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Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation
Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo
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Úlcera corneal neurotrófica de 2,5<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1,5<span class="elsevierStyleHsp" style=""></span>mm teñida con fluoresceína, 17 días después de la ciclofotocoagulación.</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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Location and exposure of the muscle: (A) Incision in inferior temporal quadrant; we use fixation forceps to allow traction for mobilising the eyeball. (B) The muscle is isolated with a standard hook and the Guyton hook is shown; the muscle can be located directly with the Guyton hook. (C) With a small hook, the conjunctiva is dissected anterior to the insertion to facilitate mobilisation of the hook with the muscle. (D) The hook rotation manoeuver is performed and the conjunctiva slides over the hook thanks to its double bend without traction on the insertion. (E) The distal end of the hook is exposed. (F) Shows the muscle already isolated on the hook.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Pérez-Flores" "autores" => array:1 [ 0 => array:2 [ "nombre" => "I." 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RMS: root mean square.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Delgado, J. Velazco, R.M. Delgado Pelayo, N. Ruiz-Quintero" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Delgado" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Velazco" ] 2 => array:2 [ "nombre" => "R.M." "apellidos" => "Delgado Pelayo" ] 3 => array:2 [ "nombre" => "N." 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Fernández-Vega González, R.I. Barraquer Compte, A.L. Cárcamo Martínez, M. Torrico Delgadillo, M.F. de la Paz" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Á." "apellidos" => "Fernández-Vega González" "email" => array:1 [ 0 => "afdezvega@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R.I." "apellidos" => "Barraquer Compte" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A.L." "apellidos" => "Cárcamo Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "M." "apellidos" => "Torrico Delgadillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "M.F." "apellidos" => "de la Paz" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Centro de Oftalmología Barraquer, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Institut Universitari Barraquer, Universidad Autónoma de Barcelona, Barcelona, 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" => "Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0045" "etiqueta" => "Fig. 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 700 "Ancho" => 927 "Tamanyo" => 65348 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient 5. Residual leucoma after resolution of the condition one month after onset.</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 cornea is one of the most densely innervated tissues in the human body. Innervation is mainly by the ophthalmic division of the trigeminal nerve which, through the long ciliary nerves, exerts a trophic influence on the corneal epithelium.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1–5</span></a> Alteration of this sensory innervation can lead to loss of that trophic influence, causing a deficiency in the blink and tear reflexes, a reduction in cell metabolism and decreased proliferation of basal cells, which can result in epithelial defects and affect the healing of the cornea. All this can lead to neurotrophic keratitis, with the development of recurrent and difficult-to-treat corneal ulcers.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6–9</span></a> The most common cause is herpes simplex or herpes zoster virus eye infection, but any illness, surgical or traumatic procedure that damages corneal sensory innervation can lead to neurotrophic keratitis.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6,10–14</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diode-laser transscleral cyclophotocoagulation is a method used to reduce intraocular pressure (IOP) in patients with glaucoma which destroys the secretory ciliary epithelial cells, thereby reducing the secretion of aqueous humour. The radiation produced by the diode laser interacts with the target biological tissues and causes a photothermal effect which generates photocoagulation, necrosis and inflammation of the tissues.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15–20</span></a> Although treatment in each case has to be individualised, when performing transscleral cyclophotocoagulation using a continuous wavelength semiconductor laser diode that emits a wavelength of 810<span class="elsevierStyleHsp" style=""></span>nm, it is recommended that the contact probe be placed 1–1.5<span class="elsevierStyleHsp" style=""></span>mm posterior to the limbus with no more than 24 hits in an area of 170°–270°. Moreover, it is advisable to use powers of 1500–2500<span class="elsevierStyleHsp" style=""></span>mW for 1.5–2.5<span class="elsevierStyleHsp" style=""></span>s (2.25–6.25<span class="elsevierStyleHsp" style=""></span>J), avoiding the 3- and 9-o’clock meridians as far as possible in order not to damage the vessels and long ciliary nerves. A standard technique would be to start using low powers of around 1500<span class="elsevierStyleHsp" style=""></span>mW for 1.5<span class="elsevierStyleHsp" style=""></span>s (2.25<span class="elsevierStyleHsp" style=""></span>J), and then gradually increase until an audible “pop” sound is heard, indicating thermal decomposition of the tissues, then lower the power. However, it is recommended not to exceed 2500<span class="elsevierStyleHsp" style=""></span>mW for 2.5<span class="elsevierStyleHsp" style=""></span>s (6.25<span class="elsevierStyleHsp" style=""></span>J) as the chances of complications increase.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15–17,21–26</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The complications of this treatment published so far include anterior uveitis, eye pain, temporary increase in IOP, choroidal detachment, chronic hypotonia, decompensated corneal graft, macular pucker, cystoid macular oedema, hyphema, vitreous haemorrhage, loss of visual acuity, retinal detachment, conjunctival and scleral burns, corneal oedema, sympathetic ophthalmia and phthisis bulbi.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15–17,27</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">There is very little literature on the relationship between transscleral diode laser cyclophotocoagulation and neurotrophic keratitis,<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">28,29</span></a> so the possible role of this technique in the development of neurotrophic ulcers is not fully understood.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects, materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This article presents the retrospective descriptive case series study in which we reviewed patients with glaucoma at the Barraquer Ophthalmology Centre who were treated with transscleral cyclophotocoagulation and shortly thereafter developed neurotrophic keratitis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We found 5 eyes in 5 patients who developed neurotrophic ulcers soon after cyclodestructive treatment and studied their different personal characteristics, including gender, age, type of glaucoma, refraction, previous medical and surgical history and previous medical treatments, as well as risk factors for corneal hypoaesthesia.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The laser parameters used to perform the cyclophotocoagulation were recorded, with the number of hits made, the extent of the area treated in degrees and the power used.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The surgical technique performed on all the patients included in the study was transscleral cyclophotocoagulation with continuous-wave semiconductor laser diode emitting at 810<span class="elsevierStyleHsp" style=""></span>nm. The laser system used was an Iris Medical Oculight SL<span class="elsevierStyleSup">®</span> by IRIDEX with a G-Probe TM.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We determined the time from surgery until onset of neurotrophic defects and the treatment received and outcome.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Two of the patients included in the study had died and the other 3 continued under follow-up at our centre.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study included 5 patients, 3 male and 2 female, with a mean age of 63.2 years. All 5 had chronic open-angle glaucoma and had been under follow-up for an average of 12.2 years prior to the cyclophotocoagulation treatment. During that time, they were all treated long-term with beta-blockers, prostaglandins and at least one other topical hypotensive agent (an alpha-agonist or a carbonic anhydrase inhibitor). In 2 cases, filtering surgery was required to control their IOP (one required 2 trabeculectomies 6 and 3 years before the cyclophotocoagulation (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>) and the other had an Ahmed valve implanted 3 years beforehand).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Only 1 of the patients (<a class="elsevierStyleCrossRefs" href="#fig0015">Figs. 3 and 4</a>) had not previously had surgery on the eye on which the cyclodestructive procedure was applied. In the other cases, in addition to the filtering surgery already mentioned, 3 patients had undergone extracapsular cataract extraction (10, 27 and 36 years before the cyclodestructive treatment), and one had also required penetrating keratoplasty twice (first for bullous keratopathy and then for fungal keratitis), the second of which was a year before the cyclophotocoagulation (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>). One of the cases also had corneal dystrophy, diagnosed 30 years previously, but which had not caused any symptoms in all that time.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Another important finding was that 3 of the patients had high myopia with a mean spherical equivalent of −7.3 diopters (D). The refraction was not available for the other 2 patients, but for one of them, who had Down's syndrome, we did have the biometry measurement (<a class="elsevierStyleCrossRefs" href="#fig0030">Figs. 6 and 7</a>), 24.98<span class="elsevierStyleHsp" style=""></span>mm, which indicated axial myopia.</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In terms of general previous medical history, one of the patients had been diagnosed with type <span class="elsevierStyleSmallCaps">2</span> diabetes 3 years previously, although there had been no eye involvement up to the time of treatment (<a class="elsevierStyleCrossRefs" href="#fig0040">Figs. 8 and 9</a>).</p><elsevierMultimedia ident="fig0040"></elsevierMultimedia><elsevierMultimedia ident="fig0045"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Focusing on the laser parameters used during cyclophotocoagulation, we found that the mean number of hits was 22.4 on an average surface area of 274° (with a range of 200–360°). The mean energy used in these cases was 2880<span class="elsevierStyleHsp" style=""></span>mW for 3<span class="elsevierStyleHsp" style=""></span>s (8.6<span class="elsevierStyleHsp" style=""></span>J) with a range of 7.5–9<span class="elsevierStyleHsp" style=""></span>J; 3 patients received hits over 270° or more, with 3000<span class="elsevierStyleHsp" style=""></span>mW for 3<span class="elsevierStyleHsp" style=""></span>s (9<span class="elsevierStyleHsp" style=""></span>J) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">After the cyclophotocoagulation all the patients developed neurotrophic keratitis, with the first epithelial defects appearing, on average, 22 days (range 10–35 days) post-treatment.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In all cases, the ulcers were treated with topical artificial tears, topical antibiotics and therapeutic contact lens or eye-patch. Four of the patients also required blood components (50% autologous serum or platelet-rich plasma) and one was also treated with minoarte (carboxymethyl glucose sulfate).</p><p id="par0090" class="elsevierStylePara elsevierViewall">The neurotrophic defects took an average of 36 days to clear up. All the patients had further episodes of recurrent corneal ulcers which, in 3 cases, resulted in residual leucoma affecting visual acuity. The Down's syndrome patient's eye was the one with the worst prognosis, although not because of neurotrophic keratitis, but because he suffered total retinal detachment that led to phthisis bulbi.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Two of the patients required a second cyclophotocoagulation session due to poor control of their IOP and, once again, high parameters were used (average of 17.5 hits over an area of 195° and mean power of 2925<span class="elsevierStyleHsp" style=""></span>mW for 3<span class="elsevierStyleHsp" style=""></span>s). Again, in the following month, both patients developed neurotrophic corneal defects which continued to recur over the next few years.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The aim of this study was to analyse the relationship between treatment with diode laser transscleral cyclophotocoagulation and development of neurotrophic keratitis.</p><p id="par0105" class="elsevierStylePara elsevierViewall">It is well known that long-term use of topical beta-blockers, corneal surgery with large incisions, diabetes mellitus and some corneal dystrophies are predisposing and trigger factors for corneal hypoaesthesia.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16,30</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">In our series, we found that 2 patients had one of these risk factors (long-term topical instillation of beta-blockers), 2 patients had 2 (long-term topical instillation of beta-blockers and eye surgery with large corneal incisions – ECCE and penetrating keratoplasty) and the fifth patient had 4 (long-term topical beta-blockers, ECCE, diabetes mellitus and corneal dystrophy). However, they had all had been living with these risk factors for years without developing neurotrophic keratitis, until they had cyclophotocoagulation. Even the patient who had undergone 2 keratoplasties and an ECCE, who was the one with the shortest free interval between the risk factor and the cyclophotocoagulation, went a year after the last transplant without any neurotrophic damage. We would therefore argue that these factors may have been predisposing factors, but they were not what triggered the neurotrophic keratitis.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The trigger in our patients was the transscleral cyclophotocoagulation which, due to the application of high laser power (8.6<span class="elsevierStyleHsp" style=""></span>J on average) over a large area (270–360°), when added to the predisposing factors, caused damage to the long ciliary nerves and resulted in neurotrophic keratopathy. As has been demonstrated, if radiation is applied for longer than recommended, heat conduction can cause raising of the temperature beyond the irradiated target tissue, indirectly causing undesired effects in adjacent non-target regions. Add to that the application of a high average power level, and we create a very harmful vaporisation effect, in which the tissue temperature increases and mechanical rupture and thermal decomposition of tissues occur, the sign of which is the audible “pop” we mentioned earlier.<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">20,22,23,25,26</span></a> This situation requires lower laser power as described in the application technique.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the study by Schuman et al.<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">26</span></a> in 1991, the effect of transscleral cyclophotocoagulation was analysed on human cadaver eyes using different energy levels. The authors concluded that, above 5<span class="elsevierStyleHsp" style=""></span>J, explosive tissue damage occurs and that the optimum power setting for diode laser cyclophotocoagulation is between 3 and 4.5<span class="elsevierStyleHsp" style=""></span>J.</p><p id="par0125" class="elsevierStylePara elsevierViewall">As discussed earlier, most experts recommend not exceeding 2500<span class="elsevierStyleHsp" style=""></span>mW for 2.5<span class="elsevierStyleHsp" style=""></span>s (6.25<span class="elsevierStyleHsp" style=""></span>J) and not treating an area greater than 270°, as doing otherwise can increase the risk of complications.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15–17,21–24,26</span></a> However, in our study, the mean energy used (2880<span class="elsevierStyleHsp" style=""></span>mW for 3<span class="elsevierStyleHsp" style=""></span>s [8.6<span class="elsevierStyleHsp" style=""></span>J over 274°]) was considerably higher than the figure recommended.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In an experimental model with 6 mice subjected to stereotactic trigeminal electrolysis,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">14</span></a> the corneal nerves were not histologically recognisable at 48<span class="elsevierStyleHsp" style=""></span>h. In that study, over the following 7 days, a reduction in basal epithelial cell proliferation was observed with increase in cell apoptosis in all the layers of the cornea. In our patients, the diode laser damaged the sensory nerve fibres, with the result that the undamaged innervation remaining in the areas not irradiated with the laser was not enough to maintain the epithelium, and they all developed neurotrophic keratitis over the following 10–35 days. Histology studies would be required to determine the extent of the damage to corneal innervation and be able to demonstrate the damage to the long ciliary nerves after the cyclophotocoagulation, but we believe the most plausible explanation to be that the damage was caused by a hyperthermia lesion due to the excessive energy levels used in the treatment.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Another finding we consider relevant is that 4 of the patients had high myopia (spherical equivalent −7.3 D). This is important, since people with high myopia have thinner sclera than normal, which means that the long ciliary nerves, which in the ciliary body run through the suprachoroids and, as they approach the limbus, become integrated into the sclera,<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1–5</span></a> are more likely to be damaged by transscleral cyclophotocoagulation. In 1997, Palmer et al. showed in their experiment<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> that differences in scleral thickness must be taken into account in the energy to be used with cyclophotocoagulation, since patients with thinner sclera are more likely to suffer greater tissue damage. Accordingly, high myopia must also be taken into account, as it may act as an additional risk factor.</p><p id="par0140" class="elsevierStylePara elsevierViewall">We were able to conclude that neurotrophic keratopathy is a rare complication that can occur after laser diode transscleral cyclophotocoagulation as a result of damage to the long ciliary nerves. It may be more likely in patients who already have risk factors prior to the treatment, such as the use of topical beta-blockers, previous eye surgery, diabetes mellitus, corneal dystrophies and high myopia. To avoid complications with this technique, it is crucial to respect the recommended treatment parameters. Particular care should above all be taken with patients who have the above risk factors, and we recommend using lower parameters in terms of area and power. If neurotrophic keratitis develops, blood components and carboxymethyl glucose sulfate can be helpful for resolving the disorder.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors have no commercial interests and have received no financial support.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres676658" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec682689" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres676657" "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" => "xpalclavsec682688" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, materials 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" => "2015-05-25" "fechaAceptado" => "2015-12-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec682689" "palabras" => array:3 [ 0 => "Neurotrophic keratitis" 1 => "Transscleral cyclophotocoagulation" 2 => "Neurotrophic corneal ulcer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec682688" "palabras" => array:3 [ 0 => "Queratitis neurotrófica" 1 => "Ciclofotocoagulación transescleral" 2 => "Úlcera corneal neurotrófica" ] ] ] ] "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 study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880<span class="elsevierStyleHsp" style=""></span>mW for 3<span class="elsevierStyleHsp" style=""></span>s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudiar la relación existente entre el tratamiento con ciclofotocoagulación transescleral con láser de diodo y el desarrollo de queratitis neurotróficas por lesión de la inervación sensitiva corneal.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se han estudiado 5 ojos de 5 pacientes que fueron tratados con ciclofotocoagulación transescleral con láser de diodo y al poco tiempo desarrollaron úlceras neurotróficas. Se han recogido las diferentes características personales de los pacientes, incluyendo refracción y factores de riesgo de hipoestesia corneal, así como los parámetros de láser empleados en el tratamiento.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se comprobó que los 5 pacientes presentaban factores predisponentes de hipoestesia corneal previos a la cirugía (uso de betabloqueantes tópicos crónicos, cirugías corneales, diabetes mellitus o distrofias corneales). Sin embargo, ninguno había desarrollado queratitis neurotróficas hasta el momento de la ciclofotocoagulación. Se evidenció, además, que 4 de ellos eran altos miopes y que todos ellos fueron tratados con parámetros elevados de láser (2.880<span class="elsevierStyleHsp" style=""></span>mW por 3<span class="elsevierStyleHsp" style=""></span>s, en una superficie de 275° de media), y se desencadenaron úlceras neurotróficas entre los 10 y los 35 días después de la cirugía.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La queratopatía neurotrófica es una complicación poco frecuente que puede aparecer tras la ciclofotocoagulación transescleral con láser de diodo, debido a la lesión secundaria de los nervios ciliares largos. La aparición de esta se puede ver favorecida por la existencia de factores de riesgo previos, entre los que hay que incluir la alta miopía. Es crucial respetar los parámetros de tratamiento recomendados, para evitar la aparición de esta dolencia.</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:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernández-Vega González Á, Barraquer Compte RI, Cárcamo Martínez AL, Torrico Delgadillo M, de la Paz MF. Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo. Arch Soc Esp Oftalmol. 2016;91:320–326.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Partially presented in the Master's Degree in Corneal and Ocular Surface Pathology at the Autonomous University of Barcelona and Barraquer University Institute and the Congress of the Catalan Society of Ophthalmology, Barcelona, November 2015.</p>" ] ] "multimedia" => array:10 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 700 "Ancho" => 935 "Tamanyo" => 77194 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Patient 1. 2.5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>1.5<span class="elsevierStyleHsp" style=""></span>mm neurotrophic corneal ulcer stained with fluorescein 17 days after cyclophotocoagulation.</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" => 700 "Ancho" => 925 "Tamanyo" => 85740 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Patient 1. Resolution of neurotrophic corneal ulcer one and a half months later, with positive fluorescein closure line.</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" => 700 "Ancho" => 929 "Tamanyo" => 66882 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patient 2. 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm neurotrophic corneal ulcer stained with fluorescein 18 days after cyclophotocoagulation.</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" => 700 "Ancho" => 933 "Tamanyo" => 126690 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patient 2. Corneal erosion of 0.5<span class="elsevierStyleHsp" style=""></span>mm, one and a half months after onset.</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" => 700 "Ancho" => 951 "Tamanyo" => 67952 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient 3. Residual corneal leucoma after neurotrophic corneal ulcer.</p>" ] ] 5 => array:7 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 700 "Ancho" => 926 "Tamanyo" => 107933 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient 4. Vascularised residual leucoma after multiple neurotrophic keratitis.</p>" ] ] 6 => array:7 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 700 "Ancho" => 925 "Tamanyo" => 98800 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient 4. Phthisis bulbi.</p>" ] ] 7 => array:7 [ "identificador" => "fig0040" "etiqueta" => "Fig. 8" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr8.jpeg" "Alto" => 700 "Ancho" => 927 "Tamanyo" => 65664 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Patient 5. 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>4.5<span class="elsevierStyleHsp" style=""></span>mm neurotrophic corneal ulcer stained with fluorescein, one month after cyclophotocoagulation.</p>" ] ] 8 => array:7 [ "identificador" => "fig0045" "etiqueta" => "Fig. 9" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr9.jpeg" "Alto" => 700 "Ancho" => 927 "Tamanyo" => 65348 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Patient 5. Residual leucoma after resolution of the condition one month after onset.</p>" ] ] 9 => 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:2 [ "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">BB, beta-blockers; DM2, type 2 diabetes mellitus; ECCE, extracapsular cataract extraction; RF, risk factors; PK, penetrating keratoplasty; T° onset, time neurotrophic ulcers appeared.</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">Patient \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">Gender \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">Age \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">Corneal hypoaesthesia RF \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">No. of hits \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">Degrees \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">Potency (mW) \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">Duration (s) \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">T° onset (days) \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">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BB, Trabeculectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2900 \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="char" valign="top">17 \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">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BB \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3000 \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="char" valign="top">18 \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">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BB, ECCE, PK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3000 \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="char" valign="top">10 \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">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BB, ECCE \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">270 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3000 \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="char" valign="top">35 \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">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">BB, ECCE, corneal dystrophy, DM2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">360 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2500 \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="char" valign="top">30 \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"><span class="elsevierStyleBold">Mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">63.2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">22.4</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">274</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">2880</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><span class="elsevierStyleBold">22</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1110157.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the study patients and laser parameters used.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal nerves in health and disease: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.S. Shaheen" 1 => "M. Bakir" 2 => "S. Jain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.survophthal.2013.09.002" "Revista" => array:6 [ "tituloSerie" => "Surv Ophthalmol" "fecha" => "2014" "volumen" => "59" "paginaInicial" => "263" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24461367" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Standardized baseline human corneal subbasal nerve density for clinical investigations with laser-scanning in vivo confocal microscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Parissi" 1 => "G. Karanis" 2 => "S. Randjelovic" 3 => "J. Germundsson" 4 => "E. Poletti" 5 => "A. Ruggeri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.13-12999" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2013" "volumen" => "54" "paginaInicial" => "7091" "paginaFinal" => "7102" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24084094" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anatomy of the human corneal innervation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.F. Marfurt" 1 => "J. Cox" 2 => "S. Deek" 3 => "L. Dvorscak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.exer.2009.12.010" "Revista" => array:6 [ "tituloSerie" => "Exp Eye Res" "fecha" => "2010" "volumen" => "90" "paginaInicial" => "478" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20036654" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "In vivo confocal microscopy of human corneal nerves in health, in ocular and systemic disease, and following corneal surgery: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.V. Patel" 1 => "C.N. McGhee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.2008.150615" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2009" "volumen" => "93" "paginaInicial" => "853" "paginaFinal" => "860" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19019923" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal nerves: structure, contents and function" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.J. Müller" 1 => "C.F. Marfurt" 2 => "F. Kruse" 3 => "T.M. Tervo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Exp Eye Res" "fecha" => "2003" "volumen" => "76" "paginaInicial" => "521" "paginaFinal" => "542" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12697417" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotrophic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Bernard" 1 => "S. Chang" 2 => "B. Erich" 3 => "J. Groos Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cornea: fundamentals diagnosis and management" "paginaInicial" => "1101" "paginaFinal" => "1110" "serieFecha" => "2011" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotrophic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Semeraro" 1 => "E. Forbice" 2 => "V. Romano" 3 => "M. Angi" 4 => "M.R. Romano" 5 => "M.E. Filippelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000354380" "Revista" => array:6 [ "tituloSerie" => "Ophthalmologica" "fecha" => "2014" "volumen" => "231" "paginaInicial" => "191" "paginaFinal" => "197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24107451" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of neurotrophic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Sacchetti" 1 => "A. Lambiase" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S45921" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2014" "volumen" => "8" "paginaInicial" => "571" "paginaFinal" => "579" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24672223" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotrophic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Bonini" 1 => "P. Rama" 2 => "D. Olzi" 3 => "A. Lambiase" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eye (Lond)" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "989" "paginaFinal" => "995" "itemHostRev" => array:3 [ "pii" => "S1473309915002479" "estado" => "S300" "issn" => "14733099" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Degeneration and regeneration of corneal nerves in response to HSV-1 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.J. Chucair-Elliott" 1 => "M. Zheng" 2 => "D.J. Carr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.14-15596" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2015" "volumen" => "56" "paginaInicial" => "1097" "paginaFinal" => "1107" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25587055" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Selective changes in human corneal sensation associated with herpes simplex virus keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Gallar" 1 => "T.M. Tervo" 2 => "W. Neira" 3 => "J.M. Holopainen" 4 => "M.E. Lamberg" 5 => "F. Miñana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-5225" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2010" "volumen" => "51" "paginaInicial" => "4516" "paginaFinal" => "4522" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20375335" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal sensation and subbasal nerve alterations in patients with herpes simplex keratitis: an in vivo confocal microscopy study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Hamrah" 1 => "A. Cruzat" 2 => "M.H. Dastjerdi" 3 => "L. Zheng" 4 => "B.M. Shahatit" 5 => "H.A. Bayhan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2010.07.010" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2010" "volumen" => "117" "paginaInicial" => "1930" "paginaFinal" => "1936" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20810171" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corneal changes in neurosurgically induced neurotrophic keratitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Lambiase" 1 => "M. Sacchetti" 2 => "A. Mastropasqua" 3 => "S. Bonini" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamaophthalmol.2013.5064" "Revista" => array:6 [ "tituloSerie" => "JAMA Ophthalmol" "fecha" => "2013" "volumen" => "131" "paginaInicial" => "1547" "paginaFinal" => "1553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24158681" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel mouse model for neurotrophic keratopathy: trigeminal nerve stereotactic electrolysis through the brain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Ferrari" 1 => "S.K. Chauhan" 2 => "H. Ueno" 3 => "N. Nallasamy" 4 => "S. Gandolfi" 5 => "L. Borges" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-5688" "Revista" => array:7 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "2532" "paginaFinal" => "2539" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21071731" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022347614012645" "estado" => "S300" "issn" => "00223476" ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Kanski" 1 => "B. Bowling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Oftalmología clínica" "paginaInicial" => "390" "edicion" => "7th edition" "serieFecha" => "2012" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Procedimientos ciclodestructivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Lanzagorta" 1 => "E. Gutierrez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:6 [ "editores" => "J.L.Urcelay" "paginaInicial" => "119" "paginaFinal" => "122" "serieVolumen" => "11" "serieTitulo" => "Cirugía de glaucoma paso a paso" "serieFecha" => "2012" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transscleral diode cyclophotocoagulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Bhartiya" 1 => "P. Ichhpijani" 2 => "D. Angmo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Glaucoma surgery: textbook of the International Society of Glaucoma Surgery" "paginaInicial" => "65" "paginaFinal" => "70" "serieFecha" => "2014" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of transscleral diode laser cyclophotocoagulation in patients with good visual acuity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Ghosh" 1 => "S. Manvikar" 2 => "N. Ray-Chaudhuri" 3 => "M. Birch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5301/ejo.5000389" "Revista" => array:6 [ "tituloSerie" => "Eur J Ophthalmol" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "375" "paginaFinal" => "381" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24242221" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cyclophotocoagulation: a report by the American Academy of Ophthalmology" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.A. Pastor" 1 => "K. Singh" 2 => "D.A. Lee" 3 => "M.S. Juzych" 4 => "S.C. Lin" 5 => "P.A. Netland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2001" "volumen" => "108" "paginaInicial" => "2130" "paginaFinal" => "2138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11713091" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathology of cyclodiode laser: a series of 9 enucleated eyes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.A. McKelvie" 1 => "M.J. Walland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2002" "volumen" => "86" "paginaInicial" => "381" "paginaFinal" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11914203" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diode laser contact transscleral cyclophotocoagulation: getting the most from the G-probe" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.J. Noecker" 1 => "T. Kelly" 2 => "E. Patterson" 3 => "L.A. Herrygers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ophthalmic Surg Lasers Imaging" "fecha" => "2004" "volumen" => "35" "paginaInicial" => "124" "paginaFinal" => "130" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15088822" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contact diode laser transscleral cyclophotocoagulation for refractory glaucoma: comparison of 2 treatment protocols" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.H. Chang" 1 => "Y.C. Chen" 2 => "C.Y. Li" 3 => "S.C. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Ophthalmol" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "511" "paginaFinal" => "516" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15491035" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 2 centre study of the dose–response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.C. Murphy" 1 => "C.A. Burnett" 2 => "P.G. Spry" 3 => "D.C. Broadway" 4 => "J.P. Diamond" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2003" "volumen" => "87" "paginaInicial" => "1252" "paginaFinal" => "1257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14507761" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of total energy delivery on success rate after contact diode laser transscleral cyclophotocoagulation: a retrospective case review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.A. Hauber" 1 => "W.J. Scherer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Glaucoma" "fecha" => "2002" "volumen" => "11" "paginaInicial" => "329" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12169970" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Audible pops during cyclodiode procedures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Rebolleda" 1 => "F.J. Muñoz" 2 => "J. Murube" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Glaucoma" "fecha" => "1999" "volumen" => "8" "paginaInicial" => "177" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10376257" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Energy levels and probe placement in contact transscleral semiconductor diode laser cyclophotocoagulation in human cadaver eyes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.S. Schuman" 1 => "R.J. Noecker" 2 => "C.A. Puliafito" 3 => "J.J. Jacobson" 4 => "G.J. Shepps" 5 => "N. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Ophthalmol" "fecha" => "1991" "volumen" => "109" "paginaInicial" => "1534" "paginaFinal" => "1538" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1755733" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on results and complications of cyclophotocoagulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K. Ishida" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICU.0b013e32835d9335" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Ophthalmol" "fecha" => "2013" "volumen" => "24" "paginaInicial" => "102" "paginaFinal" => "110" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23313903" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurotrophic corneal defects after diode laser cycloablation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.M. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophtalmol" "fecha" => "1998" "volumen" => "126" "paginaInicial" => "725" "paginaFinal" => "727" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparative study between diode laser cyclophotocoagulation and the Ahmed glaucoma valve implant in neovascular glaucoma: a long-term follow-up" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Yildirim" 1 => "I.S. Yalvac" 2 => "A. Sahin" 3 => "A. Ozer" 4 => "T. Bozca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0b013e31817d235c" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma" "fecha" => "2009" "volumen" => "18" "paginaInicial" => "192" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19295370" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673604168529" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of topical timolol (0.5%) and betaxolol (0.5%) on corneal sensitivity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.S. Weissman" 1 => "P.A. Asbell" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "1990" "volumen" => "74" "paginaInicial" => "409" "paginaFinal" => "412" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2378856" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Transscleral diode laser cyclophotocoagulation on autopsy eyes with abnormally thinned sclera" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.J. Palmer" 1 => "J. Cohen" 2 => "E. Torczynski" 3 => "T.A. Deutsch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ophthalmic Surg Lasers" "fecha" => "1997" "volumen" => "28" "paginaInicial" => "495" "paginaFinal" => "500" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9189953" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009100000007/v1_201606230404/S2173579416300251/v1_201606230404/en/main.assets" "Apartado" => array:4 [ "identificador" => "5816" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009100000007/v1_201606230404/S2173579416300251/v1_201606230404/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300251?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
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