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La OCTA del plexo superficial en el ojo derecho (B izquierdo) muestra una región de no perfusión nasal superior a la fóvea (flecha). El área correspondiente del plexo profundo (B derecha) revela una región adicional de no perfusión (flecha-cuadrado).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V.M. Asensio-Sánchez" "autores" => array:1 [ 0 => array:2 [ "nombre" => "V.M." "apellidos" => "Asensio-Sánchez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579424000379" "doi" => "10.1016/j.oftale.2024.02.006" "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/S2173579424000379?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669124000224?idApp=UINPBA00004N" "url" => "/03656691/0000009900000005/v1_202405010633/S0365669124000224/v1_202405010633/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579424000355" "issn" => "21735794" "doi" => "10.1016/j.oftale.2024.02.004" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "2206" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Arch Soc Esp Oftalmol. 2024;99:222-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Ophthalmology in images</span>" "titulo" => "Multimodal study of diffuse choroid metastasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "222" "paginaFinal" => "223" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio multimodal de las metástasis coroideas difusas" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1734 "Ancho" => 1874 "Tamanyo" => 338842 ] ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García-Gil, A. Feliciano-Sánchez, R. Martínez-Costa Pérez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García-Gil" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Feliciano-Sánchez" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Martínez-Costa Pérez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669124000200" "doi" => "10.1016/j.oftal.2024.01.005" "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/S0365669124000200?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579424000355?idApp=UINPBA00004N" "url" => "/21735794/0000009900000005/v1_202405010625/S2173579424000355/v1_202405010625/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579424000252" "issn" => "21735794" "doi" => "10.1016/j.oftale.2024.02.002" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "2205" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2024;99:213-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Multimodal and retro-mode imaging in sclerochoroidal calcification: A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "213" "paginaFinal" => "217" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Imágenes multimodales y retromodo en la calcificación esclerocoroidea: reporte de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1445 "Ancho" => 1740 "Tamanyo" => 414855 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In RMI 169 degrees from OD (A) and OS (B); and 89 degrees (C and D respectively) performance by Mirante (Nidek, Japan), we observed hyperreflectivities lesions that protrude above the retinal surface (arrow).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Lopez, M. Rabinovich, D. Colantuono, E.H. Souied" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Lopez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Rabinovich" ] 2 => array:2 [ "nombre" => "D." "apellidos" => "Colantuono" ] 3 => array:2 [ "nombre" => "E.H." "apellidos" => "Souied" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669124000194" "doi" => "10.1016/j.oftal.2023.12.010" "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/S0365669124000194?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579424000252?idApp=UINPBA00004N" "url" => "/21735794/0000009900000005/v1_202405010625/S2173579424000252/v1_202405010625/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Unusual case of retinal arterial branch occlusion: possible variant of Sneddon syndrome" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "218" "paginaFinal" => "221" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "V.M. Asensio-Sánchez" "autores" => array:1 [ 0 => array:4 [ "nombre" => "V.M." "apellidos" => "Asensio-Sánchez" "email" => array:1 [ 0 => "vmasensio@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, 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" => "Un caso inusual de oclusión de rama arterial retiniana: posible variante del síndrome de Sneddon" ] ] "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" => 591 "Ancho" => 680 "Tamanyo" => 38241 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0280" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Color fundus photograph shows retinal blanching adjacent to the superior temporal artery. No intra-arterial emboli are evident.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Sneddon's syndrome (SS) is a rare neurodermatological disease manifested by multiple cerebral strokes and <span class="elsevierStyleItalic">livedo reticularis.</span><a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Exceptionally, it involves the heart, kidney and retina.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Livedoid vasculopathy (LV) is a thrombotic vasculopathy of the cutaneous microcirculation characterized by livedo reticularis combined with painful flares of necrotic-fibrotic appearance in both legs, mainly in the malleolar region.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Typical histopathological findings of LV are occlusion of dermal vessels by intravascular fibrin with segmental hyalinization and endothelial proliferation.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> An important characteristic is the absence of fibrinoid necrosis and vessel wall inflammation, which differentiates LV from true vasculitis.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> A rare case of superior temporal retinal artery occlusion (TRAO) in a patient with LV is presented, in which findings with optical coherence tomography angiography (OCTA) showed reduced macular microcirculation in the adelphic eye. This data explains the fundamental role of progressive loss of microcirculation in the pathogenesis of SS, which is present even before the damage reaches clinical expression.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical case</span><p id="par0010" class="elsevierStylePara elsevierViewall">Male, age 45 on January 2016, diagnosed with Sneddon's syndrome associated with skin ulcers (internal medicine medical history did not refer to stroke). Dermal biopsy showed obliterative vasculopathy compatible with LV. In June 2023, aged 52, he attended the emergency department for sudden and painless loss of vision in the left eye (LE). Visual acuity in the right eye (RE) was 1 and hand movement in the LE. Ocular pressure by applanation was 15<span class="elsevierStyleHsp" style=""></span>mmHg in the RE and 16<span class="elsevierStyleHsp" style=""></span>mmHg in the LE. The patient exhibited a relative afferent pupillary defect in the LE. Fundus examination of the LE showed a whitish edematous retina in the region of the superior temporal artery suggesting an TRAO (<a class="elsevierStyleCrossRef" href="#fig0005">Fig.1</a>), the RE was normal. The patient refused angiography. OCTA of 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm indicated that the vision decrease was attributed to macular ischemia. Analysis of the superficial and deep capillary plexuses revealed an enlarged foveal avascular zone with irregular contour and lack of retinal perfusion in the supero-temporal region and inferior to the fovea in the LE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In the RE, OCTA of the superficial plexus showed a region of ischemia superior nasal to the fovea, while the corresponding area in the deep plexus revealed an additional region without perfusion (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Systemically, the patient exhibited violaceous erythematous patches distributed over upper and lower limbs, with a very painful ulcer in the supramalleolar area of the left ankle surrounded by reticular, reddish and violaceous striae associated with scarring (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Due to concerns about vision deficit and ophthalmologic findings of TRAO, a systemic examination was performed. Medical evaluation by brain computed tomography, echocardiography, carotid doppler, Holter monitoring, blood count, blood chemistry, thyroid, autoantibody and coagulation tests were normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">TRAO may occur in association with LV in middle-aged patients and may be an atypical expression of Sneddon's syndrome. SS is a noninflammatory systemic thrombotic vasculopathy of small and medium-sized vessels characterized by cerebrovascular disease and concomitant livedo reticularis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> LV is a rare vasculopathy typically characterized by bilateral lesions in the lower extremities, more frequent in women than in men in a 3:1 ratio and with ages between 15 and 50 years.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> The average age of onset is 30 years, which sets patients up for decades of functional impairment. Increased thrombotic activity and decreased fibrinolytic activity, along with endothelial damage, are thought to be the cause of thrombus formation in capillary and small vessels.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> Ulcers characterize the active stage of the disease. People with vascular disease are prone to develop retinal vascular occlusions.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> The patient presented in this article had no risk factors for RTAO (normal systemic study), therefore, it is reasonable to think that LV was associated with the pathogenetic mechanism of RTAO, since LV produces occlusion in dermal vessels by intravascular fibrin deposition, with endothelial proliferation and subsequent hyalinization of the arterial segment.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> One of the main advantages of OCTA over fluorescein angiography is the ability to detect areas of ischemia noninvasively. Thus, it is possible to identify ischemic areas even in eyes with no or relatively few symptoms, such as the right eye of the patient described. Clinically it is important to consider that these patients with SS have an increased risk of longitudinally progressive visual loss, so OCTA findings would be a good monitoring method. As TRAO can be considered a form of cerebrovascular injury,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,6</span></a> the present case can be considered a variant of SS just like the patient described by Song HB et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> References have described 6 cases of central retinal artery occlusion in Sneddon's syndrome, of which 3 were men and 3 were women ranging in age from 18 to 50 years.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,8–10</span></a> We have not found any cases of TRAO in SS in the literature.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient described exhibited several characteristics that make him unique with respect to other published cases, such as the absence of a history of stroke, the absence of antiphospholipid antibodies, the presence of skin ulceration (which is a sign of activity) and a late presentation age. This case highlights two things, the first is the atypical presentation, underlining the importance of watchfulness in a patient with idiopathic vasculopathy of small and medium gauge vessels, the second is that it is necessary to be vigilant with these patients because altered microcirculation is one of the factors associated with SS and is bilateral.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Informed consent</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors confirm that they have obtained all consents required by applicable law for the publication of any personal data or images of patients, research subjects, or other persons appearing in materials submitted to Elsevier and have retained a written copy of all consents. If requested by Elsevier, the authors agree to provide copies or evidence that such consents have been obtained.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Article funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">None</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2137764" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1815053" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2137765" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1815054" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Informed consent" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Article funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-12-06" "fechaAceptado" => "2024-01-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1815053" "palabras" => array:5 [ 0 => "Sneddon's syndrome" 1 => "Livedoid vasculopathy" 2 => "Retinal artery occlusion" 3 => "Bilateral macular ischemia" 4 => "Optical coherence tomography angiography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1815054" "palabras" => array:5 [ 0 => "Síndrome de sneddon" 1 => "Vasculopatía livedoide" 2 => "Oclusión de la arteria retiniana" 3 => "Isquemia macular bilateral" 4 => "Angiografía por tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sneddon's syndrome (SS) manifests through multiple strokes and livedo reticularis. Livedoid vasculopathy (VL) is characterized by a long history of foot and leg ulceration and histopathology indicating a thrombotic process. Arterial retinal branch occlusion is described in a 52-year-old male with VL. He did not present noticeable laboratory abnormalities, such as antiphospholipid antibodies, or a history of strokes. Retinal artery occlusion accompanied by VL could be a variant of Sneddon's syndrome. Optical coherence tomography angiography revealed a reduction in the macula's vascular layers in the asymptomatic eye, indicating localized microvascular changes as an evolving marker in the pathogenesis of SS.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El síndrome de Sneddon (SS) se manifiesta por múltiples accidentes cerebrovasculares y livedo reticularis. La vasculopatía livedoide (VL) se caracteriza por una larga historia de ulceración de pies y piernas y una histopatología que indica un proceso trombótico. Se describe una oclusión de rama arterial retiniana en un varón de 52 años con VL. No presentó anomalías de laboratorio perceptibles, como anticuerpos antifosfolípidos, ni antecedentes de accidentes cerebrovasculares. La oclusión de arteria retiniana acompañada de VL podría ser una variante del síndrome de Sneddon. Con angiografía por tomografía de coherencia óptica se observó en la mácula en el ojo asintomático una reducción de las capas vasculares, lo que indica cambios microvasculares localizados como marcador evolutivo en la patogénesis del SS.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 591 "Ancho" => 680 "Tamanyo" => 38241 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0280" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Color fundus photograph shows retinal blanching adjacent to the superior temporal artery. No intra-arterial emboli are evident.</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" => 827 "Ancho" => 1255 "Tamanyo" => 246487 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0285" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Conventional OCTA of the superficial (A left) and deep (A right) plexus of the left eye showing a region of nonperfused retina supero-temporal and inferior to the fovea. OCTA of the superficial plexus in the right eye (B left), showing a region of nasal nonperfusion superior to the fovea (arrow). The corresponding area of the deep plexus (B right) reveals an additional region of nonperfusion (arrow-square).</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" => 800 "Ancho" => 1255 "Tamanyo" => 136688 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0290" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Systemic examination showed purple or reddish patches secondary to blood flow deficit near the skin surface in the upper limbs (A-B, arrows) and active ulcer in the internal malleolus of the left lower limb (C) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sneddon syndrome: under diagnosed disease, complex clinical manifestations and challenging diagnosis. 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Unusual case of retinal arterial branch occlusion: possible variant of Sneddon syndrome
Un caso inusual de oclusión de rama arterial retiniana: posible variante del síndrome de Sneddon
V.M. Asensio-Sánchez
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Servicio de Oftalmología, Hospital Clínico Universitario, Valladolid, Spain