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A) Fotografía de polo anterior. B) Hendidura.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. García de Oteyza, J. Álvarez de Toledo" "autores" => array:2 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "García de Oteyza" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez de Toledo" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579417301299" "doi" => "10.1016/j.oftale.2017.06.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301299?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300308?idApp=UINPBA00004N" "url" => "/03656691/0000009200000009/v1_201708280004/S0365669117300308/v1_201708280004/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579417300403" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.11.012" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1141" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Soc Esp Oftalmol. 2017;92:e53-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Endothelial loss with AcrySof<span class="elsevierStyleSup">®</span> Cachet<span class="elsevierStyleSup">®</span> angle-supported phakic lens" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e53" "paginaFinal" => "e54" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pérdida endotelial con la lente fáquica de apoyo angular AcrySof<span class="elsevierStyleSup">®</span> Cachet<span class="elsevierStyleSup">®</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Galvis, A. Tello, N.I. Carreño, R.D. Berrospi, C.A. Niño, M.O. Cuadros" "autores" => array:6 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Galvis" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Tello" ] 2 => array:2 [ "nombre" => "N.I." "apellidos" => "Carreño" ] 3 => array:2 [ "nombre" => "R.D." "apellidos" => "Berrospi" ] 4 => array:2 [ "nombre" => "C.A." "apellidos" => "Niño" ] 5 => array:2 [ "nombre" => "M.O." "apellidos" => "Cuadros" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669117300163" "doi" => "10.1016/j.oftal.2016.11.020" "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/S0365669117300163?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300403?idApp=UINPBA00004N" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417300403/v2_201708291316/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579417301500" "issn" => "21735794" "doi" => "10.1016/j.oftale.2017.07.004" "estado" => "S300" "fechaPublicacion" => "2017-09-01" "aid" => "1150" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2017;92:447-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Neurotrophic keratopathy in a patient with familial amyloidosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "447" "paginaFinal" => "450" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Queratopatía neurotrófica corneal bilateral en paciente con amiloidosis familiar bilateral" ] ] "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" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 489 "Ancho" => 1350 "Tamanyo" => 149156 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Post-treatment corneal neurotrophic ulcers. (A) Right eye. (B) Left eye. The right eye ulcer healed adequately with topical treatment, whereas the LE ulcer required tarsorrhaphy, similarly with good clinic evolution.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.M. de Carvalho Mendes Castenheira, P. Pujol Vives, M. Asaad Ammaar" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "de Carvalho Mendes Castenheira" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Pujol Vives" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Asaad Ammaar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669117300254" "doi" => "10.1016/j.oftal.2016.12.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669117300254?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417301500?idApp=UINPBA00004N" "url" => "/21735794/0000009200000009/v2_201708291316/S2173579417301500/v2_201708291316/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Sterile infiltrates after cross-linking" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "451" "paginaFinal" => "454" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. García de Oteyza, J. Álvarez de Toledo" "autores" => array:2 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "García de Oteyza" "email" => array:1 [ 0 => "gonzalo_gdeoteyza@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Álvarez de Toledo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Córnea y Segmento Anterior, Centro de Oftalmología Barraquer, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infiltrados estériles tras <span class="elsevierStyleItalic">cross-linking</span>" ] ] "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" => 676 "Ancho" => 1575 "Tamanyo" => 139556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Result 3 days after the cross-linking, showing whitish infiltrates occupying superficial layers as well as the absence of conjunctival hyperemia: (A) anterior pole photograph and (B) Cleft photograph.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Corneal collagen photo-reticulation with ultraviolet A light and vitamin B2 (riboflavin), known as corneal cross-linking (CXL), has been accepted worldwide as a treatment to halt the progression of keratocone. The application of CXL modifies the chemical structure of collagen, increasing stromal rigidity and halting the progression of ectasia. Even though CXL is a safe technique, a range of complications have been described including corneal haze, infectious ulcers, stromal lysis, herpetic keratitis reactivation and sterile infiltrates.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">Female, 20, with keratocone diagnostic who consulted referring progressively diminishing visual acuity (VA) predominantly in the left eye (LE), with onset 3 years earlier. No personal and familial antecedents.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination revealed VA of 0.65 in the RE that did not improve with correction. The LE exhibited a corrected visual acuity (CVA) of 0.08 corrected with −10 −6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>90°. Biomicroscopy revealed Vogt striations in the RE as well as slight central curvarture. LE displayed significant central cornea destructuring, presence of vertex lesions and marked thinning. Topographic examination of RE showed a “duck” type pattern with high keratometry (66D) and pachymetry with thinnest point of 419<span class="elsevierStyleHsp" style=""></span>μm. LE revealed a “bow tie” pattern with 21<span class="elsevierStyleHsp" style=""></span>μm pachymetry (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). A test with a gas-permeable rigid contact lens in the RE produced a VA of 0.9 and adequate tolerance by the patient.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">On the basis of said examination, the diagnostic was asymmetric bilateral keratocone. It was decided to perform deep anterior lamellar keratoplasty (DALK) in the LE. Due to the keratocone stage in the RE and high progression probability, it was decided to perform CXL. This report will focus exclusively on the results of the RE.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The accelerated CXL technique was carried out, firstly removing epithelium in a central 8<span class="elsevierStyleHsp" style=""></span>mm area assisted by a 20% alcohol solution and a Desmarres blade. After de-epithelization, central pachymetry was 404<span class="elsevierStyleHsp" style=""></span>μm. Riboflavin drops at a concentration of 0.1% (Vibex Rapid®) were applied during 10<span class="elsevierStyleHsp" style=""></span>min separated by 2<span class="elsevierStyleHsp" style=""></span>min intervals. Finally, the cornea was irradiated with the KXL System (Avedro Inc., Waltham, MS, USA) applying an energy of 5.4<span class="elsevierStyleHsp" style=""></span>mW/cm<span class="elsevierStyleSup">2</span> during 3<span class="elsevierStyleHsp" style=""></span>min, placing a therapeutic contact lens (TCL).</p><p id="par0030" class="elsevierStylePara elsevierViewall">At treatment day 3, the patient exhibited whitish central infiltrates occupying the superficial layers of the cornea. Epithelium was whole and no reaction could be observed in the anterior chamber. In addition, no hyperemia or secretions were observed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Samples were taken for culture and it was decided to treat with tobramycin and dexamethasone 5 times a day as well as a vancomycin every 2<span class="elsevierStyleHsp" style=""></span>h.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">After one week, culture was negative and, observing that the infiltrates had improved, tobramycin and dexamethasone treatment was maintained and progressively diminished in the course of 2 months.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patient evolution was followed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and, one year after treatment, she exhibited a CVA of 0.2 and poorly tolerated high diopter correction in spectacles as well as contact lens intolerance. Accordingly, DALK was considered, which became penetrating keratoplasty due to intra-surgery macro-perforation (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Six months later, CVA in RE was 0.5.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Sterile infiltrates are a rare complication of CXL. Incidence varies with each series (0.97<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>–7.6%<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>). The majority of publications have similarities with the present case, i.e., absence of hyperemia, superficial whitish infiltrates with negative culture responding to corticoids.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> However, very few cases like the present one have been described, with central instead of peripheral infiltrates.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Several hypothesis explaining said infiltrates have been proposed. Angunawela et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> suggested they could be due to an immune reaction to Staphylococcus anti-genes. However, said infiltrates were not found in the usual location of catarrh infiltrates. Epithelium elimination does not explain either the appearance of said infiltrates because, in other photo-ablation procedures, said complication was not found by the authors. The possible connection with the use of TCL does not seem either to explain the present case because the infiltrates should have appeared in the periphery, where the TCL has less contact with the corneal surface and facilitates tear stagnation. Another possible cause is the relationship with self-immune diseases or the use of nonsteroid anti-inflammatories4.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the view of the authors, the present case could be explained with one of the 2 following options. Ghanem et al.1 proposed that the phototoxic effect of UVA on keratinocytes, demonstrated in vitro and in vivo, could trigger the appearance of infiltrates. The thermal effect has been previously studied and does not seem to have any relationship. In turn, Mangioris et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> believed that the cause could be due to individual hypersensitivity to riboflavin or UVA light in the anterior stroma.</p><p id="par0060" class="elsevierStylePara elsevierViewall">By way of conclusion, the appearance of sterile infiltrates after CXL, even being rare, constitute a complication to be taken into account as it could be related to the products utilized during the procedure, in which case the patient should be informed previously.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0065" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres888088" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec874034" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres888087" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec874035" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-10" "fechaAceptado" => "2017-01-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec874034" "palabras" => array:4 [ 0 => "Sterile infiltrates" 1 => "Cross-linking" 2 => "Complication" 3 => "Keratoconus" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec874035" "palabras" => array:4 [ 0 => "Infiltrados estériles" 1 => "<span class="elsevierStyleItalic">Cross-linking</span>" 2 => "Complicación" 3 => "Queratocono" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case report</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A 20 year-old woman presented with an asymmetric bilateral keratoconus. Cross-linking of the right eye was performed due of its topographic and pachymetric conditions. Three days after the procedure, the patient presented with some corneal infiltrates that where classified as sterile.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-linking is known for its efficacy and safety. Nevertheless, there can be complications. Sterile infiltrates have already been described, although their aetiology is still not clear.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mujer de 20 años que acude diagnosticada de queratocono bilateral asimétrico. Debido a las características topográficas y paquimétricas del queratocono del ojo derecho se decidió realizar la técnica de <span class="elsevierStyleItalic">cross-linking</span>. Tres días después del procedimiento, la paciente acude con unos infiltrados blanquecinos que resultaron ser estériles.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El <span class="elsevierStyleItalic">cross-linking</span> es una técnica eficaz a la par que segura. Sin embargo, en ocasiones pueden ocurrir ciertas complicaciones. Los infiltrados estériles han sido descritos aunque su procedencia sigue sin estar aclarada.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: García de Oteyza G, Álvarez de Toledo J. Infiltrados estériles tras <span class="elsevierStyleItalic">cross-linking</span>. Arch Soc Esp Oftalmol. 2017;92:451–454.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1709 "Ancho" => 2250 "Tamanyo" => 596590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">(A) right eye cleft, showing Vogt striations. (B) Right eye corneal topograph showing a duck-type pattern; (C) Left eye cleft showing increased curvature together with corneal thinning that distorts its structure. (D) Left eye topograph showing the bow tie keratocone pattern.</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" => 676 "Ancho" => 1575 "Tamanyo" => 139556 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Result 3 days after the cross-linking, showing whitish infiltrates occupying superficial layers as well as the absence of conjunctival hyperemia: (A) anterior pole photograph and (B) Cleft photograph.</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" => 589 "Ancho" => 1750 "Tamanyo" => 118239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evolution of the case in cleft photographs: (A) one week after cross-linking; (B) one month after cross-linking; (C) one year after cross-linking.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 628 "Ancho" => 1575 "Tamanyo" => 130630 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Post-surgery result after penetrating keratoplasty: (A) anterior pole photograph and (B) cleft.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral sterile corneal ring infiltrate after riboflavin-UVA collagen cross-linking in keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.C. 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