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Original article
Assessment of the biometric modifications of the eye in LASIK during suction
Evaluación de las modificaciones biométricas del ojo durante la succión del LASIK
J.I. Fernández-Vigoa,b,
Corresponding author
, I. Almorín-Fernández-Vigoc, B. Burgos-Blascob, L. De-Pablo-Gómez-de-Liañoa,d, I. Sánchez-Guillénc,e, A. Macarro-Merinoa, J.Á. Fernández-Vigoa,c,f
a Centro Internacional de Oftalmología Avanzada, Madrid, Spain
b Department of Ophthalmology, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria (IdISSC), Madrid, Spain
c Centro Internacional de Oftalmología Avanzada, Badajoz, Spain
d Department of Ophthalmology, Hospital 12 de Octubre, Madrid, Spain
e Department of Ophthalmology, Hospital Perpetuo Socorro, Badajoz, Spain
f Department of Ophthalmology, Universidad de Extremadura, Badajoz, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">LASIK technique &#40;Laser-assisted in Situ Keratomileusis&#41; continues to be the most widely performed in corneal refractive surgery&#44; with millions of patients having undergone and still undergoing surgery with this technique&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Due to its social and health relevance&#44; and although it modifies the cornea&#44; the possible repercussion of this surgical technique on other ocular structures is still being studied&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The safety of this technique remains controversial due to the hypothetical increase in alterations caused to the posterior segment&#46; The frequent spontaneous appearance of vitreoretinal lesions in myopic patients and their possible coincidence with the postoperative period of refractive surgery keeps the issue relevant&#44; especially considering the medical and legal implications&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Various authors have studied the relationship between LASIK and vitreous&#44;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> retinal&#44;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> macular<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;11</span></a> and optic nerve<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> disorders&#46; An extensive review carried out by Arevalo assessed the subject&#44; trying to analyze the possible mechanisms that could explain retinal damage&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Most of the published studies refer to complications in isolated clinical cases and the date of presentation of the complication in the postoperative period also being highly variable&#46; Hence&#44; studies that provide conclusive data to demonstrate their potential relationship are mandatory&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on this possible association&#44; our interest has been to study what could the pathophysiological mechanism that could justify the relationship between LASIK and posterior segment complications&#46; Some hypothesis state that suction deforms the globe and increases its posterior length&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> This deformation would cause changes in the anatomical relationship between intraocular structures&#44; especially in the vitreous and vitreoretinal adhesions&#44; which would be the cause of retinal lesions&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of our work is to analyze the biometric changes that undergo the eye in LASIK surgery during suction&#44; discussing whether these could justify potential injuries in the posterior segment&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Prospective observational study in which 43 consecutive patients were included&#46; All patients underwent LASIK surgery to correct their refractive error &#40;myopia and&#47;or astigmatism&#41; and signed the corresponding consent form&#46; The study protocol adhered to the tenets of the Declaration of Helsinki and was approved by the Ethics Committee of the center&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patients with systemic diseases that&#44; while not being a contraindication to LASIK&#44; could be associated with retinal circulatory disorders &#40;diabetes&#44; arterial hypertension or vascular accidents&#41; were not included in the study&#46; Only myopic patients were included&#44; hypermetropic individuals were excluded&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The preoperative exam was the one usually performed in candidates for LASIK&#44; which includes a complete ophthalmological exam &#40;with biomicroscopy with a 78-diopter lens and indirect ophthalmoscopy&#41; with the specific refractive surgery protocol&#58; Orbscan &#40;Bausch and Lomb&#44; Germany&#41; topography and pachymetry and ultrasonic pachymetry&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The surgeries were performed by the same surgeon &#40;JAFV&#41; and the LASIK technique used was the standard technique using the One-use Plus microkeratome &#40;MORIA&#44; Antony&#44; France&#41; with the 600&#8239;mmHg vacuum setting&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The biometry was performed using the axis II-Quantel M&#174; biometer &#40;Quantel Medical&#44; Cedex&#44; France&#41; with an 11 Mhz transducer whose electronic resolution is 0&#8239;&#177;&#8239;0&#46;04&#8239;mm&#46; The first biometry was performed immediately before applying the suction ring and the second was once the vacuum was reached after the ocular pressure had risen above 60&#8239;mmHg &#40;controlled using a Barraquer tonometer&#41; with the loss of light perception&#46; In each case&#44; the mean of 10 measurements was taken as the value&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">During the biometry&#44; the following were measured&#58; the aqueous depth &#40;AQD&#44; distance between the posterior face of the cornea and the anterior face of the lens&#41;&#44; the lens thickness &#40;LT&#44; distance between the anterior and posterior face&#41;&#44; the cavity length vitreous &#40;VCL&#44; distance between the posterior face of the lens and the inner limiting membrane&#41; and the modified axial length &#40;AXL&#44; distance between the corneal endothelium and the retina&#41;&#46; One eye was randomly selected for analysis&#46; In seven patients&#44; both eyes were measured and the data were compared in another analysis&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">The sample size calculation was performed using GRANMO &#40;7&#46;12 software&#44; Barcelona&#44; Spain&#41;&#46; To achieve a power beta of 0&#46;8 with an alpha risk of 0&#46;05 in a two-sided contrast&#44; a sample of 32 subjects was estimated to detect a difference equal to or greater than 0&#46;5 units&#44; assuming a standard deviation of 1 unit in paired measurements&#46; Data were collected in an Access &#174; &#40;Microsoft&#41; database and later exported to SPSS&#174; &#40;Statistical Package for Social Sciences&#44; v25&#46;0&#59; SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41; for analysis&#46; The Kolmogorov-Smirnov test was used to evaluate the normality of the data&#59; all variables had a normal distribution&#46; The mean values &#8203;&#8203;of each of the biometrics performed were analyzed&#44; comparing the data obtained before and during suction using the Student&#39;s <span class="elsevierStyleItalic">t</span>-test for paired samples&#46; An increase in the measurements was considered if it was &#62;0&#46;10&#44; a decrease if it was &#60;0&#46;10&#44; and stability if it was &#177;0&#46;10&#8239;mm given the possible variability of the measurements&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Statistical significance was established at p&#8239;&#60;&#8239;0&#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0060" class="elsevierStylePara elsevierViewall">The mean age of the patients was&#58; 38&#46;3&#8239;&#177;&#8239;11&#46;5 years &#40;range&#58; 26&#8211;52 years&#41;&#44; of whom 19 were women &#40;44&#46;2&#37;&#41; and 15 were men &#40;34&#46;9&#37;&#41;&#46; The mean refractive error of the patients was &#8722;4&#46;5&#8239;&#177;&#8239;2&#46;3 diopters in spherical equivalent&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">As for the parameters measured before and during suction&#44; mean values are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The mean AXL before suction was 24&#46;55&#8239;&#177;&#8239;1&#46;11&#8239;mm and during suction&#44; it was 24&#46;67&#8239;&#177;&#8239;1&#46;03&#8239;mm &#40;p&#8239;&#61;&#8239;0&#46;039&#41;&#46; The average increase was 0&#46;12&#8239;mm&#44; which implies a relative increase of 0&#46;5&#37; of its total value&#46; The AQD was 3&#46;24&#8239;&#177;&#8239;0&#46;34&#8239;mm before suction and 3&#46;28&#8239;&#177;&#8239;0&#46;26&#8239;mm during suction &#40;p&#8239;&#61;&#8239;0&#46;231&#41;&#46; The mean increase in AQD was 0&#46;04&#8239;mm&#44; which represents an increase of 1&#46;2&#37; of its total value&#46; Regarding the LT&#44; this was 4&#46;18&#8239;&#177;&#8239;0&#46;35&#8239;mm before suction and 3&#46;98&#8239;&#177;&#8239;0&#46;34&#8239;mm during suction &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; The lens decreased its thickness by 0&#46;20&#8239;mm&#44; which represents 4&#46;8&#37; of its value&#46; The VCL was 17&#46;23&#8239;&#177;&#8239;1&#46;15&#8239;mm before suction and 17&#46;45&#8239;&#177;&#8239;1&#46;22&#8239;mm during suction &#40;p&#8239;&#60;&#8239;0&#46;001&#41;&#46; This length increased by 0&#46;22&#8239;mm&#44; which represents 1&#46;3&#37;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">The results obtained according to the biometric modifications during suction &#40;increase&#44; without change or decrease&#41; are reflected in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; It is noteworthy that in a considerable percentage of patients&#44; AXL &#40;42&#37;&#41;&#44; VCL &#40;70&#37;&#41; and AQD &#40;35&#37;&#41; increased&#44; the increase in LT being in a low proportion of patients &#40;2&#37;&#41;&#44; while there was a decrease in the latter in 67&#37; of cases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> describes the results of the group of seven patients who underwent measurements in both eyes&#44; where we especially highlight the behaviour of the vitreous cavity and the AXL in this subgroup&#46; Thus&#44; we found that the measurements were highly variable since the anterior-posterior distance increased in both eyes in one patient&#44; increased in the right eye and decreased in the left eye in three patients&#44; increased in the left eye and decreased in the right eye in three patients and did not decrease in both eyes in any patient&#46; In these same patients&#44; the length of the vitreous cavity increased in both eyes in five patients and increased in one eye and decreased in the other in two patients&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In the individual analysis&#44; we highlighted the most relevant changes&#58; the greatest increase in AXL was from 23&#46;00 to 23&#46;60&#8239;mm&#46; The greatest increase in the vitreous cavity was from 15&#46;78 to 17&#46;32&#8239;mm&#46; The greatest decrease in LT was from 4&#46;41 to 3&#46;73&#8239;mm&#44; and in AQD from 3&#46;26 to 2&#46;65&#8239;mm&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">Refractive surgery must be proven safe given it is an elective surgery&#46; To discard any doubts&#44; studies must be carried out to demonstrate its safety&#46; Therefore&#44; analyzing the potential side effects of the technique should be a fundamental line of research in refractive surgery&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although there are many patients operated of LASIK&#44; it has not been possible to demonstrate a significant relationship between the surgery and the lesions in the different ocular structures that could be attributed to the surgical maneuvres&#46; However&#44; there are reports of isolated clinical cases with different ocular complications in patients undergoing LASIK&#46; In this line of study&#44; a case of bilateral serous detachment of the macula<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and some cases of optic neuropathy<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> have been described&#46; Besides these anecdotal findings&#44; vitreous and retinal changes have been studied with special interest&#46; In general&#44; the most important series describe very low incidences of retinal detachments in LASIK patients&#44; between 0&#46;08 and 0&#46;033&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Something similar happens with posterior vitreous detachment &#40;PVD&#41; where the association is discussed&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In addition to complications&#44; studies on the impact on different ocular structures&#44; for example on the nerve fiber layer or the optic nerve&#44; have been carried out without finding significant alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Therefore&#44; there does not seem to be a clear relationship between the LASIK technique and vitreoretinal complications&#46; However&#44; studies are needed to definitively confirm or rule out this relationship&#46; The explanation given on a model made in cadaver eyes indicates that the AXL increases &#40;1&#46;125&#8239;mm&#41;&#44; suggesting an anterior movement of the vitreous base that would cause traction that could predispose&#44; in susceptible eyes&#44; to retinal tears during and after LASIK&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> In the eye in vivo&#44; it is hypothesized that suction deforms the eye in the anterior-posterior axis and the globe length increases&#46; Also&#44; because it is a closed system&#44; the eye contracts on the horizontal axis and the equatorial axis decreases&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">During LASIK surgery there are two changes whose importance or significance we are unaware of&#58; a great and abrupt increase of the intraocular pressure&#44; although for a very short duration &#40;generally less than 10&#8239;s&#41;&#44; and a deformation of the globe in two phases&#44; when inducing suction and with the cut of the microkeratome&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the present work&#44; the modifications suffered by the eye in its antero-posterior axis and some of its components during suction have been measured&#46; In the most common hypothesis&#44; the eye undergoes anteroposterior elongation at the moment of suction&#44; since the globe would herniate through the suction ring and consequently suffer compression in the herniated area&#46; Therefore&#44; there would be traction which could be the cause of vitreoretinal complications&#46; Besides the fact that for this to happen the vitreous would have to be rigid and not follow the deformation of the globe&#8217;s walls&#44; the magnitude of the changes would have to be clinically relevant in order to cause complications&#46; The changes observed in the suction in the present work do fit this explanation&#44; given that the anterior-posterior length or AXL increased&#46; The thickness of the lens decreases and the vitreous cavity increases its length&#44; that is&#44; there is a slight increase in the vitreous cavity caused by an anterior displacement of the posterior capsule of the lens&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Our results are similar to those obtained by Mirshahi and Kohnen&#44; although with small variations&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These authors described that the mean AXL of the eyes was 25&#46;08&#8239;mm without producing significant changes &#40;&#8722;0&#46;01&#8239;mm&#59; p&#8239;&#61;&#8239;0&#46;51&#41;&#46; In our study&#44; the average AXL was 24&#46;55&#8239;mm&#44; there being a significant increase &#40;&#43;0&#46;12&#41;&#46; The lens in this study decreased in agreement with the present study&#44; undergoing modifications of a similar magnitude &#40;mean change -0&#46;20&#8239;mm in both studies&#41;&#46; The vitreous cavity increased in 76&#46;2&#37; of the eyes by a mean of 0&#46;20&#8239;mm&#44; as in our study where 70&#37; of the eyes suffered an elongation with a mean of 0&#46;22&#8239;mm&#46; Finally&#44; the anterior chamber depth or AQD did not change significantly in both studies&#46; Similarly&#44; Davis and Evangelista observed by ultrasound a decrease in LT of -0&#46;14&#8239;&#177;&#8239;0&#46;45&#8239;mm &#40;p&#8239;&#60;&#8239;0&#46;05&#41; during suction&#44; while there was an increase in VCL of 0&#46;25&#8239;&#177;&#8239;0&#46;36&#8239;mm &#40;p&#8239;&#60;&#8239;0&#46;05&#41; and a trend not significant to the increase in AXL&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> The only difference observed was that they appreciated a decrease in anterior chamber depth of &#8722;0&#46;06&#8239;&#177;&#8239;0&#46;36&#8239;mm &#40;p&#8239;&#60;&#8239;0&#46;05&#41;&#44; that is&#44; of a very low magnitude&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Thus&#44; the changes that the eye undergoes during suction are minimal in intensity and with enormous variability&#46; This last statement is based on two findings&#46; In the patients in which we measured both eyes&#44; only 1 patient out of 7 produced a bilateral increase in AXL&#44; while in the other 6 patients&#44; one eye increased and the other decreased &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Regarding the vitreous cavity&#44; of the 7 patients studied&#44; in 5 it increased in both eyes and in two patients it increased in one eye and decreased in the contralateral eye&#46; Therefore&#44; variations do not occur in all cases&#46; From a conceptual point of view&#44; two aspects must also be differentiated&#58; although some changes are frequent and statistically significant&#44; their magnitude is minimal&#44; so these changes are of such a low magnitude that they could hardly justify injuries&#46; As we have described&#44; the vitreous underwent a minimal mean increase of 0&#46;22&#8239;mm&#44; which represents 1&#46;3&#37; of its size&#44; while the AXL underwent a percentage change of 0&#46;5&#37; of its absolute value&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In this regard&#44; the deformation of the globe could justify a change in the relationships between the intraocular structures&#44; especially between the vitreous and the retina&#46; Mirshasi and Kohnen observed that after surgery&#44; 3&#47;14 eyes &#40;21&#46;4&#37;&#41; would develop PVD for which there were no ultrasound signs preoperatively&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> After femto-LASIK surgery&#44; Gavrilov et al&#46; observed a partial or total PVD in 5 eyes &#40;16&#37;&#41; and concluded that although less vacuum is required than in LASIK with a microkeratome&#44; the reported incidence of PVD is similar between both techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">However&#44; if we compare LASIK with other common surgical ocular procedures&#44; the changes caused by the former are very small&#46; The important changes that the eye undergoes in surgery of the anterior segment such as cataract surgery &#40;hypotension and hypothalamia or athalamia&#44; hypertension and deepening of the anterior chamber after viscoelastic injection or when introducing the phacoemulsification or irrigation-aspiration terminals with the constant displacement of the posterior capsule and its effect on the anterior vitreous&#44; as well as the marked deformation of the eye when the intraocular lens is inserted&#41; or in vitreoretinal surgery with exchanges or indentations&#44; are much more relevant than those that occur in LASIK surgery&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In this work&#44; certain limitations must be commented&#46; First&#44; the eye was only assessed during suction&#44; but the deformation during the microkeratome cut was not measured&#44; which could result in other ocular changes that should be analyzed in subsequent works&#46; Because an ultrasound probe was used to measure biometric parameters&#44; modified AXL and AQD are included&#44; given that measurements are made from the corneal endothelium&#46; The subgroup of patients in which both eyes are analyzed is very small &#40;7 patients&#41;&#44; so the conclusions do not have statistical power&#44; and their clinical relevance is limited&#46; Nevertheless&#44; in our opinion and in light of the data presented&#44; it is difficult to think that the changes produced by suction could cause injuries to the eye&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In conclusion&#44; LASIK suction maneuvres cause biometric changes in the eye globe&#44; especially resulting in a decrease in the thickness of the lens and an increase in the vitreous cavity and AXL&#46; Although they are notable due to their frequency&#44; the small magnitude of the induced changes may hardly cause anatomical alterations&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To study the biometric modifications of the eyeball during suction in Laser assisted in Situ Keratomileusis &#40;LASIK&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Observational and cross-sectional study&#46; We studied 43 patients who underwent surgery for myopia and myopic astigmatism&#46; Mean age was 38&#46;3&#8239;&#177;&#8239;11&#46;5 years&#44; and 19 were female &#40;44&#46;2&#37;&#41;&#46; Conventional LASIK surgery with a manual microkeratome was performed&#46; Before and during the suction maneuvre the following parameters were measured using an 11 Mhz biometric probe&#58; aqueous depth &#40;AQD&#41;&#44; lens thickness &#40;LT&#41;&#44; vitreous cavity length &#40;VCL&#41; and axial length &#40;AXL&#41;&#46; Paired <span class="elsevierStyleItalic">t</span>-test was used to compare the biometric measurements before and during suction&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The mean spherical equivalent refractive error was &#8722;4&#46;5&#8239;&#177;&#8239;2&#46;3 diopters&#46; During suction&#44; the AQD did not change significantly &#40;p&#8239;&#61;&#8239;0&#46;231&#41;&#46; However&#44; AXL and VCL increased by 0&#46;12&#8239;mm and 0&#46;22&#8239;mm respectively &#40;p&#8239;&#61;&#8239;0&#46;039 and &#60;0&#46;01&#41; and LT decreased by 0&#46;20&#8239;mm &#40;p&#8239;&#60;&#8239;0&#46;01&#41;&#46; AXL increased in 42&#37; of the eyes and decreased in 16&#37;&#44; VCL increased in 70&#37; of the eyes and decreased in 9&#37;&#44; and the LT was reduced in 67&#37; of the eyes&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Suction maneuvres during LASIK surgery produce changes of little magnitude in the eye globe&#44; mainly a decrease in LT and an increase in VCL and AXL&#46; Therefore&#44; these modifications are expected to produce minimal anatomic alterations&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudiar las modificaciones biom&#233;tricas del globo ocular durante la succi&#243;n en la cirug&#237;a de Keratomileusis In Situ asistida por L&#225;ser &#40;LASIK&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional transversal&#46; Se estudiaron 43 pacientes intervenidos de miop&#237;a y astigmatismo mi&#243;pico&#46; La edad media fue de 38&#44;3&#8239;&#177;&#8239;11&#44;5 a&#241;os&#44; 19 eran mujeres &#40;44&#44;2&#37;&#41;&#46; Se realiz&#243; una cirug&#237;a LASIK convencional con microqueratomo manual&#46; Antes y durante la maniobra de succi&#243;n se midieron los siguientes par&#225;metros mediante una sonda biom&#233;trica de 11 Mhz&#58; profundidad acuosa &#40;AQD&#41;&#44; espesor del cristalino &#40;LT&#41;&#44; longitud de la cavidad v&#237;trea &#40;VCL&#41; y longitud axial &#40;AXL&#41;&#46; Se utiliz&#243; la prueba t pareada para comparar las medidas biom&#233;tricas antes y durante la succi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">El equivalente esf&#233;rico medio fue de -4&#44;5&#8239;&#177;&#8239;2&#44;3 dioptr&#237;as&#46; Durante la succi&#243;n&#44; la AQD no aument&#243; significativamente &#40;p&#8239;&#61;&#8239;0&#44;231&#41;&#46; Sin embargo&#44; la AXL y VCL aumentaron en 0&#44;12&#8239;mm y 0&#44;2&#8239;mm respectivamente &#40;p&#8239;&#61;&#8239;0&#44;039 y &#60;0&#44;01&#41; y LT disminuy&#243; en 0&#44;20&#8239;mm &#40;p&#8239;&#60;&#8239;0&#44;01&#41;&#46; La AXL aument&#243; en el 42&#37; de los ojos y disminuy&#243; en el 16&#37;&#44; mientras que la VCL aument&#243; en el 70&#37; de los ojos y disminuy&#243; en el 9&#37;&#44; y el LT se redujo en el 67&#37; de los ojos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Las maniobras de succi&#243;n durante la cirug&#237;a LASIK producen cambios de poca magnitud en el globo ocular&#44; principalmente disminuci&#243;n de LT y aumento de VCL y AXL&#46; Por lo tanto&#44; es esperable que estas modificaciones produzcan alteraciones anat&#243;micas m&#237;nimas&#46;</p></span>"
        "secciones" => array:4 [
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          3 => array:2 [
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            "titulo" => "Conclusiones"
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        ]
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AXL&#8239;&#61;&#8239;axial length&#59; AQD&#8239;&#61;&#8239;aqueous depth&#59; LT&#8239;&#61;&#8239;lens thickness&#59; VCL&#8239;&#61;&#8239;vitreous cavity length&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before suction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">During suction&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">P-value&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AXL &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;55&#8239;&#177;&#8239;1&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;67&#8239;&#177;&#8239;1&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;22&#46;68&#8211;27&#46;01&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;22&#46;77&#8211;27&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AQD &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;24&#8239;&#177;&#8239;0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;28&#8239;&#177;&#8239;0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#46;52&#8211;4&#46;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;2&#46;70&#8211;3&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LT &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;18&#8239;&#177;&#8239;0&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;98&#8239;&#177;&#8239;0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#46;66&#8211;5&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;3&#46;45&#8211;4&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">VCL &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;23&#8239;&#177;&#8239;1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;45&#8239;&#177;&#8239;1&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;14&#46;88&#8211;20&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;14&#46;89&#8211;20&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Results of the biometric modifications of the eye during the suction maneuvre in LASIK surgery&#46; Mean&#8239;&#177;&#8239;standard deviation&#44; range&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">AXL&#8239;&#61;&#8239;axial length&#59; AQD&#8239;&#61;&#8239;aqueous depth&#59; LT&#8239;&#61;&#8239;lens thickness&#59; VCL&#8239;&#61;&#8239;vitreous cavity length&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Increase&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No change&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Decrease&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AXL &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 eyes &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 eyes &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 eyes &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AQD &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 eyes &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 eyes &#40;35&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 eyes &#40;30&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LT &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 eye &#40;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">29 eyes &#40;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">VCL &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 eyes &#40;70&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 eyes &#40;21&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4 eyes &#40;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3233366.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Distribution of the eyes by groups according to the modifications suffered by the different intraocular structures during LASIK suction&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">R&#8239;&#61;&#8239;right eye&#59; L&#8239;&#61;&#8239;left eye&#59; AXL&#8239;&#61;&#8239;axial length&#59; AQD&#8239;&#61;&#8239;aqueous depth&#59; LT&#8239;&#61;&#8239;lens thickness&#59; VCL&#8239;&#61;&#8239;vitreous cavity length&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Before suction</th><th class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">During suction</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LT &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">LT &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">VCL &#40;mm&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 R&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">4 R&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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ISSN: 21735794
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

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