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Original article
Outcomes and complications after phacoemulsification in retinoblastoma patients with cataract after radiation treatment
Facoemulsificación en pacientes con retinoblastoma y catarata por radioterapia: resultados y complicaciones
M. Velásquez-Aguilara, H. Matiz-Morenob, M. Amato-Almanzaa, C.Y. Chen-Lópezb, G. Márquez-Garcíab, M.A. Ramírez-Ortiza,
Corresponding author
marco@unam.mx

Corresponding author.
a Servicio de Oftalmología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
b Instituto Oftalmológico Conde de Valenciana, Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Retinoblastoma &#40;Rb&#41; is the most common malign tumor in children and one of the most frequent solid tumors in children&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">1</span></a> The Mexican Retinoblastoma Group reported that every year approximately 100 new cases occur in Mexico&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">2</span></a> Treatment for RB has evolved in the last decade and&#44; even though enucleation in advanced stages remains as treatment of choice to avoid demise&#44; several options are available in bilateral RB in which the least compromised eye has useful vision&#46; In patients with vitreous seeding or tumors below 3<span class="elsevierStyleHsp" style=""></span>mm diameter who did not respond adequately to chemotherapy and&#47;or laser treatment&#44; therapeutic consultation can be attempted with external radiotherapy or brachytherapy&#46; The external radiotherapy dose applied for treating intraocular RB ranges between 25 and 50<span class="elsevierStyleHsp" style=""></span>Gy&#44; depending on the severity of the case and taking into account that 2<span class="elsevierStyleHsp" style=""></span>Gy are required to affect the lens and promote the formation of cataracts expecting that in the short and midterm lens opacification with posterior subcapsular predominance will occur in 22&#8211;87&#37; of patients and 9&#46;7&#8211;31&#37; in brachytherapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">3&#44;4</span></a> It has been observed that above 6&#46;51<span class="elsevierStyleHsp" style=""></span>Gy the risk of progression in less than 4 years is up to 66&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> Lens opacification etiology is due to the damage caused by radiation in the epithelial cells in the germinal lens area because it produces cell death with compensating mitosis and cells with opacity at the posterior capsule level because the chlorine channels are located in the epithelial cell membrane and their action mechanism is completely altered&#46; A further complication are secondary tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">5</span></a> In order to minimize the side effects&#44; it is important to prepare an adequate approach for the treatment and establish a target volume or tissue to be treated from the beginning&#44; focusing on the posterior chamber&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The objective of this study is to describe the visual results and complications associated to cataract surgery secondary to radiotherapy treatment in patients with bilateral Rb&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The database of the Federico Gomez Children&#39;s Hospital of Mexico identified patients with RB who received supplementary treatment with external radiotherapy for treating intraocular RB and operated for secondary cataracts between January 1997 and August 2015&#46; All patients underwent an ophthalmological examination by an independent observer&#44; measuring best corrected visual acuity before and after phacoemulsification&#44; tonometry and search for neoplasia activity in the retinal tumors&#46; Preoperative and postoperative visual acuity was measured with HOTV posters in preschool children and ETDRS in children in school age&#46; Said measurements were subsequently converted to the LogMAR scale for averaging&#46; The International Intraocular Retinoblastoma Classification was utilized for grading the extension of RB in patients&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All patients were operated by a single surgeon &#40;HMM&#41; applying the following technique&#58; through 2 ports&#44; the main one having 2&#46;2<span class="elsevierStyleHsp" style=""></span>mm and the secondary 1<span class="elsevierStyleHsp" style=""></span>mm in the corneoscleral limbus&#44; anterior capsule staining with Triphan blue&#44; placement of viscoelastic and anterior continuous circular capsulorhexis&#44; the surgeon carried out lens phacoaspiration and surface cleaning&#44; preserving the entirety of the posterior capsule with INFINITI<span class="elsevierStyleSup">&#174;</span> Vision System &#40;Alcon Laboratories Inc&#46;&#44; Fort Worth&#44; TX&#44; USA&#41;&#46; Subsequently&#44; AcrySoft<span class="elsevierStyleSup">&#174;</span> IQ &#40;Alcon Laboratories Inc&#46;&#44; Fort Worth&#44; TX&#44; USA&#41; lens was placed&#46; Viscoelastic was withdrawn and the main surgical wound was sutured with a simple Nylon 10-0 stitch&#46; The lens calculation was carried out with the immersion technique applying the SRK-T formula&#44; placing the lens indicated for emmetropia&#46; Postoperative treatment consisted in topical administration of 1&#37; prednisolone in the operated eye at least 4 times a day&#44; with progressive dose reduction based on inflammatory response&#46; Topical antibiotic treatment consisted in moxifloxacin&#44; that was prescribed every 6 hours for one week&#46; Said treatment was repeated upon withdrawal of the suture one month later&#46; In addition&#44; topical 0&#46;25&#37; tropicamide and phenylephrine were prescribed every 12 hours for one month&#46; All patients had at least one year follow-up&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Descriptive statistics and range test with Wilcoxon sign were performed to establish pre- and postoperative visual acuity differences utilizing the Stata 10 application &#40;College Station&#44; TX&#44; USA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study included 15 consecutive patients with bilateral Rb &#40;15 single eyes&#41;&#46; Three patients had familial RB&#46; All patients were treated with linear accelerator external radiotherapy &#40;36&#8211;45<span class="elsevierStyleHsp" style=""></span>Gy distributed in 20 sessions&#41;&#44; except one patient who was treated with cobalt pump&#46; In addition&#44; 3 patients were administered ocular brachytherapy&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinic and demographic characteristics of each patient&#46; Mean age at RB diagnostic was one year and 3 months &#40;range&#58; from 2 months to 2 years 9 months&#41;&#46; Mean age at cataract surgery was 7 years and 6 months &#40;range&#58; 4 years 2 months to 12 years&#41;&#46; No preference for laterality or gender was observed&#46; Seven patients exhibited advanced RB &#40;groups C and D as per the International Retinoblastoma Classification&#41;&#46; Mean time between external radiotherapy administration and cataract surgery was 123 months &#40;range&#58; 44&#8211;227 months&#41;&#46; Mean preoperative visual acuity was 1&#46;0<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;20&#47;200&#41;&#44; with an interval of 0&#46;4&#8211;1&#46;6 &#40;20&#47;50&#8211;20&#47;800&#41;&#46; Postoperative mean best corrected visual capacity was 0&#46;7<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;20&#47;100&#41;&#44; with a range of 0&#46;1&#8211;1&#46;6 in the last visit &#40;20&#47;25&#8211;20&#47;800&#41;&#46; Twelve patients exhibited visual acuity improvements of at least 2 lines &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Three patients exhibited diminished visual acuity&#44; 2 due to causes associated to radiotherapy treatment&#58; one had dense vitreous hemorrhage and secondary glaucoma 2 months after surgery&#44; and 2 patients with a history of external radiotherapy and ocular brachytherapy developed exudative maculopathy&#46; Corneal alterations such as band keratopathy affecting corneal transparency or visual acuity were not observed&#46; Mean follow up after cataract surgery was 46 months&#46; Relapses in previously treated tumors were not observed in any patient included in this study&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the fact that the applied surgical technique did not include posterior capsulotomy&#44; all patients underwent YAG laser capsulotomy in a period of 4 weeks after the identification of opacities&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the pre- and postoperative visual acuity as well as tumor location and the complications that directly compromised visual acuity&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">The treatment of cataract secondary to radiotherapy in patients with intraocular RB is a challenging procedure for anterior segment surgeons because&#44; in addition to tissue exhibiting inflammatory sequels&#44; there is a risk of neoplasia reactivation due to intraocular manipulation&#46; There are 2 cataract surgery indications in these patients&#58; the first is for improving visual acuity and the second for improving retinal visualization and intraocular lesions during RB supervision&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">A series of cases reported by Osman et al&#46; analyzed visual results in a 23-year period in 20 patients with RB who underwent cataract surgery due to radiation&#44; observing characteristics and risks involved in carrying out the procedure with modern techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">4</span></a> Said author found positive results as in the present study&#44; with a mean age of 4 years at surgery&#46; Comparing this variable&#44; it can be seen that the present population had less postoperative complications&#44; possibly related to higher mean age at surgery&#44; while literature reports more inflammation and risk of complication despite the application of protection techniques for surrounding tissue&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">9&#44;10</span></a> Children tend to present inflammatory reactions that are difficult to control and require anti-inflammatory treatment&#46; In addition&#44; posterior capsule opacity appears in a high percentage&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Another series of cases reported by Payne et al&#46; analyzed techniques involving posterior pole in 12 patients who underwent surgery with a 6 year follow-up&#44; applying extracapsular cataract extraction with anterior vitrectomy&#46; In some cases&#44; posterior capsulotomy was performed in the same procedure&#44; creating direct communication between the posterior and anterior segment of the ocular globe&#46; However&#44; said authors did not report RB recurrence or progression in any of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a> Hoen et al&#46; reported a 25-year experience in the St&#46; Jude hospital treating this type of patients&#46; Their surgical technique was similar to that utilized in the present study&#44; i&#46;e&#46;&#44; preserving the posterior capsule intact&#44; and did not observe RB recurrence&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">12</span></a> In contrast&#44; Santosh et al&#46;&#44; despite leaving the capsule whole&#44; reported 20&#37; retinoblastoma recurrence during follow-up&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">13</span></a> Brooks et al&#46; reported 3 recurrences&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a> The present study&#44; with a mean follow-up of 41 months&#44; to date has not identified any recurrence&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Group B predominated in the RB staging of the present patients&#44; which demonstrates adequate management of the disease enabling the success of advanced stages in order to subsequently consider therapies for improving quality of life based on the complications that may arise such as dry eye&#44; exposure keratopathy&#44; cataracts and maculopathies&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">5&#44;15&#44;16</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The visual results found in the present study are positive&#44; as the majority of cases exhibited visual acuity improvements after carrying out best optical correction&#46; The mean visual capacity was 0&#46;7<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;20&#47;100 in the Snellen scale&#41;&#44; with a range of 0&#46;1&#8211;1&#46;6<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;20&#47;25&#8211;20&#47;800 Snellen&#41;&#44; with the widest distribution being between 0&#46;4 and 0&#46;7<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;20&#47;40&#8211;20&#47;100 Snellen&#41;&#46; A fundamental contribution to this result was the close follow-up and the commitment with parents in addition to adequate communication&#46; These results are similar to those reported in other studies of RB treatment carried out in excellence centers&#46;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">11&#8211;16</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Complications identified in the present study were posterior capsule opacity in 4&#47;15 patients &#40;26&#46;6&#37;&#41;&#44; superior retina detachment in one patient &#40;6&#46;6&#37;&#41;&#44; with positive evolution without requiring surgical treatment at this date&#44; and maculopathy due to radiation in 2 patients&#44; with final visual acuity of 20&#47;220&#47;400&#44; respectively&#46; One of the patients exhibited dense vitreous hemorrhage and secondary glaucoma with diminished visual acuity&#46; This patient was in group D and had a tumor involving the entire macular area having residual tissue with surface vascularization&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Recurrences have not arisen during the mean follow-up period of 46 months &#40;13&#8211;124&#41;&#46; As reported by Brooks&#44; which is the largest study carried out to date&#44; the mean follow-up was 72 months<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">11</span></a>&#59; however&#44; in the other studies the mean postoperative follow-up was not as long&#44; with a range of 18&#8211;58 months&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">12&#8211;16</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Cataract surgery involves complications that must be followed up in the short&#44; medium and long-term such as capsular opacity&#44; significant inflammatory processes&#44; hemorrhage&#44; endophthalmitis&#44; retina detachment or corneal endothelial cell lesions&#46; Patients with RB should be followed up very closely&#44; always taking into account the following 3 factors&#58; &#40;1&#41; tumor presentation age &#40;children under 2 years&#41; involves high risk of amblyopia in patients developing secondary cataract&#44; which means that the utmost effort must be made to treat these patients endeavoring to maintain the lowest possible inflammation which is very intense in pediatric patients&#59; &#40;2&#41; closely follow the posterior pole and intentionally seek recurrence data to provide timely treatment&#44; and &#40;3&#41; always offer the best refractive rehabilitation for patients in order to achieve positive visual results and thus ensure better quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">14</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Due to technological developments&#44; current cataract surgery techniques enable very small manipulations as well as lower surgery times&#46; Phacoemulsification is the most widely used technique due to lens characteristics at this age&#46; The airtightness achieved with this technique is very useful in RB cases as it minimizes the risk of contact between intraocular content and the conjunctiva or the sclera&#46; A study carried out by Tartarella et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">15</span></a> analyzed the safety of phacoemulsification in patients with cataract due to radiation and RB history&#44; analyzing aqueous humor samples without finding tumor activity&#46; However&#44; it was emphasized to leave the posterior capsule intact and avoid single chamber as well as to continue prolonged follow-up due to recurrence risks reported in other case series&#46; In the population of the present study&#44; the applied technique was phacoemulsification with intraocular lens placement in the capsular sac without posterior capsulotomy or posterior pole approach&#46; An important factor to avoid posterior capsulotomy was that the majority of patients were over 5 years old when cataract surgery was performed&#44; which meant that postoperative inflammation was lower and easier to control&#44; thus producing less anterior vitreous and posterior capsule opacity&#46; However&#44; the follow-up of the base disease remained close&#44; with timely treatment of complications when required&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The visual results in patients with RB who underwent surgery for radiation cataracts with intraocular lens implant are positive&#46; The ophthalmologist must maintain close and prolonged follow-up of these patients due to the risk of complications and recurrence of the tumor&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0095" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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    "fechaRecibido" => "2016-07-19"
    "fechaAceptado" => "2016-11-21"
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Retinoblastoma"
            1 => "Cataract"
            2 => "Phacoemulsification"
            3 => "Radiation-induced abnormalities"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "Retinoblastoma"
            1 => "Catarata"
            2 => "Facoemulsificaci&#243;n"
            3 => "Alteraciones inducidas por radioterapia"
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the visual outcome and complications associated with phacoemulsification in patients with bilateral retinoblastoma &#40;Rb&#41;&#44; with lens opacification secondary to external beam radiotherapy&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive study was performed on patients with Rb&#44; treated in Federico Gomez Children&#39;s Hospital&#44; Mexico&#44; from January 1997 to August 2015&#44; with external beam radiotherapy eye salvaging&#46; Statistical analysis was performed using Stata 10&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 15 patients were included&#46; The mean age at phacoemulsification was 7&#46;5 years&#46; Mean preoperative visual acuity was 1&#46;0<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;range 0&#46;4&#8211;1&#46;6&#41;&#44; and the mean postoperative visual acuity was 0&#46;7<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;range 0&#46;1&#8211;1&#46;6&#41;&#46; Twelve patients had visual improvement &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The visual acuity decreased in one patient with vitreous hemorrhage and secondary glaucoma&#44; and 2 patients with exudative maculopathy secondary to radiation&#46; Mean follow up was 46 months and not a single patient showed tumor re-activation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cataract surgery produces a statistically significant improvement in visual acuity&#46; These patients have increased risk for eye complications in the mid- and long-term&#46; It is important to conduct a close follow up due to reactivation of tumor&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Purpose"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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            "titulo" => "Conclusions"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los resultados visuales y las complicaciones asociadas al tratamiento quir&#250;rgico de catarata secundaria a radioterapia externa en pacientes con retinoblastoma &#40;Rb&#41; bilateral&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio descriptivo de aquellos pacientes que acudieron al Hospital Infantil de M&#233;xico Federico G&#243;mez de enero de 1997 a agosto de 2015 con diagn&#243;stico de Rb y que desarrollaron catarata secundaria al tratamiento con radioterapia externa&#46; Se realiz&#243; un an&#225;lisis estad&#237;stico utilizando el programa Stata 10&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 15 pacientes&#46; La edad promedio de facoemulsificaci&#243;n fue 7&#44;5 a&#241;os&#46; La agudeza visual preoperatoria promedio fue 1&#44;0<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;rango 0&#44;4 a 1&#44;6&#41;&#44; mientras que la capacidad visual mejor corregida postoperatoria fue en promedio 0&#44;7<span class="elsevierStyleHsp" style=""></span>LogMAR &#40;rango 0&#44;1 a 1&#44;6&#41;&#46; Doce pacientes presentaron mejor&#237;a de la agudeza visual de al menos 2 l&#237;neas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Una paciente present&#243; hemorragia v&#237;trea densa y glaucoma secundario&#44; y 2 pacientes desarrollaron maculopat&#237;a exudativa por radioterapia&#46; El seguimiento promedio fue de 46 meses&#44; durante el cual no se presentaron reactivaciones tumorales&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La facoemulsificaci&#243;n produce mejor&#237;a visual estad&#237;sticamente significativa&#46; Estos pacientes tienen un riesgo incrementado de complicaciones oculares a medio y largo plazo&#44; originadas por el tratamiento del Rb intraocular con radioterapia&#46; Es importante un estrecho seguimiento debido a la posibilidad de recurrencia del Rb&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Vel&#225;squez-Aguilar M&#44; Matiz-Moreno H&#44; Amato-Almanza M&#44; Chen-L&#243;pez CY&#44; M&#225;rquez-Garc&#237;a G&#44; Ram&#237;rez-Ortiz MA&#46; Facoemulsificaci&#243;n en pacientes con retinoblastoma y catarata por radioterapia&#58; resultados y complicaciones&#46; Arch Soc Esp Oftalmol&#46; 2017&#59;92&#58;160&#8211;165&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Presented in part as a poster during the annual meeting of the Association for Research in Vision and Ophthalmology &#40;ARVO&#41;&#44; 5&#8211;9 May 2013&#44; Seattle&#44; Washington&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">F&#58; female&#59; M&#58; male&#59; Rb&#58; retinoblastoma&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>&#58; Murphree&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">7</span></a></p>"
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                  <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">&#35;&nbsp;\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">Sex&nbsp;\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">Diagnostic age &#40;months&#41;&nbsp;\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">RB Group<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\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">Radiotherapy age &#40;months&#41;&nbsp;\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">Cataract surgery age &#40;months&#41;&nbsp;\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">Time between radiotherapy and surgery &#40;months&#41;&nbsp;\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">Indication for external radiotherapy&nbsp;\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">Ocular brachytherapy&nbsp;\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">Follow-up &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">223&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitreous seeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">192&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">244&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitreous seeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Consolidation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitreous seeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitreous seeding&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Consolidation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">102&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">146&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">143&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Relapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1375920.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">According to the International Retinoblastoma Classification&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinic characteristics of patients with bilateral retinoblastoma treated with external radiotherapy and submitted to cataract surgery&#46;</p>"
        ]
      ]
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
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                  \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 &#35;&nbsp;\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">Preoperative visual acuity &#40;LogMAR&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peripheral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Peripheral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radiation maculopathy&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Macular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Macular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vitreous hemorrhage&#44; glaucoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Macular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Macular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Equatorial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Radiation maculopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Macular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                            1 => "M&#46; Flores-Rojo"
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