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Post-lasik corneal ectasia in patients with significant differences in keratometry readings between both eyes
Ectasia corneal post-LASIK en pacientes con diferencias significativas en las lecturas queratométricas de ambos ojos
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Ortega-Usobiaga, F. Llovet-Osuna, M.R. Djodeyre, A. Llovet-Rausell, J. Beltran-Sanz, J. Baviera-Sabater" "autores" => array:6 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Ortega-Usobiaga" "email" => array:1 [ 0 => "jortega@clinicabaviera.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" => "F." "apellidos" => "Llovet-Osuna" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "M.R." "apellidos" => "Djodeyre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "A." "apellidos" => "Llovet-Rausell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Beltran-Sanz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Baviera-Sabater" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Catarata y Cirugía Refractiva, Clínica Baviera, Bilbao, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Investigación y Desarrollo, Clínica Baviera, Valencia, Spain" "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" => "Ectasia corneal post-LASIK en pacientes con diferencias significativas en las lecturas queratométricas de ambos ojos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1206 "Ancho" => 1628 "Tamanyo" => 120868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SE refractive exactitude.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Laser excimer (LASIK) assisted keratomileusis provides fast visual acuity recovery with low incidence of complications. However, corneal ectasia can appear, mainly after the treatment of high myopic refractive errors, high manifested astigmatisms, high corneal curvature, thin corneal pachymetry and irregular astigmatisms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> As only 50% of post-LASIK keratectasia appear in the first year after surgery, this complication must be analyzed in a longer term.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The objective of this study is to assess the incidence of corneal ectasia and long-term visual and refractive results after LASIK in patients with a mean central keratometry reading difference (KM) between both eyes (BE) of ≥<span class="elsevierStyleHsp" style=""></span>1.25 diopters (D).</p><p id="par0010" class="elsevierStylePara elsevierViewall">As the frequency of corneal ectasia (and that of other post-LASIK complications) is low, analyzing long series of a single institution can provide more data on clinically relevant parameters and enable more efficient management of said complications. A series of a single institution provides incidence data in an environment in which many of the possible variables are controlled due to compliance with action protocols for surgeons and patients before, during and after surgery. Likewise, as the incidence of keratectasia is low, a large sample is required to obtain relevant conclusions and these samples are very difficult to find in a single center.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">This study presents a broad series of patients with significant differences in KM between BE, with all the procedures being carried out in the same institution using the same microkeratome. A retrospective review of cases was carried out to provide information on the incidence of ectasia and risk factors in order to improve knowledge on said entity.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A review of 35 eyes of 22 patients in a series of patients consecutively operated in our institution between 2003 and 2011. Said series comprised over 30,000 annual refractive procedures in 19 centers carried out by 84 surgeons.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The inclusion criteria were: myopic refractive error (defined as negative spherical equivalent [SE]), normal presurgery corneal topographic and KM difference ≥<span class="elsevierStyleHsp" style=""></span>1.25 D between BE, measured by means of an autorefractor keratometer and confirmed (at least 1.00 D) by means of Orbscan II device (Bausch & Lomb, Claremont, California, USA).</p><p id="par0030" class="elsevierStylePara elsevierViewall">The exclusion criteria included hypermetropia (positive SE), insufficient follow-up (<2 years) and abnormal presurgery corneal topography. All the patients exhibited stable refraction at least in the year prior to the procedure. None referred significant ocular or systemic disease or family history involving keratoconus.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The pre- and post-surgery examinations included uncorrected distant visual acuity (UDVA), corrected distant visual acuity (CDVA), refraction, cycloplegic refraction, slitlamp biomicroscopy assessment, intraocular pressure, indirect ophthalmoscopy, keratometry, and pachymetry Orbscan II corneal topography. Emmetropia was sought in all cases. To obtain the average post-surgery CDVA, the Snellen visual acuities were converted to their log-MAR equivalents to calculate the final mean visual acuity. The corneal ectasia diagnostic was based on topographic findings. The statistical analysis of data was performed using SPSS for Windows (version 17.0. SPSS Inc., Chicago, USA).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data collection complied with national data protection laws. No special informed consent was included due to the retrospective nature of the study.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0045" class="elsevierStylePara elsevierViewall">After a complete presurgery ophthalmological study following a standard protocol to confirm that patients were candidates for corneal refractive surgery, informed consent was obtained in writing signed by all patients. All the interventions were carried out according to standard protocols. The patients were instructed to carry out adequate palpebral hygiene starting 3 days before the operation. The microkeratome was manual linear Moria LSK-One (Microtech Inc., Moria, France). The same blade was used in BE of the same patient. The corneal lenticule was always carved first in the left eye and then in the right one, while laser ablation was carried out first in the right and then in the left eye utilizing a Technolas excimer laser (217C and 217-Z-100; Bausch & Lomb, Claremont, California, USA) or Mel 80 (Carl Zeiss Meditec Inc., Jena, Germany). After surgery, a topical combination of 3<span class="elsevierStyleHsp" style=""></span>mg/ml tobramycin and 1<span class="elsevierStyleHsp" style=""></span>mg/ml dexamethasone was prescribed (Tobradex, Alcon, Barcelona, Spain) 4 times a day for one week as well as preservative-free artificial tears. All patients were assessed in the first 24<span class="elsevierStyleHsp" style=""></span>h, after one week and 3 months. Only the patients who visited the practice after 2 years were included in the study.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The variables included in the study were corneal ectasia incidence and visual results, including UDVA and CDVA (in the last available visit).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Functional and refractive results</span><p id="par0055" class="elsevierStylePara elsevierViewall">Predictability was defined as the percentage of eyes with a post-surgery SE of ±1.00 D. Indicators for measuring visual results were the efficacy index (post-surgery CUVA/presurgery CDVA) and safety index (post-surgery CDVA/presurgery CDVA).</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">During the period of the study, 315,259 LASIK procedures were performed in 164,603 patients. Overall, 35 eyes (20 patients) fulfilled the inclusion and exclusion criteria (0.021%). The mean age was of 36.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.55 years (range 25–61 years) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The functional and refractive results are shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–5</a> and in <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The mean follow-up was of 4.90<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.95 years (range 2.01–8.78 years). No intra-surgery (for example, poorly carved lenticules or epithelial defects) or post-surgery (diffuse lamellar keratitis, epithelial growth, infection or epithelial recovery) complications appeared. None of the patients were identified as having corneal ectasia.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The ectasia risk factors include pre-existing keratoconus (or frustrated keratoconus, i.e., eyes exhibiting ectasia characteristics without clinical evidence,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> poor residual stromal corneal bed, thin pre-surgery corneal thickness, elevated ablations, large ablation diameter, young age (<30 years) and high myopia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,6,7</span></a> Many described cases exhibited topographic or clinical evidence of frustrated keratoconus, manifested keratoconus or pellucid marginal degeneration<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a>. Due to the diversity of risk factors, scoring systems have been proposed to predict post-LASIK ectasia.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Some authors believe there is a group of factors that produce an aggregate risk of ectasia but without defining specific critical values.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–14</span></a> In 2005, the group of reference refractive surgeons established consensus to conclude that “the decision of performing LASIK must take into account the clinic case globally”.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">All the patients of this case were studied at least 2 years after the operation. Follow-up length is essential, particularly after LASIK, because corneal ectasia only appears in the first year in 50% of the cases.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In one of the most rigorous studies published to date, the mean time of appearance of post-LASIK ectasia was of 16.3 months.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Even though no ectasia were found in this series, it must be mentioned that 3 eyes of patients were excluded due to abnormal presurgery topographs and, even though ectasia hadn’t developed at the time, it could develop in the future.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In this study, the minimum residual stromal post-surgery bed was of 389<span class="elsevierStyleHsp" style=""></span>μ, confirmed with intra-surgery ultrasound pachymetry. Some authors postulate that the most important risk factors are residual bed and presurgery topograph.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Usually surgeons plan on leaving a minimum residual after ablation of at least 250<span class="elsevierStyleHsp" style=""></span>μ.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> However, ectasia may appear in patients without obvious risk factors.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Rao et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> suggested that the elevation of the anterior and posterior corneal faces in the Orbscan topograph could be related with the possibility of post-LASIK keratectasia. Said data were analyzed in the patients of this study.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The obtained functional and refractive results are similar to those found in the literature, taking into account that the treated myopic spherical equivalent range is very broad, ranging from slight to advanced myopia. Accordingly, 63% of the study patients achieved uncorrected vision of 20/20 or greater, 83% exhibited between +1.00 and −1.00 D of the foreseen refraction and 5.7% lost 2 or more CDVA lines. In clinical studies by the Food and Drug Administration (FDA) of USA, these numbers are in the range of 67–86%, 94–100% and 2.15%, respectively when the treated myopia was slight (under −6.00 D). When myopia was between −6.00 and −12.00 D, the numbers get worse in the FDA studies up to 26–71%, 41–96% and 0–4.5%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">When a patient exhibits a high KM difference between BE, we must not consider that this excludes LASIK although we must study in depth the global clinic case and discard corneal topography anomalies.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0105" class="elsevierStylePara elsevierViewall">No conflict of interests has been declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres352623" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec334085" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres352622" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec334086" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Functional and refractive results" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-05-29" "fechaAceptado" => "2013-11-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec334085" "palabras" => array:5 [ 0 => "LASIK" 1 => "Keratometry" 2 => "Corneal ectasia" 3 => "Complications" 4 => "Corneal topography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec334086" "palabras" => array:5 [ 0 => "LASIK" 1 => "Queratometría" 2 => "Ectasia corneal" 3 => "Complicaciones" 4 => "Topografía corneal" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A study is made on the incidence of corneal ectasia after laser in situ keratomi-leusis (LASIK) in patients with large differences in mean keratometry (MK) readings between both eyes (OU). Visual outcomes were also evaluated.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The medical records of 164,603 patients (315,259 eyes) who underwent LASIK from January 2003 to December 2011 were reviewed in order to identify patients with a difference in MK of ≥1.25 D between OU. The main outcome measures were incidence of ectasia after LASIK, and visual outcome.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 35 eyes that met the inclusion criteria were found. Functional and visual results were those expected for myopia studies. After a minimum follow-up of 2 years, no corneal ectasia was found in 3 eyes (2 patients).</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The possibility of finding a patient with an asymmetry in MK and normal topography is low (0.021%), and it does not seem to be a contraindication of LASIK. Although no corneal ectasia was found in this case series, and as it is a potentially sight-threatening complication, patients with very different MK between OU should be studied carefully before undergoing LASIK.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Investigar la incidencia de ectasia corneal tras queratomileusis <span class="elsevierStyleItalic">in situ</span> asistida porláser excímer (LASIK) en pacientes con diferencias significativas en la lectura queratométrica media (KM) entre ambos ojos (AO). Además se evalúan los resultados visuales.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han revisado las historias clínicas de 164.603 pacientes (315.259 ojos) interve-nidos con LASIK de enero de 2003 a diciembre de 2011 para identificar pacientes con unadiferencia de KM<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>1,25 D entre AO. Además de este criterio, debían ser pacientes miopescon topografía corneal normal. Las principales variables de estudio fueron la incidencia deectasia tras LASIK y el resultado visual.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 35 ojos de 20 pacientes cumplieron con los criterios de inclusión y exclusión. Los resultados funcionales y visuales fueron los esperados para las refracciones estudiadas. No se encontraron ectasias en la serie estudiada tras un seguimiento mínimo de 2 años.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La posibilidad de encontrar en un paciente asimetría de KM y topografía normales pequeña (0,021%) y no parece ser una contraindicación para realizar LASIK. A pesar de noencontrarse ectasias en la serie estudiada, ya que esta es una complicación potencialmente grave para la visión, los pacientes con elevadas diferencias en la KM entre AO deben ser estudiados cuidadosamente antes de ser intervenidos mediante LASIK.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Ortega-Usobiaga J, Llovet-Osuna F, Djodeyre MR, Llovet-Rausell A, Beltran-Sanz J, Baviera-Sabater J. Ectasia corneal post-LASIK en pacientes con diferencias significativas en las lecturas queratométricas de ambos ojos. Arch Soc Esp Oftalmol. 2014;89:99–103.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1033 "Ancho" => 1647 "Tamanyo" => 115443 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Uncorrected distant visual acuity (UDVA).</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" => 1106 "Ancho" => 1653 "Tamanyo" => 111092 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Change in corrected distant visual acuity (CDVA).</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" => 1502 "Ancho" => 1660 "Tamanyo" => 214521 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Treated vs obtained spherical equivalent (SE).</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" => 1206 "Ancho" => 1628 "Tamanyo" => 120868 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SE refractive exactitude.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1084 "Ancho" => 1647 "Tamanyo" => 125778 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Refractive astigmatism.</p>" ] ] 5 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (range).</p><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">BFS, best fit sphere (Orbscan); BFSA, best fit sphere anterior; BFSP, best fit sphere posterior; CDVA, corrected distant visual acuity; D, diopters; EA, elevation of anterior face (Orbscan); SE, spherical equivalent; PE, posterior face elevation (Orbscan); I–S, KM inferior–superior corneal morphology index: mean keatometry; UDVA, uncorrected distant visual acuity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameter</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Number of eyes \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">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Patients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Male/female \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">12/8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Age (years) \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">36.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.55 (25–61) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Sphere (D) \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">−1.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.77 (+3.75 to −7.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Astigmatism (D) \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">−1.77<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.40 (−0.25 to −5.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">SE (D) \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">−4.18<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.01 (−0.25 to −14.50) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">KM (D) \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">44.32<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.96 (40.50–48.25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">KM difference between BE (autokeratometer) (D) \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">1.76<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.54 (1.25–3.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">KM difference between BE (Orbscan) (D) \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">1.47<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.39 (1.00–2.40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">CDVA (log-MAR) \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">0.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.11 (0–0.52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Presurgery pachymetry (μm) \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">560.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>30.07 (509–623) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Anterior elevation (EA) (μm) \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">11.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.35 (6.00–17.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Anterior BFS (BFSA) (D) \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">43.07<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.62 (41.10–46.60) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Anterior ratio (EA/BFSA) \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">0.27<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.07 (0.15–0.39) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Posterior elevation (PE) (μm) \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">29.00<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>10.39 (13.00–47.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Posterior BFS (BFSP) (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.84<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.09 (43.20–59.00) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Posterior ratio (PE/BFSP) \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">0.55<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.20 (0.30–0.89) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">I–S \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">0.74<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.20 (−1.18–2.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab526659.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Presurgery data.</p>" ] ] 6 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (range).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameter</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Number of eyes \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Lenticule thickness (μm) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">90.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>16.90 (65–130) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Ablation (μm) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.77<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>39.70 (9–154) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Residual stromal bed (μm) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">389.83<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>50.91 (319–490) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Post-surgery corneal thickness (μm) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">478.34<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>52.13 (404–581) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab526658.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Intra-surgery data.</p>" ] ] 7 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">Efficacy indicates post-surgery UDVA<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>presurgery CDVA; efficacy index indicates post-surgery UDVA/presurgery CDVA; safety indicates presurgery-post-surgery CDVA ≥2 lines; safety index indicates post-surgery CDVA/presurgery CDVA.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Parameter</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Number of eyes \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Efficacy (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Efficacy index<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.33 (0.05–1.43) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Safety (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Safety index<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.05<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.20 (0.44–1.45) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Predictability between 1.00 D (%) \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab526657.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation (range).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Data on visual results and predictability.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:20 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors and 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Randleman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2007.08.020" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2007" "volumen" => "144" "paginaInicial" => "977" "paginaFinal" => "978" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18036880" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk assessment for ectasia after corneal refractive surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.B. Randleman" 1 => "M. Woodward" 2 => "M.J. Lynn" 3 => "R.D. Stulting" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2007.03.073" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2008" "volumen" => "115" "paginaInicial" => "37" "paginaFinal" => "50" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17624434" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratoconus and corneal ectasia after LASIK" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.S. Binder" 1 => "R.L. Lindstrom" 2 => "R.D. Stulting" 3 => "E. Donnenfeld" 4 => "H. Wu" 5 => "P. McDonnell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2005.12.002" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "2035" "paginaFinal" => "2038" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16412891" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of ectasia after laser in situ keratomileusis: risk factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.S. Binder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2007.04.043" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2007" "volumen" => "33" "paginaInicial" => "1530" "paginaFinal" => "1538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17720066" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Video kerato graphic indices to aid in screening for keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Y.S. Rabinowitz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Refract Surg" "fecha" => "1995" "volumen" => "11" "paginaInicial" => "371" "paginaFinal" => "379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8528916" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for corneal ectasia after LASIK" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.F. Tabbara" 1 => "A.A. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
| 2018 March | 5 | 0 | 5 |
| 2018 February | 5 | 1 | 6 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 12 | 2 | 14 |
| 2017 November | 19 | 7 | 26 |
| 2017 October | 18 | 2 | 20 |
| 2017 September | 17 | 2 | 19 |
| 2017 August | 8 | 3 | 11 |
| 2017 July | 17 | 2 | 19 |
| 2017 June | 21 | 13 | 34 |
| 2017 May | 36 | 6 | 42 |
| 2017 April | 33 | 10 | 43 |
| 2017 March | 38 | 20 | 58 |
| 2017 February | 54 | 1 | 55 |
| 2017 January | 20 | 1 | 21 |
| 2016 December | 38 | 7 | 45 |
| 2016 November | 49 | 3 | 52 |
| 2016 October | 40 | 6 | 46 |
| 2016 September | 18 | 5 | 23 |
| 2016 August | 35 | 7 | 42 |
| 2016 July | 17 | 1 | 18 |
| 2016 June | 26 | 5 | 31 |
| 2016 May | 22 | 5 | 27 |
| 2016 April | 21 | 19 | 40 |
| 2016 March | 26 | 7 | 33 |
| 2016 February | 23 | 18 | 41 |
| 2016 January | 22 | 12 | 34 |
| 2015 December | 28 | 15 | 43 |
| 2015 November | 15 | 9 | 24 |
| 2015 October | 35 | 14 | 49 |
| 2015 September | 27 | 11 | 38 |
| 2015 August | 39 | 5 | 44 |
| 2015 July | 39 | 7 | 46 |
| 2015 June | 27 | 7 | 34 |
| 2015 May | 26 | 6 | 32 |
| 2015 April | 27 | 7 | 34 |
| 2015 March | 12 | 6 | 18 |
| 2015 February | 24 | 2 | 26 |
| 2015 January | 22 | 6 | 28 |
| 2014 December | 29 | 13 | 42 |
| 2014 November | 18 | 3 | 21 |
| 2014 October | 33 | 10 | 43 |
| 2014 September | 47 | 24 | 71 |
| 2014 August | 8 | 1 | 9 |
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