomy, the Mermoud forceps was used to remove the Schlemm (CS) canal; then the scleral spur identified as a white cord was removed immediately after the removal of the canal. For this purpose, after cutting with a 30-degree blade, the spur was excised with the Mermoud forceps (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Mitomycin C at 0.02% was applied to the scleral bed and subconjunctival space for 30 s and then washed. The implant (Esnoper®, AJL Ophthalmics, Álava, Spain)<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a> is inserted into the supra-ciliary space (<a class="elsevierStyleCrossRefs" href="#fig0010">Figs. 2–4</a>). The scleral mat and conjunctiva were sutured with separate 10-0 nylon stitches. Finally, a subconjunctival injection of 0.5 ml betamethasone (3 mg/ml) and occlusion with oxytetracycline and hydrocortisone ointment was applied.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In group B a conjunctival flap with a fornix base was made, together with episcleral cauterization, dissection of the scleral mat with a thickness of 1/3 of the total sclera and, penetrating 2 mm in the clear cornea, the deep scleral mat was dissected and later removed. Mitomycin C 0.02% was applied to the scleral bed and the subconjunctival space for 30 s and then washed away. The implant was placed in the scleral bed (Esnoper®, AJL Ophthalmics, Álava, Spain), the scleral mat and the conjunctiva were sutured (separate stitches of 10-0 nylon)<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and occlusion with oxytetracycline and hydrocortisone ointment for 24 h.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Post-operative examination protocol</span><p id="par0060" class="elsevierStylePara elsevierViewall">Patients were scanned at 1 day, 1 week and 1, 3, 6 and 12 months after surgery. Postoperative treatment in all cases was: topical ciprofloxacin for 7 days and tobramycin with dexamethasone (Tobradex®, Alcon Laboratories, Fort Worth, USA) in drops four times a day for one month with gradual reduction. In all visits the IOP was measured between 8:00 and 10:00 h and the anterior segment was evaluated with a slit lamp. Success was defined in both groups as absolute (AS; IOP < 21 mmHg without medication) or relative (RS; IOP < 21 mmHg with medication). Failure was defined as IOP > 21 mmHg with medication, or when the eye required another drainage surgery.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The statistical analysis of the variables was done with the Student t-test and the chi-square test. A value of p ≤ 0.05 was considered significant. Calculations were made using SPSS software version 20.0 for Windows (SPSS, Chicago, Illinois, USA).</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Overall, 98 eyes were operated with spurectomy (group A) and 53 with NPDS (group B). Follow-up was 12 months in both groups. Mean age was 64.29 ± 12.9 years (range 23–85) and 60.87 ± 10.04 years (range 20–82) in groups A and B, respectively. The sample in group A comprised 36 females (47.4%) and 40 males (52.6%), and in group B, 26 males (49%) and 27 females (51%). The distribution according to the type of glaucoma in group A was: 58 eyes with primary open angle glaucoma (POAG) (59.18%), 15 eyes with pigmentary glaucoma (15.3%), 20 eyes with pseudoexfoliative glaucoma (20.41%), 5 eyes with inflammatory glaucoma (5.1%). In the group B this distribution was: 41 eyes with POAG (77,35%), 4 eyes with pseudo-exfoliative glaucoma (7,54%), 3 eyes with pseudo-exfoliative glaucoma (5,66%), 2 eyes with inflammatory glaucoma (3,77%), 2 eyes with closed angle glaucoma (3,77%) and 1 eye with iridocorneal syndrome (1,88%) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Control of IOP</span><p id="par0075" class="elsevierStylePara elsevierViewall">Mean IOP in group A was 25.69 ± 8.11 mmHg before surgery and 15.73 (SD 4.16) mmHg (CI: 14.86–16.6) at 12 months after surgery. In group B the mean preoperative IOP was 26.66 ± 5.93 mmHg, while the mean value at one year was 18.19 (SD 5.93) mmHg (CI: 16.74–19.64). In both groups the change in IOP was statistically significant (both p < 0.05). The reduction in IOP was greater in group A than in group B (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pre- and post-operative medical treatment. Success and failure rates</span><p id="par0080" class="elsevierStylePara elsevierViewall">One year after the spurectomy, the average number of drugs was 0.26 per eye, while in the NPDS group it was 0.91. The total number of eyes requiring medication in group A was 13 and 28 in group B.</p><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to goniopuncture treatment, 13 patients in group A (13.26%) and 6 in group B (11.32%) were treated.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Group A showed AS in 75.5% of the cases (74 eyes), RS in 12.25% (12 eyes) and failure in 12.25% (12 eyes). On the other hand, group B showed AS in 47.17% of the cases (25 eyes), RS in 41.5% (22 eyes) and failure in 11.32% (6 eyes). The differences in AS compared to RS between the two groups reached statistical significance. With spurectomy, more cases maintained IOP < 21 without medical treatment.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Complications</span><p id="par0095" class="elsevierStylePara elsevierViewall">As for complications, in group A (spurectomy) a total of 20 (20.41%) were recorded, including microperforation in 5 eyes (5.1%), incarcerating iris in 4 eyes (4.08%), hyphema in 4 eyes (4.08%), 3 eyes requiring <span class="elsevierStyleItalic">needling</span> (3.06%), positive Seidel test 2 eyes (2.04%), choroid detachment 1 eye (1.02%) and implant extrusion 1 eye (1.02%). In group B, complications were reported in 20,75% of cases (11 eyes): microperforation in 6 eyes (11,3%), hyphema in 2 eyes (3,77%), Seidel test in 2 eyes (3,77%) and Dellen type ulcer in 1 eye (1,88%). There was no statistically significant difference in the rate of complications between both groups (p = 0.960).</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The recent evolution of non-penetrating surgery for the treatment of glaucoma has made it possible to know that IOP can be successfully reduced without the creation of filtration blebs.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This new conceptual basis has reached consensus on the superior safety profile of non-penetrating procedures, although there are no indexed agreements on efficacy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> NPDS provides external filtration of aqueous humor in the subconjunctival space. This technique, with the addition of implants, antimetabolites, and goniopuncture, can provide IOP results similar to those obtained with trabeculectomy, but with fewer complications.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–17</span></a> Until now, few studies have directly compared NPDS and trabeculectomy. Rulli et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> reviewed all of the available scientific literature on surgical treatment of glaucoma and found that trabeculectomy is the most effective surgical procedure for reducing IOP in patients with OAPG, but it is associated with a higher incidence of complications compared to NPDS. In addition, Cheng et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> analyzed the efficacy of NPDS in treating OAPG and concluded that intraoperative use of mitomycin C and implants may improve success rates. After reviewing available published research focused on this topic and selecting only randomized and controlled clinical trials, these authors established a mean reduction of IOP after NPDS of 35.2%. These results are comparable to those obtained in our case series. Specifically, in the NPDS group of our study the average achieved reduction was 31.12%, and this value was even higher in the spurectomy group (38.77%). Therefore, our results in terms of IOP reduction with NPDS were consistent with those previously reported,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> with spurectomy being the best.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the reduction of the amount of medication needed to lower the postoperative IOP pressure, Al-Obeidan et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> reported an average decrease of this value from 2.95 to 0.22 in a sample of 194 eyes operated with NPDS and mitomycin C and an average follow-up of 60.9 months. In our study, at one year after spurectomy only 13 eyes (13.27%) required medical treatment (mean 2 ± 0.71 drugs) and in the NPDS group 28 eyes (52.83%) (1.73 ± 0.37), noting that spurectomy is good for lowering IOP and requires less use of drugs.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Several modifications have been proposed to increase the effectiveness of NPDS combined with implants. Muñoz<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> described a sutureless technique for placing the implant (T-flux®) at the supracoroid level through an incision made after the scleral spur. This author reported absolute and relative success rates of 73.8 and 19.6%, respectively. Bonilla et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> conducted a 20-eye study of 16 patients with significant cataract and uncontrolled open-angle glaucoma with medical treatment to evaluate the results of a surgical procedure combining cataract surgery and NPDS with the Esnoper® implantation 2 mm behind the scleral spur. These authors found a 95% success rate (45% absolute success and 50% relative success). This result is similar to that obtained in the present series with the spurectomy technique (87.75% of total success; AS: 75.5%; RS: 12.25%) using also the Esnoper implant.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There is also another version of this implant (Esnoper-Clip, ALJ Ophthalmology, Álava, Spain) that has been developed after our study to maintain supra- and intra-scleral spaces. A preliminary study has evaluated this implant and concludes that it is a promising alternative to avoid collapse over time.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Loscos et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> have also reported on the safety and efficacy of NDPS combined with the above-mentioned implant in a 48-eye cohort of 41 patients. They found a significant reduction in postoperative IOP, as well as in the number of glaucoma medications required, with a variety of mild intraoperative and postoperative complications that mostly resolved spontaneously. Cheng et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported that the most frequent postoperative complications in nonperforating glaucoma surgery are hyphema (10.53%), shallow anterior chamber (5.9%), hypotony (5.33%), choroid detachment (9.7%) and cataract (10.77%). In our series, these complications were significantly less frequent and severe. Specifically, in our study the complications were similar in both groups, with no statistically significant differences. In both groups we had cases of microperforations. Many authors agree that this condition is related to the learning curve and report that the probability of microperforation is 30% in the first 10–20 cases. After the initial phase of learning the probability decreases until 2–3 %.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,24,25</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The fact that better results were obtained in group A than in group B could be explained by the opening of the supra-ciliary space that allows the drainage of the aqueous humor, in addition to the sub-conjunctival as well as by the supra-ciliary routes. Furthermore, it facilitates the implantation of the device without resistance in this space, by the disinsertion of the longitudinal fibers of the ciliary body that were previously inserted in the portion that were extracted from the scleral spur. Therefore, the implant could be in a more anterior position (supra-ciliary-supracoroid) compared to the classic NPDS. This situation may be beneficial in preventing obstruction of the supracoroid space and scarring of the scleral mat of the trabecular descematic membrane (TDM). This increases the effectiveness of the procedure and reduces the incidence of post-operative complications.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion, a new surgical approach is proposed using a modification of the classic NPDS technique called spurectomy with the implantation of the Esnoper® device. Spurectomy is a safe and effective alternative for the surgical treatment of glaucoma in a medium-term follow-up. Future studies with larger sample sizes and longer follow-ups are required to establish the safety and effectiveness of this technique in maintaining supracoroid drainage. In addition, more studies should be conducted to evaluate the efficacy of this technique with the use of other implants.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interest in this study.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1490607" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1353429" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1490608" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1353430" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Pre-operative evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Surgical technique" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Post-operative examination protocol" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Control of IOP" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Pre- and post-operative medical treatment. Success and failure rates" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Complications" ] ] ] 7 => array:2 [ "identificador" => "sec0060" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-14" "fechaAceptado" => "2020-09-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1353429" "palabras" => array:4 [ 0 => "Non-penetrating glaucoma surgery" 1 => "Suprachoroidal outflow" 2 => "Spurectomy" 3 => "Supraciliar implant" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1353430" "palabras" => array:4 [ 0 => "Cirugía de glaucoma no perforante" 1 => "Drenaje supracoroideo" 2 => "Espolonectomía" 3 => "Implante supraciliar" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To evaluate the outcomes of a novel modification of the non-penetrating deep sclerectomy (NPDS) approach for glaucoma management called spurectomy.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observational comparative non-randomized retrospective study including 98 glaucomatous eyes of 76 patients operated on with the spurectomy technique consisting of the combination of the excision of the scleral spur with NPDS (group A). A control group (group B) including 53 glaucomatous eyes of 43 patients operated on with classical NPDS was also included. Changes in intraocular pressure (IOP) and medications required as well as complications were recorded in a 12-month follow-up.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Mean IOP decreased from 25.69 ± 8.11 preoperatively to 15.73 ± 4.16 mm Hg postoperatively in group A (p < 0.001). In group B, mean IOP decreased from 26.66 ± 5.93 preoperatively to 18.19 ± 5.93 mm Hg postoperatively (P < .001). Differences between groups in postoperative IOP was statistically significant (P < .001). At 12 months after surgery, 13.27% and 52.83% of eyes in groups A and B required topical antihypertensive therapy (P < .001). The rate of absolute success after surgery was 87.5% and 47.17% in groups A and B, with significantly higher rate of relative success in group B (P < .001). No significant differences among groups were found in the complication rate (P = .960). The most common postoperative complication was microperforation of the trabeculo-descemetic membrane in both groups.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Spurectomy is a safe and effective technique when compared with conventional NPDS and seems a promising alternative in the surgical management of glaucoma, optimizing the efficacy of the treatment and minimizing complications.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evaluar los resultados de una nueva modificación de la esclerectomía profunda no perforante (EPNP) denominada espolonectomía.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo no aleatorizado y comparativo que incluyó 98 ojos (grupo A) operados con espolonectomía, que consiste en la combinación de la escisión del espolón escleral con EPNP. El grupo control (B) incluyó 53 ojos operados con EPNP clásica. Durante 12 meses se estudiaron la presión intraocular (PIO), los medicamentos antiglaucomatosos que requirieron y las complicaciones.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">La PIO media disminuyó de 25,69 ± 8,11 preoperatoria a 15,73 ± 4,16 mmHg después de la cirugía en el grupo A (p < 0,001). En el grupo B disminuyó de 26,66 ± 5,93 preoperatoria a 18,19 ± 5,93 mmHg postoperatoria (p < 0,001). Las diferencias entre grupos de la PIO postoperatoria fue estadísticamente significativa (p < 0,001). A los 12 meses después de la cirugía, el 13,27 y el 52,83% de ojos en los grupos A y B requirieron tratamiento antihipertensivo tópico (p < 0,001). La tasa de éxito absoluto después de la cirugía fue del 87,5 y del 47,17% en los grupos A y B, con una tasa significativamente mayor de éxito relativo en el grupo B (p < 0,001). No hubo diferencias significativas entre los grupos en la tasa de complicaciones (p = 0,960). La complicación postoperatoria más frecuente fue la microperforación de la membrana trabeculo-descemética en ambos grupos.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La espolonectomía es una técnica segura y eficaz en comparación con la EPNP convencional y parece una alternativa prometedora en el tratamiento quirúrgico del glaucoma, optimizando la eficacia del tratamiento y minimizando las complicaciones.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vila-Mascarell E, Vila-Arteaga J, Suriano MM, Fons Moreno A. Espolonectomía: una nueva modificación de la esclerectomía profunda no perforante. Arch Soc Esp Oftalmol. 2021;96:195–201. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2020.09.009">https://doi.org/10.1016/j.oftal.2020.09.009</span></p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3002 "Ancho" => 2500 "Tamanyo" => 607298 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Spurectomy diagram. A) shows the structures that the surgeon must identify to perform the surgery (C: conjunctiva; S: Schlemm’s channel; L: Schwalbe’s line; T: trabecular meshwork; EE: scleral spur; CC: ciliary body; I: iris). B) Peritomy of the base of the fornix and intraoperative dissection of the superficial scleral mat. C) Intraoperative excision of the deep scleral mat. D) Showing the structures underneath the removed deep scleral mat. E) The open suprachoroidal space after the removal of the scleral spur F) Schematic view of the completion of surgery with the Esnoper implant in the suprachoroidal space.</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" => 524 "Ancho" => 1500 "Tamanyo" => 119741 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Spurectomy. A,B) Intraoperative exeresis of the scleral spur with the help of a 30 degree blade and Mermoud forceps (the red arrow points to the spur). C) Insertion of the Esnoper® implant (red asterisk) in the suprachoroidal space.</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" => 525 "Ancho" => 1255 "Tamanyo" => 48773 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Pre-operative (A) and post-operative (B) gonioscopic image, showing how the trabeculum (T) and the scleral spur (E) are interrupted when reaching the trabeculodescemetic membrane (asterisk) where the Snoper® can be seen.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 838 "Ancho" => 2175 "Tamanyo" => 153014 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Anterior segment OCT vision of eye structures in one eye after spurectomy.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 795 "Ancho" => 2175 "Tamanyo" => 108713 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Post-operative changes in IOP with the two assessed surgical techniques: spurectomy and deep non-perforating sclerectomy A) Distribution of mean preoperative and postoperative IOP values in both groups. B) Confidence intervals of the average level of the post-operative IOP in both groups.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group A \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Group B \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.29 ± 12.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.87 ± 10.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47.4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">51% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.6% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Type of glaucoma</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OAPG \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59.18% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.35% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pigmentary glaucoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.3% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pseudoexfoliative glaucoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.66% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inflammatory glaucoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.77% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pseudophakic glaucoma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.54% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.65% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Pre-operative IOP</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.69 ± 8.11 mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26.66 ± 5.93 mmHg \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2560411.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Comparison between both groups.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.C. 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