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Clinical characteristics and OCT analysis of a case series of posterior microphthalmos
Características clínicas y análisis de OCT de una serie de casos de microftalmos posterior
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No evidence of opacity relapse.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. García Franco, A. Arias Gómez, M. García Roa, P. Ramírez Neria, S. Corredor Casas" "autores" => array:5 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "García Franco" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Arias Gómez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "García Roa" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Ramírez Neria" ] 4 => array:2 [ "nombre" => "S." 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Villalaín-Rodes, N. Pastora Salvador, J. Peralta Calvo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "I." "apellidos" => "Villalaín-Rodes" "email" => array:1 [ 0 => "ivillalainr@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "N." "apellidos" => "Pastora Salvador" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Peralta Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología Infantil, Hospital Infantil Universitario La Paz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características clínicas y análisis de OCT de una serie de casos de microftalmos posterior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 806 "Ancho" => 1501 "Tamanyo" => 142532 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient 1 images. (A) RE ocular ultrasound showing diminished AL (18.4<span class="elsevierStyleHsp" style=""></span>mm longitudinal diameter) with thickened sclera (1.8<span class="elsevierStyleHsp" style=""></span>mm); no retinal or serous choroidal detachment can be observed. A small calcification with posterior shadow on the nasal side of the papilla can be seen, underlying a transveral 23<span class="elsevierStyleHsp" style=""></span>mm diameter drusen. No evidence of clear signs of complications in this study. Normal vascularization. (B and C) RE and LE funduscopies showing blurred edges corresponding to large size optic nerve drusen. Typical microphthalmic foveal fold in RE and image suggesting SRNVM in LE. (D) Fluorescein angiography LE indicating diffuse secondary neovascularization around the macula (late hyperfluorescence defined by red arrows). (E) Macular OCT showing destructuring of outer layers (yellow arrow), intraretinal fluid cysts (orange arrows) and image suggesting SRNVM (blue arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital microphthalmos is a variable volume reduction of the ocular globe (axial length<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>2 SD from mean) caused by genetic, environmental or unknown causes.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Two variants have been identified, i.e., nanophthalmos (a generalized reduction of the ocular globe) and posterior microphthalmos (PM) (posterior segment shortening).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> In the latter variant, typically the anterior segment of the eye exhibits a normal appearance but the disparity between the growth of the sclera and the neurosensory retina gives rise to a typical sclerochoroidal thickening and papillomacular fold (PMF) due to the “redundance” of retinal tissue in relation to the outer layers.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–5</span></a> It can be associated to a range of alterations such as foveoschisis, pigment retinopathy, foveolar avascular zone reduction, pseudo-papiledema and uveal effusion, among others.</p><p id="par0010" class="elsevierStylePara elsevierViewall">PM is an infrequent condition that can be found in paediatric patients with high hypermetropia.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–4,6</span></a> If it goes unnoticed in early childhood, children are likely to develop deep amblyopia.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The main objective of this study is to analyze the clinic and tomographic characteristics of optical coherence tomography (OCT) images of paediatric PM, as well as to study possible correlations between both. In addition, the evolution of the disease, the therapeutic approach and the differences that could arise in what concerns treatments and complications have also been studied in order to provide a better understanding of the disease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A retrospective study of a clinic case series of patients with paediatric PM (5 patients, 10 eyes) recruited in the Paediatric Ophthalmology Dept. of the La Paz hospital (Madrid) currently in follow-up.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The inclusion criteria for the study comprised patients under 16 years of age fulfilling the following characteristics: (1) ocular axial length under 20<span class="elsevierStyleHsp" style=""></span>mm measured with ultrasound; (2) hypermetropia over +8<span class="elsevierStyleHsp" style=""></span>Dp; (3) anterior pole without alterations; (4) typical microphthalmos macular thickening or macular fold; (5) normal intraocular pressure and (6) absence of ocular malformations or systemic malformation syndromes. The study excluded patients with anterior pole alterations (microphthalmia) and concurrent ocular or systemic alterations that could compromise anatomical or functional findings.</p><p id="par0030" class="elsevierStylePara elsevierViewall">A comparative analysis was conducted by means of reviewing complete clinic records with the following data: baseline and final visual acuity (VA) (Snellen test), refraction under cycloplegia, slit lamp examination, intraocular pressure measurements and ocular ultrasound with axial length measurement taken at diagnostic. Additional data included eye fundus examination and OCT images.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The morphology and inner structure of PMF was examined with OCT (Cirrus version 5.0. Carl Zeiss Meditec, Inc., Dublin, CA, USA), obtaining macular fold height, cystic changes or other structural alterations. This analysis produced the different PMF phenotypes and the correlation between these parameters and patient VA or severity grade.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Similarly, optic nerve anomalies that could be associated to the disease were analyzed together with strabismus that could coexist with the PM clinic.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">Mean age at diagnostic was 5.0 years (range 0.8–11.0) and mean follow-up was 51.20 months (range 23–91). Mean refraction (spherical equivalent) was +15.35<span class="elsevierStyleHsp" style=""></span>Dp, mean axial length was 16.20<span class="elsevierStyleHsp" style=""></span>mm and mean VA at diagnostic was 0.13 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">All cases exhibited the typical foveal fold or foveal hypoplasia. Retinal folds presented in horizontal position and none of the patients had a normal foveal depression.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In all eyes, the retina pigment epithelium, outer photoreceptor segments, outer limiting membrane and outer nuclear layer were not comprised within the PMF; in contrast, the inner and outer portions of the inner plexiform layer were included within the fold structure.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Several fold “phenotypes” were differentiated with OCT having different heights, shapes and protrusions over the vitreous cavity, including “inverted U” shape with cysts in the ganglion cells in one case, “low dome” with cystoid spaces in the inner nuclear layer in 2 cases and “macular creasing” without foveal profile in 2 cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Three of the 5 patients exhibited intraretinal cystic cavities, one of them in the ganglion cell layer and two in the inner nuclear layer. No cysts were found in the outer retinal or plexiform layers.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> One case exhibited subretinal fluid associated to the presence of an active subretinal neovascular membrane (SRNVM) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The hyper-reflective Bruch membrane-retina pigment epithelium-outer retina remained intact in all eyes. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows some of the variables analyzed in the study.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In the present series, patients 3 and 4 exhibited macular creasing without typical PMF, although these did not correlate with the longest axial lengths (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><p id="par0075" class="elsevierStylePara elsevierViewall">No correlation was observed in the data analysis between VA and macular thickness (Pearsons correlation coefficient of −0.01 in RE and −0.17 in LE). However, conclusions cannot be drawn in relation to this observation due to small sample size.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Only one patient exhibited endotropia associated to high accommodative hypermetropia without requiring surgical treatment. Two of the cases exhibited nystagmus due to poor vision and no fixation. Optic nerve drusen were observed in all cases (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><p id="par0085" class="elsevierStylePara elsevierViewall">Refractometry was conducted under cycloplegia, as well as complete optical correction treatment of amblyopia with occlusions in all cases. One patient was administered oral acetazolamide (250<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h) which improved the OCT results and discretely diminished macular thickness (from 430 to 428<span class="elsevierStyleHsp" style=""></span>μm) after 2 years treatment, with preserved vision. Another patient was administered brinzolamide eyedrops at 12-h intervals, but was excluded from the study due to poor compliance. Only one patient required intravitreal injections with ranibizumab (0.05<span class="elsevierStyleHsp" style=""></span>ml) and subsequent surgical treatment after exhibiting a peripapillary SRNVM complication, probably originated in large papillary drusen, with subsequent tractional retina detachment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">PM is an infrequent entity that must be suspected in paediatric patients with increased hypermetropia and diminished vision. Adequate detection, management and follow-up of this disease is important to improve and preserve the vision of these patients and to identify possible complications.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the present series, VA varied between 0.1 and 0.7 without evidencing a direct correlation with macular thickness, PMF height or the presence of intraretinal cysts.</p><p id="par0105" class="elsevierStylePara elsevierViewall">All cases evidenced absence of foveal depression and various PMF morphotypes in OCT: (1) low dome, (2) Inverted “U” and (3) macular creasing. It could be said that neurosensory PMF was “partial thickness” as it did not include outer photoreceptors segments, IS/OS, outer limiting membrane or outer nuclear layer. These findings are similar to those previously described in the literature.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7,8</span></a> A possible explanation is that the outer retina is separated from the PMF due to its proximity to the retina pigment epithelium and that vitreous traction predominantly acts upon the inner retina. Three of the 5 cases exhibited intraretinal cystic cavities, which could represent structural changes secondary to the retinal fold instead of inflammatory cysts.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,7</span></a> These cystic changes were observed in different cases, regardless of the macular thickness or PMF height.</p><p id="par0110" class="elsevierStylePara elsevierViewall">An association between the mutation of the <span class="elsevierStyleItalic">MFRP</span> gene and the autosomic recessive syndrome has been described, consisting in microphthalmos, <span class="elsevierStyleItalic">retinitis pigmentosa</span>, foveoschisis and optic nerve drusen.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> All the patients of the present series exhibited pseudo-papiledema due to drusen but none fulfilled clinic characteristics for <span class="elsevierStyleItalic">retinitis pigmentosa</span>. The electrophysiological study of these patients was not available for the study. Only one patient had a negative genetic study due to an uncle on the mothers side with <span class="elsevierStyleItalic">retinitis pigmentosa</span>.</p><p id="par0115" class="elsevierStylePara elsevierViewall">Fluorescein angiography was utilized in a single case: a 13-year-old patient with secondary neovascularization that required 9 injections of the antiangiogenic ranibizumab (0.05<span class="elsevierStyleHsp" style=""></span>ml). Subsequently, vitreous-hyaloid traction with retinal schisis was detected in the papilomacular bundle and tractional retina detachment in “tent-like” shape that required surgical treatment. In the follow-up period, said patient required 2 ranibizumab injections in the fellow eye due to secondary neovascularization. To date, surgery has not been necessary.</p><p id="par0125" class="elsevierStylePara elsevierViewall">On the other hand, 2 patients received treatment with carbonic anhydrase inhibitors, one treatment being oral and the other topical ocular. The recommended oral medication dose is 500<span class="elsevierStyleHsp" style=""></span>mg/day, although there is insufficient evidence to determine its effectiveness. As regards the use of topical carbonic anhydrase inhibitors, it is considered that 2% dorzolamide at 12-h intervals could improve VA and macular thickness.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The uveal effusion syndrome that expresses in nanophthalmic eyes gives rise to exudative detachment of the choroids, the retina and the ciliary body, idiopathically due to venous congestion caused by a thickened sclera that exerts compression. Conventionally, the standard treatment in these cases are partial or total sclerotomy. However, this is an invasive technique that is not free of complications. An initial option is the use of topical carbonic anhydrase inhibitors.</p><p id="par0140" class="elsevierStylePara elsevierViewall">By way of conclusion, it is crucial for clinic ophthalmologists to become acquainted with the clinic characteristics and imaging tests of PM. Due to the complexity of the disease, full ophthalmological examinations are required for diagnosis as well as for identifying possible complications. Adequate management of the high refractive error in these patients and the consequent amblyopia is essential.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0150" class="elsevierStylePara elsevierViewall">No conflict of interests was declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1335172" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1229798" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1335171" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1229797" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-09-28" "fechaAceptado" => "2020-02-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1229798" "palabras" => array:5 [ 0 => "Posterior microphthalmos" 1 => "Hypermetropia" 2 => "Amblyopia" 3 => "Papillomacular fold" 4 => "Optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1229797" "palabras" => array:5 [ 0 => "Microftalmos posterior" 1 => "Hipermetropía" 2 => "Ambliopía" 3 => "Pliegue papilomacular" 4 => "Tomografía de coherencia óptica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posterior microphthalmos is a rare condition that can be found in paediatric patients with increased farsightedness and reduced vision. A retrospective study is presented of 5 cases of posterior microphthalmia aged between 4 and 13 years. The following parameters were obtained: visual acuity, cycloplegic refractive error, optical biometry, slit lamp examination, intraocular pressure, and ocular ultrasound. The refraction, axial length and average visual acuity was +15.35<span class="elsevierStyleHsp" style=""></span>Dp, 16.20<span class="elsevierStyleHsp" style=""></span>mm and 0.13, respectively. The fundus was examined, optical coherence tomography was performed, and also retinography and fluorescein angiography in one case. In all cases, the absence of foveal depression and different morphotypes of the papillo-macular fold were observed in the tomography. In the absence of a specific treatment, the appropriate detection, management, and monitoring of this disease is important to improve and maintain the vision of patients and recognize possible complications.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El microftalmos posterior es un cuadro poco frecuente que puede encontrarse en pacientes pediátricos con hipermetropía elevada y visión reducida. Presentamos un estudio retrospectivo de 5 casos de microftalmía posterior en niños de edades comprendidas entre 4 y 13 años. Se obtuvieron los siguientes parámetros: agudeza visual, refracción bajo cicloplejía, biometría, examen en lámpara de hendidura, presión intraocular y ecografía ocular. La refracción, la longitud axial y la agudeza visual media fueron de +15,35<span class="elsevierStyleHsp" style=""></span>Dp; 16,20<span class="elsevierStyleHsp" style=""></span>mm y 0,13, respectivamente. Se examinó el fondo de ojo, se realizó tomografía de coherencia óptica y, en uno de los casos, retinografía y angiografía fluoresceínica. En todos los casos se evidenció ausencia de depresión foveal y diferentes morfotipos del pliegue papilo-macular por tomografía. Al no existir un tratamiento específico, es importante una adecuada detección, manejo y seguimiento de esta enfermedad para mejorar y mantener la visión de los pacientes y reconocer posibles complicaciones.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villalaín-Rodes I, Pastora Salvador N, Peralta Calvo J. Características clínicas y análisis de OCT de una serie de casos de microftalmos posterior. Arch Soc Esp Oftalmol. 2020;95:239–243.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">3rd Prize for the best Poster Communication at the 94th Congress of the SEO held in Granada, 2018.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 335 "Ancho" => 1500 "Tamanyo" => 194773 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Inner structure and morphotypes of PMF under optical coherence tomography (horizontal section). (A) Patient 2: inverted U-shaped PMF with cysts in the ganglion cell layer. (B) Patient 4: macular creasing without preserved foveal profile. (C) Patient 5: low dome with cystic cavities in CNI.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 806 "Ancho" => 1501 "Tamanyo" => 142532 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Patient 1 images. (A) RE ocular ultrasound showing diminished AL (18.4<span class="elsevierStyleHsp" style=""></span>mm longitudinal diameter) with thickened sclera (1.8<span class="elsevierStyleHsp" style=""></span>mm); no retinal or serous choroidal detachment can be observed. A small calcification with posterior shadow on the nasal side of the papilla can be seen, underlying a transveral 23<span class="elsevierStyleHsp" style=""></span>mm diameter drusen. No evidence of clear signs of complications in this study. Normal vascularization. (B and C) RE and LE funduscopies showing blurred edges corresponding to large size optic nerve drusen. Typical microphthalmic foveal fold in RE and image suggesting SRNVM in LE. (D) Fluorescein angiography LE indicating diffuse secondary neovascularization around the macula (late hyperfluorescence defined by red arrows). (E) Macular OCT showing destructuring of outer layers (yellow arrow), intraretinal fluid cysts (orange arrows) and image suggesting SRNVM (blue arrow).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">ACD: anterior chamber depth; ARFX: autorefractometry; VA: visual acuity; WC: with correction; FC: finger counting; AL: axial length; RE: right eye; LE: left eye; PMF: papillomacular fold.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Age \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">ARFX \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">AL (mm) \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">ACD (mm) \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">Baseline VA \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">Final VA WC \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">PMF height (μm) \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">Cystic changes \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">PMF morphology \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">Central subfield macular thickness (μm) \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" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \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">RE: +15.00; −1.25 to 168°;LE: +14.75; −0.75 to 163° \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">18.4/18.8 \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">3.45/3.38 \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">0.5/CD<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>cm \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">0.7/0.1 \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">101 \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">Yes \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">Dome \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">438/– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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">RE: +15.25; −1.00 to 17°;LE: +16.25; −1.00 to 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">15.4/15.5 \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">0.1/0.1 \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">0.1/0.1 \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">432/343 \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">Yes \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">Inverted U \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">387/822 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 \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">RE: +19.00; −0.50 to 12°;LE: +19.25; −0.50 to 172° \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">15/16 \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">– \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">0.1/0.15 \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">0.32/0.4 \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">127 \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">No \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">Macular creasing \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">442/414 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \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">RE: +15.75; −1.75 to 175°;LE: +15.50; −2.00 to 10° \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">15.5/15.4 \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">0.05/0.05 \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">0.16/0.2 \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">No \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">Macular creasing \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">469/448 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \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">RE: +15.25; −1.50 to 6°;LE: +13.25; −1.25 to 174° \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">16/16 \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">2.41/3.99 \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">Fixates and follows \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">0.2/0.16 \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">112 \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">Yes \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">Dome \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">424/486 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2288560.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Study variables for 5 patients (RE/LE).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Microftalmos posterior con pliegue papilomacular: informe de un caso" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. 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