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Correlation of higher order aberrations in the anterior corneal surface and degree of keratoconus measured with a Scheimpflug camera
Correlación de aberraciones de alto orden en la cara anterior de la córnea y el grado de queratocono medidas con cámara de Scheimpflug
a Departamento de Córnea, Asociación para Evitar la Ceguera en México D.F., Coyoacán, Mexico
b Departamento de Córnea, Centro Cardio-Neuro-Oftlamológico y Trasplante, Santo Domingo, Dominican Republic
c Departamento de Córnea, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Residual leucoma after resolution of the condition one month after onset.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Á. Fernández-Vega González, R.I. Barraquer Compte, A.L. Cárcamo Martínez, M. Torrico Delgadillo, M.F. de la Paz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Á." "apellidos" => "Fernández-Vega González" ] 1 => array:2 [ "nombre" => "R.I." "apellidos" => "Barraquer Compte" ] 2 => array:2 [ "nombre" => "A.L." "apellidos" => "Cárcamo Martínez" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Torrico Delgadillo" ] 4 => array:2 [ "nombre" => "M.F." 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"apellidos" => "Ruiz-Quintero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Departamento de Córnea, Asociación para Evitar la Ceguera en México D.F., Coyoacán, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Córnea, Centro Cardio-Neuro-Oftlamológico y Trasplante, Santo Domingo, Dominican Republic" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Departamento de Córnea, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Correlación de aberraciones de alto orden en la cara anterior de la córnea y el grado de queratocono medidas con cámara de Scheimpflug" ] ] "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" => 798 "Ancho" => 1584 "Tamanyo" => 39932 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Correlation between the keratoconus stage and the RMS of the higher-order aberrations. RMS: root mean square.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Keratoconus is a bilateral non-inflammatory corneal ectasia which leads to protrusion, distortion and scarring of the cornea.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> The clinical signs are well defined, but early forms of the disease can go unnoticed unless a topographical study is performed.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is an uncommon condition; the annual incidence is estimated to be approximately one in every 2000 inhabitants. It affects all ethnic groups and has no gender predominance. In an assessment of corneal topography of first-degree relatives of patients with keratoconus, an incidence of 11% was found, compared with 0.05% in the general population.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although there are several hypotheses, the cause remains unknown. Most of the time it is an isolated condition.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a> Some studies have identified hereditary factors as risk factors in keratoconus.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It has also been associated with various syndromes such as Marfan's and Down's; between 0.5% and 15% as a possible result of rubbing the eyes, due to the high rate of blepharitis in this population. Other conditions such as atopy, use of contact lenses, eye trauma, connective tissue disorders and mitral valve prolapse have also been involved.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">7</span></a> Proinflammatory cytokine levels have been found to be elevated in keratoconus tears compared to a control group, indicating the development of chronic inflammatory events in the pathogenesis of the disease.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Recent studies have evaluated the Shack–Hartmann wavefront sensor, which has proven its accuracy for obtaining the refraction value and measuring the eye aberrations without altering the accommodation state.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In 2009, an article was published in the <span class="elsevierStyleItalic">Revista Mexicana de Oftalmología</span> [Mexican Journal of Ophthalmology] on a study of 55 eyes, which found that vertical coma is the predominant higher-order aberration in eyes with keratoconus and spherical aberration is a significant parameter for distinguishing between the different stages of keratoconus.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is now known that aberrations on the anterior surface of the cornea have greater involvement in patients with keratoconus.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In patients with keratoconus, the anterior corneal surface is the most important source of optical errors. It is reported that in patients diagnosed with keratoconus, there is a greater presence of vertical coma aberrations.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">12–14</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Aberrometry uses wavefront sensors to measure the complete refractive status, including irregular astigmatism in the optical system. In physical optics, light is expressed as a wave and light waves dissipate in all directions, like a spherical wave.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> The wavefront is the form of light waves in the input stage; light from infinity is perceived as a planar wavefront.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Unlike the topographic analysis, wavefront technology can detect subclinical keratoconus with a sensitivity and specificity of 91% and 94% respectively.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a> Other biomechanical factors of the cornea need to be considered.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">When beginning to interpret wavefront maps, the Optical Society of America (OSA, 2000) recommended the expansion of Zernike polynomials as the standard method for representing the error in the wavefront of an optical system. These are considered the basic description or building blocks of any wavefront. Corneal aberrometry can determine corneal optical aberrations, which constitute 80% of all total ocular aberrations.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Higher-order aberrations (HOA) have been studied many times for refractive surgery. Maeda et al. applied wavefront technology to study aberrations in eyes with keratoconus.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Wavefront technology is having an increasingly major impact on clinical practice: the correction of ocular aberrations opens up the possibility of an improvement in image optical quality in an individual. This is an objective and non-invasive test.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0070" class="elsevierStylePara elsevierViewall">We conducted a descriptive cross-sectional study in which higher-order aberrations on the anterior surface of the cornea were obtained using a Scheimpflug camera (Pentacam, Oculus Inc., Wetzlar, Germany) in patients diagnosed with keratoconus. Topographic mapping was also obtained to classify keratoconus stage. The study was conducted between January 2009 and April 2014. The procedures for obtaining data were consistent with the ethical standards of the responsible committee on human experimentation (institutional).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Corneal aberrations were measured using the Scheimpflug camera, which has a programme that analyses the anterior corneal surface and measures the curvature and elevation, performs Fourier and Zernicke analyses, obtains 8 indices and classifies the morphology of the cornea and the possibility of keratoconus in 4 stages (adapted to Amsler and Muckenhirn), considering only the aberrations of the anterior corneal surface. Topographical and aberrometric maps were analysed for 152 eyes (both eyes of each patient) diagnosed with keratoconus and confirmed clinically and topographically, which had full records, topographical maps and reliable aberrometry. Patients with corneal lesions or scarring or with collagen diseases or previous eye surgery were excluded.</p><p id="par0080" class="elsevierStylePara elsevierViewall">All patients previously had a full eye examination. Lastly the coma, trefoil and higher-order aberrations were analysed and correlated with the degree of keratoconus.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0085" class="elsevierStylePara elsevierViewall">We studied 152 eyes in 76 patients with keratoconus. The patient group consisted of 41 males (54%) and 35 females (46%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Out of the total, 52 eyes were keratoconus stage 3 (34%), 47 were stage 2 (31%), 35 stage 4 (23%), 13 stage 0 (9%) and 5 stage 1 (3%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The average keratometry for K1 was 50.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.19 dioptres (36.2–76.4) and for K2 was 55.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.54 dioptres (43.8–83.1). The average corneal thickness was 413.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>100.41 micrometres (μm) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The average coma aberration was 4.33<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.53<span class="elsevierStyleHsp" style=""></span>μm and average trefoil aberration was 1.19<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.42<span class="elsevierStyleHsp" style=""></span>μm. There was a positive correlation between the degree of keratoconus and the coma aberration, with a value of 0.606 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>); the correlation with the HOA was 0.611 (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). Between trefoil and degree of keratoconus, it was 0.339 (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). All the results had a <span class="elsevierStyleItalic">p</span> value of 0.01 and a 95% confidence interval.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The majority of the patients were male, in line with findings reported in the literature. The correlation was higher in the higher-order aberration and coma; it proved to be lower in trefoil.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this study, we found that coma and HOA on the anterior corneal surface increase as the degree of keratoconus increases. This had been reported previously for the aberrations taken from the optical system as a whole. From that, we established that this correlation could be mainly due to the corneal aberrations on the anterior surface, and not the total ocular aberrations. Our findings that the main HOA in eyes with keratoconus is the coma are consistent with the Maeda y Alió studies.</p><p id="par0105" class="elsevierStylePara elsevierViewall">The Alió and Shabayek study reports that the coma-type aberration could be used as a guide to distinguish between the different keratoconus stages, as they found a statistically significant correlation between the coma aberration and the average keratometry.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The clinical relevance of the study is obtaining objective and non-invasive information using wavefront technology in the study of keratoconus and HOA. Most of the published studies focused on studying total aberrations in eyes with keratoconus. However, we propose that the aberrations on the anterior surface of the cornea are representative of the entire optical system and significantly correlated with the degree of keratoconus. Nonetheless, we would advocate conducting further studies to support the data obtained in this analysis.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion, the study of HOA on the anterior surface of the cornea in eyes with keratoconus could be a diagnostic tool for staging and quantifying the degree of keratoconus when this condition is suspected and these HOA should therefore be considered in future classifications.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethics</span><p id="par0120" class="elsevierStylePara elsevierViewall">This protocol was designed based on ethical principles for medical research involving human beings adopted by the 18th World Medical Assembly in Helsinki.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0125" class="elsevierStylePara elsevierViewall">No conflicts of interest declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres676655" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec682686" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres676656" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec682687" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Ethics" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-04-22" "fechaAceptado" => "2016-01-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec682686" "palabras" => array:5 [ 0 => "High order aberrations" 1 => "Scheimpflug" 2 => "Keratoconus" 3 => "Coma" 4 => "Trefoil" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec682687" "palabras" => array:5 [ 0 => "Aberraciones de alto orden" 1 => "Scheimpflug" 2 => "Queratocono" 3 => "Coma" 4 => "Trefoil" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the correlation of higher order aberrations in anterior corneal surface and degree of keratoconus measured with a Scheimpflug camera.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive, cross-sectional study was conducted on 152 eyes (both eyes of each patient) of patients with keratoconus, from January 2009 to April 2014. An examination was performed on the corneal aberrometry in the anterior corneal surface, and topographic mapping (by Amsler and Muckenhirn classification) was used to determine the degree of keratoconus. The correlation between high-order aberrations in anterior corneal surface and the degree of keratoconus was determined.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Coma aberration significantly correlated with keratoconus severity (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.60, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01), as well as with the high order aberration (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.61, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). Trefoil and keratoconus were weakly correlated (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.34, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Higher order aberrations in anterior corneal surface were positively correlated with the degree of keratoconus in a similar way to the entire optical system.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la correlación de las aberraciones de alto orden en la cara anterior de la córnea y el grado de queratocono medidas con cámara de Scheimpflug.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realizó un estudio descriptivo y transversal en 152 ojos de pacientes (ambos ojos de cada paciente) con queratocono, desde enero del 2009 hasta abril del 2014. Se analizaron las aberraciones en la cara anterior de la córnea y se utilizó el mapa topográfico (clasificación de Amsler y Muckenhirn) para determinar el grado de queratocono y encontrar la correlación que existe entre las aberraciones de alto orden en la cara anterior de la córnea y el grado de queratocono.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La aberración coma se correlacionó significativamente con la severidad del queratocono (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.60; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01); de la misma forma que la aberraciones de alto orden (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,61; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01). Trefoil y el grado de queratocono se correlacionaron en menor medida (r<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,34; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,01).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las aberraciones de alto orden en la cara anterior de la córnea se correlacionan de forma positiva con el grado de queratocono, por lo que deberían ser consideradas en el abordaje diagnóstico de dicho padecimiento.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Delgado S, Velazco J, Delgado Pelayo RM, Ruiz-Quintero N. Correlación de aberraciones de alto orden en la cara anterior de la córnea y el grado de queratocono medidas con cámara de Scheimpflug. Arch Soc Esp Oftalmol. 2016;91:316–319.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This work was presented at the National Congress of Ophthalmology Residents, Mexico City from 12 to 14 February and won first prize in the “Dr. Anselmo Fonte” award for free work in clinical sciences at the congress. 2015.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1122 "Ancho" => 1503 "Tamanyo" => 53483 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Gender of the patients diagnosed with keratoconus.</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" => 701 "Ancho" => 1575 "Tamanyo" => 38871 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Keratoconus stage.</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" => 941 "Ancho" => 1602 "Tamanyo" => 40484 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between the coma aberration and keratoconus stage.</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" => 798 "Ancho" => 1584 "Tamanyo" => 39932 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Correlation between the keratoconus stage and the RMS of the higher-order aberrations. RMS: root mean square.</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" => 820 "Ancho" => 1554 "Tamanyo" => 40491 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between the trefoil aberration and keratoconus stage.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "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="" valign="top" scope="col" style="border-bottom: 2px solid black"> \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">Average (μm) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">K2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.66<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Corneal thickness \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">413.37<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>100.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1110156.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Keratometry readings and average corneal thickness.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0100" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "David Maurice's contribution to ophthalmic instrumentation: roots of the scanning slit confocal microscope" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.R. 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| Year/Month | Html | Total | |
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