Original article
Transepithelial or intrastromal femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery
Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas
D. Lopes
, T. Loureiro, R. Carreira, S. Rodrigues Barros, J. Nobre Cardoso, P. Campos, I. Machado, N. Campos
Corresponding author
Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal
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The choroidal thinning (white arrow) at nasal level could be physiological and attributable to the patient’s myopia. Subfoveal hyperreflectivity resolved at two weeks (B) leaving a minimal sequel of subfoveal RPE thickening at 1.5 months (C). The outer nasal layers progressively recovered (B and C). In A-OCT 8<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>8 <span class="elsevierStyleItalic">en-face,</span> at ellipsoid layer level, hyperreflective points were observed surrounding the papilla (green arrow) at debut (D). After two weeks (E), these peripapillary hyperreflective points decreased but hyporeflective spots were observed (white arrow), which correlate with the disruption of the outer retina in autofluorescence. After 1.5 months (F), hyporeflective spots decreased and white peripapillary spots disappeared. The A-OCT 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3 showed at choriocapillary level two apparent hypoperfusion spots in the debut of the disease (G), which correlate with the shadow of the subfoveal column hyperreflectivity.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Moll-Udina, I. Hernanz, M. Dotti, V. Llorenç, A. Adán" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Moll-Udina" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Hernanz" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Dotti" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Llorenç" ] 4 => array:2 [ "nombre" => "A." 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Lopes, T. Loureiro, R. Carreira, S. Rodrigues Barros, J. Nobre Cardoso, P. Campos, I. Machado, N. Campos" "autores" => array:8 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Lopes" "email" => array:1 [ 0 => "cdiogolopes@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Loureiro" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Carreira" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Rodrigues Barros" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Nobre Cardoso" ] 5 => array:2 [ "nombre" => "P." "apellidos" => "Campos" ] 6 => array:2 [ "nombre" => "I." "apellidos" => "Machado" ] 7 => array:2 [ "nombre" => "N." "apellidos" => "Campos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Oftalmología, Hospital Garcia de Orta, Almada, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 993 "Ancho" => 2175 "Tamanyo" => 129792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of astigmatism angles of error.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Modern cataract surgery allows cataract surgeons to reach excellent visual acuity results with safety and consistency. Thus, patient expectations regarding postoperative outcomes have also increased, and it’s known that residual astigmatism inferior to 1.00 D, depending on the axis, the age of the patient, the spherical equivalent and the previous refractive error, may result in deterioration of visual acuity and visual symptoms, like blurred vision, glare, and halos.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> A study with 4540 eyes showed that corneal astigmatism is present in the majority of patients undergoing cataract surgery, with 64.6% of the eyes presenting corneal astigmatism between 0.25 and 1.25 diopters (D) and 22.2% with astigmatism of 1.50 D or higher.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cataract surgery is a great opportunity to correct preexisting corneal astigmatism and to prevent residual refractive astigmatism, in order to achieve a high quality vision and patient’s satisfaction, mainly in patients requesting refractive cataract surgery and spectacles independence. There are many methods to correct preexisting corneal astigmatism during cataract surgery including on-axis incision, opposite clear corneal incisions, limbal relaxing incisions (LRIs) and toric intraocular lens (IOL) implantation.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Reduction of corneal astigmatism through manual limbal relaxing incisions (LRIs) is an option but as revealed by a survey of 233 surgeons, only 31% routinely performed LRIs.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Potential complications related with LRIs, including overcorrection, undercorrection, infection, perforation of the cornea, decreased corneal sensation, induced irregular astigmatism and ocular discomfort, can explain the low adhesion of surgeons to this manual technique that is more dependent on surgeon’s skills.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The introduction of femtosecond laser (FSL) technology in cataract surgery allowed superior incisional precision and predictability associated with minimal collateral effects on adjacent tissues, achieving higher levels of safety and reproducibility than manual techniques.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical application of the image-guided femtosecond laser (FSL) to treat corneal astigmatism with arcuate incisions (AIs) has been reported in multiple situations, including post-keratoplasty and residual astigmatism after cataract surgery.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13</span></a> Femtosecond lasers can be programmed to create transepithelial or intrastromal AIs in the sub-Bowman layer of the cornea. The purpose of this study was to compare the results of these two types of arcuate incisions performed at the time of femtosecond laser-assisted cataract surgery (FLACS) to treat low-to-moderate corneal astigmatism.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">In this retrospective study, data on patients who underwent elective FLACS with femtosecond laser AIs, transepithelial AI in one eye and intrastromal AI in the fellow eye, for astigmatism management were reviewed and collected, at a single center over a period of 5 months. The study was conducted in accordance with the Declaration of Helsinki. All patients were informed about the risks and benefits of the proposed surgery and signed a written consent for surgery in accordance with institutional guidelines. All included patients had bilateral cataract and corneal astigmatism between 0.70 to 2.00 D measured by IOL Master® 700 (Carl Zeiss Meditec AG, Jena, Germany). The eyes of each patient were divided into 2 groups, the transepithelial and the intrastromal group. The two eyes of each patient were randomly assigned using the tool "random numbers" of the Quickcalcs software (<a href="https://www.graphpad.com/quickcalcs/">https://www.graphpad.com/quickcalcs/</a>). Contact lens wearers, patients with history of corneal surgery, irregular astigmatism, high ametropia, history of vitreoretinal surgery or any ocular pathology limiting visual acuity were excluded from the study.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Preoperative evaluation and planning included slit-lamp biomicroscopy, dilated fundoscopy, optical biometry with Zeiss IOL Master 700 (Carl Zeiss Meditec AG, Jena, Germany) and corneal topographic analysis with Pentacam HR (Oculus, Inc., Wetzlar, Germany). Intraocular lens (IOL) power calculations were performed with the IOL Master using the Barret Universal II formula for all axial lengths. Each surgeon used their own surgically induced astigmatism values, ranging from 0.25 D to 0.5 D.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Femtosecond laser treatment of the cataract, transepithelial and intrastromal AIs were performed with Catalys FSL platform (Johnson & Johnson Vision, California, USA) and for that reason the surgical planning was based in nomograms developed for this device in particular. Transepithelial AIs planning was based on a modified Donnenfled limbal relaxing incision nomogram that takes into account the contribution of posterior corneal astigmatism, as reported by Baharozian et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> According to this adaptation, it was used 100% of the suggested correction for against-the-rule (ATR, 180°± 30°) astigmatism, 80% for oblique astigmatism (OBL, 45° ± 14° or 135° ± 14°) and 70% for with-the-rule (WTR, 90° ± 30°) astigmatism. Guided by real-time spectral domain optical coherence tomography, the anterior penetrating AIs were placed at a 9.0 mm optical zone, limbal centered, performed orthogonal to the anterior corneal surface and with a corneal depth of 80%. These incisions were not intentionally opened or manipulated at the time or after surgery. The Julian Stevens’ nomogram was used to calculate intrastromal AIs (Stevens J. Intrastromal AK nomogram calculator v3 2015. Available at: <a href="http://www.femtoemulsification.com">www.femtoemulsification.com</a>). All intrastromal, nonpenetrating AIs were programmed to be 8.0 mm diameter paired symmetrical arcs, centered on the limbus, with a 90-degree side-cut angle and a depth between 20% and 80% of real-time corneal pachymetry (the anterior portion started 20% below the epithelium and finished 20% above the endothelium). A reference marker was used to mark the limbus at 3 and 9 o’clock with the patient sitting upright, helping to dock correctly the patient’s eye underneath the laser apparatus with a proper orientation and correction for cyclotorsion. Cataract surgery was completed in another operating room by a standard phacoemulsification procedure using the Whitestar Signature phacoemulsification system (Abbott Medical Optics, Inc, California, USA) with monofocal IOL implantation (Tecnis PCB00; Abbott Medical Optics, Inc, California, USA). Patients had surgery performed by the different surgeons.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Postoperative final evaluation with visual acuity, manifest refraction and optical biometry was performed between 2 to 3 months after the surgery of the second eye. The outcome measures were the difference between preoperative and postoperative keratometric corneal cylinder (Kcyl), correction index (CI), percentage of eyes with overcorrection, percentage of eyes with ≤ 0.5 D Kcyl or ≤ 0.5 D manifest residual refractive astigmatism (RRA) and angle of error during the same time frame. This CI is a measure of treatment accuracy and represents the ration between the surgical induced astigmatism (SIA) and the target induced astigmatism (TIA). The analysis and calculation of these 3 parameters were performed with ASSORT software (ASSORT Pty; Cheltenham, Victoria, Australia) through a vector analysis, using the Alpins method.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Comparative and descriptive statistical analysis was performed using SPSS (SPSS Statistics, version 23, IBM Corp.). A p value less than 0.05 was considered statistically significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The study included 40 eyes of 20 patients with a mean age of 70.22 ± 7.18 years (range 63–75 years). The transepithelial group included 6 eyes with WTR, 11 with ATR and 3 with OBL astigmatism. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows details of baseline biometric parameters, preoperative and postoperative corneal astigmatism values.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The mean difference between preoperative and postoperative Kcyl was statistically significant in both groups (p < 0.001), with a mean value of 0.36 ± 0.37 in the transepithelial group and 0.53 ± 0.42 in the intrastromal group. The results of the Alpins vector analysis for each group are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. The mean SIA was 1.35 D in the transepithelial group and 0.76 D in intrastromal group. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the distribution of the SIA in both groups.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The mean CIs were 0.83 ± 0.71 and 0.68 ± 0.29 in the transepithelial and intrastromal groups, respectively. These values compared to an ideal value of 1 suggest a mean undercorrection in both groups, but more evident in the intrastromal group (p = 0.17). However, the intrastromal group revealed a lower percentage of overcorrection compared to the transepithelial group, occurring in 1 eye (5%) and in 4 eyes (25%), respectively.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The percentage of eyes achieving 0.5 D or less of postoperative Kcyl was 30% in transepithelial group and 40% in the intrastromal group (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">There were no major intraoperative or postoperative complications in any patient, just complaints of ocular discomfort after surgery in 5 eyes (20%) of patients who underwent transepithelial AIs.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">There are multiple significant predictors of the efficacy of astigmatic correction with corneal incisions including: number of incisions, incision length, age, cylinder meridian, optical zone and corneal biomechanics. Therefore, some of these factors are parameters incorporated into the available surgical nomograms to plan corneal incisions.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Manual LRIs are generally considered to have a higher chance of intraoperative or postoperative complications when compared to the femtosecond system, but as LRI are generally performed by experienced surgeons, both techniques have been shown to be efficacious and safe at reducing corneal astigmatism during cataract surgery.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> However, femtosecond technology presented a higher correction index than LRIs and it has the advantage of being a more reproducible and less time-consuming technique.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">To our knowledge, this is one of the first studies comparing transepithelial and intrastromal AIs created by a single laser platform. The current study showed that the transepithelial AIs present a higher astigmatism correction than the intrastromal AIs (CI of 0.83 vs 0.68), however this higher correction index is associated with a higher percentage of eyes with overcorrection (25% vs 5%). The inferior keratometric results in the transepithelial group (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), despite its higher correction index, are explained by the higher percentage of overcorrection, resulting in some cases of astigmatism inversion. None of the cases of overcorrection in the intrastromal group was related to vertical gas breakthrough and anterior penetration as described by Kankariya et al. in 2014, also using the Catalys precision laser system.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Recently Ganaesh et al. also compared these two types of arcuate incisions using the same platform laser but using a different adaptation of the Donnenfeld nomogram for transepithelial AIs planning.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> The anterior penetrating group showed a superior CI (0.95 vs 0.55) and a superior percentage of eyes showing overcorrection (48% vs 28%) compared to the intrastromal group as well. The nomogram adaptation and the decision about opening the anterior penetrant incisions can be relevant contributors to the higher CI (0,95 vs 0,83) and the higher percentage of overcorrection (48 vs 25 %) in comparison to our study.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The results obtained in the intrastromal group are in accordance with the expected results for Julian Stevens’ nomogram that was designed to provide a 70% astigmatic correction and minimize the risk of overcorrection. The values of CI in both groups were very similar to other the studies performed with the same nomograms, Day et al. reported a CI of 0.63 with intrastromal FSL AIs and Baharozian et al, a mean CI of 0.83 with transepithelial FSL AIs.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,22</span></a> Despite the small sample size, it was noticed that all the 5 cases of overcorrection occurred in eyes with ATR astigmatism. However, if the CI was calculated with a parameter that reflected the total amount of astigmatism instead of postoperative Kcyl, possibly the percentage of overcorrection would be inferior in these cases.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This is also supported by the following facts: posterior corneal astigmatism is usually ATR<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and FSL AIs do not influence posterior corneal curvature as reported by Loffler et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Residual astigmatism is a common cause of patient dissatisfaction and spectacles dependence after cataract surgery. This astigmatism was evaluated in the current study through two parameters: postoperative Kcyl, which measures the anterior corneal astigmatism, and manifest RRA, which reflects the astigmatism component of the manifest refraction, providing a more meaningful influence in patient’s visual acuity. Both groups showed a statistically significant reduction in Kcyl after AIs, achieving a Kcyl ≤ 0.5 D in 30 % of the eyes in the transepithelial group and 40 % in the intrastromal group. However, analyzing the manifest RRA, 75% of eyes achieved residual astigmatism ≤ 0.5 D in the transepithelial group and 90% in the intrastromal group.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The distribution of the angle error (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), which represents the angle between the intended axis and the axis of the real incisional effect, revealed an interquartile range of 30 degrees in the transepithelial group and 24 degrees in the intrastromal group. This error probably results from imperfect construction or location of corneal incisions and it influences the efficacy of corneal incisions as reported by Chan et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> An automated identification of the steep corneal meridian for femtosecond AIs placement would improve astigmatic axis accuracy, reducing the angle of error that in this study presented an interquartile range similar to that reported by Kaufmann et al. with manual LRI and by Day et al. also with femtosecond technology.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,22</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The main limitations of this study are the small sample size of each group, surgeries performed by different surgeons and the short follow-up period. The remodeling of transepithelial peripheral corneal incisions generally occurs during the first 6 months after surgery and the keratometric stability can remain up to at least 3 years.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,26</span></a> The FSL transepithelial AIs were not deliberately opened and this may have introduced some variability in the SIA as some incisions may have opened spontaneously. In opposite, intrastromal AIs are thought to be more stable due to intact Bowman and Descemet layers. Another limitation, common to all studies involving astigmatic correction of low magnitudes is the inherent measurement variability and thus the results must be interpreted with caution, in particular, the CI.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In conclusion, both types of AIs performed during FLACS are easily programmed, allowing a significant decrease of corneal astigmatism with safety, at least in a short follow up period. The transepithelial AIs allowed a higher CI but it is associated with a higher proportion of overcorrection, mainly in ATR astigmatisms. This can be a problem for some patients that are more sensitive to a flipped axis, especially when it occurs only in one eye.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> This type of AIs gives the possibility of manipulation to adjust its effect but a spontaneous opening can also contribute to the variability of results. Although the intrastromal AIs presented a lower CI, the results are more predictable and consistent, presenting a higher percentage of patients with manifest RRA equal or inferior to half diopter.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Future studies with the available nomograms including some adjustments and new variables, such as corneal hysteresis could optimize the outcomes.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The integration of an automated system into the FSL platform to detect the steep meridian and the precise axis where the arcuate corneal keratotomies should be performed would be also very important to avoid some potential issues related to manual marking.</p></span><span id="sec1020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1080">Conflict of interests</span><p id="par1065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1460017" "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" => "xpalclavsec1330542" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1460016" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1330541" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec1020" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-05-31" "fechaAceptado" => "2020-09-22" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1330542" "palabras" => array:5 [ 0 => "Cataract surgery" 1 => "Arcuate incisions" 2 => "Femtosecond laser" 3 => "Astigmatism" 4 => "Nomogram" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1330541" "palabras" => array:5 [ 0 => "Cirugía de cataratas" 1 => "Incisiones arcuatas" 2 => "Láser de femtosegundo" 3 => "Astigmatismo" 4 => "Nomograma" ] ] ] ] "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="spar0045" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to compare the results of intrastromal arcuate incisions (AIs) and transepithelial AIs to treat corneal astigmatism during femtosecond laser-assisted cataract surgery (FLACS).</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This retrospective study included 20 patients with corneal astigmatism between 0.70 and 2.00 diopters (D) who underwent FLACS with concurrent intrastromal AIs in one eye and transepithelial AIs in the fellow eye. The main outcomes measures at 2–3 months of follow-up were the difference between pre-operative and postoperative keratometric corneal cylinder (Kcyl), the correction index (CI) and the percentage of overcorrection.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The mean difference between preoperative and postoperative Kcyl revealed a mean value of 0.36 ± 0.37 D in the transepithelial group and 0.53 ± 0.42 D in the intrastromal group (p < 0.001). The mean CI was 0.83 ± 0.71 in the transepithelial group and 0.68 ± 0.29 in intrastromal group (p = 0.17). Five eyes (25 %) had an astigmatism overcorrection in the transepithelial group and 1 eye (5%) in the intrastromal group.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Both intrastromal and transepithelial AIs showed potential for mild to moderate astigmatism correction and appeared to be a safe procedure. Despite transepithelial AIs presented a higher CI, the intrastromal AIs results were more predictable.</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="spar0065" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio fue comparar los resultados de las incisiones arcuatas (IAs) intraestromales y transepiteliales para tratar el astigmatismo corneal en el momento de la cirugía de catarata asistida con láser de femtosegundo (FLACS).</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Este estudio retrospectivo incluyó 20 pacientes con astigmatismo corneal entre 0,70 y 2,00 dioptrías (D) que se sometieron a FLACS con IAs intraestromales en un ojo y IAs transepiteliales en el ojo adelfo. Los principales datos evaluados a los 2-3 meses de seguimiento fueron la diferencia entre el cilindro corneal queratométrico preoperatorio y postoperatorio (Kcyl), el índice de corrección (IC) y el porcentaje de sobrecorrección.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La diferencia media entre Kcyl preoperatorio y postoperatorio reveló un valor medio de 0.36 ± 0.37 D en el grupo transepitelial y 0.53 ± 0.42 D en el grupo intraestromal (p < 0.001). El IC medio fue de 0.83 ± 0.71 en el grupo transepitelial y 0.68 ± 0.29 en el grupo intraestromal (p = 0.17). Cinco ojos (25%) tuvieron una sobrecorrección del astigmatismo en el grupo transepitelial y 1 ojo (5%) en el grupo intraestromal.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Tanto las IAs intraestromales como IAs transepiteliales mostraron potencial para la corrección de astigmatismo leve a moderado y parecen ser un procedimiento seguro. A pesar de que las IAs transepiteliales presentaron un IC más alto, los resultados de las IAs intraestromales fueron más predecibles.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "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="npar0005">Please cite this article as: Lopes D, Loureiro T, Carreira R, Rodrigues Barros S, Nobre Cardoso J, Campos P, et al. Queratotomía arcuata transepitelial o intraestromal con láser de femtosegundo para corrección de astigmatismo corneal en el momento de la cirugía de cataratas. Arch Soc Esp Oftalmol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.oftal.2020.09.019">https://doi.org/10.1016/j.oftal.2020.09.019</span></p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 657 "Ancho" => 2175 "Tamanyo" => 130071 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of the surgical induced astigmatism (SIA) in the transepithelial (A) and intrastromal (B) groups.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 866 "Ancho" => 1341 "Tamanyo" => 77009 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Distribution of eyes with different grades of postoperative keratometric corneal cylinder by group.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 993 "Ancho" => 2175 "Tamanyo" => 129792 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of astigmatism angles of error.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Note: Δ Kcyl = Preoperative Kcyl - Postoperative Kcyl.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Kcyl: keratometric cylinder; CDVA: corrected-distance visual acuity; UCDVA: uncorrected-distance visual acuity; SD: standard deviation.</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"> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean ± SD (Range)</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">p value \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transepithelial \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">Intrastromal \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">Age (y) \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 " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.22 ± 7.18(63; 75)</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">Preoperative CDVA(LogMAR) \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">0.40 ± 0.19 (0.20; 0.60) \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">0.35 ± 0.17 (0.10; 0.60) \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></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">Postoperative UCDVA(LogMAR) \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">0.80 ± 0.18 (0.50; 1.00) \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">0.80 ± 0.22 (0.5; 1.25) \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">0.93 \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">Postoperative CDVA(LogMAR) \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">0.90 ± 0.15 (0.80; 1.20) \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">0.95 ± 0.23 (0.80; 1.20) \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 \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">Preoperative cornealkeratometry (D) \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">43.03 ± 1.92 (39.88; 48.46) \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">43.20 ± 1.91 (41.25; 49.41) \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">Postoperative cornealkeratometry (D) \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">43.07 ± 1.93 (40.12; 48.38) \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">43.18 ± 1.93 (41.40; 49.06) \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">0.65 \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">Preoperative Kcyl (D) \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">1.17 ± 0.44 (0.71; 1.98) \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">1.22 ± 0.17 (0.93; 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">0.28 \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">Postoperative Kcyl (D) \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">0.90 ± 0.44 (1.55; 0.33) \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">0.66 ± 0.31 (0.29; 1.42) \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">0.13 \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">Δ Kcyl (D) \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 ± 0.37 (0.21 ; 1.38) \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">0.53 ± 0.42 (0.33; 1.59) \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></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2511977.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Demographics and ocular biometric preoperative and postoperative parameters.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">SD: standard deviation; TIA: Target induced astigmatism; SIA: Surgical Induced Astigmatism.</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"> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean ± SD (Range)</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">p value \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Transepithelial \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">Instrastromal \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">TIA (D) \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">1.25 ± 0.7 (1.00; 2.25) \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">1.26 ± 0.27 (0.80; 1.51) \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">0.59 \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">SIA (D) \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">1.35 ± 0.88 (0.19; 2.30) \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">0.76 ± 0.35 (0.19; 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">0.05 \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">Difference vector (D) \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">0.83 ± 0.56 (0.42; 2.38) \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">0.75 ± 0.35 (0.17; 1.33) \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></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">Correction Index \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">0.83 ± 0.51 (0.19; 1.90) \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">0.68 ± 0.29 (0.14; 1.10) \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">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">% Astigmatism Corrected \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 ± 51 \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">62 ± 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">Angle of Error (degrees) \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">−12.00 ± 20.87 (−37; 41) \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">5.5 ± 17.77 (−28; 41) \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></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2511976.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Vector analysis parameters values.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of astigmatism on multifocal and monofocal intraocular lenses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Hayashi" 1 => "H. Hayashi" 2 => "F. Nakao" 3 => "F. Hayashi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(00)00526-2" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2000" "volumen" => "130" "paginaInicial" => "477" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11024420" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dissatisfaction after implantation of multifocal intraocular lenses" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "N.E. de Vries" 1 => "C.A.B. Webers" 2 => "W.R.H. Touwslager" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2010.11.032" "Revista" => array:5 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2011" "volumen" => "37" "paginaInicial" => "859" "paginaFinal" => "865" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of corneal astigmatism before cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Ferrer-Blasco" 1 => "R. Montes-Mico" 2 => "S.C. Peixoto-de-Matos" 3 => "J.M. Gonzalez-Meijome" 4 => "A. Cervino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2008.09.027" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "70" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19101427" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correction of moderate corneal astigmatism during cataract surgery: toric intraocular lens versus peripheral corneal relaxing incisions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Hirnschall" 1 => "V. Gangwani" 2 => "A. Crnej" 3 => "J. Koshy" 4 => "V. Maurino" 5 => "O. Findl" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2013.08.049" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "354" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24440102" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toric intraocular lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Mendicute" 1 => "C. Irigoyen" 2 => "M. Ruiz" 3 => "I. Illarramendi" 4 => "T. Ferrer-Blasco" 5 => "R. Montés-Micó" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2008.11.043" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2009" "volumen" => "35" "paginaInicial" => "451" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19251137" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Limbal relaxing incisions versus on-axis incisions to reduce corneal astigmatism at the time of cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Kaufmann" 1 => "J. Peter" 2 => "K. Ooi" 3 => "S. Phipps" 4 => "P. Cooper" 5 => "M. Goggin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2005.08.046" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2005" "volumen" => "31" "paginaInicial" => "2261" "paginaFinal" => "2265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16473215" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Duffey RJ, Leaming D. US Trends in Refractive Surgery: The2008 ISRS/AAO Survey. Atlanta, GA: The International Societyof Refractive Surgery & American Academy of Ophthalmology; 2008, <a target="_blank" href="http://file:///C:/Users/Usuario/Downloads/2008-US-Trends-Survey-Presentation.pdf">file:///C:/Users/Usuario/Downloads/2008-US-Trends-Survey-Presentation.pdf</a>." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical correction of refractive errors after penetrating keratoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Hardten" 1 => "R.L. Lindstrom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00004397-199703710-00003" "Revista" => array:6 [ "tituloSerie" => "Int Ophthalmol Clin" "fecha" => "1997" "volumen" => "37" "paginaInicial" => "1" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9429929" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of keratitis associated with limbal relaxing incision" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Haripriya" 1 => "A. Smita" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0301-4738.198862" "Revista" => array:6 [ "tituloSerie" => "Indian J Ophthalmol" "fecha" => "2016" "volumen" => "64" "paginaInicial" => "936" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28112139" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Femtosecond laser-assisted cataract surgery: a current review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Moshirfar" 1 => "D.S. Churgin" 2 => "M. Hsu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0974-9233.90129" "Revista" => array:6 [ "tituloSerie" => "Middle East Afr J Ophthalmol" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "285" "paginaFinal" => "291" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22224016" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Femtosecond laser-assisted cataract incisions: architectural stability and reproducibility" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Masket" 1 => "M. Sarayba" 2 => "T. Ignacio" 3 => "N. Fram" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2010.03.027" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "1048" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20494782" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Femtosecond-assisted arcuate keratotomy for the correction of postkeratoplasty astigmatism: vector analysis and accuracy of laser incisions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P. Loriaut" 1 => "V.M. Borderie" 2 => "L. Laroche" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0000000000000487" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2015" "volumen" => "34" "paginaInicial" => "1063" "paginaFinal" => "1066" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26114816" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Femtosecond laser-assisted arcuate keratotomy versus toric IOL implantation for correcting astigmatism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Yoo" 1 => "S. Yun" 2 => "J.Y. Kim" 3 => "M.J. Kim" 4 => "H. Tchah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3928/1081597X-20150820-01" "Revista" => array:6 [ "tituloSerie" => "J Refract Surg" "fecha" => "2015" "volumen" => "31" "paginaInicial" => "574" "paginaFinal" => "578" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26352561" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel nomogram for the treatment of astigmatism with femtosecond-laser arcuate incisions at the time of cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.J. Baharozian" 1 => "C. Song" 2 => "K.M. Hatch" 3 => "J.H. Talamo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S141255" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "1841" "paginaFinal" => "1848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29075096" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Astigmatism analysis by the Alpins method" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Alpins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0886-3350(00)00798-7" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2001" "volumen" => "27" "paginaInicial" => "31" "paginaFinal" => "49" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11165856" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AstigMATIC: an automatic tool for standard astigmatism vector analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Gauvin" 1 => "A. Wallerstein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12886-018-0920-1" "Revista" => array:5 [ "tituloSerie" => "BMC Ophthalmol" "fecha" => "2018" "volumen" => "18" "paginaInicial" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30241474" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of limbal relaxing incisions during phacoemulsification surgery based on nomogram review and numerical simulation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Cristobal" 1 => "M.A. del Buey" 2 => "F.J. Ascaso" 3 => "E. Lanchares" 4 => "B. Calvo" 5 => "M. Doblare" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e3181a27387" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2009" "volumen" => "28" "paginaInicial" => "1042" "paginaFinal" => "1049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19724205" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of femtosecond laser intrastromal astigmatic keratotomy efficacy for astigmatism management in cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C. Day" 1 => "J.D. Stevens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2015.09.028" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "251" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27026450" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Refractive outcomes after limbal relaxing incisions or femtosecond laser arcuate keratotomy to manage corneal astigmatism at the time of cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.W. Roberts" 1 => "V.K. Wagh" 2 => "D.L. Sullivan" 3 => "T.J. Archer" 4 => "D.P.S. O’Brart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2018.05.027" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2018" "volumen" => "44" "paginaInicial" => "955" "paginaFinal" => "963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30033111" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anterior gas breakthrough during femtosecond intrastromal astigmatic keratotomy (FISK)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "V.P. Kankariya" 1 => "V.F. Diakonis" 2 => "G.D. Kymionis" 3 => "S.H. Yoo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3928/1081597X-20140711-02" "Revista" => array:6 [ "tituloSerie" => "J Refract Surg" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "511" "paginaFinal" => "513" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25075806" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of astigmatism correction between anterior penetrating and intrastromal arcuate incisions in eyes undergoing femtosecond laser-assisted cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Ganesh" 1 => "S. Brar" 2 => "R. Reddy Arra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/j.jcrs.0000000000000069" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2020" "volumen" => "46" "paginaInicial" => "394" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32050207" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nonpenetrating femtosecond laser intrastromal astigmatic keratotomy in eyes having cataract surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.C. Day" 1 => "N.M. Lau" 2 => "J.D. Stevens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2015.07.045" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2016" "volumen" => "42" "paginaInicial" => "102" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26948784" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contribution of posterior corneal astigmatism to total corneal astigmatism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.D. Koch" 1 => "S.F. Ali" 2 => "M.P. Weikert" 3 => "M. Shirayama" 4 => "R. Jenkins" 5 => "L. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2012.08.036" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "2080" "paginaFinal" => "2087" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23069271" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tomographic analysis of anterior and posterior and total corneal refractive power changes after femtosecond laser-assisted keratotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "F. Loffler" 1 => "M. Bohm" 2 => "M. Herzog" 3 => "K. Petermann" 4 => "T. Kohnen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2017.05.015" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2017" "volumen" => "180" "paginaInicial" => "102" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28549845" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vector analysis of corneal astigmatism after combined femtosecond-assisted phacoemulsification and arcuate keratotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "T.C.Y. Chan" 1 => "G.P.M. Cheng" 2 => "Z. Wang" 3 => "C.C.Y. Tham" 4 => "V.C.P. Woo" 5 => "V. Jhanji" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2015.05.004" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2015" "volumen" => "160" "paginaInicial" => "250" "paginaFinal" => "255.e2" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25982969" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term stability of keratometric astigmatism after limbal relaxing incisions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Lim" 1 => "E. Borasio" 2 => "L. Ilari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2014.01.045" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2014" "volumen" => "40" "paginaInicial" => "1676" "paginaFinal" => "1681" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25155388" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Correction of low levels of astigmatism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.A. Bullimore" 1 => "G. Spooner" 2 => "G. Sluyterman" 3 => "J.G. Dishler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcrs.2014.12.060" "Revista" => array:6 [ "tituloSerie" => "J Cataract Refract Surg" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "1641" "paginaFinal" => "1649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26432121" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of keratometric and topographic cylinder and axis measurements on normal corneas with low astigmatism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.H. Karabatsas" 1 => "I. Papaefthymiou" 2 => "I.M. Aslanides" 3 => "D.Z. Chatzoulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/112067210501500102" "Revista" => array:6 [ "tituloSerie" => "Eur J Ophthalmol" "fecha" => "2005" "volumen" => "15" "paginaInicial" => "8" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15751233" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The visual impact of lens-induced astigmatism is linked to habitual axis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Hughes" 1 => "E.A.H. Mallen" 2 => "D.B. Elliott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OPX.0000000000001000" "Revista" => array:5 [ "tituloSerie" => "Optom Vis Sci Off Publ Am Acad Optom" "fecha" => "2017" "volumen" => "94" "paginaInicial" => "260" "paginaFinal" => "264" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/unassign/S2173579421000098/v1_202102040630/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735794/unassign/S2173579421000098/v1_202102040630/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579421000098?idApp=UINPBA00004N" ]
