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"apellidos" => "Abreu Reyes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S036566911600112X" "doi" => "10.1016/j.oftal.2016.02.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036566911600112X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416300536?idApp=UINPBA00004N" "url" => "/21735794/0000009100000012/v1_201612011629/S2173579416300536/v1_201612011629/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579416301347" "issn" => "21735794" "doi" => "10.1016/j.oftale.2016.09.011" "estado" => "S300" "fechaPublicacion" => "2016-12-01" "aid" => "1039" "copyright" => "Sociedad Española de Oftalmología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Arch Soc Esp Oftalmol. 2016;91:592-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 169 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 143 "PDF" => 14 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Horizontal gaze palsy and progressive scoliosis in a patient with congenital esotropia and inability to abduct. 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Removal after three months" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "596" "paginaFinal" => "598" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M.A. Sierra-Rodríguez, J.M. López-López, S. Jiménez-Prada de Miguel" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M.A." "apellidos" => "Sierra-Rodríguez" "email" => array:1 [ 0 => "sffera@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.M." "apellidos" => "López-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Jiménez-Prada de Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Comarcal de Benavente, Benavente, Zamora, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital del Río Hortega, Valladolid, 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" => "Perfluorocarbono líquido subfoveal. Extracción después de 3 meses" ] ] "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" => 466 "Ancho" => 975 "Tamanyo" => 152812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">OCT image 4 months after surgery, showing normal macular profile with some atrophy after LPFC extraction and resolution of postop CME.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Liquid perfluorocarbon (LPFC) is broadly used in vitreoretinal surgery. However, the manipulation of LPFC could give rise to complications. Subretinal LPFC migration has been described with a frequency ranging between 0.9 and 11.1%,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> which could be greater when retinal tear tractions are not released and in patients undergoing 23<span class="elsevierStyleHsp" style=""></span>g vitrectomy against conventional 20<span class="elsevierStyleHsp" style=""></span>g vitrectomy<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> due to the formation of multiple small bubbles. In the subfoveal location, most authors recommend LPFC extraction,<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3,4</span></a> to which end several surgical techniques have been described.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3–7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the present case, several LPFC bubbles migrated to the subretinal space, one of which remained under the fovea.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Clinic case</span><p id="par0015" class="elsevierStylePara elsevierViewall">Male, 77, with complete regmatogenous retina detachment, macular involvement and hand movements visual acuity in the right eye (RE) with onset 2 days earlier (complicated phacoemulsification 8 months earlier).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Two days later, surgical treatment was performed, placing a 2.5<span class="elsevierStyleHsp" style=""></span>mm cerclage and carrying out 20<span class="elsevierStyleHsp" style=""></span>g pars plana vitrectomy, draining subretinal fluid with LPFC, laser endophotocoagulation of retinal tears and liquid–gas exchange with 15% octofluoropropane (C3F8) as the retinal tears were located at 4 o’clock.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Prior to complete reabsorption of said gas, the patient referred poor vision and central scotoma. Ocular fundus revealed a LPFC subfoveal bubble of approximately 750<span class="elsevierStyleHsp" style=""></span>μm as well as other smaller bubbles located in the subretinal space at the level of the papillomacular bundle (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Three months later, a new 20<span class="elsevierStyleHsp" style=""></span>g pars plana vitrectomy was performed for removing the subfoveal LPFC bubbles. Endolaser retinotomy was performed close to the upper temporal arch, through which a 41<span class="elsevierStyleHsp" style=""></span>g cannula was inserted in the subretinal space, coupled to a syringe and a silicone injection system connected to the vitreotome, substituting silicone by BSS. A small amount of BSS was slowly injected in the subretinal space to achieve a therapeutic macular retinal detachment to facilitate the absorption of the LPFC subfoveal bubble, with subsequent exchange of air – 20% sulfur hexafluoride (SF6).</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the immediate postop, the retina was reapplied without subfoveal LPFC. However, optical coherence tomography (OCT) taken one month after surgery revealed a post-surgery cystic macular edema (CME) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), treated administering 3 monthly transseptal triamcinolone injections which achieved partial edema resolution. On the basis of this result, a fourth intravitreal injection was administered which achieved a normal macular profile (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), maintained at this date (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>), with best corrected visual acuity of 0.3.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Despite subfoveal LPFC retention being an infrequent complication of vitreoretinal surgery in accordance with the few published cases,<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1–9</span></a> it is an important and potentially severe complication.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The time elapsed since the extraction of the subfoveal LPFC appears to influence the final visual acuity as the retention of subretinal LPFC has a potentially toxic effect on the retina pigment epithelium (RPE), and in long-term progressive photoreceptor atrophy.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1,6,9</span></a> Some authors consider said extraction to be safe and efficient, with very low or no toxicity if performed before 3 months.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> In the present case, the authors believe that the ophthalmoscopic and tomographic results as well as the final visual acuity have been very positive because useful vision was achieved despite significant poor prognostic factors, i.e., complete retina detachment in an elderly patient, post-surgery CME which took 4 months to resolve, and an LPFC bubbles which remained 3 months in the subretinal space.</p><p id="par0050" class="elsevierStylePara elsevierViewall">A further aspect to be taken into account is the risk of producing iatrogenic injuries during extraction, such as direct traumatism with the suction cannula which could produce macular hole, submacular hemorrhage, retinotomy enlargement and photoreceptor lesions with irreversible visual damages.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, it is possible to achieve a useful final visual acuity in patients with the complications described above despite poor prognostic factors, provided that the fovea is not damaged and maneuvers that could damage the macula are avoided during the extraction of the LPFC bubble.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interests</span><p id="par0060" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres764850" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec766279" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres764849" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec766280" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinic case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-11-24" "fechaAceptado" => "2016-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec766279" "palabras" => array:5 [ 0 => "Perfluorocarbon liquid" 1 => "Subfoveal" 2 => "Vitrectomy" 3 => "Macula" 4 => "Macular surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec766280" "palabras" => array:5 [ 0 => "Perfluorocarbono líquido" 1 => "Subfoveal" 2 => "Vitrectomía" 3 => "Mácula" 4 => "Cirugía macular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical case</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A case of surgical removal of a subfoveal perfluorocarbon liquid (PFCL) bubble that remained trapped inside the subretinal space. PFCL bubble extraction was performed by performing a therapeutic and vacuum PFCL bubble macular retinal detachment.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Discussion</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The elapsed time before subfoveal PFCL extraction seems to influence the visual result. There are other factors which could influence the final visual acuity significantly, nevertheless it is possible to achieve useful vision, as long as the fovea is not damaged and iatrogenic injuries are avoided during PFCL bubble extraction.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Caso clínico</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso de extracción quirúrgica de una burbuja de perfluorocarbono líquido (PFCL) subfoveal, mediante la producción de un desprendimiento retiniano macular terapéutico y aspirado de la burbuja de PFCL.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discusión</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tiempo transcurrido hasta la extracción del PFCL subfoveal parece tener influencia sobre el resultado visual. Existen otros factores que pueden influir de manera importante en la agudeza visual final, a pesar de los cuales es posible conseguir una visión útil, siempre y cuando no se dañe la fóvea, y se eviten lesiones iatrogénicas durante la extracción de la burbuja de PFCL.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Caso clínico" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sierra-Rodríguez MA, López-López JM, Jiménez-Prada de Miguel S. Perfluorocarbono líquido subfoveal. Extracción después de 3 meses. Arch Soc Esp Oftalmol. 2016;91:589–591.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 734 "Ancho" => 975 "Tamanyo" => 75996 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Ophthalmoscopic image, right eye, showing subfoveal LPFC bubble (approximately 750<span class="elsevierStyleHsp" style=""></span>μm) and other smaller bubbles in the papillomacular bundle.</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" => 468 "Ancho" => 975 "Tamanyo" => 140069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">OCT image of <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, clearly illustrating subretinal LPFC bubbles.</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" => 481 "Ancho" => 975 "Tamanyo" => 116495 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">OCT image one month after surgery, showing postop CME.</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" => 466 "Ancho" => 975 "Tamanyo" => 152812 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">OCT image 4 months after surgery, showing normal macular profile with some atrophy after LPFC extraction and resolution of postop CME.</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" => 728 "Ancho" => 975 "Tamanyo" => 78440 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ophthalmoscopic image after LPFC extraction, showing intra-surgery laser marks and absence of LPFC bubbles.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Displacement of retained subfoveal perfluorocarbon liquid after vitreoretinal surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "V. 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