Prevalence of keratoconus in an adolescent population | Revista Mexicana de Oftalmología

array:23 ["pii" => "S0187451914000316" "issn" => "01874519" "doi" => "10.1016/j.mexoft.2014.03.002" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "22" "copyright" => "Sociedad Mexicana de Oftalmología" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Mex Oftalmol. 2014;88:95-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3850 "formatos" => array:3 [ "EPUB" => 45 "HTML" => 2933 "PDF" => 872 ] ] "itemSiguiente" => array:19 [ "pii" => "S0187451914000328" "issn" => "01874519" "doi" => "10.1016/j.mexoft.2014.02.002" "estado" => "S300" "fechaPublicacion" => "2014-07-01" "aid" => "23" "copyright" => "Sociedad Mexicana de Oftalmología" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Mex Oftalmol. 2014;88:99-103" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9203 "formatos" => array:3 [ "EPUB" => 56 "HTML" => 7568 "PDF" => 1579 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Artículo original" "titulo" => "Densidad y morfología de células del endotelio corneal en adultos jóvenes del norte de México" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "99" "paginaFinal" => "103" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Density and morphology of corneal endothelial cells in young adults in northern Mexico" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1523 "Ancho" => 2167 "Tamanyo" => 336326 ] ] "descripcion" => array:1 [ "es" => "Microscopia especular." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Rocío Guadalupe Contreras-Corona, Edwin Javier Anaya-Pava, Arturo Jaime Gallegos-Valencia, José Antonio Villarreal-Maíz" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Rocío Guadalupe" "apellidos" => "Contreras-Corona" ] 1 => array:2 [ "nombre" => "Edwin Javier" "apellidos" => "Anaya-Pava" ] 2 => array:2 [ "nombre" => "Arturo Jaime" "apellidos" => "Gallegos-Valencia" ] 3 => array:2 [ "nombre" => "José Antonio" "apellidos" => "Villarreal-Maíz" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0187451914000328?idApp=UINPBA00004N" "url" => "/01874519/0000008800000003/v1_201408160139/S0187451914000328/v1_201408160139/es/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Prevalence of keratoconus in an adolescent population" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "95" "paginaFinal" => "98" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge E. Valdez-García, Rubén Sepúlveda, Jessica J. Salazar-Martínez, Juan F. Lozano-Ramírez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jorge E." "apellidos" => "Valdez-García" "email" => array:1 [ 0 => "jorge.valdez@itesm.mx" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0005" ] 2 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Rubén" "apellidos" => "Sepúlveda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "Jessica J." "apellidos" => "Salazar-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Juan F." "apellidos" => "Lozano-Ramírez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Instituto de Oftalmología y Ciencias Visuales - TecSalud. Tecnológico de Monterrey, Monterrey, México" "etiqueta" => "a" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Catedra de Oftalmología y Ciencias Visuales. Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, México" "etiqueta" => "b" "identificador" => "aff0005" ] 2 => array:3 [ "entidad" => "Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, México" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Av. I Morones Prieto #3000 PTE. Edificio CITES Piso PB Col, Los Doctores Monterrey, NL 64710, Mexico. Tel.: +52 81 8888 2000." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia de Queratocono en Población Adolescente" ] ] "textoCompleto" => "IntroductionKeratoconus is a progressive and idiopathic disease in which the cornea develops into an irregular and conic shape. The clinical signs include thinning of the cornea in its central or paracentral region, an apical protrusion, or an elevation of the central zone with an irregular astigmatism, and this condition can progress to the point of corneal perforation in extreme cases<a class="elsevierStyleCrossRef" href="#bib0005">1</a>; all of these issues can make it difficult to achieve adequate visual correction with the simple use of glasses.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> Keratoconus is a rare disease, as classified by the Office of Rare Diseases of the National Institute of Health. Despite this, keratoconus is the most common form of dystrophy or corneal ectasia, with an incidence of 50–230 per 100,000 persons.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Some initial studies revealed a greater prevalence of keratoconus among women than men. Today, studies have not been able to find a significant difference between genders, and some studies have even found higher prevalence rate among males.<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a>Some reports have documented the age of onset as being as early as birth and up to 51 years of age. However, the vast majority of patients develop the disease between 12 and 20 years of age (it is diagnosed in adolescence and reaches its most severe form between the second and fourth decades of life).<a class="elsevierStyleCrossRefs" href="#bib0020">4,5</a> Based on these reports, we find the need to study this age population in order to define future strategies for diagnosis and treatment.Keratoconus is a disease that is almost exclusively bilateral, yet asymmetric, as it begins in one eye and after 2–6 years it affects the contralateral eye. It is rare to find a purely unilateral disease. Hall reported that from a total of 288 patients, eight cases were unilateral, while Tuft reported that 4.3% of his sample exhibited unilateral keratoconus.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a>In Mexico, the research on keratoconus is scarce; the articles published show statistics that are similar to those in international literature, which indicates a higher prevalence in male patients with a mean age of 24.5 years.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> This study will examine a specific population – adolescents. There is debate concerning the prevalence of keratoconus in the general population, but our focus is on the prevalence of keratoconus in the adolescent population visiting an ophthalmology concentration clinic.ObjectiveTo explore the epidemiology of keratoconus in Mexico among an adolescent population, and to compare the prevalence rates of this condition with international literature reports.MethodsThis study is a retrospective clinical study, which will examine the prevalence rates of keratoconus, for which 500 records were randomly selected. The calculated sample was 221 patients, using Raosoft®, with a 5% margin of error, a 90% confidence interval, and a population of 1200 patients. The patient records used were from patients between the ages of 10–20 years. A database was developed using Microsoft® Excel in which patients’ identification, gender, age, three main diagnoses at fist clinic visit, as well as refraction and visual acuity for both eyes were documented. After this, descriptive statistical analysis was performed for prevalence and means. All of the refractions that were documented were performed via skiascopy under cycloplegia. Since this was a general study about the prevalence of keratoconus in a specific population, no exclusion criteria were developed for this study. Before initiating, we received approval from the ethics committee, and the study adheres to the tenets of the Declaration of Helsinki.ResultsOf the 500 records that were examined, keratoconus was diagnosed in 9 patients, with a prevalence rate of 1.8% (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The proportion of keratoconus per gender was 6 (66.6%) females and 3 (33.3%) males. The mean age at diagnosis was 16.1 years, with 17.3 years of age for males and 15.5 years of age for females.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The refractive errors detected were 2 patients with simple myopia, 2 with simple myopic astigmatism, 4 with compound myopic astigmatism, and 1 with mixed astigmatism. Of the detected patients, 3 (33.3%) had a penetrating keratoplasty and 5 (55.5%) were managed conservatively with rigid gas permeable contact lenses, with periodic adjustments. There was loss to follow-up of 1 (11.1%) patient, after the second visit and no management was appropriately delivered.DiscussionOur study on keratoconus cannot be compared to an equally designed study from Mexico because no other studies use a similar population. Our 1.8% prevalence rate compares to that of Jonas et al. in India, where they obtained a 2.7% prevalence rate, sample of 4711 subjects, and in a study conducted in Jerusalem by Millodot et al., who reported a prevalence rate of 2.34% in a sample of 981 volunteers.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> Even though these studies exhibit slightly higher prevalence rates, our results can be regarded as being somewhat similar to those reported in these studies, especially if we compare our prevalence rates to those found by Ihalainen (0.03%).<a class="elsevierStyleCrossRef" href="#bib0055">11</a>In relation to gender, we found prevalence rates of 66.6% and 33.3% for women and men, respectively. When we compare these results to those of the study conducted in Cuba by Diaz et al. – who reported similar prevalence rates per gender at 66% for females and 34% for males, had a sample of 73 patients – it is evident that these results are in contrast to those observed in several studies from the United States (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRefs" href="#bib0025">5,7,12–15</a><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The mean age at diagnosis noted in our study was 16.1 years, which can be compared to the mean age at diagnosis found by Olivares and Guerrero, which was 15.39±3.95 years, which had a sample of 74 patients. Even though the mean age reported in our study indicated a younger age, we obtained results that were similar to those found in the general population.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> When comparing our study's results with those reported by Ruiz-Morales et al., they obtained an age at diagnosis of 24.5 years, study with a sample of 166 patients. While this indicates an older age at diagnosis, it should be considered that the study was conducted on post-transplant patients.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Bilaterality is an important aspect to consider when analyzing a patient with suspected keratoconus. Our study demonstrated bilaterality in 8 (88.8%) patients, although it was asymmetric. Kennedy et al. found an incidence of bilateral involvement to be in 38 (59%) patients at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> Our results obtained, could indicate a late approach to these patients in our clinicTheories surrounding the diseases associated with keratoconus can be found in the literature. Some of these theories are based on the effects of hormonal stimulation as the genesis of this pathology. Also, keratoconus is associated with Trisomy 21 and allergic processes, but in our study, no relationships with other diseases were detected.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>The relevance of the management of these patients is important to note, as 33.3% of patients ended their treatment in penetrating keratoplasty in our study, clearly indicating that patients are being subjected to radical treatments. The reason behind this is based on the fact that patients at our clinic have already been to other clinics, and they are referred to us (a concentration clinic). Other factors include the fact that this is a population of low socioeconomic status and poor education level; these factors are often seen in the records in which patients’ visual acuity has been significantly affected, and where keratoconus is present and cannot be treated by noninvasive methods.As the first study using the inclusion criteria specified above, we should highlight the need to perform additional studies. Our study was conducted with a calculated sample of 221 patients. The results are supported by our data, but in order to better compare and extrapolate our epidemiological data, a study that involves a higher number of subjects needs to be performed. In addition to having a larger sample size, other variables should be included such as family history, data concerning atopy, and factors concerning environmental exposure.The importance of performing similar protocols in populations of this age group is necessary to establish statistics that can help identify the incidence and prevalence of keratoconus in populations of similar geographic areas (this study was conducted in the north of Mexico). Importantly, we can use these studies to establish etiologies, assess proper characteristics, and develop guidelines for the treatment of keratoconus.ConclusionKeratoconus identification, diagnosis and treatment are of high importance for primary care physicians, optometrist and ophthalmologist when screening patients in this age group. The incorporation of epidemiology and public health organizations into a future project to identify probable causes can help us understand risk factors for our population, and the best method for detection and timely management.FundingThe authors received no sponsorship to carry out this article.Conflict of interestThe authors declare no conflict of interest." 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In Mexico, the epidemiological information about the pathology is scarce. PurposeTo explore the epidemiology of keratoconus in Mexico among adolescents, and to compare the prevalence with international literature reports. This study identified associated pathologies and examined the management of patients. MethodsA retrospective study was conducted in an ophthalmology clinic; 500 charts were randomly selected from patients between 10 and 20 years of age in order to acquire information about the identification of the patient; the patient's gender, birthday, and age; three principal diagnoses at the first visit; as well as refraction and visual acuity in both eyes. After this, statistical analysis of the information was done. ResultsThe prevalence rate of keratoconus was 1.8%, affecting 66% of females and 33.3% of males. The mean age of presentation was 16.1 years. The most frequently associated refractive error was compound myopic astigmatism (44.4%); 88.8% presented with bilateralism. The majority of patients were being managed conservatively. ConclusionThrough this study, we found that our statistics matched those of internationally published reports concerning the early age of onset of the disease and its corresponding bilateralism. However, contrary to the international reports, it was evident that this condition was more prevalent among the females in our study sample, and no other associated pathologies were found." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "IntroducciónEl queratocono es una enfermedad idiopática y progresiva, donde la cornea adquiere una forma irregular y cónica, siendo la forma más común de distrofia o ectasia corneal desarrollándose entre los 12 y 20 años de edad. En México no se cuenta con suficiente información epidemiológica en cuanto a la patología. ObjetivoExplorar la epidemiología del queratocono en México en adolescentes y comparar la prevalencia con reportes internacionales. Este estudio identifico patologías asociadas y evaluó el manejo de estos pacientes. MétodosEstudio retrospectivo en una clínica oftalmológica; 500 expedientes fueron aleatoriamente seleccionados de pacientes entre 10 y 20 años de edad, obteniendo: identificación del paciente, sexo, fecha de nacimiento y edad, tres diagnósticos principales en su primer visita, refracción y agudeza visual en ambos ojos. Posterior a la captura de datos, se realizo el análisis estadístico. ResultadosLa tasa de prevalencia de queratocono fue de 1.8%, afectando al 66% de las mujeres y el 33% de hombres. La edad media de presentación fue de 16.1 años de edad. El error refractivo asociado a queratocono más común fue astigmatismo miópico compuesto (44.4%); 88.8% se presentó con bilateralidad. La mayoría de los pacientes se trato de manera conservadora. ConclusiónA través de este estudio, encontramos que nuestros resultados concuerdan con lo publicado internacionalmente en referencia al inicio temprano del queratocono y la bilateralidad. Pero, contrario a lo reportado, fue evidente que esta condición es más prevalente entre las mujeres de nuestra muestra, además no se encontraron patologías asociadas a queratocono." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Number of Patients \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">500 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Keratoconus diagnosis</td></tr><tr title="table-row"><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">General prevalence \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.8% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.6% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age at diagnosis</td></tr><tr title="table-row"><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">General \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.1 years \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15.5 years \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.3 years \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Refractive errors</td></tr><tr title="table-row"><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">Simple Myopia \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Compound Myopic Astigmatism \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Simple Myopic Astigmatism \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Mixed Astigmatism \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Treatment</td></tr><tr title="table-row"><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">Corneal transplant \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">RGP<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> contact lens \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" 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">Loss to follow-up \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \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="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab540415.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "RGP=rigid gas permeable." ] ] ] "descripcion" => array:1 [ "en" => "Data concentrate for diagnosis of keratoconus." ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "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"><td 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" style="border-bottom: 2px solid black">Author \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Male with KC<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Female with KC \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Buxton<a class="elsevierStyleCrossRef" href="#bib0065">13</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Woodward<a class="elsevierStyleCrossRef" href="#bib0070">14</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">61% \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Palimeris<a class="elsevierStyleCrossRef" href="#bib0075">15</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">68.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Kennedy<a class="elsevierStyleCrossRef" href="#bib0025">5</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.7% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Tuft<a class="elsevierStyleCrossRef" href="#bib0035">7</a> \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.92:1 \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="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1:1 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab540416.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "KC=keratoconus." ] ] ] "descripcion" => array:1 [ "en" => "Comparative table indicating keratoconus prevalence per gender in different studies.<a class="elsevierStyleCrossRefs" href="#bib0025">5,7,13–15</a>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous perforation of the cornea in mild keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.C. Lam" 1 => "P.R. Bhatt" 2 => "K. Ramaesh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e3181e2efcf" "Revista" => array:7 [ "tituloSerie" => "Cornea" "fecha" => "2011" "volumen" => "30" "numero" => "1" "paginaInicial" => "103" "paginaFinal" => "104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20847678" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratoconus: age of onset and natural history" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.L. Olivares-Jiménez" 1 => "J.C. Guerrero-Jurado" 2 => "F.J. Bermudez-Rodriguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Optom Vis Sci" "fecha" => "1997" "volumen" => "74" "numero" => "3" "paginaInicial" => "147" "paginaFinal" => "151" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9159804" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratoconus: overview and update on treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Espandar" 1 => "J. Meyer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0974-9233.61212" "Revista" => array:7 [ "tituloSerie" => "Middle East Afr J Ophthalmol" "fecha" => "2010" "volumen" => "17" "numero" => "1" "paginaInicial" => "15" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20543932" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Keratoconus patients at Jordan University Hospital: a descriptive study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.A. Abu Ameerh" 1 => "R.M. Al Refai" 2 => "M.D. Al Bdour" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/OPTH.S38287" "Revista" => array:6 [ "tituloSerie" => "Clin Ophthalmol" "fecha" => "2012" "volumen" => "6" "paginaInicial" => "1895" "paginaFinal" => "1899" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23204831" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A 48-year clinical and epidemiologic study of keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.H. Kennedy" 1 => "W.M. Bourne" 2 => "J.A. Dyer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "1986" "volumen" => "101" "numero" => "3" "paginaInicial" => "267" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3513592" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comprehensive study of keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.G. Hall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Physiol Opt" "fecha" => "1963" "volumen" => "20" "paginaInicial" => "215" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14088302" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognostic factors for the progression of keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "S.J. Tuft" 1 => "L.C. Moodaley" 2 => "W.M. Gregory" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ophthalmology" "fecha" => "1994" "volumen" => "101" "numero" => "3" "paginaInicial" => "439" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8127564" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frecuencia del queratocono y transplante de cornea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.L. Ruiz-Morales" 1 => "K. Verdiguel-Sotelo" 2 => "A. Hernández-López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Rev Med Inst Mex Seguro Soc" "fecha" => "2010" "volumen" => "48" "numero" => "3" "paginaInicial" => "309" "paginaFinal" => "312" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21192904" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and associations of keratoconus in rural maharashtra in central India: the central India eye and medical study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.B. Jonas" 1 => "V. Nangia" 2 => "A. Matin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2009.06.024" "Revista" => array:7 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2009" "volumen" => "148" "numero" => "5" "paginaInicial" => "760" "paginaFinal" => "765" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19674732" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and associated factors of keratoconus in Jerusalem: a cross-sectional study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Millodot" 1 => "E. Shneor" 2 => "S. Albou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/09286586.2011.560747" "Revista" => array:7 [ "tituloSerie" => "Ophthalmic Epidemiol" "fecha" => "2011" "volumen" => "18" "numero" => "2" "paginaInicial" => "91" "paginaFinal" => "97" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21401417" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and epidemiological features of keratoconus genetic and external factors in the pathogenesis of the disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Ihalainen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Ophthalmol Suppl" "fecha" => "1986" "volumen" => "178" "paginaInicial" => "1" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3019073" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Características epidemiológicas en pacientes portadores de queratocono" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Díaz" 1 => "A. Caíñas" 2 => "C. 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Pecego" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Ophthalmology" "fecha" => "1981" "volumen" => "88" "numero" => "8" "paginaInicial" => "771" "paginaFinal" => "773" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7033863" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors for likelihood of corneal transplantation in keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E.G. Woodward" 1 => "L.C. Moodaley" 2 => "A. O’Hagan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/eye.1990.64" "Revista" => array:7 [ "tituloSerie" => "Eye" "fecha" => "1990" "volumen" => "4" "numero" => "3" "paginaInicial" => "493" "paginaFinal" => "496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2209915" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Some observations on the pathogenesis and management of keratoconus" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Palimeris" 1 => "D. Droutsas" 2 => "E. 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Original Article

Prevalence of keratoconus in an adolescent population

Prevalencia de Queratocono en Población Adolescente

Jorge E. Valdez-Garcíaa,b,c,

Corresponding author

jorge.valdez@itesm.mx

Corresponding author at: Av. I Morones Prieto #3000 PTE. Edificio CITES Piso PB Col, Los Doctores Monterrey, NL 64710, Mexico. Tel.: +52 81 8888 2000.

, Rubén Sepúlvedac, Jessica J. Salazar-Martínezc, Juan F. Lozano-Ramírezb,c

a Instituto de Oftalmología y Ciencias Visuales - TecSalud. Tecnológico de Monterrey, Monterrey, México

b Catedra de Oftalmología y Ciencias Visuales. Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, México

c Escuela de Medicina y Ciencias de la Salud, Tecnológico de Monterrey, Monterrey, México

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Keratoconus is a progressive and idiopathic disease in which the cornea develops into an irregular and conic shape&#46; The clinical signs include thinning of the cornea in its central or paracentral region&#44; an apical protrusion&#44; or an elevation of the central zone with an irregular astigmatism&#44; and this condition can progress to the point of corneal perforation in extreme cases<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#59; all of these issues can make it difficult to achieve adequate visual correction with the simple use of glasses&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Keratoconus is a rare disease&#44; as classified by the Office of Rare Diseases of the National Institute of Health&#46; Despite this&#44; keratoconus is the most common form of dystrophy or corneal ectasia&#44; with an incidence of 50&#8211;230 per 100&#44;000 persons&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Some initial studies revealed a greater prevalence of keratoconus among women than men&#46; Today&#44; studies have not been able to find a significant difference between genders&#44; and some studies have even found higher prevalence rate among males&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Some reports have documented the age of onset as being as early as birth and up to 51 years of age&#46; However&#44; the vast majority of patients develop the disease between 12 and 20 years of age &#40;it is diagnosed in adolescence and reaches its most severe form between the second and fourth decades of life&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Based on these reports&#44; we find the need to study this age population in order to define future strategies for diagnosis and treatment&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Keratoconus is a disease that is almost exclusively bilateral&#44; yet asymmetric&#44; as it begins in one eye and after 2&#8211;6 years it affects the contralateral eye&#46; It is rare to find a purely unilateral disease&#46; Hall reported that from a total of 288 patients&#44; eight cases were unilateral&#44; while Tuft reported that 4&#46;3&#37; of his sample exhibited unilateral keratoconus&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In Mexico&#44; the research on keratoconus is scarce&#59; the articles published show statistics that are similar to those in international literature&#44; which indicates a higher prevalence in male patients with a mean age of 24&#46;5 years&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This study will examine a specific population &#8211; adolescents&#46; There is debate concerning the prevalence of keratoconus in the general population&#44; but our focus is on the prevalence of keratoconus in the adolescent population visiting an ophthalmology concentration clinic&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Objective</span><p id="par0030" class="elsevierStylePara elsevierViewall">To explore the epidemiology of keratoconus in Mexico among an adolescent population&#44; and to compare the prevalence rates of this condition with international literature reports&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Methods</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study is a retrospective clinical study&#44; which will examine the prevalence rates of keratoconus&#44; for which 500 records were randomly selected&#46; The calculated sample was 221 patients&#44; using Raosoft<span class="elsevierStyleSup">&#174;</span>&#44; with a 5&#37; margin of error&#44; a 90&#37; confidence interval&#44; and a population of 1200 patients&#46; The patient records used were from patients between the ages of 10&#8211;20 years&#46; A database was developed using Microsoft<span class="elsevierStyleSup">&#174;</span> Excel in which patients&#8217; identification&#44; gender&#44; age&#44; three main diagnoses at fist clinic visit&#44; as well as refraction and visual acuity for both eyes were documented&#46; After this&#44; descriptive statistical analysis was performed for prevalence and means&#46; All of the refractions that were documented were performed via skiascopy under cycloplegia&#46; Since this was a general study about the prevalence of keratoconus in a specific population&#44; no exclusion criteria were developed for this study&#46; Before initiating&#44; we received approval from the ethics committee&#44; and the study adheres to the tenets of the Declaration of Helsinki&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Of the 500 records that were examined&#44; keratoconus was diagnosed in 9 patients&#44; with a prevalence rate of 1&#46;8&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The proportion of keratoconus per gender was 6 &#40;66&#46;6&#37;&#41; females and 3 &#40;33&#46;3&#37;&#41; males&#46; The mean age at diagnosis was 16&#46;1 years&#44; with 17&#46;3 years of age for males and 15&#46;5 years of age for females&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The refractive errors detected were 2 patients with simple myopia&#44; 2 with simple myopic astigmatism&#44; 4 with compound myopic astigmatism&#44; and 1 with mixed astigmatism&#46; Of the detected patients&#44; 3 &#40;33&#46;3&#37;&#41; had a penetrating keratoplasty and 5 &#40;55&#46;5&#37;&#41; were managed conservatively with rigid gas permeable contact lenses&#44; with periodic adjustments&#46; There was loss to follow-up of 1 &#40;11&#46;1&#37;&#41; patient&#44; after the second visit and no management was appropriately delivered&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Our study on keratoconus cannot be compared to an equally designed study from Mexico because no other studies use a similar population&#46; Our 1&#46;8&#37; prevalence rate compares to that of Jonas et al&#46; in India&#44; where they obtained a 2&#46;7&#37; prevalence rate&#44; sample of 4711 subjects&#44; and in a study conducted in Jerusalem by Millodot et al&#46;&#44; who reported a prevalence rate of 2&#46;34&#37; in a sample of 981 volunteers&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Even though these studies exhibit slightly higher prevalence rates&#44; our results can be regarded as being somewhat similar to those reported in these studies&#44; especially if we compare our prevalence rates to those found by Ihalainen &#40;0&#46;03&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In relation to gender&#44; we found prevalence rates of 66&#46;6&#37; and 33&#46;3&#37; for women and men&#44; respectively&#46; When we compare these results to those of the study conducted in Cuba by Diaz et al&#46; &#8211; who reported similar prevalence rates per gender at 66&#37; for females and 34&#37; for males&#44; had a sample of 73 patients &#8211; it is evident that these results are in contrast to those observed in several studies from the United States &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;12&#8211;15</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The mean age at diagnosis noted in our study was 16&#46;1 years&#44; which can be compared to the mean age at diagnosis found by Olivares and Guerrero&#44; which was 15&#46;39<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;95 years&#44; which had a sample of 74 patients&#46; Even though the mean age reported in our study indicated a younger age&#44; we obtained results that were similar to those found in the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> When comparing our study&#39;s results with those reported by Ruiz-Morales et al&#46;&#44; they obtained an age at diagnosis of 24&#46;5 years&#44; study with a sample of 166 patients&#46; While this indicates an older age at diagnosis&#44; it should be considered that the study was conducted on post-transplant patients&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Bilaterality is an important aspect to consider when analyzing a patient with suspected keratoconus&#46; Our study demonstrated bilaterality in 8 &#40;88&#46;8&#37;&#41; patients&#44; although it was asymmetric&#46; Kennedy et al&#46; found an incidence of bilateral involvement to be in 38 &#40;59&#37;&#41; patients at the time of diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Our results obtained&#44; could indicate a late approach to these patients in our clinic</p><p id="par0070" class="elsevierStylePara elsevierViewall">Theories surrounding the diseases associated with keratoconus can be found in the literature&#46; Some of these theories are based on the effects of hormonal stimulation as the genesis of this pathology&#46; Also&#44; keratoconus is associated with Trisomy 21 and allergic processes&#44; but in our study&#44; no relationships with other diseases were detected&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The relevance of the management of these patients is important to note&#44; as 33&#46;3&#37; of patients ended their treatment in penetrating keratoplasty in our study&#44; clearly indicating that patients are being subjected to radical treatments&#46; The reason behind this is based on the fact that patients at our clinic have already been to other clinics&#44; and they are referred to us &#40;a concentration clinic&#41;&#46; Other factors include the fact that this is a population of low socioeconomic status and poor education level&#59; these factors are often seen in the records in which patients&#8217; visual acuity has been significantly affected&#44; and where keratoconus is present and cannot be treated by noninvasive methods&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As the first study using the inclusion criteria specified above&#44; we should highlight the need to perform additional studies&#46; Our study was conducted with a calculated sample of 221 patients&#46; The results are supported by our data&#44; but in order to better compare and extrapolate our epidemiological data&#44; a study that involves a higher number of subjects needs to be performed&#46; In addition to having a larger sample size&#44; other variables should be included such as family history&#44; data concerning atopy&#44; and factors concerning environmental exposure&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The importance of performing similar protocols in populations of this age group is necessary to establish statistics that can help identify the incidence and prevalence of keratoconus in populations of similar geographic areas &#40;this study was conducted in the north of Mexico&#41;&#46; Importantly&#44; we can use these studies to establish etiologies&#44; assess proper characteristics&#44; and develop guidelines for the treatment of keratoconus&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">Keratoconus identification&#44; diagnosis and treatment are of high importance for primary care physicians&#44; optometrist and ophthalmologist when screening patients in this age group&#46; The incorporation of epidemiology and public health organizations into a future project to identify probable causes can help us understand risk factors for our population&#44; and the best method for detection and timely management&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0095" class="elsevierStylePara elsevierViewall">The authors received no sponsorship to carry out this article&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2013-12-12"
    "fechaAceptado" => "2014-03-07"
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          "clase" => "keyword"
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          "identificador" => "xpalclavsec341218"
          "palabras" => array:6 [
            0 => "Keratoconus"
            1 => "Retinoscopy"
            2 => "Astigmatism"
            3 => "Cycloplegia"
            4 => "Keratoplasty"
            5 => "Epidemiology"
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          "palabras" => array:6 [
            0 => "Queratocono"
            1 => "Retinoscop&#237;a"
            2 => "Astigmatismo"
            3 => "Cicloplegia"
            4 => "Queratoplastia"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Keratoconus is an idiopathic and progressive disease&#44; where the cornea develops an irregular and conical shape&#44; being the most common form of dystrophy or corneal ectasia&#44; developing between the age of 12 and 20&#46; In Mexico&#44; the epidemiological information about the pathology is scarce&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Purpose</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To explore the epidemiology of keratoconus in Mexico among adolescents&#44; and to compare the prevalence with international literature reports&#46; This study identified associated pathologies and examined the management of patients&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was conducted in an ophthalmology clinic&#59; 500 charts were randomly selected from patients between 10 and 20 years of age in order to acquire information about the identification of the patient&#59; the patient&#39;s gender&#44; birthday&#44; and age&#59; three principal diagnoses at the first visit&#59; as well as refraction and visual acuity in both eyes&#46; After this&#44; statistical analysis of the information was done&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The prevalence rate of keratoconus was 1&#46;8&#37;&#44; affecting 66&#37; of females and 33&#46;3&#37; of males&#46; The mean age of presentation was 16&#46;1 years&#46; The most frequently associated refractive error was compound myopic astigmatism &#40;44&#46;4&#37;&#41;&#59; 88&#46;8&#37; presented with bilateralism&#46; The majority of patients were being managed conservatively&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Through this study&#44; we found that our statistics matched those of internationally published reports concerning the early age of onset of the disease and its corresponding bilateralism&#46; However&#44; contrary to the international reports&#44; it was evident that this condition was more prevalent among the females in our study sample&#44; and no other associated pathologies were found&#46;</p>"
      ]
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El queratocono es una enfermedad idiop&#225;tica y progresiva&#44; donde la cornea adquiere una forma irregular y c&#243;nica&#44; siendo la forma m&#225;s com&#250;n de distrofia o ectasia corneal desarroll&#225;ndose entre los 12 y 20 a&#241;os de edad&#46; En M&#233;xico no se cuenta con suficiente informaci&#243;n epidemiol&#243;gica en cuanto a la patolog&#237;a&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Explorar la epidemiolog&#237;a del queratocono en M&#233;xico en adolescentes y comparar la prevalencia con reportes internacionales&#46; Este estudio identifico patolog&#237;as asociadas y evalu&#243; el manejo de estos pacientes&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en una cl&#237;nica oftalmol&#243;gica&#59; 500 expedientes fueron aleatoriamente seleccionados de pacientes entre 10 y 20 a&#241;os de edad&#44; obteniendo&#58; identificaci&#243;n del paciente&#44; sexo&#44; fecha de nacimiento y edad&#44; tres diagn&#243;sticos principales en su primer visita&#44; refracci&#243;n y agudeza visual en ambos ojos&#46; Posterior a la captura de datos&#44; se realizo el an&#225;lisis estad&#237;stico&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La tasa de prevalencia de queratocono fue de 1&#46;8&#37;&#44; afectando al 66&#37; de las mujeres y el 33&#37; de hombres&#46; La edad media de presentaci&#243;n fue de 16&#46;1 a&#241;os de edad&#46; El error refractivo asociado a queratocono m&#225;s com&#250;n fue astigmatismo mi&#243;pico compuesto &#40;44&#46;4&#37;&#41;&#59; 88&#46;8&#37; se present&#243; con bilateralidad&#46; La mayor&#237;a de los pacientes se trato de manera conservadora&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0060">Conclusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A trav&#233;s de este estudio&#44; encontramos que nuestros resultados concuerdan con lo publicado internacionalmente en referencia al inicio temprano del queratocono y la bilateralidad&#46; Pero&#44; contrario a lo reportado&#44; fue evidente que esta condici&#243;n es m&#225;s prevalente entre las mujeres de nuestra muestra&#44; adem&#225;s no se encontraron patolog&#237;as asociadas a queratocono&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Number of Patients&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">500&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Keratoconus diagnosis</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>General prevalence&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#46;6&#37;&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"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Mean age at diagnosis</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">16&#46;1 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" 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" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">15&#46;5 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#46;3 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Compound Myopic Astigmatism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Simple Myopic Astigmatism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mixed Astigmatism&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&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="" 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" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&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="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RGP<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> contact lens&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&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">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparative table indicating keratoconus prevalence per gender in different studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;7&#44;13&#8211;15</span></a></p>"
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          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous perforation of the cornea in mild keratoconus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "F&#46;C&#46; Lam"
                            1 => "P&#46;R&#46; Bhatt"
                            2 => "K&#46; Ramaesh"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1097/ICO.0b013e3181e2efcf"
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                        "tituloSerie" => "Cornea"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "numero" => "1"
                        "paginaInicial" => "103"
                        "paginaFinal" => "104"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20847678"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Keratoconus&#58; age of onset and natural history"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;L&#46; Olivares-Jim&#233;nez"
                            1 => "J&#46;C&#46; Guerrero-Jurado"
                            2 => "F&#46;J&#46; Bermudez-Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Optom Vis Sci"
                        "fecha" => "1997"
                        "volumen" => "74"
                        "numero" => "3"
                        "paginaInicial" => "147"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9159804"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
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            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Keratoconus&#58; overview and update on treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Espandar"
                            1 => "J&#46; Meyer"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-9233.61212"
                      "Revista" => array:7 [
                        "tituloSerie" => "Middle East Afr J Ophthalmol"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "numero" => "1"
                        "paginaInicial" => "15"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20543932"
                            "web" => "Medline"
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            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Keratoconus patients at Jordan University Hospital&#58; a descriptive study"
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                          "autores" => array:3 [
                            0 => "M&#46;A&#46; Abu Ameerh"
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                    0 => array:2 [
                      "doi" => "10.2147/OPTH.S38287"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Ophthalmol"
                        "fecha" => "2012"
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                        "paginaInicial" => "1895"
                        "paginaFinal" => "1899"
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                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A 48-year clinical and epidemiologic study of keratoconus"
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                            0 => "R&#46;H&#46; Kennedy"
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                            2 => "J&#46;A&#46; Dyer"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "1986"
                        "volumen" => "101"
                        "numero" => "3"
                        "paginaInicial" => "267"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
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                  "contribucion" => array:1 [
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                      "titulo" => "A comprehensive study of keratoconus"
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                        0 => array:2 [
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                          "autores" => array:1 [
                            0 => "K&#46;G&#46; Hall"
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Physiol Opt"
                        "fecha" => "1963"
                        "volumen" => "20"
                        "paginaInicial" => "215"
                        "paginaFinal" => "256"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14088302"
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                        "numero" => "3"
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                        "paginaFinal" => "312"
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                        "paginaFinal" => "765"
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                      "titulo" => "Clinical and epidemiological features of keratoconus genetic and external factors in the pathogenesis of the disease"
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                        "paginaFinal" => "64"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3019073"
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                    ]
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                      "titulo" => "Graft reaction after unilateral and bilateral keratoplasty for keratoconus"
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Article information

ISSN: 01874519
Original language: English

DOI:10.1016/j.mexoft.2014.03.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	2	0	2
2024 October	48	19	67
2024 September	45	26	71
2024 August	36	34	70
2024 July	31	15	46
2024 June	53	25	78
2024 May	48	26	74
2024 April	33	17	50
2024 March	61	9	70
2024 February	80	18	98
2024 January	44	14	58
2023 December	53	41	94
2023 November	53	38	91
2023 October	84	52	136
2023 September	40	15	55
2023 August	34	19	53
2023 July	50	31	81
2023 June	61	38	99
2023 May	122	31	153
2023 April	91	50	141
2023 March	87	33	120
2023 February	84	31	115
2023 January	67	24	91
2022 December	46	40	86
2022 November	54	41	95
2022 October	51	31	82
2022 September	62	26	88
2022 August	60	17	77
2022 July	39	12	51
2022 June	48	26	74
2022 May	48	23	71
2022 April	118	12	130
2022 March	87	24	111
2022 February	63	7	70
2022 January	109	16	125
2021 December	67	22	89
2021 November	40	20	60
2021 October	36	61	97
2021 September	47	29	76
2021 August	57	8	65
2021 July	50	36	86
2021 June	32	24	56
2021 May	40	23	63
2021 April	102	28	130
2021 March	52	12	64
2021 February	61	16	77
2021 January	60	19	79
2020 December	44	11	55
2020 November	41	12	53
2020 October	45	15	60
2020 September	105	20	125
2020 August	42	5	47
2020 July	34	9	43
2020 June	31	9	40
2020 May	40	12	52
2020 April	29	8	37
2020 March	59	11	70
2020 February	45	8	53
2020 January	50	4	54
2019 December	57	8	65
2019 November	46	12	58
2019 October	43	19	62
2019 September	73	9	82
2019 August	42	4	46
2019 July	75	10	85
2019 June	142	18	160
2019 May	248	44	292
2019 April	119	23	142
2019 March	47	11	58
2019 February	47	13	60
2019 January	55	11	66
2018 December	46	11	57
2018 November	65	1	66
2018 October	89	14	103
2018 September	32	7	39
2018 August	40	2	42
2018 July	23	5	28
2018 June	27	5	32
2018 May	27	7	34
2018 April	51	6	57
2018 March	31	0	31
2018 February	24	3	27
2018 January	26	0	26
2017 December	23	3	26
2017 November	33	7	40
2017 October	26	14	40
2017 September	22	7	29
2017 August	31	3	34
2017 July	22	3	25
2017 June	21	8	29
2017 May	28	16	44
2017 April	32	7	39
2017 March	34	14	48
2017 February	22	7	29
2017 January	33	3	36
2016 December	36	12	48
2016 November	65	5	70
2016 October	63	5	68
2016 September	65	10	75
2016 August	45	4	49
2016 July	44	5	49
2016 June	33	18	51
2016 May	16	21	37
2016 April	32	18	50
2016 March	28	20	48
2016 February	13	33	46
2016 January	12	22	34
2015 December	11	13	24
2015 November	22	21	43
2015 October	25	20	45
2015 September	22	13	35
2015 August	18	18	36
2015 July	13	23	36
2015 June	17	23	40
2015 May	30	26	56
2015 April	21	27	48
2015 March	25	28	53
2015 February	26	13	39
2015 January	22	10	32
2014 December	38	12	50
2014 November	28	11	39
2014 October	58	34	92
2014 September	127	47	174
2014 August	99	20	119

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