Original article
Efficacy of the SENSIMED Triggerfish® in the postoperative follow-up of PHACO-ExPRESS combined surgery
Eficacia del SENSIMED Triggerfish® para el seguimiento postoperatorio de la cirugía combinada FACO-ExPRESS
V. Osorio-Alayo
, V.T. Pérez-Torregrosa, R. Clemente-Tomás, Á. Olate-Pérez, M. Cerdà-Ibáñez, A. Gargallo-Benedicto, A. Barreiro-Rego, A. Duch-Samper
Corresponding author
Servicio de Oftalmología, Hospital Clínico Universitario de Valencia, Valencia, Spain
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Puede observarse la disminución de los valores de las amplitudes de las curvas de registro tras la intervención (tanto en el periodo diurno como nocturno), lo que representa una reducción directamente proporcional de la PIO-G en estos pacientes.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "V. Osorio-Alayo, V.T. Pérez-Torregrosa, R. Clemente-Tomás, Á. Olate-Pérez, M. Cerdà-Ibáñez, A. Gargallo-Benedicto, A. Barreiro-Rego, A. Duch-Samper" "autores" => array:8 [ 0 => array:2 [ "nombre" => "V." "apellidos" => "Osorio-Alayo" ] 1 => array:2 [ "nombre" => "V.T." "apellidos" => "Pérez-Torregrosa" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Clemente-Tomás" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Olate-Pérez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Cerdà-Ibáñez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Gargallo-Benedicto" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Barreiro-Rego" ] 7 => array:2 [ "nombre" => "A." 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Osorio-Alayo, V.T. Pérez-Torregrosa, R. Clemente-Tomás, Á. Olate-Pérez, M. Cerdà-Ibáñez, A. Gargallo-Benedicto, A. Barreiro-Rego, A. Duch-Samper" "autores" => array:8 [ 0 => array:4 [ "nombre" => "V." "apellidos" => "Osorio-Alayo" "email" => array:1 [ 0 => "vanesa_osorio@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "V.T." "apellidos" => "Pérez-Torregrosa" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Clemente-Tomás" ] 3 => array:2 [ "nombre" => "Á." "apellidos" => "Olate-Pérez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Cerdà-Ibáñez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Gargallo-Benedicto" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Barreiro-Rego" ] 7 => 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" => "Eficacia del SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> para el seguimiento postoperatorio de la cirugía combinada FACO-ExPRESS" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1368 "Ancho" => 1645 "Tamanyo" => 95725 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean IOP-S amplitude (measurement unit: millivolt equivalent/mVeq) during the diurnal (left) and nocturnal periods (right), recorded before (black) and after (green) FACO-ExPRESS surgery with the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system. Diminished amplitude curves after surgery can be appreciated (both for the diurnal and nocturnal period), representing a directly proportional reduction of IOP-G in these patients.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Cataracts and glaucoma are the main causes of blindness worldwide.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">1,2</span></a> Due to asymptomatic onset, glaucoma can be diagnosed only in advanced stages due to visual field alterations and irreversible visual acuity (VA) loss.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Intraocular pressure (IOP) is not a necessary or sufficient condition for diagnosing glaucoma although it has proved to be the main risk factor for the development and progression thereof,<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> and various medical<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">4</span></a> and surgical treatments are focused on controlling it. Goldmann applanation tonometry is regarded as the <span class="elsevierStyleItalic">gold standard</span> for measuring IOP. However, it requires hospital admission or outpatient follow-up in order to record IOP changes in the course of a 24-hour period. It is known that IOP fluctuates due to circadian curves as well as to postural changes,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">5,6</span></a> which increases the importance of recording IOP throughout the day.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> (Sensimed AG, Lausanne, Switzerland) is a noninvasive recording system that comprises a monitoring sensor in a soft contact lens (SCL), an antenna and a portable recorder developed by Sensimed in order to improve glaucoma control. Said system provides wireless automated recording of continuously changing ocular dimensions (corneoscleral) in a 24-h period.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The ExPRESS implant is a valveless device considered within filtrating surgical techniques for treating glaucoma. It is a safe surgical option which could be more efficient than trabeculectomy.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The present study reports combined FACO-ExPRESS surgery as a treatment for primary open angle glaucoma (POAG). Changes in IOP, measured with Goldman applanation tonometry (IOP Goldmann or IOP-G) and circadian patterns before and after surgery were recorded utilizing the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A prospective, descriptive and observational non-randomized study carried out in the University Clinic Hospital of Valencia (Valencia, Spain). The study comprised 15 eyes of 11 patients between 61 and 85 years of age with cataracts and POAG in treatment with at least 2 topical hypotensor medicaments. The study selected eyes with cataracts and POAG included in the waiting list for combined FACO-ExPRESS surgery. POAG was defined as patients with open angle in gonioscopy, visual field alteration with Humphrey<span class="elsevierStyleSup">®</span> automated perimetry (Carl Zeiss Meditec AG, Jena, Germany), retinal nerve fiber layer (RNFL) thinning in Cirrus™ HD-OCT (Carl Zeiss Meditec AG, Jena, Germany) and IOP-G<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg at diagnostic. The study excluded patients with secondary (pseudoexfoliative, neovascular, uveitic, cortisolic) and narrow angle glaucoma as well as those with retinal or surface problems.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The present study complies with the principles of the Helsinki declaration and the norms of Spanish laws currently in force. The ethics committee of the authors’ institution approved the study and each patient signed an informed consent for surgery and participation in the study. Funding was indirect: the Ophthalmology Dept. was provided with the SCL, antennae and recorders by Sensimed at no cost.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A full ophthalmological examination was carried out prior to surgery, including clinical records and anamnesis, best corrected visual acuity (BCVA) in logarithmic progression scale of the minimum angle of resolution (log MAR), slitlamp biomicroscopy, Goldmann applanation tonometry (AT 900, Haag Strait, Berna, Germany), gonioscopy, ocular fundus with dilatation, pachymetry, Humphrey<span class="elsevierStyleSup">®</span> automated perimetry, RNFL optical coherence tomography with Cirrus™ HD-OCT and IOL biometry with Master 500 (Carl Zeiss Meditec AG, Jena, Germany).</p><p id="par0045" class="elsevierStylePara elsevierViewall">SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> is a noninvasive monitoring system comprised by a SCL, an antenna and a portable recorder (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A–<span class="elsevierStyleSmallCaps">C</span>) that records during 24<span class="elsevierStyleHsp" style=""></span>h all changes in the dimensions of the corneoscleral area in relation to changes in IOP.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10</span></a> The device records a 30-s interval every 5<span class="elsevierStyleHsp" style=""></span>min,<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">7</span></a> amounting to 288 measurements in the course of 24<span class="elsevierStyleHsp" style=""></span>h. Within this data, the program traces the curve that is displayed at the end of each recording session. The measurement unit was millivolt equivalent (mVeq), which is exclusive to the system.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Two 24-h records were taken with the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> device. A record was defined as of the placement of the SCL, antenna and recorder. Prior to the first record, taken 30 days before surgery, keratometry was verified to select the adequate SCL size for each patient. The patients were instructed to use artificial tears continuously during the recording and to refrain from the use of spectacles with metal frames or other electric devices as well as to refrain from driving motr vehicles, showering, rubbing their eyes or sleeping on the side of the antenna so as to avoid damaging it. In addition, they were given a notebook to annotate their activities in the course of the day and were informed about the importance of annotating the time of going to sleep and waking up.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Mean and baseline IOP-G was taken from the last 3 ocular pressures taken prior to surgery.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The ExPRESS P-50 implant (Alcon Laboratories, Fort Worth, Texas, USA) is a valveless stainless steel device measuring 2.64<span class="elsevierStyleHsp" style=""></span>mm long, 0.4<span class="elsevierStyleHsp" style=""></span>mm diameter and 50<span class="elsevierStyleHsp" style=""></span>μm internal gauge which, after implantation, provides communication between the anterior chamber and the subconjunctival space through a scleral flap.</p><p id="par0065" class="elsevierStylePara elsevierViewall">All the FACO-ExPRESS surgeries were carried out by the same surgeon according to the usual technique<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> with fornix-based conjunctival peritomy after peribulbar anesthesia (5<span class="elsevierStyleHsp" style=""></span>ml de bupivacaine and 5<span class="elsevierStyleHsp" style=""></span>ml mepivacaine). After surgery, all hypotensor eyedrops were suspended and antibiotic and anti-inflammatory eyedrops were prescribed. The protocol applied for postop care was 0.1% diclofenac sodium (Voltaren, Thea Labs, Clermont-Ferrand, France) every 6<span class="elsevierStyleHsp" style=""></span>h during 4 weeks and a combination of dexamethasone and tobramycin (Tobradex, Laboratorios Alcon Cusí SA, Barcelona, Spain) in descending dosage during 8 weeks.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Final IOP-G was calculated on the basis of the recordings of day 7, 30 and 60 post-surgery.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The second Sensimed recording was carried out on day 60 postop. Monitoring began at the same time as in the first (pre-surgery) recording to avoid changes in patient routine that could influence results. Only one patient with hypotensor treatment was found (brinzolamide) during said recording.</p><p id="par0080" class="elsevierStylePara elsevierViewall">BCVA was measured on postop day 30 and 60, registering complications and the number of hypotensor medicaments after surgery.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Two-phase cosinor mathematical analysis<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">12–14</span></a> (cosine analysis) provided information about curve amplitude and patterns (diurnal or nocturnal acrophase). Acrophase was defined as the phase producing the highest value of the IOP circadian curve registered with the Sensimed system (IOP Sensimed or IOP-S). The statistical analysis was carried out with the SPSS Statistics version 20 application. Mean (SD) and median (min/max) were utilized for the descriptive analysis. For univariate analysis, the T for student test for dependent samples and Chi square tests were utilized with a statistical significance value established at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>0.05. with a confidence interval of 95%.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Initially, the study analyzed 15 eyes (6 right eyes and 9 left eyes) of 11 patients: 3 male (8.3%) and 8 female (91.7%) aged between 61 and 85 (mean 72.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.45). Four patients underwent bilateral surgery and 7 had unilateral surgery. The final sample comprised 13 eyes, as 2 were excluded due to errors in post surgery control records, while one patient (one eye) declined the follow-up. All patients had POAG and cataracts. The follow-up comprised 2 months. The most frequent comorbidities were hypercholesterolemia (75%), arterial hypertension (66.7%) and diabetes (50%).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The mean amount of hypotensor medicaments utilized prior to surgery was 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 with a range of 2–4 active principles. During the 2-month follow-up only one patient (one eye) required the reintroduction of a drug for controlling IOP.</p><p id="par0100" class="elsevierStylePara elsevierViewall">None of the eyes exhibited diminished VA in the postop. Mean presurgery BCVA (log MAR) increased from 0.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2 to 0.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002) at month 1 and 0.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02) at month 2 after surgery.</p><p id="par0105" class="elsevierStylePara elsevierViewall">None of the eyes exhibited athalamia. Only one eye exhibited hypotony below 5<span class="elsevierStyleHsp" style=""></span>mmHg associated to choroidal detachment, both with absolute resolution. Nine eyes (75%) exhibited corneal surface and conjunctival alterations (superficial dotted keratitis and hyperemia) after the first session, which diminished in intensity during the second session with the continuous use of artificial tears.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Mean presurgery IOP-G was 18.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.8<span class="elsevierStyleHsp" style=""></span>mmHg with medication. Mean IOP-G in the postop was 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002) at 7 days, 13.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001) at month 1 and 13.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>mmHg at month 2, signifying a 30.7% IOP-G reduction at 7 days, 27.7% reduction at month 1 and 26% at month 2 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Curve amplitude diminished significantly from 168<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>67.8<span class="elsevierStyleHsp" style=""></span>mVeq in the pre-op to 93.3<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>49.8<span class="elsevierStyleHsp" style=""></span>mVeq (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007) in the postop (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> shows an example of the changes in pressure curves before and after surgery). Similarly, the mean amplitude of diurnal and nocturnal periods diminished significantly, with the diurnal period going from 146.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>80.9<span class="elsevierStyleHsp" style=""></span>mVeq prior to surgery to 36.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>36<span class="elsevierStyleHsp" style=""></span>mVeq (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000) after surgery, while in the nocturnal period the reduction was from 61.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mVeq pre-op to −23.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>47.6<span class="elsevierStyleHsp" style=""></span>mVeq (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.014) postop (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Prior to surgery, the 12 eyes exhibited the same pattern, i.e., diurnal acrophase (maximum value) between 04:39 and 12:41. Only 2 eyes changed into a nocturnal pattern (nocturnal acrophase) between 18:46 and 03:37 at month 2 postop (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">Since the 50s of the past century several attempts have been made to manufacture a device for continuous IOP monitoring.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">15,16</span></a> In 2004, Leonardi published a noninvasive prototype comprising a sensor integrated in a non-wireless contact lens that monitored changes in corneal curvature in relation to IOP variations.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> In 2007, the wireless SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> prototype was released, with trials in humans beginning 2009.<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">17–20</span></a> After demonstrating tolerability and safety.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21–23</span></a> the use of said device is considered for the daily clinical practice.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> In 2016, the <span class="elsevierStyleItalic">Food and Drug Administration</span> approved the device for marketing with the indication for detecting fluctuating IOP-S patterns with the purpose of identifying the best period of the day to measure IOP-G with conventional methods.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">25</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The main controversy surrounding SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> consists in 2 issues:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0135" class="elsevierStylePara elsevierViewall">It does not measure IOP directly as it measures changes in ocular globe dimensions at the corneoscleral junction.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0140" class="elsevierStylePara elsevierViewall">The millivolt equivalent (mVeq) as the exclusive unit of measure.</p></li></ul></p><p id="par0145" class="elsevierStylePara elsevierViewall">As regards the first issue, Leonardi demonstrated the direct relationship between IOP and corneal curvature changes, i.e., a variation of 1<span class="elsevierStyleHsp" style=""></span>mmHg in IOP-G was equivalent to a change of 3<span class="elsevierStyleHsp" style=""></span>μm in the central corneal curvature radius.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">9</span></a> However, the second issue will remain an inconvenience until the development of an algorithm for converting to mm Hg.</p><p id="par0150" class="elsevierStylePara elsevierViewall">In addition, it must be emphasized that the measurements taken by Sensimed are relative and not absolute, i.e., they show changes as from an initial point which in all curves has a value of zero (first data). As the recording continues, the sensor records volume changes in ocular dimensions that could increase or diminish. If said dimensions increase, the value for the next point will be greater (positive value) and if they diminish the value for the next point would be smaller (less positive or negative).</p><p id="par0155" class="elsevierStylePara elsevierViewall">Some studies have utilized SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> with the aim of demonstrating the changes that occur after specific procedures. Two of said studies were carried out in patients with normotensive glaucoma (NTG) who underwent selective laser trabeculoplasty (SLT). The first of said studies demonstrated that the SLT significantly diminished the values of the IOP and its fluctuations during the nocturnal period<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">11</span></a> while the second demonstrated that the amplitude (cosine method) diminished in all patients with a successful SLT.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">12</span></a> The third study, comprising 10 patients with narrow angle glaucoma after cataract surgery, reported a significant reduction of the mean IOP and the mean range of fluctuations during the nocturnal period<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a> at 3 months follow-up. The last study recruited patients with COAG who, at 12 months follow-up after canaloplasty (4 patients) or canaloplasty associated to cataract surgery (6 patients) evidenced diminished mean IOP and fluctuation amplitude.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The present study is the first to research changes in circadian patterns of IOP-S and its amplitudes after filtrating surgeries such as the ExPRESS implant combined with cataract surgery in patients with POAG. Both surgeries have demonstrated to be effective for diminishing IOP-G<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">8</span></a> although only cataract surgery has been studied with SENSIMED Triggerfish<span class="elsevierStyleSup">®</span>.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">26</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">There are no references in the literature about the best days for recording. The authors chose pre-op day 30 randomly while day 60 postop was chosen because as of that day patients discontinued treatments that could influence results.</p><p id="par0170" class="elsevierStylePara elsevierViewall">After reviewing patient notes, the authors realized that they woke up at approximately 05:30–6:00, whereas the rest periods with lower activity began at approximately 18:30. For this reason it was decided to divide the day in 2 periods: the diurnal period from 05:00 to 17:59 (patients awake and active) and 8 nocturnal period from 18:00 to 04:59 (sleep/relax and lower activity). The starting time of each period (05:00 and 18:00 respectively) was taken forward approximately 30<span class="elsevierStyleHsp" style=""></span>min vis-à-vis the patient notes to ensure that all records belonged to the adequate period. When analyzing said data, it was found that patients with POAG exhibited a maximum diurnal peak between 04:39 and 12:41, in contrast with other studies that reported a predominantly nocturnal acrophase.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21,26</span></a> Similarly, a significant change in the curve amplitude was demonstrated not only in the diurnal<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">11,26</span></a> but also in the nocturnal period.</p><p id="par0175" class="elsevierStylePara elsevierViewall">The limitations of the present study include being a single center study with a very specific and small population sample (POAG) which limits the extrapolation of data to more general populations. In addition, the lens were fitted and the data analyzed and interpreted by a single person, which makes the study dependent on his/her experience and training for reliable information. However, the authors wish to emphasize what they believe to be the main limitation of the study, i.e. the millivolt equivalent (mVeq) as the sole and exclusive measurement unit captured by the SCL sensor which does not include a conversion table to Mercury millimeters (mmHg), which excludes the possibility of making direct comparisons with tonometry (IOP-G). For this reason, in order to assess changes after surgery, the authors compared curve amplitude changes. Due to the cosene analysis of Sensimed it was possible to determine the IOP-S patterns and to analyze its amplitudes as well as to assess its fluctuations.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In conclusion, the results obtained in this study suggest that SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> is a monitoring system that could become a useful tool for post-surgery follow-up of glaucoma by enabling a more individualized follow-up of patients. Unfortunately there is no evidence relating IOP-S patterns or amplitudes as risk factors for progression of the disease. For this reason it is necessary to carry out more prospective studies with larger sample sizes and longer follow-up periods to research said factors and assess the efficiency of said system.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">No conflict of interest was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres873557" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec862205" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres873558" "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" => "xpalclavsec862204" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-08-01" "fechaAceptado" => "2017-04-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec862205" "palabras" => array:8 [ 0 => "Glaucoma" 1 => "Glaucoma open-angle" 2 => "24<span class="elsevierStyleHsp" style=""></span>hours" 3 => "Intraocular pressure fluctuation" 4 => "Sensimed triggerfish" 5 => "Contact lens sensor" 6 => "Glaucoma/surgery" 7 => "ExPRESS" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec862204" "palabras" => array:8 [ 0 => "Glaucoma" 1 => "Glaucoma ángulo abierto" 2 => "24<span class="elsevierStyleHsp" style=""></span>horas" 3 => "Fluctuación presión intraocular" 4 => "Sensimed triggerfish" 5 => "Sensor lentes de contacto" 6 => "Glaucoma/cirugía" 7 => "ExPRESS" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the usefulness of the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system in the postoperative control of combined phacoemulsification and ExPRESS implant (PHACO-ExPRESS) surgery in patients with cataract and chronic open angle glaucoma (COAG) during a 2 months follow-up.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective study conducted on 15 eyes that were subjected to PHACO-ExPRESS combined surgery. Using the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system, two records of the circadian patterns of intraocular pressure (IOP) were performed, one before and one after surgery. A record was made of the best corrected visual acuity (BCVA), comorbidities, previous IOP, and 7–30–60 days after surgery, as well as any hypotensive drugs and complications.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The final sample was 12 eyes. The mean pre-operative BCVA (log MAR chart) before surgery was 0.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.2, and after surgery 0.14<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.1 (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.02). The previous IOP was 18.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.8<span class="elsevierStyleHsp" style=""></span>mmHg with 2.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.7 drugs. The mean IOP at 7, 30, and 60 days after surgery decreased to 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.1<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.002), 13.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), and 13.9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.5<span class="elsevierStyleHsp" style=""></span>mmHg (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), respectively. The amplitudes of the circadian curves changed significantly after surgery (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007). The mean values between daytime and night-time periods decreased significantly from 146.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>80.9<span class="elsevierStyleHsp" style=""></span>mVeq and 61.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mVeq before surgery to 36.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>36<span class="elsevierStyleHsp" style=""></span>mVeq (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.000), and −23,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>47.6<span class="elsevierStyleHsp" style=""></span>mVeq (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.014) after surgery, respectively. There were complications in one patient.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> monitoring system showed changes in the curves of the circadian patterns, as well as decreased mean amplitudes after the combined PHACO-ExPRESS technique, suggesting that it may become a useful tool for postoperative follow-up of COAG.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "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">Estudiar la utilidad del sistema SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> en el control postoperatorio de la cirugía combinada de facoemulsificación e implante ExPRESS (FACO-ExPRESS) en pacientes con catarata y glaucoma primario de ángulo abierto (GPAA) con un seguimiento de 2 meses.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 15 ojos intervenidos de cirugía combinada FACO-ExPRESS. Utilizando el sistema SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> (Sensimed AG, Lausanne, Suiza) se realizaron 2 registros de los patrones circadianos de la presión intraocular (PIO), uno previa y otro posterior a la cirugía. Se registró la agudeza visual mejor corregida, comorbilidades, PIO previa y de los días 7–30-60 poscirugía, medicamentos hipotensores y complicaciones.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La muestra final fue de 12 ojos. La agudeza visual mejor corregida (escala Log MAR) media preoperatoria fue 0,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,2 y poscirugía 0,4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,1 (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,02). La PIO media previa fue de 18,7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3,8<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg con 2,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0,7 fármacos. La PIO media en los días 7, 30 y 60 descendió a 13<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4,1<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,002), 13,5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) y 13,9<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2,5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001) respectivamente. Las amplitudes de las curvas circadianas cambiaron significativamente entre antes y después de la cirugía (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,007). Los valores medios de los periodos diurno y nocturno disminuyeron significativamente de 146,8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>80,9<span class="elsevierStyleHsp" style=""></span>mVeq y 61,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>92<span class="elsevierStyleHsp" style=""></span>mVeq precirugía a 36,4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>36mVeq (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,000) y –23,2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>47,6<span class="elsevierStyleHsp" style=""></span>mVeq (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,014) poscirugía, respectivamente. Un paciente presentó complicaciones.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El sistema de monitorización SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> mostró cambios en los patrones circadianos, así como disminución de las amplitudes medias de las curvas tras la técnica combinada FACO-ExPRESS, lo que sugiere que este sistema puede convertirse en una herramienta útil para el seguimiento postoperatorio del GPAA.</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: Osorio-Alayo V, Pérez-Torregrosa VT, Clemente-Tomás R, Olate-Pérez Á, Cerdà-Ibáñez M, Gargallo-Benedicto A, et al. Eficacia del SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> para el seguimiento postoperatorio de la cirugía combinada FACO-ExPRESS. Arch Soc Esp Oftalmol. 2017;92:372–378.</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" => 1196 "Ancho" => 1400 "Tamanyo" => 208378 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system. (A) Upper left corner: contact lens with sensor (SCL). (B) Lower left corner: portable recorder. (C) Right: antenna.</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" => 1400 "Ancho" => 2330 "Tamanyo" => 147299 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Mean intraocular pressure (IOP-G) and reduction percentage at each follow-up visit.</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" => 1322 "Ancho" => 2394 "Tamanyo" => 218120 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Image showing the results of a 24-h recording of a patient. The blue and yellow lines show the preop and postop values, respectively. Upper right corner: results of amplitudes and acrophases calculated with the two-phase cosinor mathematical analysis of the Triggerfish<span class="elsevierStyleSup">®</span> program.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1368 "Ancho" => 1645 "Tamanyo" => 95725 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mean IOP-S amplitude (measurement unit: millivolt equivalent/mVeq) during the diurnal (left) and nocturnal periods (right), recorded before (black) and after (green) FACO-ExPRESS surgery with the SENSIMED Triggerfish<span class="elsevierStyleSup">®</span> system. Diminished amplitude curves after surgery can be appreciated (both for the diurnal and nocturnal period), representing a directly proportional reduction of IOP-G in these patients.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">D, diurnal pattern; N, nocturnal pattern.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">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">Preop drugs \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">Postop drugs \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">Preop BCVA (logMAR) \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">BCVA (logMAR) day 30 \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">BCVA (logMAR) day 60 \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">IOP-G pre \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">IOP-G day 7 \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">IOP-G day 30 \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">IOP-G day 60 \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">Preop amplitude \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">Postop amplitude \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">Preop acrophase \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">Postop acrophase \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17–16–17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">196.23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:20 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:59 (D) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \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">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19–14–13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">275.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">182.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8:00 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:06 (D) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28–16–14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174.75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:47 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3:37 (N) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32–16–15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">176.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:10 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:57 (D) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \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">0.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25–14–15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">174.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">74.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:49 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:27 (D) \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">6 \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">0 \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">0.2 \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="left" valign="top">24–16–23.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.08 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11:47 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12:52 (D) \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">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (brinzolamide) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15–17–20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">104.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:50 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:07 (D) \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">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><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">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32–28–28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:26 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8:40 (D) \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">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 \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">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17–20–18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">313.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12:41 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9:59 (D) \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">10 \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">0 \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">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14–16–15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">184.57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7:42 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18:46 (N) \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">11 \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">0 \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 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16–15–16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">151.94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5:10 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8:04 (D) \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">12 \t\t\t\t\t\t\n \t\t\t\t</td><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="left" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17–16–22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4:39 (D) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6:05 (D) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1474123.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Data of the 12 studied cases and their circadian patterns comprising obtained data (number of medicaments, BCVA, IOP-G and curve amplitude) before and after surgery, detailing times of the day where IOP-S produced the highest fluctuation (Acrophase).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Causes of vision loss worldwide, 1990–2010: a systematic analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 3 | 4 | 7 |
| 2020 September | 0 | 1 | 1 |
| 2018 February | 8 | 5 | 13 |
| 2017 November | 0 | 1 | 1 |
| 2017 July | 1 | 0 | 1 |
