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array:24 [ "pii" => "S2173579422000901" "issn" => "21735794" "doi" => "10.1016/j.oftale.2022.06.006" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "2012" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2022" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2022;97:497-503" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669122000983" "issn" => "03656691" "doi" => "10.1016/j.oftal.2022.01.006" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "2012" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2022;97:497-503" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo original</span>" "titulo" => "Los hallazgos oculares relacionados con el uso de bisfosfonatos orales" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "503" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The ocular findings related to oral bisphosphonate use" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Atar, S.O. Yurttaser, E. Demirhan, G. Er, Ö. Kuru" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Atar" ] 1 => array:2 [ "nombre" => "S.O." "apellidos" => "Yurttaser" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Demirhan" ] 3 => array:2 [ "nombre" => "G." "apellidos" => "Er" ] 4 => array:2 [ "nombre" => "Ö." "apellidos" => "Kuru" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579422000901" "doi" => "10.1016/j.oftale.2022.06.006" "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/S2173579422000901?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669122000983?idApp=UINPBA00004N" "url" => "/03656691/0000009700000009/v1_202209010626/S0365669122000983/v1_202209010626/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579422000883" "issn" => "21735794" "doi" => "10.1016/j.oftale.2022.06.004" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "2006" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2022;97:504-9" "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" => "<span class="elsevierStyleItalic">OVOL1</span> immunohistochemical expression is a useful tool to diagnose invasion in ocular surface squamous neoplasms" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "504" "paginaFinal" => "509" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de la expresión inmunohistoquímica de <span class="elsevierStyleItalic">OVOL1</span> como herramienta diagnóstica de invasión en las neoplasias escamosas de la superficie ocular" ] ] "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" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 886 "Ancho" => 1255 "Tamanyo" => 263499 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">H-score of c-Myc. A. Normal conjunctiva. B. Squamous papilloma showing an H-score for c-Myc of 150. C. ConIN with an H-score for c-Myc of 210. D. SCC with H-score for c-Myc of 180.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Terán, F. Ahumada, F. Vergara, J. Meza, P. Zoroquiain" "autores" => array:5 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Terán" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Ahumada" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Vergara" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Meza" ] 4 => array:2 [ "nombre" => "P." "apellidos" => "Zoroquiain" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566912200079X" "doi" => "10.1016/j.oftal.2022.02.005" "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/S036566912200079X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422000883?idApp=UINPBA00004N" "url" => "/21735794/0000009700000009/v1_202209010606/S2173579422000883/v1_202209010606/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579422001074" "issn" => "21735794" "doi" => "10.1016/j.oftale.2022.06.008" "estado" => "S300" "fechaPublicacion" => "2022-09-01" "aid" => "2013" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2022;97:490-6" "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" => "Intense pulsed light combined with meibomian gland expression for chalazion management" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "490" "paginaFinal" => "496" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Luz pulsada intensa combinada con expresión de las glándulas de Meibomio para el tratamiento del chalación" ] ] "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" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 946 "Ancho" => 2340 "Tamanyo" => 381803 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Patient with a right upper eyelid chalazion causing mechanical ptosis prior to IPL therapy. (B) Same patient as in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A without mechanical ptosis and reduction of chalazion size after three sessions of IPL therapy. (C) Patient with two left upper eyelid chalazia before IPL therapy. (D) Patient in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>C after one IPL therapy session with regression of both chalazia. (E) Patient with a left upper eyelid chalazion before IPL therapy. (F) Complete resolution of the chalazion after one IPL session for the patient in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>E. (G) Patient with a chalazion on the left upper eyelid before IPL therapy. (H) Complete resolution of the chalazion after an IPL session applied to the patient in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>G. (I) Patient with a chalazion on the right lower eyelid before IPL therapy. <span class="elsevierStyleBold">(</span>J) Complete resolution of the chalazion after one IPL session applied to the patient in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>I.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Caravaca, J.L. Alió del Barrio, M.C. Martínez Hergueta, M.A. Amesty" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Caravaca" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Alió del Barrio" ] 2 => array:2 [ "nombre" => "M.C." "apellidos" => "Martínez Hergueta" ] 3 => array:2 [ "nombre" => "M.A." "apellidos" => "Amesty" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669122001149" "doi" => "10.1016/j.oftal.2022.03.005" "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/S0365669122001149?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579422001074?idApp=UINPBA00004N" "url" => "/21735794/0000009700000009/v1_202209010606/S2173579422001074/v1_202209010606/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "The ocular findings related to oral bisphosphonate use" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "503" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Atar, S.O. Yurttaser, E. Demirhan, G. Er, Ö. Kuru" "autores" => array:5 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Atar" "email" => array:1 [ 0 => "sevgiatar@gmail.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" => "S.O." "apellidos" => "Yurttaser" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "E." "apellidos" => "Demirhan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "G." "apellidos" => "Er" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ö." "apellidos" => "Kuru" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Opthalmology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey" "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" => "Los hallazgos oculares relacionados con el uso de bisfosfonatos orales" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The BPs are primary agents to treat bone diseases characterized by increased osteoclastic bone resorption such as osteoporosis, hypercalcemia, Paget disease of bone and metastatic bone disease.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> In normal bone remodeling, bone resorption, and formation are coupled. BPs, suppress bone resorption due to impairing the ability of the osteoclast by binding bone hydroxyapatite and reducing osteoclast activity by decreasing osteoclast progenitor development and recruitment and by promoting osteoclast apoptosis. The bone formation also decreases due to the indirect effect of bone resorption inhibition by BPs.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Adverse effects of the BPs include low-grade transient fever and headache, gastrointestinal symptoms such as stomach pain and esophagitis, myalgias and arthralgias, rarely osteonecrosis of the jaw, and subtrochanteric fractures with long-term use.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Other effects are asymptomatic hypocalcemia, hypophosphatemia, and hypomagnesemia.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Ocular side effects may have appeared like pain, blurred vision, conjunctivitis, uveitis, and scleritis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Ocular or systemic administration of drugs can cause ocular involvement due to autoimmune mechanisms or direct toxic effects.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Ocular symptoms after BPs use are thought to be a result of proinflammatory mechanisms. In the mechanism of ocular involvement, the blockage of the mevalonate pathway is thought to play a role leading to upstream accumulation of inflammatory cytokines.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The accumulation of compounds that might associate with damage causes gamma-delta T-cell activation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Gamma-delta T-cell activation results in increasing IL-6, tumor necrosis factor-alfa and C-reactive protein and so inflammation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The ocular adverse events of BPs associated with ocular involvement have been reported in case reports. Cohort studies, which investigate ocular inflammation due to i.v. BPs, have contradictory results.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> In this study, we aimed to retrospectively investigate ocular involvement findings in female osteoporosis patients using oral BPs.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study adhered to all relevant tenets of the Declaration of Helsinki and was approved by the regional Institutional Ethical Review Board. In our study, patient data were reviewed retrospectively according to their medical history between 01.01.2019–01.01.2020 in the Department of Physical Medicine and Rehabilitation in a Public Tertiary Referral Hospital. 51 female patients diagnosed with osteoporosis aged 50–75 years using oral BPs for at least 1 year, and 64 age-matched non-osteoporosis female patients with not using oral BPs in their records and also those with vision problems when first admitted were included in the study. The bone mineral density (BMD) values of the study and control group patients were classified by the World Health Organization Criteria for Classification of Osteopenia and Osteoporosis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In the study group, having a history of ocular inflammation before BP use, and those with BMD T-score above −2.5 SD were excluded. In the control group, those with bone mineral density (BMD) below −1 SD were excluded. In both of the groups, the history of comorbid disease (diabetes mellitus, hypertension etc.) and systemic or ocular drug use that may cause ocular inflammation, whose eye examination findings were incompletely recorded, those who have had eye surgery or trauma, those not in the laser flare photometer quantitative measurement results were excluded from the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The ophthalmic examination records of the study group consisted of patients who received oral BP due to osteoporosis, and the control group patients who diagnosed with fibromyalgia and had not been diagnosed with osteoporosis before and were referred to ophtalmology consultation due to ocular-related symptoms, such as stinging, burning, itching, light sensitivity, and blurry vision were noted. In the study group, the duration and type of BP use were noted. Slit-lamp examination and inclusion of its lids examination, intraocular pressure (IOP) [mmHg- by Goldmann applanation tonometry], fundus examination, tear break-up time (TBUT) [seconds with fluorescein], Schirmer test (ST) (mm/5<span class="elsevierStyleHsp" style=""></span>min) were noted. The obtained values of quantitative measurements that had been made by laser flare (protein increase in the anterior chamber) photometer were noted as photons per millisecond (ph/ms) in all patients. In principle, laser flare photometry uses a laser beam that scans a measurement window projected into the anterior chamber. Light scattered by protein particles in the aqueous humor is detected by a photomultiplier and processed by a computer. The amount of back-scattered light is proportional to the concentration and size of proteins in the aqueous humor. The average of signals obtained from outside the measurement window (background signals) is subtracted from the signal coming from inside the measurement window and the result is expressed in photon counts per millisecond (ph/ms). A laser flare photometry FC-2000 (KOWA Company, Tokyo, Japan) is used a semiconductor diode laser (635<span class="elsevierStyleHsp" style=""></span>nm), a measurement window of the same size (vertical 0.3<span class="elsevierStyleHsp" style=""></span>mm, horizontal 0.5<span class="elsevierStyleHsp" style=""></span>mm), the same scanning time (0.5<span class="elsevierStyleHsp" style=""></span>s), and is operated on the same principle. Usually, seven measurements are taken, the highest and lowest values are discarded, and the machine automatically calculates the mean and standard deviation of the remaining five readings. Evaluation of meibomian glands valve morphology and meibum output and quality with digital pressure were noted.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0035" class="elsevierStylePara elsevierViewall">Analyses were performed using SPSS 25.0 for Windows. The variables were investigated using analytical methods (Kolmogorov-Smirnov) to determine whether or not they are normally distributed. For comparisons between the two groups, the Student’s <span class="elsevierStyleItalic">t</span>-test was used for normally distributed independent numerical variables, and the Mann–Whitney <span class="elsevierStyleItalic">U</span> test for non-normally distributed independent numerical variables. For comparisons between the multiple groups, the One-Way ANOVA was used. Between-group comparisons of categorical variables were made using chi-square and Fisher's tests. <span class="elsevierStyleItalic">P</span> values <.05 were taken to denote statistical significance.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The mean age of the patients was 66.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.39 in study group and 65.25<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.40 in control group. The entire study consisted of female patients. There was no significant difference between the two groups on age (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.524). The mean duration of BP use was 3.96<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.02 (range:2–5) years. Of the cases, 19 were using alendronate, 24 were using ibandronate and 8 were using risedronate. The mean exposure time for alendronate was 3.78<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.08 years, ibandronate was 4.29<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.95 years, and risedronate was 3.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.74 years.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the study group, erythematous, irregular, thickened eyelid rim or telangiectasia around the glandular orifice were detected in 7 of 102 eyes (unilateral eye involvement in seven patients), while 12 of 128 eyes (unilateral eye involvement in 12 patients) in the control group had erythematous, irregular, thickened eyelid rim or telangiectasia around the glandular orifice. Reduced and cloudy meibum secretion was detected in these patients. There was not a significant difference between the groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.492). With these findings, 57.1% (4/7) of the patients had meibomian gland dysfunction (MGD) in the study group and 66.6% (8/12) in the control group (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.678).</p><p id="par0050" class="elsevierStylePara elsevierViewall">MGD was detected in one of the patients using alendronate (%5.2) and one of the patients using risedronate (%12.5), and two of the patients using ibandronate (%8.3). The rate of MGD (4/51) was found 7.8% in study group, and 12.5% in control group. There was not a significant difference between the two groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.430).</p><p id="par0055" class="elsevierStylePara elsevierViewall">Conjunctivitis, episcleritis, uveitis, scleritis, iritis, and signs of macular degeneration were not detected in both of the groups. Also there were no pathological findings on fundus examination in both of the groups.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The mean IOP, TBUT, and Schirmer's test of the study and control groups were compared. There was not a significant difference between the two groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">It has been reported that advanced age makes a difference in the increase in mean flare values.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Although there was no significant age difference between the groups, according to the laser flare photometer records obtained, 18 of 51 patients in the study group had an exacerbation above 6<span class="elsevierStyleHsp" style=""></span>ph/ms, while 10 of 64 patients in the control group had an exacerbation above 6<span class="elsevierStyleHsp" style=""></span>ph/ms. There was a significant difference between the two groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.026). When the numbers of detected flare are analyzed, it was detected 33 of 102 eyes had flare above 6<span class="elsevierStyleHsp" style=""></span>ph/ms in the study group, 17 of 128 eyes had flare above 6<span class="elsevierStyleHsp" style=""></span>ph/ms in the control group. There was a significant difference between the two groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001).</p><p id="par0070" class="elsevierStylePara elsevierViewall">When the measurements that had been made by laser flare photometer were compared, there was a significant difference between the two groups (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The patients using BP were compared both among themselves and with the control group according to average values. There was only a significant difference between the patients using ibandronate with the control group and also using alendronate with control group patients (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">To our knowledge, it is one of the first studies to demonstrate remarkable ocular side effects such as MPD and Flare by comparing the commonly used oral BP types with healthy controls, unlike the ocular side effects shown in previous BP users.</p><p id="par0080" class="elsevierStylePara elsevierViewall">BPs are chemically stable derivatives of inorganic pyrophosphate which inhibit both formation and dissolution of calcium phosphate crystals.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The classification differentiates BPs into two groups: nitrogen-containing and non-nitrogen-containing. Nitrogen-containing BPs are also known primary cytokine producing cells.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> It is shown that acute phase response is the result of proinflammatory cytokines such as TNF-alfa and IL-6 activated by gamma-delta T cells. It is believed that ocular inflammation which is the most common type of ocular involvement occurs due to the inflammatory process.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Data concerns about ocular side effects from BPs have been obtained from several cases.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,11–16</span></a> Ocular side effects are thought to develop due to the proinflammatory effects of BPs detected in post-marketing cases.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Three large cohort studies investigating ocular eye involvement, in particular inflammation, after the use of BPs had contradictory results.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">In the pharmaco-epidemiological cohort study from Canada, comprised of 934,147 people including 10,827 first-time users of BPs, the incidence rate was 29/10,000 person-years for uveitis and 63/10,000 person-years for scleritis among the first-time users of BPs. Nevertheless, the incidence rates were 20/10,000 person-years for uveitis and 36/10,000 person-years for scleritis among non-users. In this study, the number needed to cause uveitis was 1100, and for scleritis 370.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It was found that the first-time users of BPs had an elevated risk of both uveitis and scleritis. In our study, we did not find any data from patients who had been diagnosed with uveitis, scleritis, or other ocular involvement in both groups. This may be because our study contains a small-size study group and it was a cross-sectional study, not a cohort study.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the US veteran cohort study including 35,252 new BP users, it was also investigated to identify new diagnoses with uveitis/scleritis following initiation of BP. It was found that the overall rate was 6.5 cases of uveitis/scleritis per 10,000 individuals. Fewer than half of patients with uveitis/scleritis have been diagnosed with a disease that can cause inflammatory eye involvement. The prevalence of ocular inflammation was found low, uveitis/scleritis rates were similar in users and nonusers of BPs. The rates did not differ significantly based on the route of administration (oral or parenteral) or after age adjustment.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The increase in inflammatory cells or protein in the anterior chamber may lead to flare as a result of blood-aqueous barrier disruption due to inflammation. Flare has been reported in cases after uveitis, DM, use of topical drugs, and eye surgery.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a> Flare photometric measurement is an objective measurement method that is reported to be affected by age and gender but not by daily changes, due to the increase in protein in the anterior chamber.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,20–22</span></a> In the literature search, we could not see any reported flare findings in patients using orally or infused BP. In our study, in patients using oral BP with flare rates, which are considered to be ocular inflammation findings, were found to be significantly higher than the control group, although there were no clinical diagnoses such as uveitis and scleritis. This suggests that it may be beneficial to follow-up eye complaints early on in patients using oral BP before clinical findings develop.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Pazianas et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> estimated the incidence rate of ocular inflammation in osteoporosis patients using a register-based cohort linked to prescription data and hospital data in Denmark. They found that 4769 (%5.4) patients were prescribed topical eye steroids (TES) within the first year of osteoporosis (oral BPs and non-BPs) treatment. TES treatment rates in the first year of treatment were 44 for alendronate, 40 for etidronate, 45 for risedronate, 32 for raloxifene, and 64 for strontium ranelate per 1000 patients-years. It was concluded that there was no significant difference between the different drug classes (BP versus non-BPs) after adjustment for underlying disease and age for risk of ocular inflammation requiring TES. In this cohort, mild cases that were managed by NSAID or other treatment did not analyze. In our study, the mean age of both groups was 65 and above, and we excluded the use of drugs for the morbid disease, previous ocular inflammation, or for this reason to focus on the ocular effects of oral BP. According to the average flare data of 51 patients we obtained under these conditions; A significant difference was found in patients using ibandronate and alendronate compared to the control group, but no significant difference was found with risedronate.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Patel et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> investigated ocular side effects after zoledronic acid infusion, 14 of 1054 participants reported ocular symptoms within 3 months of placebo or zoledronate infusion diagnosed by an ophthalmologist. It was found that the incidence of acute anterior uveitis and episcleritis in the zoledronate group was %1.1 and %0.1, respectively. The mean time after the infusion was found to be 3 days for ocular symptoms. Vision loss, long-term sequelae were not reported in any of the participants. Our patients had been using oral BP for an average of 3.96 years. In patients using oral form BP, which has different bioavailability with infused forms, lesions on the conjunctival and eyelid were observed in only 7 patients, although it was not significantly different from the control group.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Chronic inflammation due to BPs may lead to gland dysfunction by causing canal obstruction. At the same time, the effects of bisphosphonates on lipid metabolism may cause MGD as it will cause changes in the lipid structure in the secretion content.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As a result of our study, MGD was detected in only 4 of 51 patients (one of the patients using alendronate (5%) and one of the patients using risedronate (12.5%), and two of the patients using ibandronate (8.3%)). Despite the effects of BPs that may cause gland dysfunction, the rate of MGD in our study (7.8%) was not found to be higher than the frequency in the population. In population-based studies conducted to determine the frequency of MBD, the prevalence is between 3.5% and 69.3%, it shows a distinct variation.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24–27</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Our MGD rate may have been found low due to the small number of patients and exclusion of patients with comorbid diseases. Identified therapeutic risk factors for MGD among antiandrogen, antidepressant and antihistamine drugs, retinoic acid used in acne treatment acid, drugs used in the treatment of benign prostatic hyperplasia and postmenopausal hormone therapy counted.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28,29</span></a> With dry eye, except retinoic acid, Meibomian drugs, which are known to be related to its effects on glandular structure have not been studied directly. It may be valuable in detecting MGD for the first time in patients using BPs as a result of our study. However, a prospective study is needed to determine whether there is a direct relationship between BPs and MGD.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Besides the side effects of BPs, the therapeutic efficacy on the eye was also evaluated. Nagai et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> found that intraperitoneal alendronate significantly suppresses choroidal neovascularization that was induced by laser photocoagulation in mice. They stated that alendronate can show this efficacy by directly inhibiting the proliferation of vascular endothelial cells or by regulating angiogenic gene expression.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The use of BPs may cause the development of symptoms such as redness of the eye, burning, and blurred vision due to inflammation. When the effects on the eye are evaluated, it can be believed that their inflammatory effect is more dominant than the antiangiogenic effect.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6,30</span></a> As a result of the present study, it has been shown that long-term bisphosphonate use may cause MGD and flare.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Data concerns about ocular side effects from BPs have been obtained from several case reports and cohort studies.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,6–16</span></a> The ocular side effects have been thought to develop due to the proinflammatory effects of BPs detected in post-marketing.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> It also has been shown that BP-associated ocular inflammation cases resolve without sequelae and may not be contraindicated for the next administration.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,31</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The limitations of the present study are its retrospective nature, evaluation of only female patients with osteoporosis, exclusion of those with comorbid diseases, and the inability to access the files of parenteral BP users. The number of patients included in the study due to the elimination criteria may be insufficient to reach a meaningful result. However, the presence of flare in patients using oral BP may be worthwhile in the research for future prospective studies.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The present study is valuable as it is the pioneer study that showed flare, which may be associated with chronic inflammation, in patients using oral alendronate and ibandronate, as BP in osteoporosis treatment and also showed that oral BPs may cause similar ocular side effects like as i.v. BPs. It should be kept in mind that BPs, one of the commonly used agents in the treatment of osteoporosis, may be associated with ocular inflammation, and the patient should be informed about this. Patients with ocular complaints or findings should be referred to the ophthalmologist as soon as possible. During the treatment of ocular symptoms, if possible, medical treatment should be discontinued, but the appropriate treatment should not be missed to avoid osteoporosis complications.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Declarations of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest. None of the authors have any competing interests.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Financial disclosure statement</span><p id="par0155" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">IRB</span><p id="par0160" class="elsevierStylePara elsevierViewall">Prof Dr Cemil Tascioglu City Hospital Ethics Committee, (14.07.2020–317).</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1764783" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1551760" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1764782" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1551761" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Declarations of interest" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Financial disclosure statement" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "IRB" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-06-08" "fechaAceptado" => "2022-01-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1551760" "palabras" => array:5 [ 0 => "Bisphosphonate" 1 => "Flare" 2 => "Meibomiangland dysfunction" 3 => "Ocular" 4 => "Osteoporosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1551761" "palabras" => array:5 [ 0 => "Bisfosfonato" 1 => "Brote" 2 => "Disfunciónde laglándula de Meibomio" 3 => "Ocular" 4 => "Osteoporosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 51 female osteoporosis patients aged 50–75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The mean duration of BP use was 3.96 years. In the study group, it was detected four of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), seven of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fundus examination. The mean value of measurements of the flare (ph/ms) was 7.90<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.96 in the study group, and 5.02<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.81 in the control group. When the mean values were compared, there was a significant difference between the two groups (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.005, respectively).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo fue investigar los hallazgos de afectación ocular en pacientes femeninas con osteoporosis que usaban bisfosfonato oral (BP).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el estudio un total de 51 pacientes con osteoporosis de sexo femenino de 50 a 75 años que utilizaron BP oral durante al menos un año para el grupo de estudio y 64 pacientes de sexo femenino sin osteoporosis de la misma edad para el grupo de control. Se anotaron el tipo de BP y el tiempo de exposición. Se evaluaron los resultados del examen oftálmico de los pacientes que recibieron BP oral por osteoporosis y los controles.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La duración media del uso de BP fue de 3.96 años. Se detectó que cuatro de 51 pacientes fueron diagnosticados con disfunción de la glándula de meibomio (MGD) (7.8%), siete de 102 ojos tenían margen palpebral eritematoso, irregular, engrosado o telangiectasia alrededor de los orificios glandulares. No hubo hallazgos patológicos en el examen del fondo de ojo. El valor medio de las medidas del flare (ph/ms) fue de 7.90<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.96 en el grupo de estudio y de 5.02<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.81 en el grupo de control. Cuando se compararon los valores medios, hubo una diferencia significativa entre los dos grupos (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001). Se encontró una diferencia significativa en el valor medio de las mediciones del flare entre los pacientes que usaban alendronato e ibandronato con el grupo de control (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.005, respectivamente).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Nuestro estudio mostró que el flare de la cámara anterior asociado con la inflamación crónica del ojo se puede observar con mayor frecuencia en pacientes que usan alendronato e ibandronato por vía oral en comparación con aquellos que no lo hacen. Además, se puede decir que la BP oral puede provocar efectos secundarios oculares similares a los de la BP intravascular.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Atar S, Yurttaser SO, Demirhan E, Er G, Kuru Ö. Los hallazgos oculares relacionados con el uso de bisfosfonatos orales. Arch Soc Esp Oftalmol. 2022;97:497–503.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">IOP: intra ocular pressure; TBUT: tears break-up time; SD: standart deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "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">Groups \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IOP (±SD) (mmHg) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TBUT (±SD) (s) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Schirmer's test (±SD) (mm) \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">Study \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">17.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.71 \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">10.40<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.34 \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">15.54<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.76 \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">Control \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">16.76<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.73 \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">10.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.64 \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">16.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.27 \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">P</span> value \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"><span class="elsevierStyleItalic">.281</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"><span class="elsevierStyleItalic">.348</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"><span class="elsevierStyleItalic">.384</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The mean values of the intra ocular pressure, tear break-up time test and Schirmer’s test, and <span class="elsevierStyleItalic">P</span> values.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SD: standart deviation.</p>" "tablatextoimagen" => array:2 [ 0 => array:1 [ "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">Groups \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean (ph/ms) (±SD) [min.–max.] \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">Study \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">7.90<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.96 [5–60] \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">Alendronate</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">8.08<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.20 [5–60] \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">Ibandronate</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">8.68<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.11 [5–48] \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">Risedronate</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">5.50<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.75 [5–12] \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">Control \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">5.02<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.81 [3–11] \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] 1 => array:1 [ "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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \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">Study – control \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"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">.001</span></span> \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">Alendronate – control \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"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">.001</span></span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \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">Ibandronate – control \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"><span class="elsevierStyleBold"><span class="elsevierStyleItalic">.005</span></span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \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">Risedronate – control \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"><span class="elsevierStyleItalic">.972</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \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">Alendronate – ibandronate \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"><span class="elsevierStyleItalic">.955</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \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">Alendroante – risedroante \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"><span class="elsevierStyleItalic">.272</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \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">Ibandroante – risedronate \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"><span class="elsevierStyleItalic">.559</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">†</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">One-Way ANOVA.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean measurements of the flare of two groups and sub-groups, and <span class="elsevierStyleItalic">p</span> values.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bisphosphonates: mechanism of action and role in clinical practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.T. Drake" 1 => "B.L. Clarke" 2 => "S. Khosla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4065/83.9.1032" "Revista" => array:6 [ "tituloSerie" => "Mayo Clin Proc." "fecha" => "2008" "volumen" => "83" "paginaInicial" => "1032" "paginaFinal" => "1045" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18775204" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meyler’s side effects of drugs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.K. 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