Short communication
Delayed suprachoroidal hemorrhage after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)
Hemorragia supracoroidea diferida después de queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK)
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2173579423000440" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.04.001" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2098" "copyright" => "Sociedad Española de Oftalmología" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:355-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0365669123000692" "issn" => "03656691" "doi" => "10.1016/j.oftal.2023.03.005" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2098" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:355-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Comunicación corta</span>" "titulo" => "Hemorragia supracoroidea diferida después de queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK)" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "359" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Delayed suprachoroidal hemorrhage after descemet stripping automated endothelial keratoplasty (DSAEK)" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 382 "Ancho" => 1305 "Tamanyo" => 54346 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Caso 1. OCT de la HSC.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Oliver-Gutierrez, S. Martin Nalda, G. Segura-Duch, P. Buck, E. Ros-Sanchez, L. Bisbe" "autores" => array:6 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Oliver-Gutierrez" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Martin Nalda" ] 2 => array:2 [ "nombre" => "G." "apellidos" => "Segura-Duch" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Buck" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Ros-Sanchez" ] 5 => array:2 [ "nombre" => "L." "apellidos" => "Bisbe" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173579423000440" "doi" => "10.1016/j.oftale.2023.04.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000440?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000692?idApp=UINPBA00004N" "url" => "/03656691/0000009800000006/v1_202305311245/S0365669123000692/v1_202305311245/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173579423000695" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.04.013" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2101" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:360-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Papilledema as a possible key sign for diagnosis of cryopyrin-associated periodic syndromes (CAPS): A case report" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "360" "paginaFinal" => "364" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papiledema como posible signo guía en el diagnóstico del síndrome periódico asociado a la criopirina: a propósito de un caso" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "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" => 863 "Ancho" => 1755 "Tamanyo" => 305722 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Photograph of erythematous oedematous lesions distributed over the trunk. B. Skin biopsies (HE ×10). Oedema in the papillary dermis and perivascular infiltration of mononuclear cells with oedema and isolated neutrophils in the dermis following an interstitial pattern.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Arteaga Henríquez, M. Arteaga Henríquez, C. Álava Cruz, C.N. Hernández León, F.M. Díaz-Flores Estévez, D. Doble Rivera" "autores" => array:6 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Arteaga Henríquez" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Arteaga Henríquez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Álava Cruz" ] 3 => array:2 [ "nombre" => "C.N." "apellidos" => "Hernández León" ] 4 => array:2 [ "nombre" => "F.M." "apellidos" => "Díaz-Flores Estévez" ] 5 => array:2 [ "nombre" => "D." "apellidos" => "Doble Rivera" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000722" "doi" => "10.1016/j.oftal.2023.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000722?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000695?idApp=UINPBA00004N" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000695/v1_202306011103/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173579423000683" "issn" => "21735794" "doi" => "10.1016/j.oftale.2023.04.012" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "2097" "copyright" => "Sociedad Española de Oftalmología" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Soc Esp Oftalmol. 2023;98:351-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Usefulness of the amniotic membrane graft in the management of xen® implant exposure" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "351" "paginaFinal" => "354" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad del injerto de membrana amniótica en el manejo de la exposición del implante XEN®" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1551 "Ancho" => 1674 "Tamanyo" => 360334 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Optical coherence tomography and anterior segment imaging: distal end of XEN® protruding the conjunctiva. (B) Optical coherence tomography and anterior segment imaging: XEN® distal end exposure through conjunctiva</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Bugallo González, D. Álvarez Fernández, C. Rodríguez Balsera, L. Fernández Díaz, M.J. Viescas Fernández, M.L. Álvarez Suárez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Bugallo González" ] 1 => array:2 [ "nombre" => "D." "apellidos" => "Álvarez Fernández" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Rodríguez Balsera" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Fernández Díaz" ] 4 => array:2 [ "nombre" => "M.J." "apellidos" => "Viescas Fernández" ] 5 => array:2 [ "nombre" => "M.L." "apellidos" => "Álvarez Suárez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000680" "doi" => "10.1016/j.oftal.2023.03.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000680?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000683?idApp=UINPBA00004N" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000683/v1_202306011103/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "Delayed suprachoroidal hemorrhage after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "355" "paginaFinal" => "359" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Oliver-Gutierrez, S. Martin Nalda, G. Segura-Duch, P. Buck, E. Ros-Sanchez, L. Bisbe" "autores" => array:6 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Oliver-Gutierrez" "email" => array:1 [ 0 => "david.oliver@vallhebron.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Martin Nalda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "G." "apellidos" => "Segura-Duch" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "Buck" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "E." "apellidos" => "Ros-Sanchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Bisbe" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario Vall d’Hebron University, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro Oftalmológico Barraquer, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hemorragia supracoroidea diferida después de queratoplastia endotelial automatizada con pelado de la membrana de Descemet (DSAEK)" ] ] "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" => 657 "Ancho" => 987 "Tamanyo" => 72104 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1, 24<span class="elsevierStyleHsp" style=""></span>h after DSAEK. Shallow anterior chamber with 1<span class="elsevierStyleHsp" style=""></span>mm hyphema and iris contacting the endothelium. Lenticule is well positioned.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Massive suprachoroidal hemorrhage is a rare but devastating complication of intraocular surgery.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It consists of an accumulation of blood within the suprachoroidal space, a virtual distance between the choroid and the sclera. It is called “Acute intraoperative SCH” if it occurs during surgery; if generated during the postoperative period, it is called “Delayed SCH”. SCH is related to intraocular pressure changes that trigger engorgement of the choriocapillaris, followed by a serous effusion into the suprachoroidal space. This stretches and tears the vessels and the attachments of the ciliary body resulting in blood extravasation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">This rare complication has been reported in most intraocular procedures: cataract extraction, penetrating keratoplasty (PK), glaucoma filtering surgery, and vitreoretinal surgery.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With the introduction of less invasive keratoplasties like DMEK (Descemet Membrane Endothelial Keratoplasty) and DSAEK, the incidence of complications compared to PK has decreased.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> A reduction in SCH risk has been achieved due to minor fluctuations in intraocular pressure with the substitution of an open-sky surgical approach for small self-sealing incisions.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We only found one paper reporting 2 cases of intrasurgical SCH in DMEK<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and one DSHC in DSAEK.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We describe 2 cases of DSCH with some common risk factors after DSAEK that recently occurred in our center. More reports on this rare and under known adverse effect may allow for better prevention and/or identification of the disease.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case 1</span><p id="par0030" class="elsevierStylePara elsevierViewall">76-year-old woman visited in 2018 with significant corneal edema in her left eye. At that moment, her best visual acuity was finger counting at 20<span class="elsevierStyleHsp" style=""></span>cm.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Her ophthalmologic history is remarkable for high myopia (axial length of 27.93<span class="elsevierStyleHsp" style=""></span>mm). She had cataract surgery when she was 50 and a pars plana vitrectomy in 2015 due to a traumatic lens luxation, where a new IOL was sutured to the sulcus. Afterward, she suffered from a vitreous hemorrhage, which was resolved spontaneously; and was followed for a subretinal neovascular membrane in treatment with intravitreal injections of ranibizumab.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Her medical history included arterial hypertension, diabetes mellitus, and obesity.</p><p id="par0045" class="elsevierStylePara elsevierViewall">When she came to the Cornea specialist, a DSAEK approach was decided, and a laser peripheral iridotomy was performed. The surgery was performed under retrobulbar anesthesia, with 5<span class="elsevierStyleHsp" style=""></span>ml mix of mepivacaine and bupivacaine in equal parts, and close anesthesia care in reverse Trendelenburg positioning by a senior surgeon, SMN, as described elsewhere.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> An anterior chamber maintainer of 23G allowed for an under-air descemetorhexis, and an 8.5<span class="elsevierStyleHsp" style=""></span>mm donor corneal lenticule (thickness of 134<span class="elsevierStyleHsp" style=""></span>μm and endothelial cell count of 2570 cells/mm<span class="elsevierStyleSup">2</span>) was inserted with a Busin glide through a 4.0<span class="elsevierStyleHsp" style=""></span>mm temporal corneal incision. The anterior chamber was filled with air, and the lenticule was centered with the help of 23G Busin forceps. Four 10-0 nylon sutures were performed to avoid dehiscence of the primary wound. Afterward, following internal guidelines, vancomycin was injected into the anterior chamber to prevent infection since the patient was allergic to penicillin. Two hours later, the lenticule was well positioned, and the anterior chamber was formed. The patient remained cardiovascularly stable during the procedure, and no Valsalva maneuvers were observed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The morning after the surgery, the patient referred acute and lancinating pain. She presented conjunctival hyperemia, and the lenticule was well positioned. She had a shallow anterior chamber with the iris contacting the endothelium near the main incision and a 1<span class="elsevierStyleHsp" style=""></span>mm hyphema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The intraocular pressure was 26<span class="elsevierStyleHsp" style=""></span>mmHg. On mode B echography, hemovitreous and choroidal detachment were found.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The case was discussed with the retina department, and DSCH was diagnosed (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The SCH was drained eight days after the initial surgery; once blood was liquefied, no previous rTPA (Recombinant Tissue Plasminogen Activator) was injected. After surgery, the lenticule was well positioned, and the anterior chamber was deeper.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">One year later, her best visual acuity was hand motion. Currently, her left eye is progressing into phthisis, and she uses a cosmetic lens.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 2</span><p id="par0065" class="elsevierStylePara elsevierViewall">78-year-old man who came to our clinic in 2021 with right corneal edema. His ophthalmologic history is remarkable for high myopia (axial length of 30.44<span class="elsevierStyleHsp" style=""></span>mm) and a retinal detachment in 2002 repaired through pars plana vitrectomy and a scleral band. He also had two retinal tears in 2006 that were photocoagulated with argon laser. He underwent cataract surgery on the right eye in 2012.</p><p id="par0070" class="elsevierStylePara elsevierViewall">He had hypercholesterolemia, arterial hypertension, and atherosclerosis and was anticoagulated with edoxaban due to atrial fibrillation.</p><p id="par0075" class="elsevierStylePara elsevierViewall">With a pachymetry of 831<span class="elsevierStyleHsp" style=""></span>μm and best spectacle-corrected visual acuity of 0.05, his surgeon decided DSAEK was the best possible approach. Edoxaban was stopped 48<span class="elsevierStyleHsp" style=""></span>h before surgery to reverse its anticoagulation effects. The surgery was performed following the same techniques as case 1 by another senior surgeon, LBL. The only differences were: a chamber maintainer of 20G, a descematorhexis of 7,5<span class="elsevierStyleHsp" style=""></span>mm, 3 10-0 nylon sutures to close the primary wound, and subconjunctival cefuroxime. The donor cornea had a thickness of 122<span class="elsevierStyleHsp" style=""></span>μm and an endothelial cell count of 2700 cells/mm<span class="elsevierStyleSup">2</span>. The patient remained cardiovascularly stable during the procedure, and no Valsalva maneuvers were observed.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The morning after, re-bubbling was performed due to slight detachment of the lenticule without dislocation. A day after, he returned with microhyphema and intraocular pressure of 21<span class="elsevierStyleHsp" style=""></span>mmHg (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). After further interrogation, the patient referred a sudden onset of lancinating pain in his right eye during the first night.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">B-scan echography revealed hemovitreous and choroidal detachment. Diagnosed with DSCH, the case was redirected to the retina team. Drainage surgery was delayed until the cornea regained enough transparency. On the 23rd day after DSAEK, the SCH was drained through a scleral approach, and no previous rTPA was injected.</p><p id="par0090" class="elsevierStylePara elsevierViewall">A month later, his visual acuity was of hand motion, the donor lenticule was attached, the cornea was transparent, and the intraocular pressure was 14<span class="elsevierStyleHsp" style=""></span>mmHg.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">SCH is a rare complication that can occur during or after intraocular surgical procedures or, rarely, after perforating trauma.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Intraoperative SCH and DSCH share similar pathogenic mechanisms<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> with some common risk factors such as advanced age, blood dyscrasia or coagulation defects, and aphakia or pseudophakia.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Myopia has also been cited as a risk factor for SCH. Speaker et al. noted a 75-fold relative risk in eyes with axial length >25.8<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Delayed SCH in glaucoma surgeries has been significantly associated with low postoperative IOP and arterial hypertension.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Additionally, rhegmatogenous retinal detachment, intraoperative extensive retinal photocoagulation, and postoperative emesis have been significantly associated with DSCH in pars plana vitrectomy.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Both cases presented in this study had long axial lengths, were pseudophakic, and one was anticoagulated. Although we did not find evidence that the sulcus sutured IOL and the scleral band were acting as risk factors, we hypothesize their scars might weaken the eye’s wall, thus facilitating a vessel’s rupture in a context of severe choroidal effusion and/or detachment. Both were over 75 years old and had some systemic risk factors, such as arterial hypertension or atherosclerosis.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Delayed SCH after uncomplicated glaucoma filtering surgery is related to low IOP with high pre-surgery IOP. Our patients did not have an elevated IOP before surgery, but it is not uncommon to have a low IOP after DSAEK. Furthermore, during the unfolding of the lenticule, some pressure changes may occur. On the other hand, we postulate that a DSCH could be triggered by changes in pressure due to the movement of a misplaced retro-iris air bubble to the anterior chamber.</p><p id="par0115" class="elsevierStylePara elsevierViewall">To avoid intraoperative SCH, some measures can be considered: limit intraoperative hypertension, avoid aspirin and other anticoagulants, lower IOP before incision, prevent rapid decompression of the globe, operate in reverse Trendelenburg positioning, and elude Valsalva maneuvers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6</span></a> Although these measures might also be important to prevent DSCH, they are more specific for intraoperative SCH. We may reduce the risk of DSCH by reducing emesis and avoiding arterial hypertension or low IOP during the postoperative period.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Acute and lancinating pain during the postoperative period has been described in DSCH.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Both cases presented had this acute excruciating pain and communicated it the day after the surgery revision. One case was suspected rapidly; the other diagnosis was delayed a few days since it was not suspected.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Once the DSCH is established, the prognosis is very poor. One study reported that only 34% of eyes with SCH achieved a final visual acuity greater than 0,1 (decimal scale).<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The best management is still arguable: whether early surgical drainage is necessary or conservative management provides better results is still a topic open to discussion.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Surgical drainage is mainly preferred when clot lysis is near completion. If earlier surgery is needed, rTPA injection is frequently necessary. Nevertheless, it’s still unknown if complete liquefaction of the hemorrhage is absolutely necessary.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,8</span></a> Both cases presented were drained in the weeks after DSCH once liquefaction was completed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conclusion</span><p id="par0140" class="elsevierStylePara elsevierViewall">A thorough understanding of the pathophysiology, risk factors, and clinical outcome, as well as early detection of DSCH, can influence prognosis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is, therefore, essential for every clinician performing intraocular surgery to have some knowledge about DSCH. This topic might be under-published. More reports of this rare complication would help assess common risk factors that would allow better prevention and/or earlier identification of DSCH.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Disclosures</span><p id="par0145" class="elsevierStylePara elsevierViewall">This paper has no funding or grant support.</p><p id="par0150" class="elsevierStylePara elsevierViewall">None of the authors have any financial disclosure.</p><p id="par0155" class="elsevierStylePara elsevierViewall">All authors attest that they meet the current ICMJE criteria for authorship.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Written consent to publish this case has not been obtained. This report does not contain any personal identifying information.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1906891" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1647331" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1906892" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1647332" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 1" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 2" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Disclosures" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-12-27" "fechaAceptado" => "2023-03-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1647331" "palabras" => array:5 [ 0 => "Suprachoroidal hemorrhage" 1 => "Delayed suprachoroidal hemorrhage" 2 => "Descemet stripping automated endothelial keratoplasty" 3 => "Corneal lamellar transplantation" 4 => "Surgery complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1647332" "palabras" => array:5 [ 0 => "Hemorragia supracoroidea" 1 => "Hemorragia supracoroidea diferida" 2 => "Queratoplastia endotelial automatizada con pelado de la membrana de Descemet" 3 => "Trasplante corneal lamelar" 4 => "Complicaciones quirúrgicas" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study, a case series of 2 patients and a literature review, aims to describe the second and third known cases of delayed suprachoroidal hemorrhage after Descemet stripping automated endothelial keratoplasty. The suprachoroidal hemorrhage is defined as the presence of blood in the suprachoroidal space; final visual acuity is rarely greater than 0.1 (decimal scale). Both cases presented had known risk factors: high myopia, previous ocular surgeries, arterial hypertension, and being under anticoagulant therapy. The diagnosis of delayed suprachoroidal hemorrhage was made at the 24-h follow-up visit, as they recalled a sudden and tremendous acute pain hours after surgery. Both cases were drained through a scleral approach.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Delayed suprachoroidal hemorrhage is a rare but devastating consequence that can occur after Descemet stripping automated endothelial keratoplasty. Awareness of the most critical risk factors allows for early identification, which is of paramount importance for the prognosis of these patients.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Este estudio, una serie de 2 casos y revisión de la literatura, pretende describir el segundo y tercer caso conocido de hemorragia supracoroidea diferida (DSCH) tras una queratoplastia endotelial automatizada con pelado de Descemet (DSAEK). La hemorragia supracoroidea es la presencia de sangre en el espacio supracoroideo. La agudeza visual final no suele superar el 0,1 (escala decimal). Ambos casos presentan factores de riesgo: alta miopía, cirugía intraocular previa, hipertensión arterial o estar anticoagulados. El diagnóstico de hemorragia supracoroidea diferida se realizó en la primera visita de seguimiento: referían un dolor intenso y agudo horas después de la cirugía. Fueron tratados con drenaje transescleral.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La hemorragia supracoroidea diferida es una complicación rara pero devastadora y puede ocurrir después de un trasplante lamelar, como la queratoplastia endotelial automatizada con pelado de Descemet. Conocer esta complicación así como sus factores de riesgo permitirá un diagnóstico temprano, lo que mejorará el pronóstico de los pacientes.</p></span>" ] ] "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" => 657 "Ancho" => 987 "Tamanyo" => 72104 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Case 1, 24<span class="elsevierStyleHsp" style=""></span>h after DSAEK. Shallow anterior chamber with 1<span class="elsevierStyleHsp" style=""></span>mm hyphema and iris contacting the endothelium. Lenticule is well positioned.</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" => 752 "Ancho" => 1452 "Tamanyo" => 63203 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">OCT of SCH in case 1.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 657 "Ancho" => 987 "Tamanyo" => 40365 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 2, 48<span class="elsevierStyleHsp" style=""></span>h after DSAEK. Lenticule well positioned with anterior chamber bubble and microhypema.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suprachoroidal hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.G. Chu" 1 => "R.L. Green" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0039-6257(99)00037-5" "Revista" => array:5 [ "tituloSerie" => "Surv Ophthalmol" "fecha" => "1999" "volumen" => "43" "paginaInicial" => "4471" "paginaFinal" => "4486" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications of Descemet’s stripping with automated endothelial keratoplasty. Survey of 118 eyes at one institute" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.H. Suh" 1 => "S.H. Yoo" 2 => "A. Deobhakta" 3 => "K.E. Donaldson" 4 => "E.C. Alfonso" 5 => "W.W. Culbertson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2008.01.024" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2008" "volumen" => "115" "paginaInicial" => "1517" "paginaFinal" => "1524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18378315" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed massive suprachoroidal hemorrhage after Descemet stripping automated endothelial keratoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.B. Koenig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e318201255a" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2011" "volumen" => "30" "paginaInicial" => "818" "paginaFinal" => "819" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242783" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suprachoroidal hemorrhage during descemet membrane endothelial keratoplasty" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.W. Dockery" 1 => "K. Joubert" 2 => "J.S. Parker" 3 => "J.S. Parker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0000000000002199" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2020" "volumen" => "39" "paginaInicial" => "376" "paginaFinal" => "378" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31714406" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "DSAEK for the treatment of endothelial disease: results in the initial 100 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Busin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-0028-1109545" "Revista" => array:5 [ "tituloSerie" => "Klin Monbl Augenheilkd" "fecha" => "2009" "volumen" => "226" "paginaInicial" => "757" "paginaFinal" => "760" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed suprachoroidal hemorrhage after pars plana vitrectomy: five-year results of a retrospective multicenter cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Reibaldi" 1 => "A. Longo" 2 => "M.R. Romano" 3 => "G. Cennamo" 4 => "C. Mariotti" 5 => "F. Boscia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2015.08.035" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2015" "volumen" => "160" "paginaInicial" => "1235" "paginaFinal" => "1242.e1" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26344581" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case-control study of risk factors for intraoperative suprachoroidal expulseve hemorrhage" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.G. Speaker" 1 => "P.N. Guerriero" 2 => "J.A. Met" 3 => "C.T. Coad" 4 => "A. Berger" 5 => "M. Marmor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0161-6420(91)32316-9" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "1991" "volumen" => "98" "paginaInicial" => "202" "paginaFinal" => "210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2008278" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for delayed suprachoroidal haemorrhage following glaucoma surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.S.E. Jeganathan" 1 => "S. Ghosh" 2 => "J.B. Ruddle" 3 => "V. Gupta" 4 => "M.A. Coote" 5 => "J.G. Crowston" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.2008.141689" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2008" "volumen" => "92" "paginaInicial" => "1393" "paginaFinal" => "1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18684750" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Suprachoroidal hemorrhage: clinical features and results of secondary surgical management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.G. Reynolds" 1 => "R. Haimovici" 2 => "H.W. Flynn" 3 => "C. DiBernardo" 4 => "S.F. Byrne" 5 => "W. Feuer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0161-6420(93)31621-0" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "1993" "volumen" => "100" "paginaInicial" => "460" "paginaFinal" => "465" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8479701" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000006/v1_202306011103/S2173579423000440/v1_202306011103/en/main.assets" "Apartado" => array:4 [ "identificador" => "8724" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Short communication" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000006/v1_202306011103/S2173579423000440/v1_202306011103/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423000440?idApp=UINPBA00004N" ]
