Update on the diagnosis and treatment of normotensive glaucoma | Archivos de la Sociedad Española de Oftalmología (English Edition)

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Gutiérrez Martín" "autores" => array:1 [ 0 => array:4 [ "nombre" => "L.C." "apellidos" => "Gutiérrez Martín" "email" => array:1 [ 0 => "luciagutierrezmartin@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización en el diagnóstico y tratamiento del glaucoma normotensivo" ] ] "textoCompleto" => "Introduction: the vascular role in glaucomaThe concept of glaucomatous optic neuropathy in patients with normal intraocular pressure (IOP) has been a controversial topic since it was first described in 1857 by Von Graefe. Nowadays, this disease is accepted as part of the spectrum of Primary Open Angle Glaucoma (POAG), so we classify these patients as Normotensive Glaucoma (NTG), when they present with glaucomatous optic nerve damage, IOP values less than or equal to 21 mmHg and an open angle.It is now generally accepted that the mechanism of damage in glaucoma is multifactorial.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> However, increased IOP is the best known risk factor associated with this disease and the focus of therapeutic efforts, but other variables have been studied in recent years. In particular, cardiovascular risk factors such as alterations in systemic blood pressure, diabetes, reduced ocular vascular flow and vasospasm<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> are of particular relevance.Clinical, epidemiological and experimental findings in recent publications provide consistent evidence of impaired ocular vascular flow in POAG, which is reduced in most of them.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Vascular flow decreases as glaucomatous damage increases, but is altered in all stages of the disease. Moreover, this reduction does not only affect the optic nerve head, but also the choroid, retinal and retrobulbar circulation.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a>Vascular flow disturbances are more frequent in patients with NTG and in eyes with signs of progression than in those without disease progression. Evidence also suggests that these vascular alterations are due to vasospasm, as well as the difficulty of vascular flow autoregulation in these patients.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>The study published in March 2019 by A Toshev<a class="elsevierStyleCrossRef" href="#bib0030">6</a> compares vascular density (VD) by Optical Coherence Tomography-Angiography (OCT-A) between patients with POAG and NTG. It is a retrospective, observational study with 96 patients divided into 4 groups: patients with Ocular Hypertension (OHT), OAG, NTG and controls. After measuring the VD in the optic nerve head (RTVue XR OCT Avanti System; Optovue INC., Fremont, CA), they looked for correlations with the structural alterations found in glaucoma patients in the peripapillary nerve fibre layer (pRFNL). In that study, it was concluded that glaucomatous eyes have lower peripapillary VD than non-glaucomatous and hypertensive eyes. These results match those of previous studies,<a class="elsevierStyleCrossRefs" href="#bib0040">8,9</a> except that they found no significant differences between eyes with POAG and NTG, which other studies did, probably due to sample size. In addition, they concluded that in the POAG and NTG groups there was a strong correlation between VD and pRFNL in all sectors except the temporal.In a later study, published in August 2021 by M. Bhalla,<a class="elsevierStyleCrossRef" href="#bib0050">10</a> an attempt was made to quantify the choriocapillary vasculature using OCT-A. The choroidal circulation is involved in the nutritional support of retinal ganglion cell axons passing through the deep layers of the optic nerve head. This is a study of 90 patients divided into 3 groups: controls, NTGs and POAGs. In this case, instead of associating the vascular alterations found in glaucoma patients with structural parameters, they associated it with the functional parameters of the visual field (VF). The images were obtained with OCT-A PLEX Elite 9000 (Carl Zeiss Meditec, swept-source OCTA, SS-OCTA). In what concerns results, it is interesting to highlight the statistically significant association found between the Visual Field Index (VFI) and Mean Deviation (MD) parameters with the temporal choriocapillaris of patients with NTG. The authors of the study conclude that the associations found between choriocapillaris parameters and NTG severity, not found in subjects with POAG, suggest that vascular abnormalities more present in NTG are a relevant factor in multifactorial glaucoma damage.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>Prevalence of NTGThe prevalence of NTG varies among the different populations studied, probably because the IOP cutoff used to establish the normal value differs among series. In the Baltimore Eye Survey, which recruited a population of 5308 African and Caucasian American patients over 40 years of age, the prevalence of POAG was 2.4%, with 24% of them diagnosed as NTG. The Beaver Dam Eye Study (4926 subjects) showed a prevalence of POAG of 2.1%, of which 32% of cases had baseline IOP < 22 mmHg. Population studies in Wales, England, India, the Netherlands and Australia show that 20–39% of patients with POAG can be classified as NTG. Finally, in the Early Manifest Glaucoma Trial (EMGT) study, which enrolled patients with POAG in Sweden (255 subjects), the baseline IOP of 52% of them was less than 21 mmHg.<a class="elsevierStyleCrossRefs" href="#bib0055">11–14</a> But if the population studied is East Asian, the prevalence increases dramatically to 90% of the forms of POAG found in the Korean population. These geographic and racial differences suggest that genetic variations may play a role in the development of this disease.<a class="elsevierStyleCrossRef" href="#bib0075">15</a>Genetics of NTGOf all glaucoma cases, 43.11% are familial and there is variability in the type of inheritance found, with autosomal dominant, autosomal recessive and even no defined pattern.<a class="elsevierStyleCrossRef" href="#bib0080">16</a> Over the last few years, different genes related to POAG have been identified, such as the MYOC gene encoding the myocilin protein, the WDR36 gene, or the CYP1B1 gene, which when altered are associated with different clinical forms of the disease.<a class="elsevierStyleCrossRefs" href="#bib0080">16,17</a> The optineurin gene (OPTN) located at the GLC 1E locus on chromosome 10 has been identified in families with adult-onset POAG and NTG with autosomal dominant inheritance.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The higher prevalence of NTG in the Asian population justifies that in recent decades different studies have been carried out to try to identify genes involved in the disease, and thus the OPTN gene has been found in the Japanese population with different genotypes involved.<a class="elsevierStyleCrossRef" href="#bib0085">17</a> In addition, the characterisation of TBK1 duplication (a gene involved in different mechanisms of autophagy and inflammation) in the Korean population with NTG.<a class="elsevierStyleCrossRef" href="#bib0090">18</a>The great complexity in the inheritance and clinical presentation of the disease, as well as the variability of the genes associated with POAG and NTG, help us to understand the difficulty in the management of this disease and their understanding opens up earlier diagnostic possibilities.Differential diagnosisWhen faced with a patient with glaucomatous optic neuropathy with normal intraocular pressure levels, we must evaluate other diagnostic possibilities. Of course, before we begin, a correct corneal thickness measurement will help us to classify patients who have undergone refractive surgery and thin corneas, rather than NTG, into hypertensive forms. Similarly, routine gonioscopy in clinical practice will allow us to distinguish between patients with primary angular closure with IOP that is still controlled and even differentiate those patients who are already suspected of intermittent angular closure from a NTG. In general, POAG is a bilateral but asymmetric disease,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> therefore in the presence of unilateral damage we must always take into account the possibility of compressive, infiltrative or ischemic neuropathies. Pallor of the neuroretinal ring, the presence of afferent relative pupillary defect (ARPD), acquired dyschromatopsia, loss of visual acuity unexplained by the neuropathy itself, disproportion between the field loss and the damage observed in the disc, bitemporal or homonymous field damage, are not typically glaucomatous signs.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> In most cases, a correct anamnesis of the patient, taking into account family history, as well as ophthalmological and personal history and a correct examination in the practice with the accessory tests that we usually carry out (OCT, campimetry), will help us to discern whether the patient may have a non-glaucomatous entity that suggests the need for an imaging test.Retinal arterial occlusions can give glaucoma-like VF images, as well as fibre layer defects on OCT. If the embolus is not seen, it may confuse the diagnosis. The clinical history (e.g. sudden loss of vision) and the patient's personal history can help us make a correct diagnosis. Another example is optic neuritis, both arteritic and non-arteritic (NA); in late stages both entities may present with glaucoma-like CV defects. The NA form usually has no disc excavation (but pallor of the neuroretinal annulus), but the arteritic form usually has excavation as well as very intense pallor, typically chalky white.<a class="elsevierStyleCrossRef" href="#bib0095">19</a>Special mention should be made of myopic patients. Those with myopia magna (axial length greater than 27 mm) usually show oblique discs or peripapillary atrophy in the fundus, which are difficult to explore clinically and may present non-progressive defects in the VF. We should be aware of some specific characteristics of campimetry in high myopes: mean deviation worsens as axial length increases and oblique discs or discs with peripapillary atrophy are usually associated with an increase in the blind spot (BS) in the VF that could simulate arciform defects. In eyes with staphylomas, a correct prescription is required to make the VF. It is therefore difficult in these eyes to make a differential diagnosis between NTG and campimetric defects that may or may not be progressive over time, so it seems reasonable in these cases to treat and monitor.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> Hypotensive medication can sometimes be withdrawn over time in these patients when it is confirmed that the VF damage does not change over the years.Finally, we must not forget that such common conditions as diabetic retinopathy, essential arterial hypertension or even posterior vitreous detachment can lead to disc hemorrhage, which has been shown in studies to be a risk factor for glaucoma progression, but we should not be confused by these common conditions in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0105">21</a>Systemic assessment of NTG patientsThe Collaborative Normal-Tension Glaucoma Study (CNTGS) demonstrated strong evidence of reduced risk of disease progression in patients with NTG when IOP was lowered. However, given all previous reports, the systemic assessment of these patients is of greater relevance, bearing in mind that for glaucoma patients we must increasingly assess and act on cardiovascular risk factors, which are proving to have an important implication in the disease.According to the latest publications, Obstructive Sleep Apnea Syndrome (OSAS) has been studied in patients with POAG and especially NTG.<a class="elsevierStyleCrossRefs" href="#bib0110">22,23</a> It is a controversial subject, with contradictory results depending on the sources studied, although in routine clinical practice many patients come to our clinic with both pathologies. This syndrome consists of partial or complete upper airway closures during sleep, triggering desaturation, hypercapnia, increased vascular resistance and activation of the sympathetic system.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> For example, we found a first study by Pei-Wen Lin, published in December 2011<a class="elsevierStyleCrossRef" href="#bib0120">24</a> which involved 247 patients divided into two groups: OSAS and controls. They obtained a prevalence of NTG in patients with OSAS of 5.7%, and in moderate and severe phases of the syndrome, the prevalence increased to 7.1%, Global oxygen saturation and desaturations were correlated with pRFNL thickness measured by OCT (Carl Zeiss Meditec INC., Dublin, CA). Subsequently, this 2016 meta-analysis coordinated by S Liu<a class="elsevierStyleCrossRef" href="#bib0125">25</a> (6 primary studies, 3 cohorts and 3 case-control) found significant associations between OSAS and pRFNL. To conclude, a third and more recent study, from August 2019, conducted by D Wozniak,<a class="elsevierStyleCrossRef" href="#bib0130">26</a> contradicts the above; moreover, the authors do not consider that this syndrome justifies the need for screening for OSAS. Designed with 395 patients: 235 POAG and 160 controls. The prevalence of OSAS was 58% in patients with POAG and 54% in controls. They found no significant differences in prevalence of OSAS in both groups; nor in severity of functional parameters of the VF (Humphrey Visual Field Analyser, Sita-Fast, Carl Zeiss Meditec, Jena Germany) or structural parameters in pRFNL measured by OCT (Spectralis ocular Coherence Tomography Heidelberg Engineering INC., MA).<a class="elsevierStyleCrossRefs" href="#bib0120">24–26</a> It is possible that the high prevalence of the disease, especially in patients with other cardiovascular risk factors (obesity, hypertension, dyslipidemia) and advanced age may bias these studies, but it is the responsibility of the ophthalmologist to assess the patient with POAG in a global manner to try to improve, as far as possible, their general and ocular health.Regarding blood pressure in patients with NTG, the Baltimore Eye Survey described low diastolic blood pressure as a risk factor for the disease.<a class="elsevierStyleCrossRef" href="#bib0135">27</a> In the Low-Pressure Glaucoma Treatment Study (LoGTS), lower blood pressure was described in patients with NTG compared to patients with POAG, defined as both postural and nocturnal hypotension.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> In addition, more episodes of vasospasm were reported in these patients. In fact, the association of migraine and vasospasm was seen in 4.7% of patients diagnosed with NTG in the LoGTS study, represented by migraine and Raynaud's phenomena. Although other authors have found higher associations (Phelps and Cobbert 37% in 1985). As previously mentioned, disc hemorrhages are found in patients with all types of glaucoma, although they are more frequent in TNG. They are caused by mechanical damage to the disc, specifically to the lamina cribrosa, resulting in rupture of small capillaries. The EMGT study verified the presence of disc hemorrhages as a risk factor for disease progression.<a class="elsevierStyleCrossRef" href="#bib0070">14</a>Campimetric defects in NTGPatients with NTG can present with any glaucomatous campimetric defect, although more often, more central, deep and well-defined defects are found.<a class="elsevierStyleCrossRefs" href="#bib0005">1,28</a> Characteristically, a cecocentral Derringer Canyon defect is described in patients with NTG.<a class="elsevierStyleCrossRefs" href="#bib0005">1,29</a> In a study published in 2017, Jpark et al.<a class="elsevierStyleCrossRef" href="#bib0145">29</a> evaluated the depth of campimetric defects in patients with NTG. They studied 34 patients under the age of 40 with POAG and NTG and compared the depth of the VF defects (Humphrey Visual Field Analyser; Carl Zeiss Meditec, Dublin CA) across meridians. They concluded that patients with NTG showed deeper defects in the superior paracentral sector than in the inferior paracentral sector. Patients with POAG showed depth-symmetrical defects. They suggest that it is possible that the IOP level influences the pattern of damage and depth of the field of vision. Another interesting study from 2019 published by P Raman<a class="elsevierStyleCrossRef" href="#bib0155">31</a> recruited 65 patients with this disease and compared its progression in relation to the location of the campimetric defect at baseline diagnosis, using a standard Humphrey 24−2 Sita CV analysis programme. They defined a defect as central if it was located in the central 10 ° or peripheral if it was located between 10° and 24°. They concluded that patients with a central defect had a 3.56 times higher risk of progression than patients in the other group.<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a>Progression factors in GNTThroughout this paper reference has been made to different factors related to the progression of glaucomatous disease, especially those that have been shown to be such in large studies (e.g. disc hemorrhages).<a class="elsevierStyleCrossRef" href="#bib0070">14</a> Data from large studies such as CNTGS and EMGT confirm that the risk of progression in eyes with baseline IOP <21 mmhg is significantly lower than in eyes with IOP > or equal to 21 mmhg.<a class="elsevierStyleCrossRefs" href="#bib0070">14,17</a>A study dated January 2022 and published by SY Lee<a class="elsevierStyleCrossRef" href="#bib0150">30</a> tried to relate disease progression in TNG patients according to their clinical characteristics. It is a retrospective study involving 228 patients, in which130 eyes showed signs of structural progression (measured by GPA Cirrus HD-OCTCarl Zeiss Meditec, CA) so they were divided according to whether the structural defect was in pRFNL or its location was macular (mGCIPL), and also related to clinical parameters. The results were as follows: 50 eyes showed pRFNL progression, being more frequent and statistically significant in women, absence of AHT, disc hemorrhages and lower MD in the VF. However, 65 eyes showed mGCIPL progression, which was related to male patients, lower corneal thickness (CCT), fluctuating IOP and fluctuating systemic systolic and diastolic blood pressure. They conclude that their results show that different clinical factors may determine the location of structural glaucomatous damage and its changes, leading to more effective diagnostic and therapeutic strategies.<a class="elsevierStyleCrossRefs" href="#bib0155">31,32</a>TreatmentIt is now accepted that both the development of POAG and its progression are linked to a loss of VD and pRFNL. These terms have been evaluated in numerous studies, also in the normotensive form and have been demonstrated.<a class="elsevierStyleCrossRefs" href="#bib0170">34–36</a>As discussed in previous sections, although the final mechanisms are not fully elucidated, studies seem to show that, in POAG in general and especially in NTG, vascular alterations (changes in ocular vascular flow, vasospasm, etc.) play a fundamental role in the development and progression of the disease.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> Therefore, in recent years attempts have been made to study the relationship between topical antiglaucomatous medications and the vascular changes observed in the optic nerve head and at the macular level. In 2018, Chihara et al. published a paper stating that the selective rho-associated coiled coil-containing protein kinase (ROCK) kinase inhibitor drug Ripasudil increased peripapillary VD measured by OCT –A.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> In this more recent article published in 2021 by Y Lin,<a class="elsevierStyleCrossRef" href="#bib0170">34</a> a retrospective, non-randomised study evaluated the VD (OCT-A Optovue, INC. Fremont, CA) and pRFNL of patients diagnosed with TNG on treatment with Carteololol, Brimonidine or Dorzolamide.<a class="elsevierStyleCrossRef" href="#bib0170">34</a> The pRFNL measurements were performed with the RTVue-Xr Avanti System (Optovue Inc., Fremont, CA). This study indicates that six months of treatment with Carteolol and Dorzolamide is associated with changes in peripapillary VD. This has been observed in previous publications.<a class="elsevierStyleCrossRefs" href="#bib0185">37,38</a> In fact, the results obtained in this one, that peripapillary VD appears to increase with Dorzolamide and decrease with Carteolol, have been previously published.<a class="elsevierStyleCrossRef" href="#bib0195">39</a> The vasoconstrictor effect of beta-blockers, which are presumed to reduce IOP, should be considered when sending these hypotensive drugs to patients with NTG,<a class="elsevierStyleCrossRef" href="#bib0200">40</a> especially to those whose clinical history suggests a high component of vascular involvement in their disease (systemic hypotension, migraines, Raynaud's).Neither this nor previous studies have been able to demonstrate changes in peripapillary VD associated with the use of topical Brimonidine, the neuroprotective effect of which, demonstrated in animals,<a class="elsevierStyleCrossRef" href="#bib0165">33</a> could not be transferred to humans. We do know that after four to fourteen days of topical Brimonidine treatment, sufficient concentrations are obtained in the vitreous to have a theoretical neuroprotective effect, as occurred in animal models, by activating the neuroprotective alpha 2 receptors.The Collaborative Normal-Tension Glaucoma Study (CNTGS) demonstrated strong evidence of reducing the risk of progression in patients with NTG when IOP was reduced.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> A 20–30% reduction in baseline IOP reduces disease progression: either with topical antiglaucomatous treatment, laser treatment or surgery.<a class="elsevierStyleCrossRef" href="#bib0200">40</a> It was also found that 60% of untreated eyes with NTG did not progress within 3 years and 40% within 5 years.<a class="elsevierStyleCrossRef" href="#bib0105">21</a> It therefore seems reasonable to follow up these patients when they have mild damage to the VF, defined as initial glaucomatous damage DM ≤ −6 db.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> We should, however, be very cautious in patients with central campimetric damage, especially young patients, even when the MD values are within the levels classified as mild.Theoretically, the initial therapeutic lines are similar in the NTG to the POAG, but we must consider the above and the results of the CNTGS. The higher the baseline IOP, the more we will adjust the treatment to reduce IOP and we will use Prostaglandins as the first line unless contraindicated. Occasionally, IOP values approach the threshold of 21 mmhg and despite having topical treatment, we should consider, as in any patient with glaucoma, greater reductions for better control of the disease.Accordingly, it would seem that the need for surgery in these patients would be less than in those with a baseline IOP above 21 mmhg.<a class="elsevierStyleCrossRef" href="#bib0160">32</a> However, as in any patient with glaucomatous disease, the surgical decision should be based on failure to control the established target IOP with medical and/or laser treatment, progression of the structural and/or functional defect despite good compliance, or poor tolerance of medical treatment by the patient.<a class="elsevierStyleCrossRefs" href="#bib0005">1,32</a> NTG patients in any of these situations should undergo surgical treatment. It should be noted that these patients may be candidates for microincisional surgical techniques. Published scientific evidence indicates that these techniques have an efficacy of 20–40% IOP reduction range, depending on whether or not they are combined with phacoemulsification.<a class="elsevierStyleCrossRef" href="#bib0205">41</a> Indeed, these techniques would not be aimed at patients who require a very significant IOP reduction, but by definition patients with NTG do not start with a high baseline IOP. There is no age limitation for MIGS techniques, although they seem ideal in younger patients,<a class="elsevierStyleCrossRef" href="#bib0205">41</a> in whom it is preferable to preserve the conjunctiva in case filtering surgical techniques are required in the future. However, they should be considered in older patients who are going to undergo cataract surgery if there is poor tolerance to eye drops in order to improve their quality of life. The decision, therefore, whether to perform a MIGS technique or filtering surgery in these patients with NTG will depend, as on other occasions, on the target IOP, the CV damage, the patient's age, the condition of the conjunctiva, and the surgeon's experience.ConclusionIn this review of the different publications and large trials on NTG in recent decades, we can conclude that this is a complex disease in terms of its origin, clinical presentation and therapeutic options. The involvement of various etiological factors has been demonstrated in recent years, so although most therapeutic efforts are directed at controlling IOP, which should be done since it reduces the progression of the disease in these patients (and this was demonstrated in the CNTGS), we cannot lose sight of the patient as a whole, assessing and taking into account other problems that we must consider. For example, the genetic factors involved in this disease of which we are becoming aware oblige us to advise controls in family members, especially in those clinical forms that imply a greater risk due to the race of the patients or because several family members are affected. Likewise, cardiovascular factors, which we have presented throughout this review, cannot be left aside in the control of the patient's disease, involving if necessary other specialists for the best management thereof. It is important to make a correct differential diagnosis with other entities that can generate optic neuropathies and could confuse the diagnosis, as well as to know the most characteristic campimetric defects of NTG. Therefore, the therapeutic management of these patients should be directed at the ocular disease, using the effective resources known to date and which are most appropriate in each case: topical hypotensives, laser therapy or surgery, as well as trying to achieve better control of the cardiovascular risk factors that the patient presents. Future studies should be aimed at trying to understand the pathophysiological mechanisms and delve deeper into the genetic factors involved in this complex disease, so that we can get ahead of a prevalent disease that in some cases continues to cause blindness in our patients.Conflict of interestsThe authors declare no conflict of interest." 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Shaarawy" 1 => "M.B. Sherwood" 2 => "R.A. Hichings" 3 => "J.G. Crowstone" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "titulo" => "Medical diagnosis and therapy" "fecha" => "2009" "paginaInicial" => "91" "paginaFinal" => "99" "editorial" => "Sounders Elsevier" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The relationship between digital and ocular vasospasm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "U. Guthauser" 1 => "J. Flammer" 2 => "F. Mahler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF02181185" "Revista" => array:6 [ "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol." "fecha" => "1988" "volumen" => "226" "numero" => "3" "paginaInicial" => "224" "paginaFinal" => "226" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ocular vasospasm: a risk factor in the pathogenesis of low-tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. Gasser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF02280088" "Revista" => array:7 [ "tituloSerie" => "Int Ophthalmol." "fecha" => "1989" "volumen" => "13" "numero" => "4" "paginaInicial" => "281" "paginaFinal" => "290" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2693385" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.S. Hayreh" 1 => "M.B. Zimmerman" 2 => "P. Podhajsky" 3 => "W.L. Alward" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(14)70067-4" "Revista" => array:7 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "1994" "volumen" => "117" "numero" => "5" "paginaInicial" => "603" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8172267" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "L. Bonomi" 1 => "G. Marchini" 2 => "M. Marraffa" 3 => "P. Bernardi" 4 => "R. Morbio" 5 => "A. Varotto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(00)00138-x" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "2000" "volumen" => "107" "numero" => "7" "paginaInicial" => "1287" "paginaFinal" => "1293" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889099" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optical coherence tomography angiography of optic disc in eyes with primary open-angle glaucoma and normal-tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A.P. Toshev" 1 => "A.K. Schuster" 2 => "S.N. Ul Hassan" 3 => "N. Pfeiffer" 4 => "E.M. Hoffmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001184" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2019" "volumen" => "28" "numero" => "3" "paginaInicial" => "243" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30624391" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Low-pressure Glaucoma Treatment Study (LoGTS) study design and baseline characteristics of enrolled patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "T. Krupin" 1 => "J.M. Liebmann" 2 => "D.S. Greenfield" 3 => "L.F. Rosenberg" 4 => "R. Ritch" 5 => "J.W. Yang" 6 => "Low-Pressure Glaucoma Study Group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2004.10.034" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "2005" "volumen" => "112" "numero" => "3" "paginaInicial" => "376" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15745762" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Measuring and interpreting ocular blood flow and metabolism in glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Harris" 1 => "L. Kagemann" 2 => "R. Ehrlich" 3 => "C. Rospigliosi" 4 => "D. Moore" 5 => "B. Siesky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3129/i08-051" "Revista" => array:6 [ "tituloSerie" => "Can J Opthalmol." "fecha" => "2008" "volumen" => "43" "numero" => "3" "paginaInicial" => "328" "paginaFinal" => "336" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of optic nerve head and peripapillary retinal blood flow in glaucoma patients, ocular hypertensives, and normal subjects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Hafez" 1 => "R.L. Bizzarro" 2 => "M.R. Lesk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(03)00632-9" "Revista" => array:7 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "2003" "volumen" => "136" "numero" => "6" "paginaInicial" => "1022" "paginaFinal" => "1031" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14644212" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Investigation of the peripapillary choriocapillaris in normal tension glaucoma, primary open-angle glaucoma, and control eyes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Bhalla" 1 => "M. Heisler" 2 => "Z. Mammo" 3 => "M.J. Ju" 4 => "M.V. Sarunic" 5 => "E.V. Navajas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001861" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2021" "volumen" => "30" "numero" => "8" "paginaInicial" => "682" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33927150" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "National survey of the prevalence and risk factors of glaucoma in St. Lucia, West Indies. Part I. Prevalence findings" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "R.P. Mason" 1 => "O. Kosoko" 2 => "M.R. Wilson" 3 => "J.F. Martone" 4 => "C.L. Cowan Jr" 5 => "J.C. Gear" 6 => "D. Ross-Degnan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(89)32708-4" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "1989" "volumen" => "96" "numero" => "9" "paginaInicial" => "1363" "paginaFinal" => "1368" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2789357" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands. The Rotterdam Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I. Dielemans" 1 => "J.R. Vingerling" 2 => "R.C. Wolfs" 3 => "A. Hofman" 4 => "D.E. Grobbee" 5 => "P.T. de Jong" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(94)31090-6" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "1994" "volumen" => "101" "numero" => "11" "paginaInicial" => "1851" "paginaFinal" => "1855" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7800368" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of open-angle glaucoma in Australia. The Blue Mountains Eye Study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P. Mitchell" 1 => "W. Smith" 2 => "K. Attebo" 3 => "P.R. Healey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(96)30449-1" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "1996" "volumen" => "103" "numero" => "10" "paginaInicial" => "1661" "paginaFinal" => "1669" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8874440" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Heijl" 1 => "M.C. Leske" 2 => "B. Bengtsson" 3 => "L. Hyman" 4 => "B. Bengtsson" 5 => "M. Hussein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archopht.120.10.1268" "Revista" => array:7 [ "tituloSerie" => "Arch Ophthalmol." "fecha" => "2002" "volumen" => "120" "numero" => "10" "paginaInicial" => "1268" "paginaFinal" => "1279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12365904" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genomic characterization of TBK1 duplication in Korean normal-tension glaucoma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Kim" 1 => "Y.W. Kim" 2 => "J.W. Jeoung" 3 => "M.W. Seong" 4 => "J.S. Lee" 5 => "D.M. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001466" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2020" "volumen" => "29" "numero" => "5" "paginaInicial" => "331" "paginaFinal" => "336" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32079994" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genética del glaucoma: la luz al final del túnel catorce años después" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Escribano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.oftal.2010.12.002" "Revista" => array:6 [ "tituloSerie" => "Arch Soc Esp Oftalmol [online]" "fecha" => "2010" "volumen" => "85" "paginaInicial" => "353" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21277460" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Genetics and genetic testing for glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Miller" 1 => "J.H. Fingert" 2 => "D.I. Bettis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICU.0000000000000344" "Revista" => array:7 [ "tituloSerie" => "Curr Opin Ophthalmol." "fecha" => "2017" "volumen" => "28" "numero" => "2" "paginaInicial" => "133" "paginaFinal" => "138" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27898466" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular genetic analysis of optineurin gene for primary open-angle and normal tension glaucoma in the Japanese population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Fuse" 1 => "K. Takahashi" 2 => "H. Akiyama" 3 => "T. Nakazawa" 4 => "M. Seimiya" 5 => "S. Kuwahara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00061198-200408000-00007" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2004" "volumen" => "13" "numero" => "4" "paginaInicial" => "299" "paginaFinal" => "303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15226658" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prevalence of cupping in end-stage arteritic and nonarteritic anterior ischemic optic neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.V. Danesh-Meyer" 1 => "P.J. Savino" 2 => "R.C. Sergott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(00)00602-3" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "2001" "volumen" => "108" "numero" => "3" "paginaInicial" => "593" "paginaFinal" => "598" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237915" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Automated static perimetry: the influence of myopia and its method of correction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Aung" 1 => "P.J. Foster" 2 => "S.K. Seah" 3 => "S.P. Chan" 4 => "W.K. Lim" 5 => "H.M. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(00)00497-8" "Revista" => array:7 [ "tituloSerie" => "Ophthalmology." "fecha" => "2001" "volumen" => "108" "numero" => "2" "paginaInicial" => "290" "paginaFinal" => "295" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11158801" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk factors for progression of visual field abnormalities in normal-tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Drance" 1 => "D.R. Anderson" 2 => "M. Schulzer" 3 => "Collaborative Normal-Tension Glaucoma Study Group" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0002-9394(01)00964-3" "Revista" => array:7 [ "tituloSerie" => "Am J Ophthalmol." "fecha" => "2001" "volumen" => "131" "numero" => "6" "paginaInicial" => "699" "paginaFinal" => "708" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11384564" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High prevalence of glaucoma in patients with sleep apnea syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.S. Mojon" 1 => "C.W. Hess" 2 => "D. Goldblum" 3 => "J. Fleischhauer" 4 => "F. Koerner" 5 => "C. Bassetti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0161-6420(99)00525-4" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology." "fecha" => "1999" "volumen" => "106" "numero" => "5" "paginaInicial" => "1009" "paginaFinal" => "1012" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Sergi" 1 => "D.E. Salerno" 2 => "M. Rizzi" 3 => "M. Blini" 4 => "A. Andreoli" 5 => "D. Messenio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.ijg.0000243472.51461.24" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2007" "volumen" => "16" "numero" => "1" "paginaInicial" => "42" "paginaFinal" => "46" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17224748" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal tension glaucoma in patients with obstructive sleep apnea/hypopnea syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.W. Lin" 1 => "M. Friedman" 2 => "H.C. Lin" 3 => "H.W. Chang" 4 => "M. Wilson" 5 => "M.C. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0b013e3181f3eb81" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2011" "volumen" => "20" "numero" => "9" "paginaInicial" => "553" "paginaFinal" => "558" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20852436" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis of association of obstructive sleep apnea with glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Liu" 1 => "Y. Lin" 2 => "X. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000000357" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2016" "volumen" => "25" "numero" => "1" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26561422" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive sleep apnea in patients with primary-open angle glaucoma: no role for a screening program" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Wozniak" 1 => "R. Bourne" 2 => "G. Peretz" 3 => "J. Kean" 4 => "C. Willshire" 5 => "S. Harun" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001296" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2019" "volumen" => "28" "numero" => "8" "paginaInicial" => "668" "paginaFinal" => "675" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31162178" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans. The Baltimore Eye Survey" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sommer" 1 => "J.M. Tielsch" 2 => "J. Katz" 3 => "H.A. Quigley" 4 => "J.D. Gottsch" 5 => "J. Javitt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archopht.1991.01080080050026" "Revista" => array:7 [ "tituloSerie" => "Arch Ophthalmol." "fecha" => "1991" "volumen" => "109" "numero" => "8" "paginaInicial" => "1090" "paginaFinal" => "1095" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1867550" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Progression of visual field defects in eyes with different optic disc appearances in patients with normal tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Nakazawa" 1 => "M. Shimura" 2 => "M. Ryu" 3 => "N. Himori" 4 => "F. Nitta" 5 => "K. Omodaka" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0b013e3182182897" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2012" "volumen" => "21" "numero" => "6" "paginaInicial" => "426" "paginaFinal" => "430" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22314251" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visual field defects in young patients with open-angle glaucoma: comparison between high-tension and normal-tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.H. Park" 1 => "C. Yoo" 2 => "J. Park" 3 => "Y.Y. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000000667" "Revista" => array:8 [ "tituloSerie" => "J Glaucoma." "fecha" => "2017" "volumen" => "26" "numero" => "6" "paginaInicial" => "541" "paginaFinal" => "547" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28333895" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0954611118302063" "estado" => "S300" "issn" => "09546111" ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factors associated with differences in the initial location of structural progression in normal-tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.Y. Lee" 1 => "H. Yang" 2 => "K. Lee" 3 => "G.J. Seong" 4 => "C.Y. Kim" 5 => "H.W. Bae" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001983" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2022" "volumen" => "31" "numero" => "3" "paginaInicial" => "170" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35019877" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Baseline central visual field defect as a risk factor for NTG progression: a 5-year prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Raman" 1 => "N.B. Suliman" 2 => "M. Zahari" 3 => "N.F. Mohamad" 4 => "M.S. Kook" 5 => "N. Ramli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001359" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2019" "volumen" => "28" "numero" => "11" "paginaInicial" => "952" "paginaFinal" => "957" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31688446" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Terminología y Pautas para el Glaucoma. European Glaucoma Society. 5º Ed. p 84; 2021." ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Retinal oxidative stress induced by intraocular hypertension in rats may be ameliorated by brimonidine treatment and N-acetyl cysteine supplementation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Ozdemir" 1 => "F.I. Tolun" 2 => "M. Gul" 3 => "S. Imrek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0b013e31819c46b1" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2009" "volumen" => "18" "numero" => "9" "paginaInicial" => "662" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20010244" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optical coherence tomography angiography vessel density changes in normal-tension glaucoma treated with carteolol, brimonidine, or dorzolamide" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y.H. Lin" 1 => "W.W. Su" 2 => "S.M. Huang" 3 => "L.H. Chuang" 4 => "L.C. Chen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001859" "Revista" => array:7 [ "tituloSerie" => "J Glaucoma." "fecha" => "2021" "volumen" => "30" "numero" => "8" "paginaInicial" => "690" "paginaFinal" => "696" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33927152" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Optical coherence tomography angiography in glaucoma: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Van Melkebeke" 1 => "J. Barbosa-Breda" 2 => "M. Huygens" 3 => "I. Stalmans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000488495" "Revista" => array:7 [ "tituloSerie" => "Ophthalmic Res." "fecha" => "2018" "volumen" => "60" "numero" => "3" "paginaInicial" => "139" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29794471" "web" => "Medline" ] ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic ability of optical coherence tomography angiography macula vessel density for the diagnosis of glaucoma using difference scan sizes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.C. Penteado" 1 => "C. Bowd" 2 => "J.A. Proudfoot" 3 => "S. Moghimi" 4 => "P.I.C. Manalastas" 5 => "E. Ghahari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IJG.0000000000001447" "Revista" => array:8 [ "tituloSerie" => "J Glaucoma." "fecha" => "2020" "volumen" => "29" "numero" => "4" "paginaInicial" => "245" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31977545" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0954611119301027" "estado" => "S300" "issn" => "09546111" ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of latanoprost 0.005% and brimonidine tartrate 0.2% on pulsatile ocular blood flow in normal tension glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C.J. Liu" 1 => "Y.C. Ko" 2 => "C.Y. Cheng" 3 => "J.C. Chou" 4 => "W.M. Hsu" 5 => "J.H. Liu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.86.11.1236" "Revista" => array:7 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2002" "volumen" => "86" "numero" => "11" "paginaInicial" => "1236" "paginaFinal" => "1239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12386077" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of dorzolamide and timolol on ocular blood flow in patients with primary open angle glaucoma and ocular hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Fuchsjäger-Mayrl" 1 => "B. Wally" 2 => "G. Rainer" 3 => "W. Buehl" 4 => "T. Aggermann" 5 => "J. Kolodjaschna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.2005.067637" "Revista" => array:7 [ "tituloSerie" => "Br J Ophthalmol." "fecha" => "2005" "volumen" => "89" "numero" => "10" "paginaInicial" => "1293" "paginaFinal" => "1297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16170119" "web" => "Medline" ] ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Beta 1 and beta 2 adrenergic binding sites in bovine retina and retinal blood vessels" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Ferrari-Dileo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Invest Ophthalmol Vis Sci." "fecha" => "1988" "volumen" => "29" "numero" => "5" "paginaInicial" => "695" "paginaFinal" => "699" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2835327" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 visual field progression" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.L. Membrey" 1 => "C. Bunce" 2 => "D.P. Poinoosawmy" 3 => "F.W. Fitzke" 4 => "R.A. Hitchings" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjo.85.6.696" "Revista" => array:7 [ "tituloSerie" => "Br J Ophthalmol." "fecha" => "2001" "volumen" => "85" "numero" => "6" "paginaInicial" => "696" "paginaFinal" => "701" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11371491" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cirugía Microincisional del Glaucoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Lavin Dapena" 1 => "P. 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Update on the diagnosis and treatment of normotensive glaucoma

Actualización en el diagnóstico y tratamiento del glaucoma normotensivo

L.C. Gutiérrez Martín

Corresponding author

luciagutierrezmartin@gmail.com

Corresponding author.

Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction&#58; the vascular role in glaucoma</span><p id="par0005" class="elsevierStylePara elsevierViewall">The concept of glaucomatous optic neuropathy in patients with normal intraocular pressure &#40;IOP&#41; has been a controversial topic since it was first described in 1857 by Von Graefe&#46; Nowadays&#44; this disease is accepted as part of the spectrum of Primary Open Angle Glaucoma &#40;POAG&#41;&#44; so we classify these patients as Normotensive Glaucoma &#40;NTG&#41;&#44; when they present with glaucomatous optic nerve damage&#44; IOP values less than or equal to 21&#8239;mmHg and an open angle&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">It is now generally accepted that the mechanism of damage in glaucoma is multifactorial&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; increased IOP is the best known risk factor associated with this disease and the focus of therapeutic efforts&#44; but other variables have been studied in recent years&#46; In particular&#44; cardiovascular risk factors such as alterations in systemic blood pressure&#44; diabetes&#44; reduced ocular vascular flow and vasospasm<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> are of particular relevance&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Clinical&#44; epidemiological and experimental findings in recent publications provide consistent evidence of impaired ocular vascular flow in POAG&#44; which is reduced in most of them&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Vascular flow decreases as glaucomatous damage increases&#44; but is altered in all stages of the disease&#46; Moreover&#44; this reduction does not only affect the optic nerve head&#44; but also the choroid&#44; retinal and retrobulbar circulation&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Vascular flow disturbances are more frequent in patients with NTG and in eyes with signs of progression than in those without disease progression&#46; Evidence also suggests that these vascular alterations are due to vasospasm&#44; as well as the difficulty of vascular flow autoregulation in these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The study published in March 2019 by A Toshev<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> compares vascular density &#40;VD&#41; by Optical Coherence Tomography-Angiography &#40;OCT-A&#41; between patients with POAG and NTG&#46; It is a retrospective&#44; observational study with 96 patients divided into 4 groups&#58; patients with Ocular Hypertension &#40;OHT&#41;&#44; OAG&#44; NTG and controls&#46; After measuring the VD in the optic nerve head &#40;RTVue XR OCT Avanti System&#59; Optovue INC&#46;&#44; Fremont&#44; CA&#41;&#44; they looked for correlations with the structural alterations found in glaucoma patients in the peripapillary nerve fibre layer &#40;pRFNL&#41;&#46; In that study&#44; it was concluded that glaucomatous eyes have lower peripapillary VD than non-glaucomatous and hypertensive eyes&#46; These results match those of previous studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> except that they found no significant differences between eyes with POAG and NTG&#44; which other studies did&#44; probably due to sample size&#46; In addition&#44; they concluded that in the POAG and NTG groups there was a strong correlation between VD and pRFNL in all sectors except the temporal&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In a later study&#44; published in August 2021 by M&#46; Bhalla&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> an attempt was made to quantify the choriocapillary vasculature using OCT-A&#46; The choroidal circulation is involved in the nutritional support of retinal ganglion cell axons passing through the deep layers of the optic nerve head&#46; This is a study of 90 patients divided into 3 groups&#58; controls&#44; NTGs and POAGs&#46; In this case&#44; instead of associating the vascular alterations found in glaucoma patients with structural parameters&#44; they associated it with the functional parameters of the visual field &#40;VF&#41;&#46; The images were obtained with OCT-A PLEX Elite 9000 &#40;Carl Zeiss Meditec&#44; swept-source OCTA&#44; SS-OCTA&#41;&#46; In what concerns results&#44; it is interesting to highlight the statistically significant association found between the Visual Field Index &#40;VFI&#41; and Mean Deviation &#40;MD&#41; parameters with the temporal choriocapillaris of patients with NTG&#46; The authors of the study conclude that the associations found between choriocapillaris parameters and NTG severity&#44; not found in subjects with POAG&#44; suggest that vascular abnormalities more present in NTG are a relevant factor in multifactorial glaucoma damage&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Prevalence of NTG</span><p id="par0035" class="elsevierStylePara elsevierViewall">The prevalence of NTG varies among the different populations studied&#44; probably because the IOP cutoff used to establish the normal value differs among series&#46; In the Baltimore Eye Survey&#44; which recruited a population of 5308 African and Caucasian American patients over 40 years of age&#44; the prevalence of POAG was 2&#46;4&#37;&#44; with 24&#37; of them diagnosed as NTG&#46; The Beaver Dam Eye Study &#40;4926 subjects&#41; showed a prevalence of POAG of 2&#46;1&#37;&#44; of which 32&#37; of cases had baseline IOP&#8239;&#60;&#8239;22&#8239;mmHg&#46; Population studies in Wales&#44; England&#44; India&#44; the Netherlands and Australia show that 20&#8211;39&#37; of patients with POAG can be classified as NTG&#46; Finally&#44; in the Early Manifest Glaucoma Trial &#40;EMGT&#41; study&#44; which enrolled patients with POAG in Sweden &#40;255 subjects&#41;&#44; the baseline IOP of 52&#37; of them was less than 21&#8239;mmHg&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;14</span></a> But if the population studied is East Asian&#44; the prevalence increases dramatically to 90&#37; of the forms of POAG found in the Korean population&#46; These geographic and racial differences suggest that genetic variations may play a role in the development of this disease&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Genetics of NTG</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of all glaucoma cases&#44; 43&#46;11&#37; are familial and there is variability in the type of inheritance found&#44; with autosomal dominant&#44; autosomal recessive and even no defined pattern&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> Over the last few years&#44; different genes related to POAG have been identified&#44; such as the MYOC gene encoding the myocilin protein&#44; the WDR36 gene&#44; or the CYP1B1 gene&#44; which when altered are associated with different clinical forms of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a> The optineurin gene &#40;OPTN&#41; located at the GLC 1E locus on chromosome 10 has been identified in families with adult-onset POAG and NTG with autosomal dominant inheritance&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The higher prevalence of NTG in the Asian population justifies that in recent decades different studies have been carried out to try to identify genes involved in the disease&#44; and thus the OPTN gene has been found in the Japanese population with different genotypes involved&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In addition&#44; the characterisation of TBK1 duplication &#40;a gene involved in different mechanisms of autophagy and inflammation&#41; in the Korean population with NTG&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The great complexity in the inheritance and clinical presentation of the disease&#44; as well as the variability of the genes associated with POAG and NTG&#44; help us to understand the difficulty in the management of this disease and their understanding opens up earlier diagnostic possibilities&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Differential diagnosis</span><p id="par0050" class="elsevierStylePara elsevierViewall">When faced with a patient with glaucomatous optic neuropathy with normal intraocular pressure levels&#44; we must evaluate other diagnostic possibilities&#46; Of course&#44; before we begin&#44; a correct corneal thickness measurement will help us to classify patients who have undergone refractive surgery and thin corneas&#44; rather than NTG&#44; into hypertensive forms&#46; Similarly&#44; routine gonioscopy in clinical practice will allow us to distinguish between patients with primary angular closure with IOP that is still controlled and even differentiate those patients who are already suspected of intermittent angular closure from a NTG&#46; In general&#44; POAG is a bilateral but asymmetric disease&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> therefore in the presence of unilateral damage we must always take into account the possibility of compressive&#44; infiltrative or ischemic neuropathies&#46; Pallor of the neuroretinal ring&#44; the presence of afferent relative pupillary defect &#40;ARPD&#41;&#44; acquired dyschromatopsia&#44; loss of visual acuity unexplained by the neuropathy itself&#44; disproportion between the field loss and the damage observed in the disc&#44; bitemporal or homonymous field damage&#44; are not typically glaucomatous signs&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In most cases&#44; a correct anamnesis of the patient&#44; taking into account family history&#44; as well as ophthalmological and personal history and a correct examination in the practice with the accessory tests that we usually carry out &#40;OCT&#44; campimetry&#41;&#44; will help us to discern whether the patient may have a non-glaucomatous entity that suggests the need for an imaging test&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Retinal arterial occlusions can give glaucoma-like VF images&#44; as well as fibre layer defects on OCT&#46; If the embolus is not seen&#44; it may confuse the diagnosis&#46; The clinical history &#40;e&#46;g&#46; sudden loss of vision&#41; and the patient&#39;s personal history can help us make a correct diagnosis&#46; Another example is optic neuritis&#44; both arteritic and non-arteritic &#40;NA&#41;&#59; in late stages both entities may present with glaucoma-like CV defects&#46; The NA form usually has no disc excavation &#40;but pallor of the neuroretinal annulus&#41;&#44; but the arteritic form usually has excavation as well as very intense pallor&#44; typically chalky white&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Special mention should be made of myopic patients&#46; Those with myopia magna &#40;axial length greater than 27&#8239;mm&#41; usually show oblique discs or peripapillary atrophy in the fundus&#44; which are difficult to explore clinically and may present non-progressive defects in the VF&#46; We should be aware of some specific characteristics of campimetry in high myopes&#58; mean deviation worsens as axial length increases and oblique discs or discs with peripapillary atrophy are usually associated with an increase in the blind spot &#40;BS&#41; in the VF that could simulate arciform defects&#46; In eyes with staphylomas&#44; a correct prescription is required to make the VF&#46; It is therefore difficult in these eyes to make a differential diagnosis between NTG and campimetric defects that may or may not be progressive over time&#44; so it seems reasonable in these cases to treat and monitor&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Hypotensive medication can sometimes be withdrawn over time in these patients when it is confirmed that the VF damage does not change over the years&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Finally&#44; we must not forget that such common conditions as diabetic retinopathy&#44; essential arterial hypertension or even posterior vitreous detachment can lead to disc hemorrhage&#44; which has been shown in studies to be a risk factor for glaucoma progression&#44; but we should not be confused by these common conditions in clinical practice&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Systemic assessment of NTG patients</span><p id="par0070" class="elsevierStylePara elsevierViewall">The Collaborative Normal-Tension Glaucoma Study &#40;CNTGS&#41; demonstrated strong evidence of reduced risk of disease progression in patients with NTG when IOP was lowered&#46; However&#44; given all previous reports&#44; the systemic assessment of these patients is of greater relevance&#44; bearing in mind that for glaucoma patients we must increasingly assess and act on cardiovascular risk factors&#44; which are proving to have an important implication in the disease&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">According to the latest publications&#44; Obstructive Sleep Apnea Syndrome &#40;OSAS&#41; has been studied in patients with POAG and especially NTG&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a> It is a controversial subject&#44; with contradictory results depending on the sources studied&#44; although in routine clinical practice many patients come to our clinic with both pathologies&#46; This syndrome consists of partial or complete upper airway closures during sleep&#44; triggering desaturation&#44; hypercapnia&#44; increased vascular resistance and activation of the sympathetic system&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> For example&#44; we found a first study by Pei-Wen Lin&#44; published in December 2011<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> which involved 247 patients divided into two groups&#58; OSAS and controls&#46; They obtained a prevalence of NTG in patients with OSAS of 5&#46;7&#37;&#44; and in moderate and severe phases of the syndrome&#44; the prevalence increased to 7&#46;1&#37;&#44; Global oxygen saturation and desaturations were correlated with pRFNL thickness measured by OCT &#40;Carl Zeiss Meditec INC&#46;&#44; Dublin&#44; CA&#41;&#46; Subsequently&#44; this 2016 meta-analysis coordinated by S Liu<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> &#40;6 primary studies&#44; 3 cohorts and 3 case-control&#41; found significant associations between OSAS and pRFNL&#46; To conclude&#44; a third and more recent study&#44; from August 2019&#44; conducted by D Wozniak&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> contradicts the above&#59; moreover&#44; the authors do not consider that this syndrome justifies the need for screening for OSAS&#46; Designed with 395 patients&#58; 235 POAG and 160 controls&#46; The prevalence of OSAS was 58&#37; in patients with POAG and 54&#37; in controls&#46; They found no significant differences in prevalence of OSAS in both groups&#59; nor in severity of functional parameters of the VF &#40;Humphrey Visual Field Analyser&#44; Sita-Fast&#44; Carl Zeiss Meditec&#44; Jena Germany&#41; or structural parameters in pRFNL measured by OCT &#40;Spectralis ocular Coherence Tomography Heidelberg Engineering INC&#46;&#44; MA&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;26</span></a> It is possible that the high prevalence of the disease&#44; especially in patients with other cardiovascular risk factors &#40;obesity&#44; hypertension&#44; dyslipidemia&#41; and advanced age may bias these studies&#44; but it is the responsibility of the ophthalmologist to assess the patient with POAG in a global manner to try to improve&#44; as far as possible&#44; their general and ocular health&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Regarding blood pressure in patients with NTG&#44; the Baltimore Eye Survey described low diastolic blood pressure as a risk factor for the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> In the Low-Pressure Glaucoma Treatment Study &#40;LoGTS&#41;&#44; lower blood pressure was described in patients with NTG compared to patients with POAG&#44; defined as both postural and nocturnal hypotension&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In addition&#44; more episodes of vasospasm were reported in these patients&#46; In fact&#44; the association of migraine and vasospasm was seen in 4&#46;7&#37; of patients diagnosed with NTG in the LoGTS study&#44; represented by migraine and Raynaud&#39;s phenomena&#46; Although other authors have found higher associations &#40;Phelps and Cobbert 37&#37; in 1985&#41;&#46; As previously mentioned&#44; disc hemorrhages are found in patients with all types of glaucoma&#44; although they are more frequent in TNG&#46; They are caused by mechanical damage to the disc&#44; specifically to the <span class="elsevierStyleItalic">lamina cribrosa</span>&#44; resulting in rupture of small capillaries&#46; The EMGT study verified the presence of disc hemorrhages as a risk factor for disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Campimetric defects in NTG</span><p id="par0085" class="elsevierStylePara elsevierViewall">Patients with NTG can present with any glaucomatous campimetric defect&#44; although more often&#44; more central&#44; deep and well-defined defects are found&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;28</span></a> Characteristically&#44; a cecocentral Derringer Canyon defect is described in patients with NTG&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;29</span></a> In a study published in 2017&#44; Jpark et al&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> evaluated the depth of campimetric defects in patients with NTG&#46; They studied 34 patients under the age of 40 with POAG and NTG and compared the depth of the VF defects &#40;Humphrey Visual Field Analyser&#59; Carl Zeiss Meditec&#44; Dublin CA&#41; across meridians&#46; They concluded that patients with NTG showed deeper defects in the superior paracentral sector than in the inferior paracentral sector&#46; Patients with POAG showed depth-symmetrical defects&#46; They suggest that it is possible that the IOP level influences the pattern of damage and depth of the field of vision&#46; Another interesting study from 2019 published by P Raman<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> recruited 65 patients with this disease and compared its progression in relation to the location of the campimetric defect at baseline diagnosis&#44; using a standard Humphrey 24&#8722;2 Sita CV analysis programme&#46; They defined a defect as central if it was located in the central 10&#8239;&#176; or peripheral if it was located between 10&#176; and 24&#176;&#46; They concluded that patients with a central defect had a 3&#46;56 times higher risk of progression than patients in the other group&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Progression factors in GNT</span><p id="par0090" class="elsevierStylePara elsevierViewall">Throughout this paper reference has been made to different factors related to the progression of glaucomatous disease&#44; especially those that have been shown to be such in large studies &#40;e&#46;g&#46; disc hemorrhages&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> Data from large studies such as CNTGS and EMGT confirm that the risk of progression in eyes with baseline IOP &#60;21&#8239;mmhg is significantly lower than in eyes with IOP&#8239;&#62;&#8239;or equal to 21&#8239;mmhg&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;17</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">A study dated January 2022 and published by SY Lee<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> tried to relate disease progression in TNG patients according to their clinical characteristics&#46; It is a retrospective study involving 228 patients&#44; in which130 eyes showed signs of structural progression &#40;measured by GPA Cirrus HD-OCTCarl Zeiss Meditec&#44; CA&#41; so they were divided according to whether the structural defect was in pRFNL or its location was macular &#40;mGCIPL&#41;&#44; and also related to clinical parameters&#46; The results were as follows&#58; 50 eyes showed pRFNL progression&#44; being more frequent and statistically significant in women&#44; absence of AHT&#44; disc hemorrhages and lower MD in the VF&#46; However&#44; 65 eyes showed mGCIPL progression&#44; which was related to male patients&#44; lower corneal thickness &#40;CCT&#41;&#44; fluctuating IOP and fluctuating systemic systolic and diastolic blood pressure&#46; They conclude that their results show that different clinical factors may determine the location of structural glaucomatous damage and its changes&#44; leading to more effective diagnostic and therapeutic strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31&#44;32</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Treatment</span><p id="par0100" class="elsevierStylePara elsevierViewall">It is now accepted that both the development of POAG and its progression are linked to a loss of VD and pRFNL&#46; These terms have been evaluated in numerous studies&#44; also in the normotensive form and have been demonstrated&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#8211;36</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">As discussed in previous sections&#44; although the final mechanisms are not fully elucidated&#44; studies seem to show that&#44; in POAG in general and especially in NTG&#44; vascular alterations &#40;changes in ocular vascular flow&#44; vasospasm&#44; etc&#46;&#41; play a fundamental role in the development and progression of the disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Therefore&#44; in recent years attempts have been made to study the relationship between topical antiglaucomatous medications and the vascular changes observed in the optic nerve head and at the macular level&#46; In 2018&#44; Chihara et al&#46; published a paper stating that the selective rho-associated coiled coil-containing protein kinase &#40;ROCK&#41; kinase inhibitor drug Ripasudil increased peripapillary VD measured by OCT &#8211;A&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In this more recent article published in 2021 by Y Lin&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> a retrospective&#44; non-randomised study evaluated the VD &#40;OCT-A Optovue&#44; INC&#46; Fremont&#44; CA&#41; and pRFNL of patients diagnosed with TNG on treatment with Carteololol&#44; Brimonidine or Dorzolamide&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> The pRFNL measurements were performed with the RTVue-Xr Avanti System &#40;Optovue Inc&#46;&#44; Fremont&#44; CA&#41;&#46; This study indicates that six months of treatment with Carteolol and Dorzolamide is associated with changes in peripapillary VD&#46; This has been observed in previous publications&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> In fact&#44; the results obtained in this one&#44; that peripapillary VD appears to increase with Dorzolamide and decrease with Carteolol&#44; have been previously published&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> The vasoconstrictor effect of beta-blockers&#44; which are presumed to reduce IOP&#44; should be considered when sending these hypotensive drugs to patients with NTG&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> especially to those whose clinical history suggests a high component of vascular involvement in their disease &#40;systemic hypotension&#44; migraines&#44; Raynaud&#39;s&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Neither this nor previous studies have been able to demonstrate changes in peripapillary VD associated with the use of topical Brimonidine&#44; the neuroprotective effect of which&#44; demonstrated in animals&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> could not be transferred to humans&#46; We do know that after four to fourteen days of topical Brimonidine treatment&#44; sufficient concentrations are obtained in the vitreous to have a theoretical neuroprotective effect&#44; as occurred in animal models&#44; by activating the neuroprotective alpha 2 receptors&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The Collaborative Normal-Tension Glaucoma Study &#40;CNTGS&#41; demonstrated strong evidence of reducing the risk of progression in patients with NTG when IOP was reduced&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> A 20&#8211;30&#37; reduction in baseline IOP reduces disease progression&#58; either with topical antiglaucomatous treatment&#44; laser treatment or surgery&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> It was also found that 60&#37; of untreated eyes with NTG did not progress within 3 years and 40&#37; within 5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> It therefore seems reasonable to follow up these patients when they have mild damage to the VF&#44; defined as initial glaucomatous damage DM&#8239;&#8804;&#8239;&#8722;6&#8239;db&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> We should&#44; however&#44; be very cautious in patients with central campimetric damage&#44; especially young patients&#44; even when the MD values are within the levels classified as mild&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Theoretically&#44; the initial therapeutic lines are similar in the NTG to the POAG&#44; but we must consider the above and the results of the CNTGS&#46; The higher the baseline IOP&#44; the more we will adjust the treatment to reduce IOP and we will use Prostaglandins as the first line unless contraindicated&#46; Occasionally&#44; IOP values approach the threshold of 21&#8239;mmhg and despite having topical treatment&#44; we should consider&#44; as in any patient with glaucoma&#44; greater reductions for better control of the disease&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Accordingly&#44; it would seem that the need for surgery in these patients would be less than in those with a baseline IOP above 21&#8239;mmhg&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> However&#44; as in any patient with glaucomatous disease&#44; the surgical decision should be based on failure to control the established target IOP with medical and&#47;or laser treatment&#44; progression of the structural and&#47;or functional defect despite good compliance&#44; or poor tolerance of medical treatment by the patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;32</span></a> NTG patients in any of these situations should undergo surgical treatment&#46; It should be noted that these patients may be candidates for microincisional surgical techniques&#46; Published scientific evidence indicates that these techniques have an efficacy of 20&#8211;40&#37; IOP reduction range&#44; depending on whether or not they are combined with phacoemulsification&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> Indeed&#44; these techniques would not be aimed at patients who require a very significant IOP reduction&#44; but by definition patients with NTG do not start with a high baseline IOP&#46; There is no age limitation for MIGS techniques&#44; although they seem ideal in younger patients&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> in whom it is preferable to preserve the conjunctiva in case filtering surgical techniques are required in the future&#46; However&#44; they should be considered in older patients who are going to undergo cataract surgery if there is poor tolerance to eye drops in order to improve their quality of life&#46; The decision&#44; therefore&#44; whether to perform a MIGS technique or filtering surgery in these patients with NTG will depend&#44; as on other occasions&#44; on the target IOP&#44; the CV damage&#44; the patient&#39;s age&#44; the condition of the conjunctiva&#44; and the surgeon&#39;s experience&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0130" class="elsevierStylePara elsevierViewall">In this review of the different publications and large trials on NTG in recent decades&#44; we can conclude that this is a complex disease in terms of its origin&#44; clinical presentation and therapeutic options&#46; The involvement of various etiological factors has been demonstrated in recent years&#44; so although most therapeutic efforts are directed at controlling IOP&#44; which should be done since it reduces the progression of the disease in these patients &#40;and this was demonstrated in the CNTGS&#41;&#44; we cannot lose sight of the patient as a whole&#44; assessing and taking into account other problems that we must consider&#46; For example&#44; the genetic factors involved in this disease of which we are becoming aware oblige us to advise controls in family members&#44; especially in those clinical forms that imply a greater risk due to the race of the patients or because several family members are affected&#46; Likewise&#44; cardiovascular factors&#44; which we have presented throughout this review&#44; cannot be left aside in the control of the patient&#39;s disease&#44; involving if necessary other specialists for the best management thereof&#46; It is important to make a correct differential diagnosis with other entities that can generate optic neuropathies and could confuse the diagnosis&#44; as well as to know the most characteristic campimetric defects of NTG&#46; Therefore&#44; the therapeutic management of these patients should be directed at the ocular disease&#44; using the effective resources known to date and which are most appropriate in each case&#58; topical hypotensives&#44; laser therapy or surgery&#44; as well as trying to achieve better control of the cardiovascular risk factors that the patient presents&#46; Future studies should be aimed at trying to understand the pathophysiological mechanisms and delve deeper into the genetic factors involved in this complex disease&#44; so that we can get ahead of a prevalent disease that in some cases continues to cause blindness in our patients&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Introduction&#58; the vascular role in glaucoma"
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          "titulo" => "Prevalence of NTG"
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          "titulo" => "Conclusion"
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        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conflict of interests"
        ]
        14 => array:1 [
          "titulo" => "References"
        ]
      ]
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    "tienePdf" => true
    "fechaRecibido" => "2022-12-01"
    "fechaAceptado" => "2023-04-19"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1647327"
          "palabras" => array:4 [
            0 => "Normotensive glaucoma"
            1 => "Ocular vascular flow"
            2 => "Peripapillary and macular nerve fiber layer"
            3 => "Retinal vascular density"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1647328"
          "palabras" => array:4 [
            0 => "Glaucoma normotensivo"
            1 => "Flujo vascular ocular"
            2 => "Capa de fibras nerviosas peripapilar y macular"
            3 => "Densidad vascular retiniana"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The increased Knowledge of the multifactorial origin of glaucoma&#44; and especially the vascular involvement in normotensive glaucoma&#44; can be seen in the high number of publications on this subject in recent years&#44; which obliges us to review its diagnosis and treatment&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El mayor conocimiento del origen multifactorial del glaucoma y especialmente la implicaci&#243;n vascular en el glaucoma normotensivo&#44; se observa en el alto n&#250;mero de publicaciones a este respecto en los &#250;ltimos a&#241;os&#44; lo que nos obliga a revisar su diagn&#243;stico y tratamiento&#46;</p></span>"
      ]
    ]
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:41 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T&#46;M&#46; Shaarawy"
                            1 => "M&#46;B&#46; Sherwood"
                            2 => "R&#46;A&#46; Hichings"
                            3 => "J&#46;G&#46; Crowstone"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "titulo" => "Medical diagnosis and therapy"
                        "fecha" => "2009"
                        "paginaInicial" => "91"
                        "paginaFinal" => "99"
                        "editorial" => "Sounders Elsevier"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The relationship between digital and ocular vasospasm"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "U&#46; Guthauser"
                            1 => "J&#46; Flammer"
                            2 => "F&#46; Mahler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02181185"
                      "Revista" => array:6 [
                        "tituloSerie" => "Graefes Arch Clin Exp Ophthalmol&#46;"
                        "fecha" => "1988"
                        "volumen" => "226"
                        "numero" => "3"
                        "paginaInicial" => "224"
                        "paginaFinal" => "226"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ocular vasospasm&#58; a risk factor in the pathogenesis of low-tension glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Gasser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/BF02280088"
                      "Revista" => array:7 [
                        "tituloSerie" => "Int Ophthalmol&#46;"
                        "fecha" => "1989"
                        "volumen" => "13"
                        "numero" => "4"
                        "paginaInicial" => "281"
                        "paginaFinal" => "290"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2693385"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nocturnal arterial hypotension and its role in optic nerve head and ocular ischemic disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46;S&#46; Hayreh"
                            1 => "M&#46;B&#46; Zimmerman"
                            2 => "P&#46; Podhajsky"
                            3 => "W&#46;L&#46; Alward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9394(14)70067-4"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Ophthalmol&#46;"
                        "fecha" => "1994"
                        "volumen" => "117"
                        "numero" => "5"
                        "paginaInicial" => "603"
                        "paginaFinal" => "624"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8172267"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular risk factors for primary open angle glaucoma&#58; the Egna-Neumarkt study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "L&#46; Bonomi"
                            1 => "G&#46; Marchini"
                            2 => "M&#46; Marraffa"
                            3 => "P&#46; Bernardi"
                            4 => "R&#46; Morbio"
                            5 => "A&#46; Varotto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(00)00138-x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "2000"
                        "volumen" => "107"
                        "numero" => "7"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10889099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optical coherence tomography angiography of optic disc in eyes with primary open-angle glaucoma and normal-tension glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;P&#46; Toshev"
                            1 => "A&#46;K&#46; Schuster"
                            2 => "S&#46;N&#46; Ul Hassan"
                            3 => "N&#46; Pfeiffer"
                            4 => "E&#46;M&#46; Hoffmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001184"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2019"
                        "volumen" => "28"
                        "numero" => "3"
                        "paginaInicial" => "243"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30624391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Low-pressure Glaucoma Treatment Study &#40;LoGTS&#41; study design and baseline characteristics of enrolled patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "T&#46; Krupin"
                            1 => "J&#46;M&#46; Liebmann"
                            2 => "D&#46;S&#46; Greenfield"
                            3 => "L&#46;F&#46; Rosenberg"
                            4 => "R&#46; Ritch"
                            5 => "J&#46;W&#46; Yang"
                            6 => "Low-Pressure Glaucoma Study Group"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2004.10.034"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "numero" => "3"
                        "paginaInicial" => "376"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15745762"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Measuring and interpreting ocular blood flow and metabolism in glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Harris"
                            1 => "L&#46; Kagemann"
                            2 => "R&#46; Ehrlich"
                            3 => "C&#46; Rospigliosi"
                            4 => "D&#46; Moore"
                            5 => "B&#46; Siesky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3129/i08-051"
                      "Revista" => array:6 [
                        "tituloSerie" => "Can J Opthalmol&#46;"
                        "fecha" => "2008"
                        "volumen" => "43"
                        "numero" => "3"
                        "paginaInicial" => "328"
                        "paginaFinal" => "336"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of optic nerve head and peripapillary retinal blood flow in glaucoma patients&#44; ocular hypertensives&#44; and normal subjects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;S&#46; Hafez"
                            1 => "R&#46;L&#46; Bizzarro"
                            2 => "M&#46;R&#46; Lesk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9394(03)00632-9"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Ophthalmol&#46;"
                        "fecha" => "2003"
                        "volumen" => "136"
                        "numero" => "6"
                        "paginaInicial" => "1022"
                        "paginaFinal" => "1031"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14644212"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Investigation of the peripapillary choriocapillaris in normal tension glaucoma&#44; primary open-angle glaucoma&#44; and control eyes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Bhalla"
                            1 => "M&#46; Heisler"
                            2 => "Z&#46; Mammo"
                            3 => "M&#46;J&#46; Ju"
                            4 => "M&#46;V&#46; Sarunic"
                            5 => "E&#46;V&#46; Navajas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001861"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2021"
                        "volumen" => "30"
                        "numero" => "8"
                        "paginaInicial" => "682"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33927150"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "National survey of the prevalence and risk factors of glaucoma in St&#46; Lucia&#44; West Indies&#46; Part I&#46; Prevalence findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "R&#46;P&#46; Mason"
                            1 => "O&#46; Kosoko"
                            2 => "M&#46;R&#46; Wilson"
                            3 => "J&#46;F&#46; Martone"
                            4 => "C&#46;L&#46; Cowan Jr"
                            5 => "J&#46;C&#46; Gear"
                            6 => "D&#46; Ross-Degnan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(89)32708-4"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "1989"
                        "volumen" => "96"
                        "numero" => "9"
                        "paginaInicial" => "1363"
                        "paginaFinal" => "1368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2789357"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of primary open-angle glaucoma in a population-based study in The Netherlands&#46; The Rotterdam Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Dielemans"
                            1 => "J&#46;R&#46; Vingerling"
                            2 => "R&#46;C&#46; Wolfs"
                            3 => "A&#46; Hofman"
                            4 => "D&#46;E&#46; Grobbee"
                            5 => "P&#46;T&#46; de Jong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(94)31090-6"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "1994"
                        "volumen" => "101"
                        "numero" => "11"
                        "paginaInicial" => "1851"
                        "paginaFinal" => "1855"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7800368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of open-angle glaucoma in Australia&#46; The Blue Mountains Eye Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46; Mitchell"
                            1 => "W&#46; Smith"
                            2 => "K&#46; Attebo"
                            3 => "P&#46;R&#46; Healey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(96)30449-1"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "1996"
                        "volumen" => "103"
                        "numero" => "10"
                        "paginaInicial" => "1661"
                        "paginaFinal" => "1669"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8874440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduction of intraocular pressure and glaucoma progression&#58; results from the Early Manifest Glaucoma Trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Heijl"
                            1 => "M&#46;C&#46; Leske"
                            2 => "B&#46; Bengtsson"
                            3 => "L&#46; Hyman"
                            4 => "B&#46; Bengtsson"
                            5 => "M&#46; Hussein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.120.10.1268"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Ophthalmol&#46;"
                        "fecha" => "2002"
                        "volumen" => "120"
                        "numero" => "10"
                        "paginaInicial" => "1268"
                        "paginaFinal" => "1279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12365904"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genomic characterization of TBK1 duplication in Korean normal-tension glaucoma patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Kim"
                            1 => "Y&#46;W&#46; Kim"
                            2 => "J&#46;W&#46; Jeoung"
                            3 => "M&#46;W&#46; Seong"
                            4 => "J&#46;S&#46; Lee"
                            5 => "D&#46;M&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001466"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2020"
                        "volumen" => "29"
                        "numero" => "5"
                        "paginaInicial" => "331"
                        "paginaFinal" => "336"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32079994"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gen&#233;tica del glaucoma&#58; la luz al final del t&#250;nel catorce a&#241;os despu&#233;s"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Escribano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.oftal.2010.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Soc Esp Oftalmol &#91;online&#93;"
                        "fecha" => "2010"
                        "volumen" => "85"
                        "paginaInicial" => "353"
                        "paginaFinal" => "354"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21277460"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Genetics and genetic testing for glaucoma"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Miller"
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                            2 => "D&#46;I&#46; Bettis"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/ICU.0000000000000344"
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                        "tituloSerie" => "Curr Opin Ophthalmol&#46;"
                        "fecha" => "2017"
                        "volumen" => "28"
                        "numero" => "2"
                        "paginaInicial" => "133"
                        "paginaFinal" => "138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27898466"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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              "identificador" => "bib0090"
              "etiqueta" => "18"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molecular genetic analysis of optineurin gene for primary open-angle and normal tension glaucoma in the Japanese population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Fuse"
                            1 => "K&#46; Takahashi"
                            2 => "H&#46; Akiyama"
                            3 => "T&#46; Nakazawa"
                            4 => "M&#46; Seimiya"
                            5 => "S&#46; Kuwahara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00061198-200408000-00007"
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                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2004"
                        "volumen" => "13"
                        "numero" => "4"
                        "paginaInicial" => "299"
                        "paginaFinal" => "303"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15226658"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of cupping in end-stage arteritic and nonarteritic anterior ischemic optic neuropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;V&#46; Danesh-Meyer"
                            1 => "P&#46;J&#46; Savino"
                            2 => "R&#46;C&#46; Sergott"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(00)00602-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "2001"
                        "volumen" => "108"
                        "numero" => "3"
                        "paginaInicial" => "593"
                        "paginaFinal" => "598"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Automated static perimetry&#58; the influence of myopia and its method of correction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Aung"
                            1 => "P&#46;J&#46; Foster"
                            2 => "S&#46;K&#46; Seah"
                            3 => "S&#46;P&#46; Chan"
                            4 => "W&#46;K&#46; Lim"
                            5 => "H&#46;M&#46; Wu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(00)00497-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "2001"
                        "volumen" => "108"
                        "numero" => "2"
                        "paginaInicial" => "290"
                        "paginaFinal" => "295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11158801"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors for progression of visual field abnormalities in normal-tension glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Drance"
                            1 => "D&#46;R&#46; Anderson"
                            2 => "M&#46; Schulzer"
                            3 => "Collaborative Normal-Tension Glaucoma Study Group"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0002-9394(01)00964-3"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Ophthalmol&#46;"
                        "fecha" => "2001"
                        "volumen" => "131"
                        "numero" => "6"
                        "paginaInicial" => "699"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11384564"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High prevalence of glaucoma in patients with sleep apnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;S&#46; Mojon"
                            1 => "C&#46;W&#46; Hess"
                            2 => "D&#46; Goldblum"
                            3 => "J&#46; Fleischhauer"
                            4 => "F&#46; Koerner"
                            5 => "C&#46; Bassetti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0161-6420(99)00525-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology&#46;"
                        "fecha" => "1999"
                        "volumen" => "106"
                        "numero" => "5"
                        "paginaInicial" => "1009"
                        "paginaFinal" => "1012"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of normal tension glaucoma in obstructive sleep apnea syndrome patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Sergi"
                            1 => "D&#46;E&#46; Salerno"
                            2 => "M&#46; Rizzi"
                            3 => "M&#46; Blini"
                            4 => "A&#46; Andreoli"
                            5 => "D&#46; Messenio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/01.ijg.0000243472.51461.24"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2007"
                        "volumen" => "16"
                        "numero" => "1"
                        "paginaInicial" => "42"
                        "paginaFinal" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17224748"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normal tension glaucoma in patients with obstructive sleep apnea&#47;hypopnea syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46;W&#46; Lin"
                            1 => "M&#46; Friedman"
                            2 => "H&#46;C&#46; Lin"
                            3 => "H&#46;W&#46; Chang"
                            4 => "M&#46; Wilson"
                            5 => "M&#46;C&#46; Lin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0b013e3181f3eb81"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2011"
                        "volumen" => "20"
                        "numero" => "9"
                        "paginaInicial" => "553"
                        "paginaFinal" => "558"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20852436"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis of association of obstructive sleep apnea with glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Liu"
                            1 => "Y&#46; Lin"
                            2 => "X&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000000357"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "numero" => "1"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26561422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obstructive sleep apnea in patients with primary-open angle glaucoma&#58; no role for a screening program"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Wozniak"
                            1 => "R&#46; Bourne"
                            2 => "G&#46; Peretz"
                            3 => "J&#46; Kean"
                            4 => "C&#46; Willshire"
                            5 => "S&#46; Harun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001296"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2019"
                        "volumen" => "28"
                        "numero" => "8"
                        "paginaInicial" => "668"
                        "paginaFinal" => "675"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31162178"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Relationship between intraocular pressure and primary open angle glaucoma among white and black Americans&#46; The Baltimore Eye Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Sommer"
                            1 => "J&#46;M&#46; Tielsch"
                            2 => "J&#46; Katz"
                            3 => "H&#46;A&#46; Quigley"
                            4 => "J&#46;D&#46; Gottsch"
                            5 => "J&#46; Javitt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.1991.01080080050026"
                      "Revista" => array:7 [
                        "tituloSerie" => "Arch Ophthalmol&#46;"
                        "fecha" => "1991"
                        "volumen" => "109"
                        "numero" => "8"
                        "paginaInicial" => "1090"
                        "paginaFinal" => "1095"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1867550"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Progression of visual field defects in eyes with different optic disc appearances in patients with normal tension glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
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                            1 => "M&#46; Shimura"
                            2 => "M&#46; Ryu"
                            3 => "N&#46; Himori"
                            4 => "F&#46; Nitta"
                            5 => "K&#46; Omodaka"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0b013e3182182897"
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                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2012"
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                        "numero" => "6"
                        "paginaInicial" => "426"
                        "paginaFinal" => "430"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22314251"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0145"
              "etiqueta" => "29"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visual field defects in young patients with open-angle glaucoma&#58; comparison between high-tension and normal-tension glaucoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;H&#46; Park"
                            1 => "C&#46; Yoo"
                            2 => "J&#46; Park"
                            3 => "Y&#46;Y&#46; Kim"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000000667"
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                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2017"
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                        "numero" => "6"
                        "paginaInicial" => "541"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28333895"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0954611118302063"
                          "estado" => "S300"
                          "issn" => "09546111"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with differences in the initial location of structural progression in normal-tension glaucoma"
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                          "etal" => false
                          "autores" => array:6 [
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                            2 => "K&#46; Lee"
                            3 => "G&#46;J&#46; Seong"
                            4 => "C&#46;Y&#46; Kim"
                            5 => "H&#46;W&#46; Bae"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001983"
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                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2022"
                        "volumen" => "31"
                        "numero" => "3"
                        "paginaInicial" => "170"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35019877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Baseline central visual field defect as a risk factor for NTG progression&#58; a 5-year prospective study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
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                            1 => "N&#46;B&#46; Suliman"
                            2 => "M&#46; Zahari"
                            3 => "N&#46;F&#46; Mohamad"
                            4 => "M&#46;S&#46; Kook"
                            5 => "N&#46; Ramli"
                          ]
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                      ]
                    ]
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                    0 => array:2 [
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                        "fecha" => "2019"
                        "volumen" => "28"
                        "numero" => "11"
                        "paginaInicial" => "952"
                        "paginaFinal" => "957"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31688446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0160"
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              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Terminolog&#237;a y Pautas para el Glaucoma&#46; European Glaucoma Society&#46; 5&#186; Ed&#46; p 84&#59; 2021&#46;"
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retinal oxidative stress induced by intraocular hypertension in rats may be ameliorated by brimonidine treatment and N-acetyl cysteine supplementation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "G&#46; Ozdemir"
                            1 => "F&#46;I&#46; Tolun"
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                            3 => "S&#46; Imrek"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0b013e31819c46b1"
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                        "tituloSerie" => "J Glaucoma&#46;"
                        "fecha" => "2009"
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                        "numero" => "9"
                        "paginaInicial" => "662"
                        "paginaFinal" => "665"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20010244"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0170"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optical coherence tomography angiography vessel density changes in normal-tension glaucoma treated with carteolol&#44; brimonidine&#44; or dorzolamide"
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                        0 => array:2 [
                          "etal" => false
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                            1 => "W&#46;W&#46; Su"
                            2 => "S&#46;M&#46; Huang"
                            3 => "L&#46;H&#46; Chuang"
                            4 => "L&#46;C&#46; Chen"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/IJG.0000000000001859"
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                        "fecha" => "2021"
                        "volumen" => "30"
                        "numero" => "8"
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                        "paginaFinal" => "1239"
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                    0 => array:2 [
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                        "paginaFinal" => "1297"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16170119"
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                      "titulo" => "Beta 1 and beta 2 adrenergic binding sites in bovine retina and retinal blood vessels"
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                        "tituloSerie" => "Invest Ophthalmol Vis Sci&#46;"
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                        "numero" => "5"
                        "paginaInicial" => "695"
                        "paginaFinal" => "699"
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                        "paginaFinal" => "701"
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                    ]
                  ]
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