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Factors associated with serous retinal detachment in highly myopic eyes with inferior posterior staphyloma
Factores asociados con el desprendimiento neurosensorial macular en pacientes miopes magnos con estafiloma inferior
a Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
b Servicio de Oftalmología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
c Servicio de Oftalmología, Centro de Investigaciones Médico-Sanitarias, Málaga, Spain
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(A) Línea que pasa por el centro de la fóvea y perpendicular a la línea (B). (B) Línea tangente al epitelio pigmentario de la retina (EPR) en la base del evainamiento (flecha azul de dos puntas). La altura del envainamiento macular se define como la distancia medida entre la intersección de la línea (A) con el borde exterior del EPR y la intersección de la línea (A) y la línea (B).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Garcia-Ben, A. González Gómez, I. García Basterra, J.M. García-Campos" "autores" => array:4 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Garcia-Ben" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "González Gómez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "García Basterra" ] 3 => array:2 [ "nombre" => "J.M." 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Álvarez-Fernández, M. Cubillas-Martín, M.L. Álvarez-Suárez, M.J. Viescas-Fernández, M.R. Medina-Mejías, C. Rodríguez-Balsera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Álvarez-Fernández" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Cubillas-Martín" ] 2 => array:2 [ "nombre" => "M.L." "apellidos" => "Álvarez-Suárez" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Viescas-Fernández" ] 4 => array:2 [ "nombre" => "M.R." "apellidos" => "Medina-Mejías" ] 5 => array:2 [ "nombre" => "C." 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The detection of the accidental injection was immediate in one case (A) and at the month check-up in the other (B), so it may go unnoticed if the visual axis is not compromised or a cataract does not develop. In the image of the anterior segment after phacoemulsification with an intraocular lens implant (C) the entrance door of the implant in the posterior capsule can be seen (white arrow).gr2</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Hernanz, A. Moll-Udina, M. Dotti-Boada, M.T. Carrión, V. Llorenç, A. Adán" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Hernanz" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dotti-Boada" ] 3 => array:2 [ "nombre" => "M.T." "apellidos" => "Carrión" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 5 => array:2 [ "nombre" => "A." 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García-Ben, A. González Gómez, I. García Basterra, J.M. García-Campos" "autores" => array:4 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "García-Ben" "email" => array:1 [ 0 => "antoniobengar@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "González Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "García Basterra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "García-Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Oftalmología, Centro de Investigaciones Médico-Sanitarias, Málaga, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores asociados con el desprendimiento neurosensorial macular en pacientes miopes magnos con estafiloma inferior" ] ] "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" => 545 "Ancho" => 1305 "Tamanyo" => 59816 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Macular sheath height sutdy using optical coherence tomography (OCT) Triton Deep Range Imaging (DRI) in a myopic patient with lower staphyloma. (A) Line passing through the center of the fovea and perpendicular to line (B). (B) Line tangent to the retinal pigment epithelium (RPE) at the base of the sheath (blue double-tip arrow). Macular sheath height is defined as the distance measured between the intersection of the line (A) with the outer edge of the RPE and the intersection of line (A) and line (B).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Lower staphyloma is a subtype of staphyloma that is often accompanied by a slanting papilla syndrome, an abnormal vascular pattern and, less frequently, visual field defects.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–5</span></a> When the upper edge of the lower staphyloma crosses through the macula, the vertical slice taken by of optical coherence tomography (OCT) shows the ocular wall with two different radii: one corresponding to the general curvature of the eye outside the staphyloma and a second smaller radius corresponding to the lower staphyloma. The union of both curvatures produces an asymmetric sheathing of the macular area.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Many complications can occur at the upper edge of the lower staphyloma such as chorioretinal degenerative changes or choroidal neovascular membranes.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–11</span></a> However, neurosensorial retinal detachment in the absence of choroidal neovascular membrane is one of the most frequent exudative complications the pathogenesis of which still remains unknown.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12–15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Taking into account these facts, a group of myopic patients with inferior staphyloma was recruited to investigate the clinical factors associated with macular neurosensorial detachment.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0020" class="elsevierStylePara elsevierViewall">Cross-sectional study of 44 eyes from 27 patients carried out at the University Clinic Hospital Virgen de la Victoria in Malaga. Following the Helsinki declaration, all patients signed an informed consent form after being informed of the study characteristics and being given guarantees about the confidentiality of results.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection of patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">All the patients with myopia magna and inferior staphyloma referred to the Medical Retina Unit of the University Clinic Hospital Virgen de la Victoria in Malaga between October 2011 and May 2019, were recruited for this study. Myopia magna was defined as refractive error over or equal to six diopters (D) or an axial length > 26 mm (mm). Lower staphyloma was defined as a concave depression in the lower layer of the ocular globe, where the upper edge crosses along the fove as shown in retinography, binocular inverted image ophthalmoscopy and OCT. All patients with ocular hypertension, glaucoma, cataract, uveitis, retinal detachment, diabetic retinopathy, age-related macular degeneration, severe myopic chorioretinal degeneration (grade three, four or any grade associated with plus signs according to the international classification by Ohno-Matsui et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>) or a history of intraocular surgery except cataract surgery were excluded from the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Eye examination</span><p id="par0030" class="elsevierStylePara elsevierViewall">All patients underwent a complete eye examination comprising best visual acuity determination by means of backlit optotypes of the Early Treatment Diabetic Retinopathy Study (ETDRS) at four meters, anterior segment examination, intraocular pressure measurement withg applanation tonometry, spherical equivalent calculation, posterior segment examination with inverted image ophthalmoscopy and 20 diopter Volk lens (Volk, Ohio, USA), axial length measurement with optical interferometry (IOL-Master, Carl Zeiss Medical Inc., Dublin, CA, USA) and OCT. Spherical equivalent was defined as the sum of the spherical defect and half of the cylindrical defect.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> OCT was performed using the Swept Source (SS) Deep Range Imaging (DRI) OCT system (Topcon Corp., Tokyo, Japan) of the Triton series. This OCT uses a light source with a wavelength of 1050 nanometers (nm) and a scanning speed of 100,000 A-Scans per second. For this study, we used the "Line Scan" image acquisition protocol centered on the fovea with a vertical and a horizontal section of 12 mm in length to measure choroidal macular thickness, macular sheath height as well as to identify the anomalies present in the vitreoretinal interface. The protocol scans 128 overlapping high-resolution segments two-dimensionally. To quantify the height of the macular sheath we projected two lines, line (A) passing through the center of the fovea and line (B) perpendicular to line (A) and tangent to the outer edge of the RPE at the base of the sheath. The height of the sheath was defined as the distance between the intersection of line (A) with the outer edge of the RPE and the intersection of line (A) with line (B) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). To evaluate the thickness of the choroid, we used the Triton caliper from the outer edge of the RPE to the inner edge of the subfoveal sclera. Scans were performed between 10 AM and 12 AM in all patients. OCT was always performed by an experienced technician. To be included in this study, images had to reach a signal strength of at least 70/100.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Patients were classified in 2 groups according to the OCT findings: those showing submacular fluid were assigned to the study group (13 eyes out of 9 patients), while those showing no submacular fluid were assigned to the control group (31 eyes out of 18 patients). All patients underwent fluorescein angiography (FA) using the CRT system, 50IX/Imagenet (Topcon Corp., Tokyo, Japan).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">Quantitative data were expressed as mean ± standard deviation and qualitative data as percentages. To evaluate the differences between each of the study variables (age, sex, spherical equivalent, axial length, intraocular pressure, vitreomacular traction, epirretinal membrane, internal limiting membrane detachment, choroidal thickness, height of macular sheath and visual acuity) in patients with and without neurosensory retinal detachment, generalized estimation equation (GEE) regression models were used. Unlike standard regression techniques, GEE models take into account possible correlations between individual patient eyes. In all cases, a p value lower than 0.05 was considered statistically significant.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 44 eyes from 27 patients with lower staphyloma were recruited for this study. All patients were Spanish with a mean age of 52 ± 10.3 years. The mean refractive error was -7.2 ± 1.5 D. Mean intraocular pressure was 14.2 ± 1.8 mmHg. Mean axial length of patients was 27.43 ± 1.97 mm. Mean subfoveal choroidal thickness was 139.76 ± 38.27 m. Mean macular sheath heightwas 334.6 ± 100.4 m. Best mean visual acuity was 0.39 ± 0.24 logMAR. Ten eyes (22.7%) showed vitreomacular traction, nine eyes (20.4%) had epirretinal membranes and five eyes (11.3%) showed internal limiting membrane detachments.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 44 eyes with myopia magna and inferior staphyloma, OCT images showed the presence of a neurosensory retinal detachment in 13 of them (29.5%) (study group), while in the remaining 31 eyes (70.5%) the retina was applied (control group). The clinical characteristics of both groups of patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. We found no statistically significant differences with respect to sex (p = 0.32). The mean age was 49 ± 8.4 years in the study group and 54 ± 10.8 years in the control group (p = 0.14). Mean refraction error was - 6.5 ± 0.70 D in the study group and - 7.5 ± 1.6 D in the control group (p = 0.17). Mean axial length was 27.07 ± 0.87 mm in the study group and 27.57 ± 2.26 mm in the control group (p = 0.24). Mean subfoveal choroidal thickness was significantly thinner in the study group 124.08 ± 13.98 m than in the control group 148.83 ± 42.92 m (p = 0.02). Mean macular sheath height was significantly higher in the study group 407.5 ± 108.3 m than in the control group 306.4 ± 82.9 m (p = 0.01). Vitreomacular traction was found in four eyes (30.7%) of the study group and in six eyes (19.4%) of the control group (p = 0.27). Two eyes in the study group had epirretinal membranes (15.3%), compared with 7 eyes (22.6%) in the control group (P = 0.51). Internal limiting membrane detachment was found in one eye (7.6%) in the study group and in four eyes (12.9%) of the control group (p = 0.56). The best mean visual acuity was 0.48 ± 0.07 logMAR in the study group and 0.36 ± 0.28 logMAR in the control group; this difference was not statistically significant (p = 0.1).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In all eyes with neurosensory detachment, the images obtained by the OCT vertical section showed that the subretinal fluid was in a beveled area corresponding to the junction of the normal sclera and the ectasic sclera which in turn corresponded to the upper edge of the lower staphyloma where the macula is located. Late phase fluorescein angiography images showed granular hyperfluorescence due to a window defect inflicted by the atrophic area of the RPE (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Furthermore, no hypo- or hyperfluorescence foci were detected during the whole phase of the fluorescein angiography in patients without neurosensory detachment. No lesions suggestive of choroidal neovascularization were observed in the present study.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Neurosensory retinal detachment in the absence of choroidal neovascularization is one of the most frequent complications of the upper edge of lower staphylomas.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> However, its prevalence is not fully known as it varies according to the series from 5 to 30.9%.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18–20</span></a> The results of the present study show a prevalence of 29.5% (13/44 eyes) similar to the results reported in the studies by Ellabban et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and Maruko et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> although different to those published by Coco et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> The reason for these differences is not clear; however, it could be explained by the fact that our cohort was not selected from the general population, but consisted of patients who had been referred to a tertiary care center specialized in the diagnosis and treatment of macular diseases.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In the present study, the presence of serous retinal detachments was not associated with worse visual acuity compared to eyes without detachment. These results are consistent with those observed by Nakanishi et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> or Ellabban et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> However, they differ from those described by Cohen et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> or Donati et al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> whose series have fewer patients. It is possible that the association between neurosensory detachment and visual acuity is not strong enough to be detected with the small number of subjects in this study. In addition, serous detachment of the neurosensory retina in this type of eyes is usually flat. In eyes with flat neurosensory detachments, the diffusion of oxygen and nutrients from the choriocapillary to the photoreceptors may be sufficient, allowing the photoreceptors to survive to some extent.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Examination of choroidal thickness using the SS-OCT system is becoming a standard procedure due to the inaccessibility of choroidal structures to direct clinical examination and their involvement in various chorioretinal pathologies, such as age-associated macular degeneration, diabetic retinopathy or polyphoidal choroidal vasculopathy.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–24</span></a> In eyes with myopia magna, the posterior staphyloma area is characterised by choroidal thinning, which is more marked at the edge thereof.<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25,26</span></a> In this study, the subfoveal choroidal thickness corresponding to the upper border of the lower staphyloma is significantly thinner in myopic patients with neurosensory retinal detachment. Our findings are consistent with those published by Yamagishi et al.,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> but differ from those described by Ellabban et al.,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> who found no significant difference between eyes with and without neurosensory retinal detachment.</p><p id="par0075" class="elsevierStylePara elsevierViewall">At present, the pathogenesis of neurosensory retinal detachment without choroidal neovascularization or polypoid choroidal vasculopathy remains poorly understood. Mateo and Burés-Jelstrup<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> described 3 patients who developed serous detachment of the neurosensory retina after undergoing macular indentation for the treatment of myopic foveoschisis. This indentation changes the foveal contour from concave to convex, resulting in a smooth macular incurvation similar to that of eyes with lower staphyloma. These authors consider that the compression at the edges of the indented area could lead to diminished choroidal outflow, causing an increase in choroidal thickness which in turn would lead to the accumulation of subfoveal subretinal fluid. Yamagishi et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> consider that hemodynamic changes in the choroid may play a key role in the pathogenesis of neurosensory retinal serous detachment in eyes with lower staphyloma. Coco et al.,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Cohen et al.,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and Theodossiadis et al.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> believe that we are dealing with an atypical or chronic form of central serous chorioretinopathy. Choroidal congestion and choroidal hyperpermeability, manifested as increased choroidal thickness and the presence of dilated choroidal vessels in the SS-OCT system, may play a role in chronic central serous chorioretinopathy.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,30</span></a> In the current study, choroidal thickness was significantly thinner in the 13 eyes with neurosensory detachment than in the eyes without detachment. In previous reports, Maruko et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported that the development of such neurosensory detachment appears to be the result of impaired choroidal output flow due to increased scleral thickness. In the present study, neurosensory detachment was significantly correlated with increased height of macular sheath. Caillaux et al.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> and, more recently, Ohsugi et al.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> reported that patients with dome macula and neurosensory retinal detachment had greater macular swelling height. The term "macular bulge" represents an elevation above the RPE plane.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> However, in patients with lower staphyloma, there is an incurvation at the upper edge of the staphyloma and the term "macular sheath" is a better portrayal of this situation.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,19</span></a> On the other hand, neurosensory serous retinal detachment always occurred at the upper edge of the lower staphyloma and was characterised by granular hyperfluorescence in fluorescein angiography, indicating RPE degeneration. Furthermore, we did not detect any focus of hypo- or hyperfluorescence in patients without neurosensory retinal detachment. Therefore, it could be postulated that increased macular sheathing, associated with decreased choroidal thickness, could induce RPE degeneration, which could potentially result in a break in the external hematoretinal barrier and subsequent detachment of the neurosensory macular retina.</p><p id="par0080" class="elsevierStylePara elsevierViewall">This scientific work has the following limitations. First, its transversal nature. Second, the sample size, so studies involving a larger number of patients would be required. Third, some of the measurements were made manually using the Triton DRI OCT caliper system.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Despite the above limitations, this is the first article to analyze macular sheath height in myopic patients with lower staphyloma associated or not with neurosensory retinal detachment. This preliminary study showed that the eyes of patients with lower staphyloma who had higher sheath heights and lower choroidal thickness were at greater risk of developing neurosensory macular retinal detachment.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interests</span><p id="par0090" 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" => "xres1392414" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1277126" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1392413" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1277125" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and method" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection of patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Eye examination" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-07" "fechaAceptado" => "2020-05-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1277126" "palabras" => array:6 [ 0 => "Choroidal thickness" 1 => "Fluorescein angiography" 2 => "High myopia" 3 => "Inferior posterior staphyloma" 4 => "Serous retinal detachment" 5 => "Swept source optical coherence tomography" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1277125" "palabras" => array:6 [ 0 => "Grosor coroideo" 1 => "Angiografía fluoresceínica" 2 => "Miopía magna" 3 => "Estafiloma inferior" 4 => "Desprendimiento neurosensorial" 5 => "Tomografía de coherencia óptica swept source" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To investigate the factors associated with persistent serous retinal detachment in highly myopic eyes with inferior posterior staphyloma.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 27 highly myopic patients (44 eyes) with an inferior posterior staphyloma were recruited. Serous retinal detachment was investigated; 13 eyes had persistent sub-macular fluid (study group), and 31 eyes lacked sub-macular fluid (control group). All patients underwent complete ophthalmologic examinations, including axial length measurement and fluorescein angiography (FA). Triton Deep Range Imaging (DRI) optical coherence tomography (OCT) (Topcon Corp., Tokyo, Japan) scans through the fovea measured choroidal thicknesses, macular bend height, and vitreoretinal interface factors.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of the 44 eyes, 13 had neurosensory retinal detachment and 31 did not. No significant differences were found in any of the studied variables (age, gender, spherical equivalence, axial length, vitreomacular traction, epiretinal membrane, internal limiting membrane detachment), except a higher macular bend height (<span class="elsevierStyleItalic">P</span> = .01), and a reduced macular choroidal thickness (<span class="elsevierStyleItalic">P</span> = .02), which were associated with the risk of serous retinal detachment. No statistically significant differences in best-corrected visual acuity (BCVA) were observed between the study and control groups. Serous retinal detachment always occurred at the bisected retinal pigment epithelium of the macula corresponding to the upper edge of the staphyloma, and was characterised by multiple hyperfluorescent granular patches on fluorescein angiography.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A higher macular bend height and a reduced macular choroidal thickness may be important factors in the development of serous retinal detachment in patients with inferior posterior staphyloma.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Investigar los factores clínicos asociados con el desprendimiento neurosensorial macular en ojos de pacientes miopes magnos con estafiloma inferior.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal de 27 pacientes miopes magnos (44 ojos) con estafiloma inferior. Todos los pacientes fueron sometidos a un examen oftalmológico completo, incluyendo angiografía fluoresceína. El grosor coroideo, la interfaz vitreorretiniana y la altura del envainamiento macular se analizaron mediante el dispositivo DRI OCT Triton Swept-Source (Topcon Corp., Tokio, Japan).</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">De los 44 ojos, 13 presentaron un desprendimiento de la retina neurosensorial y 31 carecían del mismo. No observamos diferencias estadísticamente significativas en ninguna de las variables estudiadas (edad, sexo, equivalente esférico, longitud axial, agudeza visual, tracción vitreomacular, membrana epirretiniana o desprendimiento de membrana limitante interna). Los ojos con desprendimiento de la retina neurosensorial presentaron una mayor altura del envainamiento macular (p = 0.01) y una reducción del espesor coroideo (p = 0.02). El desprendimiento neurosensorial macular siempre se produjo en el borde superior del estafiloma inferior y se caracterizó por una hiperfluorescencia granular en la angiografía fluoresceínica.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Una mayor altura del envainamiento macular y un menor grosor coroideo podrían ser factores importantes en el desarrollo del desprendimiento neurosensorial macular en pacientes miopes magnos con estafiloma inferior.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: García-Ben A, González Gómez A, García Basterra I, García-Campos JM. Factores asociados con el desprendimiento neurosensorial macular en pacientes miopes magnos con estafiloma inferior. Arch Soc Esp Oftalmol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2020.05.013">https://doi.org/10.1016/j.oftal.2020.05.013</span></p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 545 "Ancho" => 1305 "Tamanyo" => 59816 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Macular sheath height sutdy using optical coherence tomography (OCT) Triton Deep Range Imaging (DRI) in a myopic patient with lower staphyloma. (A) Line passing through the center of the fovea and perpendicular to line (B). (B) Line tangent to the retinal pigment epithelium (RPE) at the base of the sheath (blue double-tip arrow). Macular sheath height is defined as the distance measured between the intersection of the line (A) with the outer edge of the RPE and the intersection of line (A) and line (B).</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1803 "Ancho" => 1505 "Tamanyo" => 202632 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Neurosensory retinal detachment at the upper edge of a lower staphyloma. A) Right eye retinography of a 43-year-old woman showing atrophy of the retinal pigment epithelium (white arrow). B) Late stage fluorescein angiography showing granular hyperfluorescence without active dye leakage (blue arrow). The Triton Deep Range Imaging (DRI) optical coherence tomography image shows a point of inflection corresponding to the superior edge of the inferior staphyloma that produces a macular sheathing in the vertical (C) but not in the horizontal section (D) with serous detachment of the subfoveal neurosensory retina.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">SD</span>: standard deviation, <span class="elsevierStyleItalic">SE:</span> standard equivalent, <span class="elsevierStyleItalic">AXL:</span> axial length, <span class="elsevierStyleItalic">TVM</span>: vitreomacular traction, <span class="elsevierStyleItalic">ERM:</span> epiretinal membrane, <span class="elsevierStyleItalic">ILM:</span> internal limiting membrane, <span class="elsevierStyleItalic">VA:</span> visual acuity, <span class="elsevierStyleItalic">logMAR:</span> logarithm for minimum angle of resolution.</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">Factor \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">Eyes with neurosensory detachment (study group) \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">Eyes without sensory detachment (control group) \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">Value of p<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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"><span class="elsevierStyleItalic">Number of eyes</span> \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">13/44(29.5%) \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">31/44(70.5%) \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">NA \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"><span class="elsevierStyleItalic">Age</span>± <span class="elsevierStyleItalic">SD</span> \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">49 ± 8.4 \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">54 ± 10.8 \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">0.14 \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 " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></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">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">5 (38.5%) \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">9 (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"> \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"><span class="elsevierStyleHsp" style=""></span>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">8 (61.5%) \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">22 (71%) \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 \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"><span class="elsevierStyleHsp" style=""></span>SE (D) ± SD \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">−6.5 ± 0.70 \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">−7.5 ± 1.64 \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></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"><span class="elsevierStyleHsp" style=""></span>Intraocular pressure (mmHg) ± SD \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">13.9 ± 1.78 \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">14.3 ± 1.88 \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">0.54 \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"><span class="elsevierStyleHsp" style=""></span>AXL (mm) ± SD \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">27.07 ± 0.87 \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">27.57 ± 2.26 \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">0.24 \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"><span class="elsevierStyleHsp" style=""></span>VMT \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">4 (30.7%) \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">6 (19.4%) \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">0.27 \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"><span class="elsevierStyleHsp" style=""></span>ERM \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 (15.3%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (22.6%) \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 \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"><span class="elsevierStyleHsp" style=""></span>ILM detachment \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 (7.6%) \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">4 (12.9%) \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">0.56 \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"><span class="elsevierStyleHsp" style=""></span>Subfoveal choroidal thickness ± SD \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">124.08 ± 13.98 \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">145.83 ± 42.92 \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">0.02 \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"><span class="elsevierStyleHsp" style=""></span>Macular sheath height ± SD \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">407.5 ± 108.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">306.4 ± 82.9 \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">0.01 \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"><span class="elsevierStyleHsp" style=""></span>VA (logMAR) ± SD \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 ± 0.07 \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">0.36 ± 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">0.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2391417.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Based on the generalized estimation equation regression models.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Comparison of different clinical features in patients with and without neurosensory detachment.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The posterior staphyloma of pathologic myopia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B.J. 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