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Treatment of vitreomacular traction syndrome with autologous plasmin enzyme
Tratamiento del síndrome de tracción vitreomacular con plasmina autógena
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Epidemiología del desprendimiento de la retina" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1307 "Ancho" => 1660 "Tamanyo" => 189909 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Palisade retinal degeneration with peripheral vitreous alterations. Case # 13.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Vilaplana, S.J. Muiños, J. Nadal, J. Elizalde, S. Mojal" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Vilaplana" ] 1 => array:2 [ "nombre" => "S.J." 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Rodríguez-Hurtado, M.P. Garrido Collado, V. César Delgado Ceballos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Rodríguez-Hurtado" "email" => array:1 [ 0 => "frhurtado@telefonica.net" ] "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" => "M.P." "apellidos" => "Garrido Collado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "V." 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The mean increase from 0.2 to 0.35 after treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The vitreomacular traction syndrome (VMTS) is a disease caused by the partial detachment of the posterior hyaloids with persistence of macular adhesion. This vitreal-macular adhesion (VMA) could cause macular edema and macular cysts. The stage at which the external retina is involved by the traction is regarded as the initial stage of macular holes.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> It is also been demonstrated that the release of VMA improves diabetic retinopathy edema.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> At present, VMA release can only be achieved by vitrectomy with manual dissection of the posterior hyaloids. However, due to vitreous surgery risks, a few years ago surgeons began to try out intravitreal injection of substances to induce posterior hyaloids detachment, which produced promising results with plasmin<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> and microplasmin.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Plasmin is a proteolytic enzyme obtained from plasminogen activation, utilizing a complex chromatography method or optionally in fresh human plasma by adding streptokinase or urokinase.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> Microplasmin is a recombinant synthetic product with properties similar to human plasmin but considerably more stable. However, its preparation requires an experienced hematology team to carry out the complex process. Microplasmin has been used to facilitate mechanical vitrectomy in hyaloid traction of diabetic retinopathy<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> and in VMTS.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> The efficacy of plasmin lies in its proteolytic effect which is free of retinal toxicity as it acts specifically on laminine and fibronectin present in the adhesion area, absolutely respecting the internal limiting membrane due to its lack of activity on collagen type <span class="elsevierStyleSmallCaps">iv</span>.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A multicenter trial, presently in phase 2, is in course to assess treatment with microplasmin as initial therapy for VMTS.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> The trial comprises 3 syndrome modes: idiopathic VMA, macular hole with traction and diabetic retinopathy tractional macular edema. In addition, the use of autogenic plasmin continues to be researched and the first results indicate that, if activated immediately prior to injection in the surgery, its results could be very similar to those of microplasmin<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> with the advantage that its preparation is easier and less expensive.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The present paper describes the initial results of treatment with autogenic plasmin in a group of patients with VMTS which is very similar to the group of the microplasmin multicenter trial. The main objective of this study is to determine whether autogenic plasmin is able to release VMA. The secondary objectives comprise the assessment of visual acuity evolution and macular thickness in these patients.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects, material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A prospective intervention study in all consecutive patients diagnosed with VMTS in our Ophthalmology Department in its idiopathic, macular hole and tractional diabetes macular edema variants. The study was approved by the Ethical Research Committee of our hospital, which verified compliance with the Helsinki standards. The inclusion criteria comprised best corrected visual acuity (BCVA) of 0.5 or less in the best eye and over 0.1 in the worst eye, assessed by a technician who did not participate in the study applying Early Treatment Diabetic Retinopathy Study (ETDRS) optotypes transformed to decimal scale, and foveal VMA, producing increased central macular thickness (CMT) diagnosed by means of optic coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc., Oberkochen, Germany). The inclusion period began in January and ended in May 2011. Exclusion criteria comprised active proliferative diabetic retinopathy, axial myopia exceeding 26<span class="elsevierStyleHsp" style=""></span>mm, previous vitrectomy, poorly controlled glaucoma, intravitreal injections within the 3 preceding months and retina detachment history.</p><p id="par0030" class="elsevierStylePara elsevierViewall">VMA was diagnosed with spectral domain OCT scanning the presence of posterior hyaloids traction in “butterfly wings” in contact with the foveolar area, producing surrounding edema, cystic cavity or foveolar fossa deformation. The CMT measured in microns in the area of maximum traction was recorded. In the baseline examination and subsequent checkups, a complete ophthalmological examination was carried out including BCVA, tonometry, quantification of corneal and lens opacities, funduscopy and retinography.</p><p id="par0035" class="elsevierStylePara elsevierViewall">After obtaining informed consents, the patients were injected with 0.2<span class="elsevierStyleHsp" style=""></span>ml of intravitreal plasmin prepared from 9<span class="elsevierStyleHsp" style=""></span>cc of each patients’ blood extracted 1<span class="elsevierStyleHsp" style=""></span>h earlier and prepared in the surgery by a hematology expert, centrifuging and treating it with urokinase (Urokinase Vedim<span class="elsevierStyleSup">®</span>, 100,000 UI, Vendim Pharma, Sant Cugat Del Valles, Spain) according to the technique described by Rizzo and improved by Díaz-Llopis.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> The injection technique was similar to that applied for intravitreal injections of antiangiogenics with the difference that the eyes required previous paracentesis. After the treatment, broad range antibiotic eye drops were prescribed for 6 days.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The patients were reviewed at week 3, assessing the hyaloids detachment and recovery of macular morphology as well as changes in CMT by means of OCT and BCVA with ETDRS optotypes. For the cases which did not exhibit VMA release, a new injection was proposed at one month after the first one, repeating the procedure up to a maximum of 3 injections, after which the patients who had not obtained detachment were referred for vitrectomy. In addition, the possible complications related to the procedure were registered. The results were analyzed by the Wilcoxon test and percentage comparisons.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Twelve eyes of 11 patients were treated (4 males and 7 females) with a mean age of 74, with one having both eyes treated. The main pathological characteristics of the eyes before and after the study are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. At the end of the study, 5 eyes had received one injection and 7 had received 3 injections. Four eyes (33.3%) achieved the detachment at the end of the study, 2 with a single injection (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and 2 with 3 injections. CMT improvement after the injections was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Seven eyes (58.3%) experienced statistically significant BCVA improvements of one line or more (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.017) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Only one severe complication arose, a sudden increase of intraocular pressure immediately after the injection which was resolved with a new paracentesis. No complications occurred in the ocular surface with the exception of subconjunctival hemorrhages typical of intravitreal injections.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The use of substances to facilitate posterior vitreous detachment (PVD) during vitrectomy has given rise to the possibility of using intravitreal injections as an isolated treatment for VMTS. The MIVIT trial is a multicenter study which established the most adequate dose of intravitreal microplasmin for obtaining PVD<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> in the first phase, while in the second phase it is utilizing intravitreal injections as baseline treatment for VMTS. Recently, it has published VMA detachment results in 44% of eyes with a single injection and in 58% with 3 injections. The autogenic plasmin utilized in the present study has obtained slightly lower (one in every 3 patients) but also significant percentages considering that it allowed patients to avoid vitrectomy. Instead of the complex preparation process required by microplasmin, the autogenic plasmin of the present study was obtained with simple plasminogen hydrolyzed with urokinase. In contrast with other authors, this study did not use streptokinase as it exhibits vitreous turbidity and frequent post-surgery inflammation,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> even at the risk of plasmin doses being slightly lower. Despite this shortcoming, the authors were able to achieve significant visual acuity improvements and diminished GCM after the injection, even in some eyes which did not exhibit complete VMA detachment. These symptomatic improvements could be due to the relaxation of the hyaloid traction caused by the proteolytic effect of plasmin,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> as the OCT of said patients revealed perimacular partial detachments which perhaps could have been better documented with high resolution echography. In addition, the improvements exhibited by the cases which did not exhibit VMA detachment could be due to other effects of plasmin on macular edema (not yet studied in depth) as could be deduced from the positive effects of intravitreal plasmin in diffuse diabetic macular edema<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> and in retinal venous branch thrombosis<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> which cannot be explained by tractional factors. The authors wish to point out a minor bias which could be caused by the mechanical action of the intravitreal injection with paracentesis due to its ocular decompression effect which could play a small role in VMA release.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, the present study indicates that plasmin obtained from autogenic plasma appears to be a reasonable alternative to microplasmin as a baseline treatment for VMTS due to the fact that it is easier and less expensive to obtain. However, studies with considerably higher amounts of patients are necessary in order to definitively establish its role as a therapeutic agent in VMA.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interests has been declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres535794" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec556104" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres535793" "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" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec556103" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-09-24" "fechaAceptado" => "2014-04-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec556104" "palabras" => array:6 [ 0 => "Vitreous detachment" 1 => "Plasminogen" 2 => "Vitreolysis" 3 => "Intraocular" 4 => "Injections" 5 => "Macular edema" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec556103" "palabras" => array:6 [ 0 => "Desprendimiento de vítreo" 1 => "Plasminógeno" 2 => "Vitreolisis" 3 => "Intraocular" 4 => "Inyecciones" 5 => "Edema macular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine whether intravitreal injection of autologous plasmin enzyme (APE) is effective in vitreomacular traction syndrome (VMTS) by improving visual acuity and restoring macular morphology.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study of 11 consecutive patients diagnosed with VMTS in the Ophthalmology Department from January to May 2011. Inclusion criteria: best corrected visual acuity (BCVA) less than 0.5, and vitreomacular attachment in foveal area resulting in macular thickness >250<span class="elsevierStyleHsp" style=""></span>μm diagnosed by optical coherence tomography (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Germany). Exclusion criteria: active proliferative diabetic retinopathy, axial myopia >26<span class="elsevierStyleHsp" style=""></span>mm, vitrectomy, glaucoma, previous intravitreal injections and previous rhegmatogenous detachment. One to the 3 monthly intravitreal injections of 0.2<span class="elsevierStyleHsp" style=""></span>ml of APE was applied, interrupting if posterior vitreous detachment was attained. Wilcoxon's test was used for statistical analysis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 12 eyes of 11 patients were treated. A complete posterior vitreous detachment was achieved in 4 (33%) eyes at the end of the study, 2 of them with one injection, and 2 with 3 monthly injections. Improvement of BCVA was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.017) and the decrease in central macular thickness also was statistically significant (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.016). There was only one complication: intraocular hypertension after injection that subsided with a new paracentesis.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Intravitreal APE injections avoided vitrectomy in VMTS in one in every 3 patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Analizar si la inyección intravítrea de plasmina autógena es eficaz en el síndrome de tracción vítreo-macular (STVM), mejorando la agudeza visual y restaurando la morfología macular.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 11 pacientes consecutivos diagnosticados de STVM en nuestro Servicio de Oftalmología de enero a mayo de 2011. Criterios de inclusión: mejor agudeza visual corregida (MAVC) inferior a 0,5 y adhesión vítreo-macular foveal, ocasionando aumento del grosor macular central (GMC) > 250<span class="elsevierStyleHsp" style=""></span>μ diagnosticado mediante tomografía de coherencia óptica (Cirrus OCT, Carl Zeiss Meditec, Inc, Oberkochen, Alemania). Criterios de exclusión: retinopatía diabética proliferante activa, miopía axial > 26<span class="elsevierStyleHsp" style=""></span>mm, vitrectomía previa, glaucoma, intravítreas previas y antecedentes de desprendimiento de retina. Se realizaron hasta 3 inyecciones mensuales de 0,2<span class="elsevierStyleHsp" style=""></span>ml de plasmina autógena, evaluándose a las 3 semanas de cada inyección el despegamiento de la adhesión vítreo-macular (AVM), MAVC, GMC y la recuperación de morfología macular en la OCT, interrumpiendo el tratamiento en caso de éxito. Análisis estadístico con test de Wilcoxon.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">De 12 ojos de 11 pacientes se consiguió despegamiento de AVM en 4 (33%), 2 con una inyección y 2 con 3 inyecciones. La mejoría de la MAVC (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,017) y la disminución del GMC (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,016) fueron estadísticamente significativas, mejorando la morfología macular en todos los casos con despegamiento de la AVM. La única complicación fue un caso de hipertensión intraocular tras la inyección, que cedió repitiendo la paracentesis.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La inyección de plasmina autógena evitó la vitrectomía del STVM en uno de cada 3 pacientes.</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" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez-Hurtado FJ, Garrido Collado MP, César Delgado Ceballos V. Tratamiento del síndrome de tracción vitreomacular con plasmina autógena. Arch Soc Esp Oftalmol. 2015;90:269–273.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2403 "Ancho" => 2501 "Tamanyo" => 515871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">OCT before and after the injection of autogenic test mean in case #8, showing posterior vitreous detachment and macular morphology recovery after a single injection.</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" => 2163 "Ancho" => 1714 "Tamanyo" => 117292 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Graph showing central macular thickness changes in patients with and without posterior vitreous detachment after autogenic plasmin injection. The mean went down from 328 to 278<span class="elsevierStyleHsp" style=""></span>μm after treatment.</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" => 2014 "Ancho" => 1655 "Tamanyo" => 95490 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Graph showing visual acuity improvement in eyes with PVD after intravitreal injection of autogenic plasmin. The mean increase from 0.2 to 0.35 after treatment.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mac. H.: macular hole; VA post: visual acuity post-treatment; VA pre: visual acuity pretreatment; Compl.: complications; PVD: posterior vitreous detachment; trDME: tractional diabetic macular edema; CMT post: central macular thickness posttreatment; CMT pre: central macular thickness pretreatment; # of inj: number of injections; VMTS: idiopathic vitreomacular traction syndrome.</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"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Diagnostic \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VA pre \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMT pre \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">VA post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">CMT post \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">PVD \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black"># of inj \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Compl. \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">336 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">254 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Mac. H. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">220 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">trDME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">454 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">277 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">Yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">416 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">420 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">240 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">245 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">Yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">trDME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">302 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">259 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">218 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">298 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">279 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">Yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">trDME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">453 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">266 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">Yes</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">trDME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">440 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">430 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">trDME \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">VMTS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">400 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">390 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab861504.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Summary of the main pathological characteristics before and after autogenic plasmin treatment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2018 February | 18 | 1 | 19 |
| 2018 January | 22 | 0 | 22 |
| 2017 December | 16 | 0 | 16 |
| 2017 November | 13 | 2 | 15 |
| 2017 October | 14 | 3 | 17 |
| 2017 September | 22 | 7 | 29 |
| 2017 August | 12 | 4 | 16 |
| 2017 July | 23 | 6 | 29 |
| 2017 June | 35 | 3 | 38 |
| 2017 May | 32 | 7 | 39 |
| 2017 April | 27 | 5 | 32 |
| 2017 March | 30 | 18 | 48 |
| 2017 February | 29 | 0 | 29 |
| 2017 January | 27 | 1 | 28 |
| 2016 December | 26 | 3 | 29 |
| 2016 November | 43 | 1 | 44 |
| 2016 October | 51 | 5 | 56 |
| 2016 September | 30 | 6 | 36 |
| 2016 August | 31 | 3 | 34 |
| 2016 July | 15 | 0 | 15 |
| 2016 June | 23 | 2 | 25 |
| 2015 July | 1 | 1 | 2 |
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