Morphometric characteristics of the optical disc and thickness of retinal nerve fibre layer using Cirrus 5000 optical coherence tomography in healthy patients attending the National Institute of Ophthalmology | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Vasquez Alania, T. Gálvez Olórtegui, P. Ayamamani Torres, N. Pantoja Dávalos, S. Fernandez Llerena" "autores" => array:5 [ 0 => array:4 [ "nombre" => "P.Y." "apellidos" => "Vasquez Alania" "email" => array:1 [ 0 => "Patzy5283@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Gálvez Olórtegui" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Ayamamani Torres" ] 3 => array:2 [ "nombre" => "N." "apellidos" => "Pantoja Dávalos" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Fernandez Llerena" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Instituto Nacional de Oftalmología, Lima, Peru" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características morfométricas de disco óptico y espesor de capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica Cirrus 5000 en pacientes sanos atendidos en el Instituto Nacional de Oftalmología" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 636 "Ancho" => 1211 "Tamanyo" => 31587 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Prevalence of megalopapilla with disc area >2.5 mm2." ] ] ] "textoCompleto" => "IntroductionThe papilla is the anterior end of the optic nerve and comprises the convergence and bundling of the retinal nerve fibers that pass through common orifices of the ocular tunics.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Ophthalmoscopic examination revealed yellowish pink circle surrounded by the scleral ring known as Elschnig ring, while binocular biomicroscopic examination shows it as a disc.<a class="elsevierStyleCrossRefs" href="#bib0005">1–3</a> The form, size, edges, cup and neuroretinal ring and area thereof are the subject of the study.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>The optic disc area exhibits individual variability as well as between populations and ranges from 0.80 mm2 up to 6 mm2.<a class="elsevierStyleCrossRefs" href="#bib0005">1,4–12</a> It measures between 2.10 and 2.45 mm2 when examined with optical coherence tomography (OCT).<a class="elsevierStyleCrossRefs" href="#bib0065">13–15</a> In a multicenter study, Marsh et al. reported a mean disc area of 2.17 mm2 for Caucasians (95% reference range: 1.56–2.99 mm2), 2.33 mm2 for Hispanics (95% reference range: 1.67–3.09 mm2) and 2.49 mm2 for Afro-Americans (95% reference range: 1.80–3.24 mm2).<a class="elsevierStyleCrossRef" href="#bib0040">8</a> On the basis of the optic disc area distribution under the Gauss curve, an optic disc is defined as a micropapilla or microdisc when its size is below the mean −2 standard deviations, and as megalopapilla or macrodisc when it is above the mean +2 standard deviations. It is expected that only 2.3% of the population exceeds said limits.<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a> Due to the high variability between populations, some studies consider that a disc > 2.5 mm2 is megalopapilla, whereas for others the limit is  > 2.7 mm2 and some up to > 2.8 mm2, all of these measures being obtained by OCT.<a class="elsevierStyleCrossRefs" href="#bib0025">5,11,18–20</a>OCT has been utilized to analyze the optic disc and the thickness of the retina nerve fiber layer (RNFL).<a class="elsevierStyleCrossRef" href="#bib0105">21</a> Said instrument provides a live cross-section of retinal structures by means of low coherence interferometry.<a class="elsevierStyleCrossRef" href="#bib0065">13</a> Multiple studies measuring optic disc with OCT have been carried out, providing a standard base for each population studied taking into account that not all ethnic groups have similar sizes.<a class="elsevierStyleCrossRefs" href="#bib0070">14,19,22</a> At present, according to the system being utilized, OCT can be divided in time domain (TD-OCT) and spectral domain (SD-OCT). OCT Cirrus (Carl Zeiss Meditec, Dublin, CA, USA) is an SD-OCT device that provides faster scan and improves axial resolution than its predecessor OCT Stratus.<a class="elsevierStyleCrossRefs" href="#bib0075">15,23,24</a> Several comparative studies have been carried out between TD-OCT and SD-OCT, obtaining adequate match between the already classic TD-OCT Stratus and the new SD-OCT Cirrus, particularly for the mean global value of peripapillary RNFL thickness.<a class="elsevierStyleCrossRef" href="#bib0125">25</a>In the studies conducted by Savini et al., Kayaarasi et al. and Paunescu et al. it was found that the optic disc area exhibited a significant positive correlation with the neuroretinal ring area, the disc and vertical cup ratio. However, neither sex or age had a significant difference in several optic disc parameters.<a class="elsevierStyleCrossRefs" href="#bib0070">14,19,22</a> On the other hand, several histological studies in humans and in the eyes of primates carried out by Quigley et al. and Jonas et al. showed that the number of nerve fibers increased linearly together with disc size increase.<a class="elsevierStyleCrossRefs" href="#bib0130">26–28</a> However, other studies comparing megalopapilla with standard sized discs measured with OCT found that the area, the disc-cup radius area, the horizontal and vertical cup-disc radius area were significantly larger in the megalopapilla group<a class="elsevierStyleCrossRefs" href="#bib0055">11,19,20</a> although no differences were found in the neuroretinal ring area and the RNFL thickness,<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> which could constitute an essential finding to differentiate it from glaucomatous neuropathy.Due to inter-population disc size variability, RNFL thickness and disc area thresholds for megalopapilla, in addition to the glaucoma overdiagnostic in patients with megalopapilla, this study was conducted to obtain a normal value of reference in patients of the National Ophthalmology Institute (Instituto Nacional de Oftalmología –INO-), in Lima, Peru. On the other hand, the normal range of morphometric characteristics of the optic disc is unknown (disc area, neuroretinal ring area, cup area, mean cup/disc ratio, cup/vertical disc ratio) and RNFL thickness as measured with OCT in the healthy population who consulted at the INO would be useful as a reference for the patients cared for at said institution.Material and methodsA transversal and descriptive study that assessed 184 eyes of 184 patients who underwent ophthalmological examination at the INO in Lima, Peru, a city having a predominantly Mestizo population, from December 2017 up to April 2018. The inclusion criteria were: patients over 18 years of age, best corrected visual acuity of  >0.5 logMAR, refractive error between +3 diopters (D) and sphere of −3 D between +1.5 D and −1.5 D cylinder, clear optic medium, intraocular pressure <21 mmHg, open chamber angle (grade 3 and 4 according to Shaffer’s classification), optic disc without characteristics of glaucoma or other pathologies, normal ocular fundus and visual field. The study excluded patients with familial glaucoma history, diabetes mellitus or hypertension with ocular compromise, hypersensitivity to 0.5% tropicamide, previous intraocular surgery and neurological disease with optic nerve compromise. All the subjects underwent a complete ophthalmological examination conducted by the same examiner that comprised visual acuity measurements with Logmar poster, keratometry, refraction, corneal curvature. Refractive error with automatic correction was taken with the auto-keratorefractometer (ARK 500 A, Nidek Co LTD, Maehama Hiroishi-cho Gamagori Aichi, Japan), biomicroscopy with slit lamp, tonometry with Goldmann applanation (©HAAG‑STREIT AG, 3098 Koeniz, Switzerland), gonioscopy, eye fundus, ultrasound pachymetry, visual field Humprey 24-2 SITA FAST (Humphrey® Analyzer II-i, Carl Zeiss Inc., Dublin, CA, USA). The study also included patients with reliable visual field, defined as a visual field with fixation losses of < 20%, false positives <15% and false negatives <15%; finally, the OCT device utilized for making the measurements was ZEISS CIRRUS™ HD-OCT Model 5000 (Carl Zeiss Inc., Dublin, CA, USA), applying the optic disc cube 200 × 200 and macular cube 512 × 128 protocols.The following variables were studied: age, sex, RNFL, disc area, ring area, cup area, mean cup/disc ratio, cup/vertical disc ratio, cup volume and megalopapilla. The latter was defined as an optic disc with an area >2.5 mm2 measured with OCT<a class="elsevierStyleCrossRefs" href="#bib0040">8,12,13,29</a> as well as a disc area above mean values +2 standard deviations.<a class="elsevierStyleCrossRefs" href="#bib0080">16–18</a> Establishing a megalopapilla prevalence of 15% and an error of 0.05%, a sample size of 185 eyes were measured.<a class="elsevierStyleCrossRef" href="#bib0055">11</a>Statistical analysisThe categorical variables were described in frequencies and percentages. The distribution type for all numeric variables was assessed by means of the Kolmogorov-Smirnov test to assess normality, according to which the central trend and dispersion measures were described as (standard deviation [SD] and interquartile ranges) respectively.Ethical considerationsThe study was approved by the INO ethics committee and complied with current ethical considerations for research with humans as well as with the principles of the Helsinki declaration. In addition, informed consent was obtained in writing from all participants prior to their inclusion in the study.ResultsOverall, 184 participants of the Mestizo ethnic group were assessed, mostly females (68.5%). Mean age was 41.74 years (standard deviation (SD) 13. 82, range: 18–65 years) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The optic disc parameter characteristics measured with OCT in the general population were: disc area: 2.21 mm2 (SD = 0.43), ring area: 1.37 mm2 (SD = 0.25), cup area: 0.84 mm2 (SD = 0.48), mean C/D ratio: 0.58 (SD = 0.16), vertical C/D ratio 0.55 (SD = 0.15), cup volume 0.29 (SD = 0.22) and RNFL 100.30 (SD = 854) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The prevalence of megalopapilla was 24%, on the basis of a disc > 2.5 mm2 and 4% if the disc area was >3.07 mm2 (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>The optic disc parameter characteristics measured with OCT in the population with megalopapilla were: disc area: 2.81 mm2 (SD = 0.21), ring area: 1.31 mm2 (SD = 0.17), cup area: 1.50 mm2 (SD = 0.28), mean C/D ratio: 0.67 (SD = 0.05), vertical C/D ratio 0.67 (SD = 0.05), cup volume 0.55 (SD = 0.18) and RNFL 100.69 (SD = 919) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>The optic disc and RNFL thickness parameters between optic discs with normal size and megalopapilla were compared. The optic disc area (p < 0.0001), cup area (p < 0.0001), mean C/D ratio (p < 0.0001), vertical C/D ratio (p < 0.0001) and cup volume (p < 0.0001) were significantly different. However, ring area (p = 0.08) and RNFL thickness (p = 0.73) did not exhibit statistically significant differences (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionWith the development of new imaging technologies for morphological optic nerve assessment such as OCT, it became necessary to determine the characteristics of our healthy population in order to obtain a reference value at our institution in addition to other relevant data such as the percentage of megalopapilla and its characteristics as well as the mean RNFL thickness.In the present study, the characteristics of optic disc parameters of healthy eyes measured with OCT were assessed, finding an optic disc area of 2.21 ± 0.43 mm2, similar to the optic disc area (2.23 ± 0.29) described by Kayaarasi et al. in a population of Turkey.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> A more specific comparison with a Hispanic population produced a similarity in the values found in the multicenter transversal study by Marsh et al. in which the disc area measured with OCT Stratus was 2.33 mm2 (95% reference range: 1.67–3.09 mm2).<a class="elsevierStyleCrossRef" href="#bib0040">8</a> However, the disc area in the population of the present study was larger than that reported in the studies by Knight et al. (1.86 ± 0.06 mm2) on a Hispanic population with OCT Cirrus 5000<a class="elsevierStyleCrossRef" href="#bib0145">29</a> and by Guerrero et al. in a population of Paraguay (1.97–2.07 ± 0.39 mm2, measured with OCT Cirrus 4000.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Several studies have demonstrated that the optic disc size varies according to the population on account of different ethnic characteristics,<a class="elsevierStyleCrossRefs" href="#bib0040">8,29</a> for which reason the results in the present study are important due to the fact that 100% of the studied population sample was Mestizo.In what concerns RNFL thickness, the found value was 100.30 ± 854 μm matching the reports related to Hispanic population authored by Alasil et al.<a class="elsevierStyleCrossRef" href="#bib0150">30</a> and Budenz et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> Likewise, said thickness is similar to that found in studies in India, as, described by Gopalakrishnan et al.<a class="elsevierStyleCrossRef" href="#bib0155">31</a> and Kayaarasi et al.<a class="elsevierStyleCrossRef" href="#bib0095">19</a> However, the RNFL thickness reported by Knight et al. (956 ± 1.4 μm<a class="elsevierStyleCrossRef" href="#bib0145">29</a>) and Guerrero et al. (94 ± 5 μm<a class="elsevierStyleCrossRef" href="#bib0055">11</a>) is smaller than that of the present study despite the fact that the studied population was also Hispanics even though said data includes relatively few subjects of Hispanic origin. For the above reasons, specific ethnic databases should be, developed in order to implement a precise use of software for the databases of our patients.The prevalence of megalopapilla is 24%, taking into account the disc area of >2.5 mm2, finding >15, 16% published by Guerrero et al. in Paraguay. This points to high ethnic-based prevalence of megalopapilla. However, if the threshold is >3.07 mm2 (larger than average +2 standard deviations), the prevalence of megalopapilla is 4%, which could also be related to ethnicity.No significant differences were found in ring area and RNFL thickness in the megalopapilla group and normal optic discs. This finding is in contrast with the reports by Savini et al.<a class="elsevierStyleCrossRef" href="#bib0110">22</a> who demonstrated that RNFL thickness measured with OCT Stratus was associated to the optic disc size. Budenz et al.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> also demonstrated thicker RNFL in larger optic discs. However, a histological study in humans showed that the mean RNFL thickness was unrelated to the disc area.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> The present findings match those of Costa et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> in which the mean RNFL is similar in eyes with megalopapilla as well as normal eyes, and also match those of Discs et al.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> who reported that normal discs are more similar than megalopapilla discs in terms of ring area and RNFL thickness, with these parameters differentiating them from glaucomatous optic neuropathy.Conclusions and recommendationsOptic nerve characteristics measured with OCT in the studied population differ from the characteristics reported by some studies of Hispanic populations, the prevalence of megalopapilla being above that reported in South American populations considering a disc area >2.5 mm2 and smaller if taking into account a disc area larger than average +2 standard deviation with a prevalence of 4%, which does not exhibit significant differences in ring area and RNFL thickness when compared to normal discs. However, the authors suggest increasing the sample in order to develop a database for the Peruvian population.FundingThe present study was funded by the researchers.Conflict of interestsNo conflict of interests was declared by the authors." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1275442" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1179863" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1275441" "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" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1179862" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Ethical considerations" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conclusions and recommendations" ] 10 => array:2 [ "identificador" => "sec0040" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 12 => array:2 [ "identificador" => "xack438037" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-05-10" "fechaAceptado" => "2019-07-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1179863" "palabras" => array:3 [ 0 => "Megalopapilla" 1 => "Optical coherence tomography" 2 => "Optical disk" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1179862" "palabras" => array:3 [ 0 => "Megalopapila" 1 => "Tomografía de coherencia óptica" 2 => "Disco óptico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo describe the morphometric characteristics and thickness of the retinal nerve fibre layer (CFNR) in healthy patients using optical coherence tomography (OCT). MethodsA cross-sectional and descriptive study was conducted on a total of 184 eyes of 184 people of mestizo origin enrolled after a complete ophthalmological evaluation at the National Institute of Ophthalmology, Lima-Peru. The morphometric parameters of the optical disc and thickness of the CFNR were measured by OCT ZEISS Cirrus HD Model 5000. Megalopapilla was defined as: area of the optical disc greater than 2.5 mm2 and area greater than the mean plus 2 standard deviations. ResultsThe areas obtained were: optical disc of 2.21 ± 0.43 mm2, neuroretinal ring of 1.37 ± 0.25 mm2, 0.84 ± 0.48 mm2 cup; mean cup/disc ratio of 0.58 ± 0.16, vertical cup/disc ratio of 0.55 ± 0.15, and a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla, being considered as a disc area greater than 2.5 mm2 and 3.07 mm2, was 24% and 4%, respectively. When comparing megalopapilla with normal discs, the area of the ring (P = .08) and thickness of CFNR (P = .73) did not show statistically significant differences. ConclusionThe mean disc area was 2.21 ± 0.43 mm2 with a CFNR thickness of 100.30 ± 8.54 μm. The prevalence of megalopapilla was 24% and 4%, considering a disc area greater than 2.5 mm2 and 3.07 mm2, respectively. These results show that the megalopapilla and normal discs are similar in terms of ring area and CFNR thickness." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoDescribir las características morfométricas y espesor de espesor de la capa de fibras nerviosas retinales (CFNR) en pacientes sanos usando la tomografía de coherencia óptica. MétodosEstudio transversal y descriptivo. Un total de 184 ojos de 184 personas de etnia mestiza fueron enrolados después de una evaluación oftalmológica completa en el Instituto Nacional de Oftalmología, Lima-Perú. Se midieron los parámetros morfométricos del disco óptico y espesor de la CFNR mediante OCT ZEISS Cirrus HD Modelo 5000. Megalopapila definida como: área del disco óptico mayor a 2,5 mm2 y área mayor que la media más 2 desviaciones estándar. ResultadosSe obtuvo un área disco óptico de 2,21 ± 0,43 mm2, anillo neuroretinal de 1,37 ± 0,25 mm2, copa de 0,84 ± 0,48 mm2; promedio de ratio copa/disco de 0,58 ± 0,16, ratio copa/disco vertical de 0,55 ± 0,15 y un espesor de CFNR 100,30 ± 8,54 µm. La prevalencia de megalopapila fue 24 y 4 %, considerando un área de disco mayor a 2,5 mm2 y 3,07 mm2 respectivamente. Al comparar megalopapilas con discos normales, el área del anillo (P = 0,08) y espesor de CFNR (P = 0,73) no mostraron diferencias estadísticamente significativas. ConclusiónEl área de disco fue 2,21 ± 0,43 mm2 con un espesor de CFNR 100,30 ± 8,54 µm. La prevalencia de megalopapila fue 24 y 4 %, considerando un área de disco mayor a 2,5 mm2 y 3,07 mm2 respectivamente. Mostramos que las megalopapilas y los discos normales son similares en términos de área del anillo y espesor de CFNR." "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" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Vasquez Alania PY, Gálvez Olórtegui T, Ayamamani Torres P, Pantoja Dávalos N, Fernandez Llerena S. Características morfométricas de disco óptico y espesor de capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica Cirrus 5000 en pacientes sanos atendidos en el Instituto Nacional de Oftalmología. Arch Soc Esp Oftalmol. 2019;94:579–584." ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 636 "Ancho" => 1211 "Tamanyo" => 31587 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Prevalence of megalopapilla with disc area >2.5 mm2." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 633 "Ancho" => 1263 "Tamanyo" => 30885 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Prevalence of megalopapilla with disc area >3.07 mm2." ] ] 2 => array:9 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: data obtained by the researchers." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Ethnic group: Mestizo (100%)." "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N = 184 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.74 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18-65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">129 (68.5<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55(31.5<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2181922.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Percentage of studied population." ] ] ] "descripcion" => array:1 [ "en" => "Results of epidemiological characteristics." ] ] 3 => array:9 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: data obtained by the researchers." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCT parameters \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disc area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.45–3.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ring area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92–2.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–1.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06–0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertical C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05–0.85 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0–0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RNFL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">854 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83–124 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2181921.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of optic disc and RNFL parameters." ] ] 4 => array:9 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: data obtained by the researchers." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCT parameters OCT \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disc area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.55–3.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ring area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.96–1.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.87–1.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51–0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertical C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.51–0.81 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.1–0.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RNFL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">919 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85–124 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2181923.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of optic disc and RNFL parameters in megalopapilla (n = 45 = 24%)." ] ] 5 => array:9 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Source: data obtained by the researchers." "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Variables \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Megalopapilla</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Value of p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RNFL \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">919 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Disc area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ring area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup area \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertical C/D ratio \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cup volume \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2181924.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of comparison of optic disc and RNFL parameters in normal subjects and megalopapilla patients." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Morphometric characteristics of the optical disc and thickness of retinal nerve fibre layer using Cirrus 5000 optical coherence tomography in healthy patients attending the National Institute of Ophthalmology

Características morfométricas de disco óptico y espesor de capa de fibras nerviosas de la retina mediante tomografía de coherencia óptica Cirrus 5000 en pacientes sanos atendidos en el Instituto Nacional de Oftalmología

P.Y. Vasquez Alania

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Patzy5283@gmail.com

Corresponding author.

, T. Gálvez Olórtegui, P. Ayamamani Torres, N. Pantoja Dávalos, S. Fernandez Llerena

Instituto Nacional de Oftalmología, Lima, Peru

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Marsh et al&#46; reported a mean disc area of 2&#46;17&#8239;mm<span class="elsevierStyleSup">2</span> for Caucasians &#40;95&#37; reference range&#58; 1&#46;56&#8211;2&#46;99&#8239;mm<span class="elsevierStyleSup">2</span>&#41;&#44; 2&#46;33&#8239;mm<span class="elsevierStyleSup">2</span> for Hispanics &#40;95&#37; reference range&#58; 1&#46;67&#8211;3&#46;09&#8239;mm<span class="elsevierStyleSup">2</span>&#41; and 2&#46;49&#8239;mm<span class="elsevierStyleSup">2</span> for Afro-Americans &#40;95&#37; reference range&#58; 1&#46;80&#8211;3&#46;24&#8239;mm<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> On the basis of the optic disc area distribution under the Gauss curve&#44; an optic disc is defined as a micropapilla or microdisc when its size is below the mean &#8722;2 standard deviations&#44; and as megalopapilla or macrodisc when it is above the mean &#43;2 standard deviations&#46; It is expected that only 2&#46;3&#37; of the population exceeds said limits&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> Due to the high variability between populations&#44; some studies consider that a disc&#8239;&#62;&#8239;2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> is megalopapilla&#44; whereas for others the limit is &#8239;&#62;&#8239;2&#46;7&#8239;mm<span class="elsevierStyleSup">2</span> and some up to &#62;&#8239;2&#46;8&#8239;mm<span class="elsevierStyleSup">2</span>&#44; all of these measures being obtained by OCT&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;11&#44;18&#8211;20</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">OCT has been utilized to analyze the optic disc and the thickness of the retina nerve fiber layer &#40;RNFL&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Said instrument provides a live cross-section of retinal structures by means of low coherence interferometry&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Multiple studies measuring optic disc with OCT have been carried out&#44; providing a standard base for each population studied taking into account that not all ethnic groups have similar sizes&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19&#44;22</span></a> At present&#44; according to the system being utilized&#44; OCT can be divided in time domain &#40;TD-OCT&#41; and spectral domain &#40;SD-OCT&#41;&#46; OCT Cirrus &#40;Carl Zeiss Meditec&#44; Dublin&#44; CA&#44; USA&#41; is an SD-OCT device that provides faster scan and improves axial resolution than its predecessor OCT Stratus&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;23&#44;24</span></a> Several comparative studies have been carried out between TD-OCT and SD-OCT&#44; obtaining adequate match between the already classic TD-OCT Stratus and the new SD-OCT Cirrus&#44; particularly for the mean global value of peripapillary RNFL thickness&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the studies conducted by Savini et al&#46;&#44; Kayaarasi et al&#46; and Paunescu et al&#46; it was found that the optic disc area exhibited a significant positive correlation with the neuroretinal ring area&#44; the disc and vertical cup ratio&#46; However&#44; neither sex or age had a significant difference in several optic disc parameters&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19&#44;22</span></a> On the other hand&#44; several histological studies in humans and in the eyes of primates carried out by Quigley et al&#46; and Jonas et al&#46; showed that the number of nerve fibers increased linearly together with disc size increase&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;28</span></a> However&#44; other studies comparing megalopapilla with standard sized discs measured with OCT found that the area&#44; the disc-cup radius area&#44; the horizontal and vertical cup-disc radius area were significantly larger in the megalopapilla group<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;19&#44;20</span></a> although no differences were found in the neuroretinal ring area and the RNFL thickness&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> which could constitute an essential finding to differentiate it from glaucomatous neuropathy&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Due to inter-population disc size variability&#44; RNFL thickness and disc area thresholds for megalopapilla&#44; in addition to the glaucoma overdiagnostic in patients with megalopapilla&#44; this study was conducted to obtain a normal value of reference in patients of the National Ophthalmology Institute &#40;<span class="elsevierStyleItalic">Instituto Nacional de Oftalmolog&#237;a</span> &#8211;INO-&#41;&#44; in Lima&#44; Peru&#46; On the other hand&#44; the normal range of morphometric characteristics of the optic disc is unknown &#40;disc area&#44; neuroretinal ring area&#44; cup area&#44; mean cup&#47;disc ratio&#44; cup&#47;vertical disc ratio&#41; and RNFL thickness as measured with OCT in the healthy population who consulted at the INO would be useful as a reference for the patients cared for at said institution&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A transversal and descriptive study that assessed 184 eyes of 184 patients who underwent ophthalmological examination at the INO in Lima&#44; Peru&#44; a city having a predominantly Mestizo population&#44; from December 2017 up to April 2018&#46; The inclusion criteria were&#58; patients over 18 years of age&#44; best corrected visual acuity of &#8239;&#62;0&#46;5&#8239;logMAR&#44; refractive error between &#43;3 diopters &#40;D&#41; and sphere of &#8722;3&#8239;D between &#43;1&#46;5&#8239;D and &#8722;1&#46;5&#8239;D cylinder&#44; clear optic medium&#44; intraocular pressure &#60;21&#8239;mmHg&#44; open chamber angle &#40;grade 3 and 4 according to Shaffer&#8217;s classification&#41;&#44; optic disc without characteristics of glaucoma or other pathologies&#44; normal ocular fundus and visual field&#46; The study excluded patients with familial glaucoma history&#44; diabetes mellitus or hypertension with ocular compromise&#44; hypersensitivity to 0&#46;5&#37; tropicamide&#44; previous intraocular surgery and neurological disease with optic nerve compromise&#46; All the subjects underwent a complete ophthalmological examination conducted by the same examiner that comprised visual acuity measurements with Logmar poster&#44; keratometry&#44; refraction&#44; corneal curvature&#46; Refractive error with automatic correction was taken with the auto-keratorefractometer &#40;ARK 500 A&#44; Nidek Co LTD&#44; Maehama Hiroishi-cho Gamagori Aichi&#44; Japan&#41;&#44; biomicroscopy with slit lamp&#44; tonometry with Goldmann applanation &#40;&#169;HAAG&#8209;STREIT AG&#44; 3098 Koeniz&#44; Switzerland&#41;&#44; gonioscopy&#44; eye fundus&#44; ultrasound pachymetry&#44; visual field Humprey 24-2 SITA FAST &#40;Humphrey&#174; Analyzer II-i&#44; Carl Zeiss Inc&#46;&#44; Dublin&#44; CA&#44; USA&#41;&#46; The study also included patients with reliable visual field&#44; defined as a visual field with fixation losses of &#60;&#8239;20&#37;&#44; false positives &#60;15&#37; and false negatives &#60;15&#37;&#59; finally&#44; the OCT device utilized for making the measurements was ZEISS CIRRUS&#8482; HD-OCT Model 5000 &#40;Carl Zeiss Inc&#46;&#44; Dublin&#44; CA&#44; USA&#41;&#44; applying the optic disc cube 200&#8239;&#215;&#8239;200 and macular cube 512&#8239;&#215;&#8239;128 protocols&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The following variables were studied&#58; age&#44; sex&#44; RNFL&#44; disc area&#44; ring area&#44; cup area&#44; mean cup&#47;disc ratio&#44; cup&#47;vertical disc ratio&#44; cup volume and megalopapilla&#46; The latter was defined as an optic disc with an area &#62;2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> measured with OCT<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;12&#44;13&#44;29</span></a> as well as a disc area above mean values &#43;2 standard deviations&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#8211;18</span></a> Establishing a megalopapilla prevalence of 15&#37; and an error of 0&#46;05&#37;&#44; a sample size of 185 eyes were measured&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The categorical variables were described in frequencies and percentages&#46; The distribution type for all numeric variables was assessed by means of the Kolmogorov-Smirnov test to assess normality&#44; according to which the central trend and dispersion measures were described as &#40;standard deviation &#91;SD&#93; and interquartile ranges&#41; respectively&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ethical considerations</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the INO ethics committee and complied with current ethical considerations for research with humans as well as with the principles of the Helsinki declaration&#46; In addition&#44; informed consent was obtained in writing from all participants prior to their inclusion in the study&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">Overall&#44; 184 participants of the Mestizo ethnic group were assessed&#44; mostly females &#40;68&#46;5&#37;&#41;&#46; Mean age was 41&#46;74 years &#40;standard deviation &#40;SD&#41; 13&#46; 82&#44; range&#58; 18&#8211;65 years&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The optic disc parameter characteristics measured with OCT in the general population were&#58; disc area&#58; 2&#46;21&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;43&#41;&#44; ring area&#58; 1&#46;37&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;25&#41;&#44; cup area&#58; 0&#46;84&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;48&#41;&#44; mean C&#47;D ratio&#58; 0&#46;58 &#40;SD&#8239;&#61;&#8239;0&#46;16&#41;&#44; vertical C&#47;D ratio 0&#46;55 &#40;SD&#8239;&#61;&#8239;0&#46;15&#41;&#44; cup volume 0&#46;29 &#40;SD&#8239;&#61;&#8239;0&#46;22&#41; and RNFL 100&#46;30 &#40;SD&#8239;&#61;&#8239;854&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The prevalence of megalopapilla was 24&#37;&#44; on the basis of a disc &#62;&#8239;2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> and 4&#37; if the disc area was &#62;3&#46;07&#8239;mm<span class="elsevierStyleSup">2</span> &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The optic disc parameter characteristics measured with OCT in the population with megalopapilla were&#58; disc area&#58; 2&#46;81&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;21&#41;&#44; ring area&#58; 1&#46;31&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;17&#41;&#44; cup area&#58; 1&#46;50&#8239;mm<span class="elsevierStyleSup">2</span> &#40;SD&#8239;&#61;&#8239;0&#46;28&#41;&#44; mean C&#47;D ratio&#58; 0&#46;67 &#40;SD&#8239;&#61;&#8239;0&#46;05&#41;&#44; vertical C&#47;D ratio 0&#46;67 &#40;SD&#8239;&#61;&#8239;0&#46;05&#41;&#44; cup volume 0&#46;55 &#40;SD&#8239;&#61;&#8239;0&#46;18&#41; and RNFL 100&#46;69 &#40;SD&#8239;&#61;&#8239;919&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The optic disc and RNFL thickness parameters between optic discs with normal size and megalopapilla were compared&#46; The optic disc area &#40;p&#8239;&#60;&#8239;0&#46;0001&#41;&#44; cup area &#40;p&#8239;&#60;&#8239;0&#46;0001&#41;&#44; mean C&#47;D ratio &#40;p&#8239;&#60;&#8239;0&#46;0001&#41;&#44; vertical C&#47;D ratio &#40;p&#8239;&#60;&#8239;0&#46;0001&#41; and cup volume &#40;p&#8239;&#60;&#8239;0&#46;0001&#41; were significantly different&#46; However&#44; ring area &#40;p&#8239;&#61;&#8239;0&#46;08&#41; and RNFL thickness &#40;p&#8239;&#61;&#8239;0&#46;73&#41; did not exhibit statistically significant differences &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">With the development of new imaging technologies for morphological optic nerve assessment such as OCT&#44; it became necessary to determine the characteristics of our healthy population in order to obtain a reference value at our institution in addition to other relevant data such as the percentage of megalopapilla and its characteristics as well as the mean RNFL thickness&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In the present study&#44; the characteristics of optic disc parameters of healthy eyes measured with OCT were assessed&#44; finding an optic disc area of 2&#46;21&#8239;&#177;&#8239;0&#46;43&#8239;mm<span class="elsevierStyleSup">2</span>&#44; similar to the optic disc area &#40;2&#46;23&#8239;&#177;&#8239;0&#46;29&#41; described by Kayaarasi et al&#46; in a population of Turkey&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> A more specific comparison with a Hispanic population produced a similarity in the values found in the multicenter transversal study by Marsh et al&#46; in which the disc area measured with OCT Stratus was 2&#46;33&#8239;mm<span class="elsevierStyleSup">2</span> &#40;95&#37; reference range&#58; 1&#46;67&#8211;3&#46;09&#8239;mm<span class="elsevierStyleSup">2</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> However&#44; the disc area in the population of the present study was larger than that reported in the studies by Knight et al&#46; &#40;1&#46;86&#8239;&#177;&#8239;0&#46;06&#8239;mm<span class="elsevierStyleSup">2</span>&#41; on a Hispanic population with OCT Cirrus 5000<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> and by Guerrero et al&#46; in a population of Paraguay &#40;1&#46;97&#8211;2&#46;07&#8239;&#177;&#8239;0&#46;39&#8239;mm<span class="elsevierStyleSup">2</span>&#44; measured with OCT Cirrus 4000&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Several studies have demonstrated that the optic disc size varies according to the population on account of different ethnic characteristics&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;29</span></a> for which reason the results in the present study are important due to the fact that 100&#37; of the studied population sample was Mestizo&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In what concerns RNFL thickness&#44; the found value was 100&#46;30&#8239;&#177;&#8239;854&#8239;&#956;m matching the reports related to Hispanic population authored by Alasil et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and Budenz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Likewise&#44; said thickness is similar to that found in studies in India&#44; as&#44; described by Gopalakrishnan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> and Kayaarasi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However&#44; the RNFL thickness reported by Knight et al&#46; &#40;956&#8239;&#177;&#8239;1&#46;4&#8239;&#956;m<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#41; and Guerrero et al&#46; &#40;94&#8239;&#177;&#8239;5&#8239;&#956;m<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#41; is smaller than that of the present study despite the fact that the studied population was also Hispanics even though said data includes relatively few subjects of Hispanic origin&#46; For the above reasons&#44; specific ethnic databases should be&#44; developed in order to implement a precise use of software for the databases of our patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The prevalence of megalopapilla is 24&#37;&#44; taking into account the disc area of &#62;2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span>&#44; finding &#62;15&#44; 16&#37; published by Guerrero et al&#46; in Paraguay&#46; This points to high ethnic-based prevalence of megalopapilla&#46; However&#44; if the threshold is &#62;3&#46;07&#8239;mm<span class="elsevierStyleSup">2</span> &#40;larger than average &#43;2 standard deviations&#41;&#44; the prevalence of megalopapilla is 4&#37;&#44; which could also be related to ethnicity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">No significant differences were found in ring area and RNFL thickness in the megalopapilla group and normal optic discs&#46; This finding is in contrast with the reports by Savini et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> who demonstrated that RNFL thickness measured with OCT Stratus was associated to the optic disc size&#46; Budenz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> also demonstrated thicker RNFL in larger optic discs&#46; However&#44; a histological study in humans showed that the mean RNFL thickness was unrelated to the disc area&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> The present findings match those of Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in which the mean RNFL is similar in eyes with megalopapilla as well as normal eyes&#44; and also match those of Discs et al&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> who reported that normal discs are more similar than megalopapilla discs in terms of ring area and RNFL thickness&#44; with these parameters differentiating them from glaucomatous optic neuropathy&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions and recommendations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Optic nerve characteristics measured with OCT in the studied population differ from the characteristics reported by some studies of Hispanic populations&#44; the prevalence of megalopapilla being above that reported in South American populations considering a disc area &#62;2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> and smaller if taking into account a disc area larger than average &#43;2 standard deviation with a prevalence of 4&#37;&#44; which does not exhibit significant differences in ring area and RNFL thickness when compared to normal discs&#46; However&#44; the authors suggest increasing the sample in order to develop a database for the Peruvian population&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">The present study was funded by the researchers&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0110" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors&#46;</p></span></span>"
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    "fechaRecibido" => "2019-05-10"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To describe the morphometric characteristics and thickness of the retinal nerve fibre layer &#40;CFNR&#41; in healthy patients using optical coherence tomography &#40;OCT&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional and descriptive study was conducted on a total of 184 eyes of 184 people of mestizo origin enrolled after a complete ophthalmological evaluation at the National Institute of Ophthalmology&#44; Lima-Peru&#46; The morphometric parameters of the optical disc and thickness of the CFNR were measured by OCT ZEISS Cirrus HD Model 5000&#46; Megalopapilla was defined as&#58; area of &#8203;&#8203;the optical disc greater than 2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> and area greater than the mean plus 2 standard deviations&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The areas obtained were&#58; optical disc of 2&#46;21&#8239;&#177;&#8239;0&#46;43&#8239;mm<span class="elsevierStyleSup">2</span>&#44; neuroretinal ring of 1&#46;37&#8239;&#177;&#8239;0&#46;25&#8239;mm<span class="elsevierStyleSup">2</span>&#44; 0&#46;84&#8239;&#177;&#8239;0&#46;48&#8239;mm<span class="elsevierStyleSup">2</span> cup&#59; mean cup&#47;disc ratio of 0&#46;58&#8239;&#177;&#8239;0&#46;16&#44; vertical cup&#47;disc ratio of 0&#46;55&#8239;&#177;&#8239;0&#46;15&#44; and a CFNR thickness of 100&#46;30&#8239;&#177;&#8239;8&#46;54&#8239;&#956;m&#46; The prevalence of megalopapilla&#44; being considered as a disc area greater than 2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> and 3&#46;07&#8239;mm<span class="elsevierStyleSup">2</span>&#44; was 24&#37; and 4&#37;&#44; respectively&#46; When comparing megalopapilla with normal discs&#44; the area of &#8203;&#8203;the ring &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;08&#41; and thickness of CFNR &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;73&#41; did not show statistically significant differences&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The mean disc area was 2&#46;21&#8239;&#177;&#8239;0&#46;43&#8239;mm<span class="elsevierStyleSup">2</span> with a CFNR thickness of 100&#46;30&#8239;&#177;&#8239;8&#46;54&#8239;&#956;m&#46; The prevalence of megalopapilla was 24&#37; and 4&#37;&#44; considering a disc area greater than 2&#46;5&#8239;mm<span class="elsevierStyleSup">2</span> and 3&#46;07&#8239;mm<span class="elsevierStyleSup">2</span>&#44; respectively&#46; These results show that the megalopapilla and normal discs are similar in terms of ring area and CFNR thickness&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Describir las caracter&#237;sticas morfom&#233;tricas y espesor de espesor de la capa de fibras nerviosas retinales &#40;CFNR&#41; en pacientes sanos usando la tomograf&#237;a de coherencia &#243;ptica&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal y descriptivo&#46; Un total de 184 ojos de 184 personas de etnia mestiza fueron enrolados despu&#233;s de una evaluaci&#243;n oftalmol&#243;gica completa en el Instituto Nacional de Oftalmolog&#237;a&#44; Lima-Per&#250;&#46; Se midieron los par&#225;metros morfom&#233;tricos del disco &#243;ptico y espesor de la CFNR mediante OCT ZEISS Cirrus HD Modelo 5000&#46; Megalopapila definida como&#58; &#225;rea del disco &#243;ptico mayor a 2&#44;5 mm<span class="elsevierStyleSup">2</span> y &#225;rea mayor que la media m&#225;s 2 desviaciones est&#225;ndar&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se obtuvo un &#225;rea disco &#243;ptico de 2&#44;21&#8239;&#177;&#8239;0&#44;43 mm<span class="elsevierStyleSup">2</span>&#44; anillo neuroretinal de 1&#44;37&#8239;&#177;&#8239;0&#44;25 mm<span class="elsevierStyleSup">2</span>&#44; copa de 0&#44;84&#8239;&#177;&#8239;0&#44;48 mm<span class="elsevierStyleSup">2</span>&#59; promedio de ratio copa&#47;disco de 0&#44;58&#8239;&#177;&#8239;0&#44;16&#44; ratio copa&#47;disco vertical de 0&#44;55&#8239;&#177;&#8239;0&#44;15 y un espesor de CFNR 100&#44;30&#8239;&#177;&#8239;8&#44;54&#8239;&#181;m&#46; La prevalencia de megalopapila fue 24 y 4 &#37;&#44; considerando un &#225;rea de disco mayor a 2&#44;5 mm<span class="elsevierStyleSup">2</span> y 3&#44;07 mm<span class="elsevierStyleSup">2</span> respectivamente&#46; Al comparar megalopapilas con discos normales&#44; el &#225;rea del anillo &#40;P&#8239;&#61;&#8239;0&#44;08&#41; y espesor de CFNR &#40;P&#8239;&#61;&#8239;0&#44;73&#41; no mostraron diferencias estad&#237;sticamente significativas&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">El &#225;rea de disco fue 2&#44;21&#8239;&#177;&#8239;0&#44;43 mm<span class="elsevierStyleSup">2</span> con un espesor de CFNR 100&#44;30&#8239;&#177;&#8239;8&#44;54&#8239;&#181;m&#46; La prevalencia de megalopapila fue 24 y 4 &#37;&#44; considerando un &#225;rea de disco mayor a 2&#44;5 mm<span class="elsevierStyleSup">2</span> y 3&#44;07 mm<span class="elsevierStyleSup">2</span> respectivamente&#46; Mostramos que las megalopapilas y los discos normales son similares en t&#233;rminos de &#225;rea del anillo y espesor de CFNR&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;45&#8211;3&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;92&#8211;2&#46;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;84&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#8211;1&#46;97&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&#8211;0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertical C&#47;D ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&#8211;0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#8211;0&#46;91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RNFL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">854&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#8211;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Characteristics of optic disc and RNFL parameters&#46;</p>"
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      ]
      4 => array:9 [
        "identificador" => "tbl0015"
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            "detalle" => "Table "
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                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCT parameters OCT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Range&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disc area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;55&#8211;3&#46;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ring area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;96&#8211;1&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;87&#8211;1&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean C&#47;D ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&#8211;0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertical C&#47;D ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;51&#8211;0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1&#8211;0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RNFL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">919&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#8211;124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2181923.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Results of optic disc and RNFL parameters in megalopapilla &#40;n&#8239;&#61;&#8239;45&#8239;&#61;&#8239;24&#37;&#41;&#46;</p>"
        ]
      ]
      5 => array:9 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; data obtained by the researchers&#46;"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0030"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
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            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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Normal</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Megalopapilla</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Value of p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RNFL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">919&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disc area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ring area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mean C&#47;D ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertical C&#47;D ratio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cup volume&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Results of comparison of optic disc and RNFL parameters in normal subjects and megalopapilla patients&#46;</p>"
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                          "etal" => false
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            5 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Optic Nerve Head &#40;ONH&#41; topographic analysis by Stratus OCT in normal subjects&#58; correlation to disc size&#44; age and ethnicity"
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                        0 => array:2 [
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                          "autores" => array:5 [
                            0 => "B&#46; Marsh"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
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            8 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Determinants of optic disc characteristics&#58; the Rotterdam study"
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            9 => array:3 [
              "identificador" => "bib0050"
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                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bjo.2003.028068"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Ophthalmol"
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                        "volumen" => "88"
                        "paginaInicial" => "761"
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            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tama&#241;o del nervio &#243;ptico detectado por tomograf&#237;a coherencia &#243;ptica en pacientes sanos atendidos en un centro oftalmol&#243;gico del Paraguay Size of the optic nerve detected by optic coherence tomography in healthy patients in an ophthalmological center of Pa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;C&#46; Guerrero-Hernandez"
                            1 => "M&#46; Samudio"
                            2 => "M&#46; Scalamogna"
                            3 => "F&#46; Correa"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Mem Inst Investig Cienc Salud"
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