Original article
Analysis and follow-up of type 1 choroidal neovascularisation with optical coherence tomography–angiography after antiangiogenic treatment
Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico
R. Torrecillas-Picazo
, M. Cerdà-Ibáñez, I. Almor Palacios, J.M. Hervás Hernandis, R. Ramón-Cosín, N. Ruiz del Rio, A. Duch-Samper
Corresponding author
Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Muestra NVC en «abanico de mar» con vaso nutricio lateral prominente. Reconstrucción en color. Delimitación del área de NVC. <span class="elsevierStyleItalic">c)</span> Angiograma a las 24<span class="elsevierStyleHsp" style=""></span>h de la primera inyección con anti-VEGF. <span class="elsevierStyleItalic">d)</span> Angiograma a la semana de la última inyección. <span class="elsevierStyleItalic">e)</span> OCT estructural a la semana de la última inyección. Persiste la alteración del EPR, con reabsorción del LSR.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Torrecillas-Picazo, M. Cerdà-Ibáñez, I. Almor Palacios, J.M. Hervás Hernandis, R. Ramón-Cosín, N. Ruiz del Rio, A. Duch-Samper" "autores" => array:7 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Torrecillas-Picazo" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Cerdà-Ibáñez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Almor Palacios" ] 3 => array:2 [ "nombre" => "J.M." 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Respuesta anatómica y funcional de los pacientes con hemangioma coroideo tratados con terapia fotodinámica" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2646 "Ancho" => 1211 "Tamanyo" => 414052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Evolution of patient number 7 in images. (A) retinography, showing orange lesion in upper temporal arch. (B) Autofluorescence, showing enhancement of lesion with hyper-and hypo-autofluorescent granulated pattern. (C) Mode B echography, showing hyperintense and homogeneous solid mass 1.6<span class="elsevierStyleHsp" style=""></span>mm height and 10.31<span class="elsevierStyleHsp" style=""></span>mm base, without posterior acoustic shadow. (D) ssOCT over the tumor, showing slightly over-elevated lesion that produces undulations of Bruch's membrane and retina pigment epithelium (arrow). Typical choroidal vasculature pattern loss can be observed (*). (E) macular OCT before treatment, showing subfoveal NSD (*). (F) retinography with retinal thicknesses graph prior to treatment: central foveal thickness 475<span class="elsevierStyleHsp" style=""></span>μm. (G) Macular OCT 20 months after a single PDT session, showing complete absence of NSD. (H) Retinography with retinal thicknesses chart after treatment, showing central foveal thickness of 249<span class="elsevierStyleHsp" style=""></span>μm.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O. Subirà, H. Brosa, D. 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Torrecillas-Picazo, M. Cerdà-Ibáñez, I. Almor Palacios, J.M. Hervás Hernandis, R. Ramón-Cosín, N. Ruiz del Rio, A. Duch-Samper" "autores" => array:7 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Torrecillas-Picazo" "email" => array:1 [ 0 => "raultorrecillas@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Cerdà-Ibáñez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Almor Palacios" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Hervás Hernandis" ] 4 => array:2 [ "nombre" => "R." "apellidos" => "Ramón-Cosín" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "Ruiz del Rio" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Duch-Samper" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1985 "Ancho" => 1700 "Tamanyo" => 501782 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(a) Wide angiogram and SS-OCT 24<span class="elsevierStyleHsp" style=""></span>h after the first anti-VEGF injection. (b) Wide angiogram and SS-OCT 7 days after the first injection. (c) Wide angiogram and SS-OCT one month after the first injection. (d) Wide angiogram and SS-OCT 7 days after the 2nd injection. (e) Wide angiogram and SS-OCT one month after the 2nd injection. (f) Wide angiogram and SS-OCT one week after the last injection. The structural OCT shows complete SRF reabsorption with uneven RPE.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since the 60s, the visualization of the retinal and choroidal vascular network was based on 2 main techniques: Fluorescein angiography (FAG) and indocyanine green angiography (ICG).<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">1</span></a> Both techniques allow the observer to watch vessels filling up in real-time and to determine contrast leak and the time when it occurs. Fluorescein patterns in ARMD have enabled the characterization of neovascular proliferative lesions and facilitated the understanding of the disease.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2,3</span></a> As described by Gass,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">4</span></a> classic CNV (CNV type 2) is characterized by well-defined hyperfluorescence in early FAG stages with extravasation in late stages that masks lesion edges. Hidden CNV (CNV type 1) is defined by a regular elevation of the retina pigment epithelium (RPE) with dotted hyperfluorescence occurring 1–2<span class="elsevierStyleHsp" style=""></span>min after fluorescein injection and diffuse extravasation in the final phase. For this reason, the distortion of the image that produces contrast extravasation, particularly in late stages, makes it difficult to adequately characterize these structures.</p><p id="par0010" class="elsevierStylePara elsevierViewall">With the appearance of spectral domain optical coherence tomography (SD-OCT), the activity or quiescence of neovascular membranes type 1 has been calculated on the basis of indirect parameters such as RPE smoothness, reflectiveness of the space underlying the RPE and the presence of subretinal hypo-reflective material corresponding to subretinal fluid (SRF) exudation which, together with the presence of intraretinal liquid, has traditionally determined the decision to treat.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">5</span></a> Unfortunately, this technique is unable to discriminate an active neovascular network from other adjacent tissue as well as fibrotic scars or drusenoid RPE detachments.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1,6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">OCT angiography (A-OCT) is a novel diagnostic imaging technique that, without being invasive, enables the characterization of retinal blood flow and visualization of the vascular network. To this end, it applies phase or amplitude decorrelation technology that is able to detect the movement of erythrocytes that occurs between successive B-scan sections generated by OCT.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">7–9</span></a> The majority of the algorithms applied by A-OCT are based on amplitude decorrelation as it does not require complex phase correction methods and exhibits an improved signal-noise ratio. The most widely used algorithm is split spectrum amplitude decorrelation angiography (SSADA). The end results are high resolution 3-D images enabling a volumetric angiographic analysis of retinal layers in combination with the structural analysis provided by OCT.<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objective of this study is to describe the vascular network of neovascular lesions, inferring the response to treatment on the basis of quantitative parameters and to sequentially quantify A-OCT changes after treatment with anti-VEGF.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Subjects, material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A prospective observational study that included 6 eyes of 6 patients with naïve CNV. The patients were selected between February and April 2016 at the Clinic Hospital of Valencia (Valencia, Comunitat Valenciana, Spain). The study had the approval of the ethical committee of the hospital and all participants signed an informed consent prior to the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Selected subjects underwent a basic ophthalmological examination that included anamnesis and clinical history, best corrected visual acuity (BCVA), anterior and posterior pole evaluation with slit lamp and intraocular pressure measurements with applanation tonometry. The study excluded patients with a history of retinal alterations other than ARMD, but had received previous treatments such as photodynamic therapy, laser photocoagulation, anti-VEGF injections or vitreoretinal surgery and refractive defects beyond the range of −6D to +6D.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The A-OCT and OCT images were taken with AngioPlex Cirrus HD-OCT model 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) and DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc., Oakland, NJ, USA). In all cases, a scanner centered in the fovea having 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm and 6<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm was utilized. The scan is a selected for the follow-up period in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a> correspond to A-OCT DRI OCT Triton due to better image quality.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">AngioPlex applies the optical microangiography algorithm (OMAG), with a scanning speed of 68,000<span class="elsevierStyleHsp" style=""></span>scans/s and a source of light with a wavelength centered at 840<span class="elsevierStyleHsp" style=""></span>nm. The resulting 3D cube comprises 245 B-scans, each made up by 245 A-scans.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">12</span></a> DRI OCT Triton SS-OCT Angio is based on the OCTARA algorithm and has a scanning speed of 100,000<span class="elsevierStyleHsp" style=""></span>scans/s and a wavelength centered at 1050<span class="elsevierStyleHsp" style=""></span>nm. The final resolution of the 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm cube reaches 320<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>320 A-scans.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">13</span></a> Both devices generate an automatic segmentation of retinal layers, that was manually adjusted for enhancing the display of the choriocapillary plexus. The membrane areas were measured manually with the software provided by the devices.</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the follow-up period, patients were treated with a total of 3 injections of an anti-VEGF medicaments, comprising ranibizumab (Lucentis; Novartis Pharma AG, Basel, Switzerland) as well as aflibercept (Eylea; Bayer, Basel, Switzerland), separated by a 30-day period. A-OCT was taken before each injection, 24<span class="elsevierStyleHsp" style=""></span>h thereafter (only in the first cycle) and at 7 days. BCVA was assessed at baseline and one month after each injection.</p><p id="par0050" class="elsevierStylePara elsevierViewall">According to the classification proposed by Freund et al.,<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> all the cases included in the study were diagnosed as CNV type 1 through OCT as they exhibited lesions indicating neovascularisation in a space limited below by the hyper-reflective monolayer corresponding to Bruch's membrane (BM) and above by the hyper reflective RPE strip. Exudation took place predominantly in the subretinal space. In contrast, CNV type II is defined by the lesions that penetrate through the RPE/BM complex and proliferate over the RPE and below the external photoreceptor layer.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The evaluation of the activity rate of CMV was based on the criteria developed by Coscas et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> for A-OCT that establishes a 5 relevant parameters: shape, ramification pattern, anastomosis, configuration of vessel ends and presence of perilesional hypointense halo. To characterize the form of the neovascular membranes, the description proposed by Kuehlewein et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a> was followed. This description distinguishes 2 main morphological types, one with a central nutritional vessel and ramification from the center of the lesion (medusa pattern) and another where over 90% of the neovascular network emerges from a lateral nutritional vessel (sea fan pattern).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study included 4 males and 2 females, all being Caucasian. The age range was comprised between 62 and 86 years, with a mean of 74 years. Baseline BCVA ranged between 0.15 and 0.6 (decimal scale, Snellen test), with a mean of 0.31. Four subjects were given ranibizumab charge doses and 2 were given aflibercept.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Case 1 is a 76-year-old male with diminished VA with 2 months evolution and metamorphopsia. Baseline BCVA was 0.3. Posterior pole photography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a) evidenced perifoveolar hard to drusen and an area temporal to the fovea with a slightly grayish appearance (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b). The cross-section in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the segmentation lines between RPE and BM, corresponding to the location of the analyzed <span class="elsevierStyleItalic">in face</span> angiograms.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>c shows a neovascular membrane with well defined edges and the typical wheel form. The ramification pattern features numerous thin capillaries with multiple anastomotic loops and vessels ending in a highly populated peripheral arch. The last activity parameter defined by the presence of hypointense perilesional halo was not fulfilled. Overall, for out of the 5 activity items proposed by Coscas et al. appear in this CNV and predict positive response to treatment. According to the Kuehlewein classification, case one CNV is compatible with the sea fan pattern. The area of the lesion prior to treatment (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>f) was 1549<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span>.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Twenty-four hours after the first anti-VEGF injection, the anastomosis is diminished, terminal vessels receded and capillaries disappeared. Swept-source OCT (SS-OCT) reveals an incipient SRF reduction (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>a). The CNV area diminished 18.2% (down to 1267<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span>). Seven days later, the biggest area reduction can be seen (overall reduction of 46% down to 837<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span>). Rarefaction of anastomosis and fragmentation of capillaries increases (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>b). The lateral nutritional vessel maintains the baseline appearance.</p><p id="par0080" class="elsevierStylePara elsevierViewall">One month after the first injection the area remained stable (826<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span>) although the first signs of re-proliferation can be seen such as increased density of superior vascular endings and of the thickness of vessels depending from the nutritional vessel (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>c). Seven days after the second anti-VEGF injection the changes observed in the first cycle are repeated and the re-proliferation processes is halted. The area is of 528<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> and overall reduction reaches 58.3% (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>d). One month after the 2nd injection a significant sharpening of the vessels takes place together with nearly complete attenuation of the initial anastomosis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>e). The last A-OCT corresponding to the week after the last treatment showed an interactive neovascular lesion. The only identifiable structure compared to baseline was the nutritional vessel. The final area was 255<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> and the overall reduction of 83.5% when compared to the original area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>f). SS-OCT reveals complete SRF reabsorption and persistence of uneven RPE. BCVA improved from 0.3 to 0.6.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Case 2 presents a 62-year-old male with progressive VA reduction and none exudative ARMD diagnostic in the contralateral eye. Baseline BCVA was 0.6. SS-OCT centered in the macula revealed findings compatible with MNV type 1 (hyper-reflective material underlying irregular RPE), with very little SRF (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>a). In this case, the neovascular network through A-OCT exhibited a lengthened shape (in sea fan pattern) with large, mature looking of vessels. The initial area was 408<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span>. A very low number of thin capillaries can be observed and no anastomotic loops could be found. Vascular endings exhibited a shop and appearance and no perilesional hypointense halo could be found. The activity criteria described above suggested quiescent CNV and predicted poor response to treatment.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Twenty-four after the first anti-VEGF injection, the area remained stable without substantial morphological changes (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>b). During the rest of the follow-up, no new CNV exudation was observed. The main nutritional vessel and the rest of the described network remained unaltered during successive checkups. The angiogram of the week after the 3rd treatment revealed the absence of changes. The final area was 346<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> (a vessel that seemed more attenuated was excluded from the measurement) with total reduction of only 15.2% vis-à-vis the baseline area (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>c and d). BCVA remained at 0.6.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Of the 4 remaining cases, to did not complete the follow-up due to exhibiting CNV eccentric to the fovea and the impossibility of centering the angiogram on the desire to macular area. In these cases, the images obtained did not enable an adequate evaluation of the lesions. The remaining 2 cases exhibited characteristics similar to case 2. The results are summarized in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">A-OCT is a novel technique that is being used increasingly in hospitals all over the world due to the possibility of noninvasively characterizing neovascular complexes in pathologies such as exudative ARMD. Applying the SSADA algorithm, Jia et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">7</span></a> demonstrated the relationship between the flow index in CNV and the density of the neovascular network, and characterized the first membranes with a definition of lesion edges superior to techniques such as FAG.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In a series of cases, Palejwala et al.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">17</span></a> identified 2 patients with CNV type I that was “non-exudative”, i.e., without late losses in FAG or SRF in SD-OCT) and emphasized the value of the screening technique for high risk patients before visual deterioration. Other authors also reported good sensitivity and specificity rates in the detection of quiescent type I neovascular membranes, as well as type II and angiomatous proliferations.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">18</span></a> A high percentage of quiescent CNV lacks a central, thick nutritious vessel, which could indicate protection against more aggressive forms of the disease.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The present study enabled monitoring the evolution of several type I CNV cases during a cycle of 3 anti-VEGF injections spanning 3 months. The activity criteria proposed by Coscas et al. have demonstrated to be a useful tool that is able to predict the response to treatment. Case 1 is a good example of the role that A-OCT plays in the follow-up of these patients. The regression pattern and the cyclic re-proliferation of CMV follows time frames that are consistent with other studies such as that by Lumbroso et al.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">19</span></a> who carried out a follow-up in CNV type 2 and determined that the duration of the complete cycle is approximately 45–60 days. The early effect of the medicament (24<span class="elsevierStyleHsp" style=""></span>h) is surprising, showing attenuation of capillaries and anastomosis. The maximum activation of the neovascular network seems to occur between day 7 and 28, and the first signs of re-proliferation appear in A-OCT taken one month after treatment. After each of the 3 treatments, the same vessels tend to reappear with diminished flow and lower capillary density. In the present case, no neovascularization areas were found.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The fact that throughout the entire process the main nutritious vessel remains unaltered is significant. This peculiarity was described by Spaide<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">20</span></a> and is replicated in other cases. It has been suggested that, in contrast with the rest of the neovascular network, the endothelial cells comprising the main vessel are coated with pericytes. This makes the nutritional vessel more resistant to the action of anti-VEGF medicaments and explains its persistence despite continued treatment.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The main limitation of the study is its small sample size and the short follow-up period. The study protocol did not include comparison with FAG/ICG, with the CNV diagnostic being obtained exclusively through OCT. The limitations of said technique also had a bearing on the results. The algorithms applied in A-OCT depend on blood flow detection, which means that small movements by the patient produced considerable artifacts. The time utilized by the majority of available devices is higher than the time required by standard OCT, and therefore it is a challenge to acquire quality images of patients with fixation alterations. Present device software includes manual application measurement tools on <span class="elsevierStyleItalic">in face</span> sections, which influences the reliability of results. For this reason, the authors consider that at present the technique can contribute more to the qualitative and descriptive aspect of clinic work. At this time, there are no 3-D volumetric measurement tools.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">21</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Despite the above, A-OCT emerges as a promising imaging mode that can supplement the use of other techniques. The possibility of visualizing CNV in ARMD opens an unexplored research field. The detection of quiescent neovascular membranes enables the identification of patients who require close follow-up. By way of conclusion, it can be stated that the diverse activity criteria related to lesion morphology could assist in planning the time to treat, particularly in <span class="elsevierStyleItalic">pro re nata</span> protocols, as well as facilitating the qualitative and quantitative follow-up of said pathology.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres845215" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec840096" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres845214" "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" => "xpalclavsec840097" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Subjects, material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-21" "fechaAceptado" => "2016-12-04" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec840096" "palabras" => array:5 [ 0 => "Choroidal neovascularisation" 1 => "Optical coherence tomography angiography" 2 => "Age-related macular degeneration" 3 => "Anti-vascular endothelial growth factor" 4 => "Retinal imaging" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec840097" "palabras" => array:5 [ 0 => "Neovascularización coroidea" 1 => "Angiografía por tomografía de coherencia óptica" 2 => "Degeneración macular asociada a la edad" 3 => "Antifactor de crecimiento vascular endotelial" 4 => "Diagnóstico por imagen" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Aim</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the characteristics of type 1 choroidal neovascularisation (CNV) in age-related macular degeneration (ARMD) using two different optical coherence tomography angiography (OCT-A) devices sequentially during a standard protocol of three intravitreal injections of an anti-vascular endothelial growth factor (anti-VEGF).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The study included 6 eyes with naïve neovascular ARMD. Macular OCT-A images were acquired using AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, USA) and DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc., Oakland, NJ, USA). The macular OCT-A scan covered an area of 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm. Distinct morphological patterns and quantifiable features of the neovascular membranes were studied on <span class="elsevierStyleItalic">en face</span> projection images, which were taken at different stages of the follow-up.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Treatment response could be estimated using the OCT-A criteria of CNV activity. Higher activity scores before treatment resulted in a greater decrease in the membrane area. The estimated net decline in area ranged from 83.5% to 1.4%. The OCT-A performed one-week after treatment revealed the greatest area reductions.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">OCT-A provides new possibilities for the non-invasive assessment of features of neovascular networks and CNV structural morphology. Newly described activity criteria can also guide therapeutic decisions, and help in evaluating responses. Quantitative and qualitative information can be provided with this technique. However, further software development and future investigation are essential to define the role of this tool on a daily basis.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Aim" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir las características de la neovascularización coroidea (NVC) tipo 1 en pacientes con degeneración macular asociada a la edad (DMAE), utilizando la angiografía por tomografía de coherencia óptica (A-OCT) secuencialmente durante el transcurso de un protocolo estándar de 3 inyecciones intravítreas de fármaco anti-VEGF.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Seis ojos con DMAE neovascular no tratados previamente fueron incluidos. Se obtuvieron imágenes por A-OCT empleando AngioPlex Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Inc., Dublin, EE. UU.) y DRI OCT Triton SS-OCT Angio (Topcon, Medical Systems, Inc. Oakland, NJ, EE. UU.). El área estudiada comprende un escáner macular de 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm. Diferentes patrones morfológicos y aspectos cuantificables de las membranas neovasculares han sido evaluados con imágenes en proyección <span class="elsevierStyleItalic">en face</span>, que fueron tomadas en distintos tiempos del seguimiento de los pacientes.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El grado de respuesta al tratamiento fue estimado empleando criterios de actividad de NVC para A-OCT. Puntuaciones más altas en los ítems de actividad antes del tratamiento resultaron en mayores reducciones del área de las membranas. Los resultados finales de reducción de área oscilaron entre el 83,5 y el 1,4%. Las A-OCT realizadas a la semana de tratamiento revelaron los mayores porcentajes de reducción.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La A-OCT ofrece la posibilidad de analizar en profundidad las características morfológicas y estructurales en NVC de tipo 1. Los criterios de actividad permiten guiar decisiones terapéuticas y evaluar la respuesta al tratamiento. Con esta técnica puede obtenerse información útil tanto cualitativa como cuantitativa. Sin embargo, son necesarios avances en el desarrollo del software y en investigación para poder definir el papel de esta herramienta en la práctica diaria.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torrecillas-Picazo R, Cerdà-Ibáñez M, Almor Palacios I, Hervás Hernandis JM, Ramón-Cosín R, Ruiz del Rio N, et al. Análisis y seguimiento con angiografía por tomografía de coherencia óptica de neovascularización coroidea tipo 1 en degeneración macular tras tratamiento antiangiogénico. Arch Soc Esp Oftalmol. 2017;92:265–272.</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" => 1375 "Ancho" => 1800 "Tamanyo" => 353318 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">(a) Structural OCT of the macular area, indicated in b. Segmentation lines under RPE and over BM, with associated subretinal fluid. (b) Posterior pole photography with macular cube indicating the scanned 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm area. (c) <span class="elsevierStyleItalic">In face</span> projection angiogram, 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm, centered in the fovea of the sea fan neovascular complex (d) equivalent angiogram with manually defined area through device software. (e) Color reconstruction of the different retinal vascular plexi (CNV in blue). (f) Wide SS-OCT of the macular area with the above-mentioned findings.</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" => 1985 "Ancho" => 1700 "Tamanyo" => 501782 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(a) Wide angiogram and SS-OCT 24<span class="elsevierStyleHsp" style=""></span>h after the first anti-VEGF injection. (b) Wide angiogram and SS-OCT 7 days after the first injection. (c) Wide angiogram and SS-OCT one month after the first injection. (d) Wide angiogram and SS-OCT 7 days after the 2nd injection. (e) Wide angiogram and SS-OCT one month after the 2nd injection. (f) Wide angiogram and SS-OCT one week after the last injection. The structural OCT shows complete SRF reabsorption with uneven RPE.</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" => 1675 "Ancho" => 1700 "Tamanyo" => 394518 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(a) Structural OCT of the macula showing RPE over elevation and unevenness, with very little SRF. (b) <span class="elsevierStyleItalic">In face</span> projection angiogram, 3<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>mm, of the foveal area showing CNV in sea fan pattern with prominent lateral nutritional vessel. Color reconstruction. Definition of the CNV area. (c) Angiogram 24<span class="elsevierStyleHsp" style=""></span>h the first anti-VEGF injection. (d) Angiogram taken one week after the last injection. (e) Structural OCT one week after the last injection, showing RPE alteration persistence and SRF absorption.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \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, years \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 \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">Eye \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">Initial VA \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">Final VA \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">Initial area \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">Final area \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">% reduction \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.549<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">255<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.5 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">408<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">346<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">512<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">505<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.4 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">OI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">409<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">375<span class="elsevierStyleHsp" style=""></span>μm<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1427463.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Demographic and ophthalmological characteristics of patients before and after the study.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mean \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">Standard deviation \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">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" 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">9.93 \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">Initial VA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.2 \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">Final VA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.22 \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">Initial area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">719.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">555.15 \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">Final area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">370.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">103.36 \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">% Of area reduction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1427462.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Mean and standard deviation of evaluating statistical parameters.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 2 | 2 | 4 |
| 2020 September | 0 | 1 | 1 |
| 2018 April | 1 | 0 | 1 |
| 2018 February | 10 | 5 | 15 |
| 2018 January | 12 | 7 | 19 |
| 2017 December | 19 | 4 | 23 |
