Identificación de extensión extraocular en el melanoma uveal mediante ecografía oftalmológica | Archivos de la Sociedad Española de Oftalmología

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El melanoma uveal &#40;MU&#41; es el tumor intraocular primario maligno m&#225;s frecuente en la poblaci&#243;n adulta&#44; con una incidencia media de aproximadamente seis casos por mill&#243;n de habitantes y a&#241;o<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">1</span></a>&#46; Tiene una supervivencia de aproximadamente el 50&#37; de pacientes tras 15 a&#241;os del diagn&#243;stico y buena respuesta local al tratamiento&#44; supervivencia que&#44; no ha aumentado en las &#250;ltimas cuatro d&#233;cadas pese a los avances en el conocimiento y tratamiento del mismo<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La infiltraci&#243;n del cuerpo ciliar y la extensi&#243;n extraocular &#40;EE&#41; son signos de riesgo cl&#237;nicos y anatomopatol&#243;gicos cuya presencia empeora el pron&#243;stico vital del MU<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#8211;9</span></a>&#46; Adem&#225;s&#44; su presencia tiende a asociarse con tipos histol&#243;gicos particulares &#40;melanomas de tipo epitelioide&#41; que se vinculan a una peor supervivencia de los pacientes afectos<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Se ha descrito que hasta un 13&#37; de los ojos enucleados presentan extensiones extraoculares<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">10&#8211;13</span></a>&#46; Fisiopatol&#243;gicamente las EE se han descrito como formas de crecimiento celular tumoral a trav&#233;s de distintas rutas esclerales preexistentes como los canales de drenaje del canal de Schlemm&#44; las arterias ciliares anteriores y posteriores&#44; las venas vorticosas&#44; la entrada de los nervios ciliares cortos y largos y el nervio &#243;ptico&#46; A pesar de la malignidad de este tumor la perforaci&#243;n escleral directa esta descrita en muy pocos casos<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">14&#44;15</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las EE que afectan al polo anterior del globo ocular son de diagn&#243;stico m&#225;s f&#225;cil&#44; en ocasiones por el propio paciente&#44; se detectan masas pigmentadas subconjuntivales o subtenonianas&#44; y en algunos casos la aparici&#243;n de l&#225;grimas pigmentadas&#46; Hay que diferenciarlos de la escleromalacia que son zonas de adelgazamiento escleral con transparencia de la &#250;vea subyacente&#44; generalmente secundarias a la radioterapia <span class="elsevierStyleItalic">proton beam</span> o braquiterapia o a enfermedades inflamatorias esclerales<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de las EE postecuatoriales es m&#225;s dif&#237;cil y se requieren para ello t&#233;cnicas de imagen sensibles para detectar estas lesiones&#46; Entre ellas destaca la ecograf&#237;a oftalmol&#243;gica&#44; demostrada en varios estudios como prueba suficiente para el diagn&#243;stico y seguimiento de las EE<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#8211;22</span></a>&#46; Se las identifica en la ecograf&#237;a como masas episclerales adyacentes a la base del tumor primario intraocular&#44; con una estructura interna y bordes regulares y una reflectividad interna baja con respecto al tumor primario&#46; La ecograf&#237;a detecta masas de al menos 1&#44;5 mm de di&#225;metro en adelante y en modo estandarizada A puede ser v&#225;lida y eficaz para detectar tanto la reflectividad interna como el pulso vascular de una EE posterior<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">21</span></a>&#46; Es importante distinguir bien una masa de la inserci&#243;n de un m&#250;sculo recto ya que pueden presentar im&#225;genes similares&#44; sobretodo cuando han sido movilizados y resuturados luego del tratamiento con braquiterapia<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por otra parte&#44; se han publicado algunos trabajos en los que se valora la biomicroscop&#237;a ultras&#243;nica &#40;BMU&#41; en el an&#225;lisis de las EE de localizaci&#243;n anterior&#44; sobre todo para la localizaci&#243;n de las v&#237;as de extensi&#243;n celular sobre el tejido escleral<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El objetivo de este estudio es describir las caracter&#237;sticas ecogr&#225;ficas de las EE tanto anteriores como posteriores de pacientes valorados en la Unidad de Retina Quir&#250;rgica y Tumores Intraoculares del Adulto &#40;URQTIA&#41; del Servicio de Oftalmolog&#237;a del Complejo Hospitalario Universitario de Santiago de Compostela&#44; en los &#250;ltimos 16 a&#241;os&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se ha llevado a cabo un estudio retrospectivo y descriptivo en 10 pacientes consecutivos&#44; con el diagn&#243;stico de MU y EE en la URQTIA&#44; en el periodo comprendido desde enero de 2003 hasta diciembre de 2019&#44; ambos incluidos&#46; Todos los pacientes fueron sometidos a una exploraci&#243;n oftalmol&#243;gica completa al diagn&#243;stico y en los seguimientos posteriores una vez aplicado el tratamiento local &#40;braquiterapia con I125&#44; enucleaci&#243;n o ambos&#41;&#46; Durante los cinco primeros a&#241;os se llev&#243; a cabo un rastreo metast&#225;sico semestral&#44; incluyendo&#58; anal&#237;tica sangu&#237;nea completa con determinaci&#243;n de enzimas hep&#225;ticas y ant&#237;geno carcinoembrionario&#44; radiograf&#237;a anteroposterior y lateral de t&#243;rax y ecograf&#237;a abdominal&#46; Se indic&#243; el tratamiento primario y secundario a cada paciente dependiendo de las caracter&#237;sticas de cada MU y de la evoluci&#243;n de los mismos&#46; En todos los pacientes sometidos a enucleaci&#243;n se estudi&#243; la pieza por el servicio de Anatom&#237;a patol&#243;gica de nuestro centro&#46; En aquellos casos en que se detect&#243; una EE despu&#233;s de la braquiterapia I125 se hizo enucleaci&#243;n con el correspondiente estudio anatomo-patol&#243;gico&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El almacenamiento y el estudio de im&#225;genes oftalmol&#243;gicas mediante fotograf&#237;as del segmento anterior y ecograf&#237;as mediante 10 MHz&#44; se realiz&#243; de acuerdo con los principios de la Declaraci&#243;n de Helsinki&#46; Se obtuvo un Consentimiento Informado por escrito de todos los pacientes incluidos&#46; La aprobaci&#243;n se obtuvo del Comit&#233; de &#201;tica local de Galicia &#40;C&#243;digo de registro 2009&#47;128&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Se han dividido las EE detectadas en estos pacientes en dos tipos&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0050" class="elsevierStylePara elsevierViewall">EE anteriores&#58; cuando las lesiones se identificaban en la porci&#243;n ocular explorable &#243;pticamente con l&#225;mpara de hendidura&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0055" class="elsevierStylePara elsevierViewall">EE posteriores&#58; cuando se detectaron exclusivamente mediante ecograf&#237;a oftalmol&#243;gica&#46; Ser&#237;an aquellos casos en los que la extensi&#243;n a trav&#233;s de la esclera ocurri&#243; en la parte del globo ocular posterior al segmento anterior explorable &#243;pticamente&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">En todos los casos se llev&#243; a cabo una ecograf&#237;a oftalmol&#243;gica&#44; tanto para el diagn&#243;stico como para el seguimiento de aquellos casos sometidos a braquiterapia &#40;I3 ABD-System Innovative Imaging&#44; CA&#44; USA y Aviso Quantel-Medical&#44; France&#41;&#46; En ambos casos las sondas ecogr&#225;ficas utilizadas eran de 10 MHz y en contacto directo con el globo ocular &#40;p&#225;rpados abiertos&#41; utilizando geles de carb&#243;meros al 2&#37; como conductor&#46; En cada ecograf&#237;a se estudiaron las proyecciones longitudinales y transversales sobre el meridiano y relaci&#243;n ecuatorial de cada una de las masas tumorales&#46; Esas proyecciones se repitieron en todas las exploraciones ecogr&#225;ficas subsiguientes con el fin de asegurar el adecuado control evolutivo de las masas&#46; Para llevar a cabo la BMU se utiliz&#243; la sonda de 50 MHz &#40;Aviso Quantel-Medical&#44; France&#41;&#44; apoyada sin contacto en una cobertura de gel tipo carb&#243;mero denso y aplicado sobre la superficie ocular con ayuda de un blefar&#243;stato&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">En cada consulta se registran las medidas de las masas&#58; altura y bases longitudinal y transversal&#46; En todas las revisiones se valoraron los cuatro cuadrantes del globo ocular en b&#250;squeda de patolog&#237;as asociadas&#44; entre ellas las EE posteriores&#46; En caso de detectar una EE&#44; se hizo fotograf&#237;as de segmento anterior y BMU en caso de ser anteriores y ecograf&#237;a con sonda de 10 MHz en las posteriores&#46; Los registros de imagen se almacenan en cada historia cl&#237;nica siguiendo las actuaciones de la Ley Org&#225;nica 3&#47;2018&#44; del 5 de diciembre&#44; de Protecci&#243;n de Datos Personales y garant&#237;a de los derechos digitales&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El an&#225;lisis de datos cl&#237;nicos y ecogr&#225;ficos se tabularon en Microsoft Excel para Windows y Mac Preview 14&#46;0&#46;0&#46; En este trabajo se realiza un estudio descriptivo analizando y evaluando diferentes variables cualitativas y cuantitativas&#46; Los an&#225;lisis de frecuencia y porcentajes de las variables cualitativas&#44; as&#237; como la media y desviaciones est&#225;ndar &#40;DS&#41; se realizaron con el paquete estad&#237;stico SPSS 21&#46;0 &#40;SPSS Inc&#44; Chicago&#44; IL&#44; USA&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0075" class="elsevierStylePara elsevierViewall">La edad media de los pacientes incluidos en el estudio ha sido de 72&#44;3 a&#241;os &#40;SD&#58; 15&#44;56&#41; y han sido ocho mujeres y dos varones&#46; En cinco casos fueron globos oculares derechos y otros cinco casos en globos oculares izquierdos&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La media de las dimensiones iniciales de los MU fue de &#40;mm&#41;&#58; Bl&#58; 13&#44;54 &#40;SD&#58; 2&#44;18&#41; x Bt&#58; 12&#44;28 &#40;SD&#58; 2&#44;09&#41; x A&#58; 7&#44;70 &#40;SD&#58; 2&#44;97&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Siguiendo la clasificaci&#243;n de tama&#241;os del <span class="elsevierStyleItalic">Collaborative Ocular Melanoma Study</span> &#40;COMS&#41;&#58; cuatro casos fueron del tama&#241;o grande &#40;3 G1 y 1 G2&#41;&#44; 5 casos fueron de tama&#241;o mediano &#40;M&#41; y un caso de tama&#241;o peque&#241;o &#40;P1&#41;&#46; Seg&#250;n la morfolog&#237;a del tumor primario se ha visto cuatro casos de champi&#241;&#243;n y seis casos de cupuliforme &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Todos los casos de melanomas en champi&#241;&#243;n fueron regulares en la presentaci&#243;n de su c&#250;pula con respecto a la base del tumor&#44; excepto en el caso 8&#46; Al comparar la media de altura de los cupuliformes &#40;6&#44;82 &#91;SD&#58; 3&#44;14&#93;&#41; con respecto a la media de la altura de los champi&#241;ones &#40;11&#44;54 &#91;SD&#58;3&#44;49&#93;&#41; hab&#237;a una diferencia esperable por la propia ruptura de la membrana de Bruch de los casos del &#250;ltimo grupo&#46; Sin embargo&#44; no era valorable la diferencia estad&#237;stica por el escaso n&#250;mero de casos en cada subserie&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">En cinco pacientes el tratamiento inicial fue la enucleaci&#243;n &#40;casos 1&#44; 4&#44; 6&#44; 8 y 10&#41; por el tama&#241;o de la masa &#40;cuatro de tama&#241;o grande COMS&#41; o por la EE de tama&#241;o grande en el momento del diagn&#243;stico del MU &#40;paciente 8&#41;&#46; En los restantes cinco casos &#40;casos 2&#44; 3&#44; 5&#44; 7 y 9&#41; la EE se present&#243; con posterioridad a la braquiterapia I125 &#40;media de 30 meses &#91;SD&#58; 22&#44;69&#93;&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En cuatro casos la EE fue anterior al ecuador&#58; dos casos diagnosticados en la visita inicial y dos despu&#233;s de la braquiterapia&#46; En seis casos la EE fue posterior al ecuador&#44; y por tanto identificadas por estudio ecogr&#225;fico &#40;tres casos en el momento del diagn&#243;stico y tres despu&#233;s de braquiterapia&#41;&#46; La medida media de las EE posteriores fue &#40;mm&#41;&#58; Bl&#58; 9&#44;60 &#40;SD&#58; 4&#44;20&#41; x A&#58; 5&#44;36 &#40;SD&#58; 1&#44;71&#41;&#44; obtenidos respectivamente como la base paralela a la esclera suprayacente y la altura de la masa&#46; Se dividieron las EE en morfolog&#237;a nodular &#40;dos casos&#41; o cupuliformes &#40;ocho casos&#41; y fueron en todos los casos adyacentes a la esclera y no se detect&#243; una conexi&#243;n transescleral con la lesi&#243;n original mediante ecograf&#237;a&#46; En todos estos casos la reflectividad y el tama&#241;o de la lesi&#243;n fue menor que la de la masa intraocular&#46; En todos estos pacientes se confirm&#243; la presencia de EE mediante visualizaci&#243;n directa en las cirug&#237;as para braquiterapia o enucleaci&#243;n&#59; en las &#250;ltimas tambi&#233;n mediante anatom&#237;a patol&#243;gica&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En los ojos enucleados el 87&#44;5&#37; de los casos mostraron un patr&#243;n epitelioide&#44; el 12&#44;5&#37; restante mostr&#243; un patr&#243;n mixto epitelioide &#43; fusocelular B&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Hasta la fecha cuatro pacientes presentaron enfermedad metast&#225;sica de forma conocida &#40;casos 2&#44; 5&#44; 6 y 7&#41;&#44; el 100&#37; de ellos mostraron afectaci&#243;n hep&#225;tica y el paciente 5 tambi&#233;n mostr&#243; afectaci&#243;n subcut&#225;nea&#46; De ellos&#44; fueron sometidos a quimioterapia en el Servicio de Oncolog&#237;a los casos 2 y 7&#46; En estos pacientes la met&#225;stasis y la aparici&#243;n de la EE fueron detectadas despu&#233;s de la misma consulta de revisi&#243;n&#44; a los 14 y 18 meses respectivamente&#46; Los casos 5 y 6 presentaron la enfermedad metast&#225;sica en los 6 meses consecutivos al diagn&#243;stico de la EE&#44; tanto en el paciente 5 despu&#233;s de la enucleaci&#243;n tras la I<span class="elsevierStyleSup">125</span> por detectar la EE 40 meses despu&#233;s&#44; o el paciente 6 en los que la EE se identific&#243; en el momento del diagn&#243;stico de la enfermedad&#46; El corto tiempo de seguimiento de los &#250;ltimos pacientes agregados no nos permite conocer con exactitud su comportamiento especialmente durante el rastreo metast&#225;sico semestral en los primeros cinco a&#241;os&#44; lo que podr&#237;a variar los resultados de este apartado&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0105" class="elsevierStylePara elsevierViewall">Las EE empeoran el pron&#243;stico de supervivencia de los pacientes con MU<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; La ecograf&#237;a juega un papel importante en el diagn&#243;stico de las EE&#44; tanto en las anteriores&#44; combinada con una minuciosa exploraci&#243;n &#243;ptica del polo anterior como en las posteriores en donde adquiere mayor importancia para el diagn&#243;stico y seguimiento<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">17&#8211;22</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las caracter&#237;sticas demogr&#225;ficas de la poblaci&#243;n de este estudio son similares a las reportadas por otros estudios&#46; La edad media al diagn&#243;stico es algo mayor con 72&#44;3 a&#241;os frente a los 61-62 a&#241;os reportados por otros estudios<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">2&#44;15&#44;16</span></a>&#44; en cuanto a la lateralidad afectada como a la distribuci&#243;n por g&#233;neros no existen diferencias significativas entre grupos&#46; En cuanto a la morfolog&#237;a de los tumores primarios de este estudio predominan los tumores cupuliformes frente a los en &#171;champi&#241;&#243;n&#187; lo que concuerda con otros estudios<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Parece que las EE pueden tener relaci&#243;n con el tama&#241;o inicial al diagn&#243;stico del tumor primario&#46; En este grupo de pacientes&#44; nueve casos correspond&#237;an a MU de tama&#241;o grande o tama&#241;o mediano&#46; S&#243;lo hab&#237;a un caso de tama&#241;o peque&#241;o &#40;paciente 9&#41; en el que se recurri&#243; a la enucleaci&#243;n por la aparici&#243;n de la EE de tama&#241;o muy grande &#40;15 X 8 mm&#41; tras 65 meses de seguimiento post-braquiterapia y con signos de buena respuesta de la masa intraocular&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La exploraci&#243;n ecogr&#225;fica de todos los cuadrantes oculares es mandatorio en los pacientes diagnosticados de melanoma uveal&#46; Existen varios signos ecogr&#225;ficos que pueden confundirnos y simular una EE&#44; entre ellos las inflamaciones del espacio de Tenon&#44; las inserciones musculares y el engrosamiento o mal localizaci&#243;n de bordes &#40;especialmente luego de cirug&#237;a&#41; son algunos de ellos&#46; En nuestra serie de casos todas las EE detectadas por ecograf&#237;a se correspondieron verdaderamente a proliferaciones tumorales secundarias al tumor intraocular primario&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">La EE puede encontrarse en el momento del diagn&#243;stico del MU o despu&#233;s de la administraci&#243;n de tratamientos conservadores como la braquiterapia&#46; En los primeros casos hay que tener en cuenta el mal pron&#243;stico vital de la enfermedad en tumores con EE al momento de diagn&#243;stico&#46; En los otros pacientes&#44; ya previamente tratados&#44; probablemente se trata de recidivas locales con un empeoramiento importante de la agresividad celular<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a>&#46; En este estudio hab&#237;a el mismo n&#250;mero de pacientes en cada uno de estos dos grupos&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La mayor&#237;a de los pacientes de esta serie fueron enucleados&#44; ya sea de manera primaria en el momento del diagn&#243;stico o bien despu&#233;s de las recidivas locales post-braquiterapia con I<span class="elsevierStyleSup">125</span> del tumor primario&#46; El tama&#241;o de las EE &#40;Bl&#58;9&#44;60 &#40;SD&#58; 4&#44;20&#41; X A&#58; 5&#44;36 &#40;SD&#58;1&#44;71&#41;&#41; fue el factor determinante para decidir la enucleaci&#243;n&#46; En estudios comparativos previos se ha planteado la posibilidad de tratamientos conservadores en casos con EE&#44; con supervivencias similares a los pacientes sometidos a la enucleaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">15</span></a> pero en nuestro estudio no se plante&#243; esta posibilidad&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En nuestro estudio se pudo comprobar en ocho pacientes la confirmaci&#243;n de la EE por estudio anatomo-patol&#243;gico&#46; Los otros dos pacientes iniciaron tratamiento de quimioterapia &#40;pacientes 2 y 7&#41; al presentar EE junto a met&#225;stasis&#59; ambos fallecieron sin llegar a la enucleaci&#243;n por lo avanzado de la enfermedad sist&#233;mica&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Algunos estudios han encontrado casos con EE posiblemente secundarias a una punci&#243;n transescleral para biopsia pron&#243;stica&#44; como consecuencia de la siembra y crecimiento de c&#233;lulas malignas en el trayecto de la punci&#243;n<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Como otras pruebas para el diagn&#243;stico por imagen de las EE se ha considerado la resonancia magn&#233;tica nuclear &#40;RMN&#41; en varios trabajos&#46; Se ha visto que es una t&#233;cnica de imagen que probablemente posee mayor sensibilidad que la ecograf&#237;a ocular para detectar las EE<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">26&#44;27</span></a>&#46; Este resultado siempre depende de la resoluci&#243;n de las im&#225;genes&#44; y la experiencia de los radi&#243;logos especializados en el diagn&#243;stico de estos tumores<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a>&#46; El costo de esta prueba no la convierte en adecuada para protocolizarla en el diagn&#243;stico y seguimiento de estos pacientes&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La presencia de EE es un signo de mal pron&#243;stico vital de los pacientes con MU&#46; La ecograf&#237;a ocular es una prueba de diagn&#243;stico importante para estas lesiones independiente de la localizaci&#243;n anterior o posterior&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0155" class="elsevierStylePara elsevierViewall">Instituto de la Salud Carlos III&#47;PI16&#47;00143&#47;FEDER&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Todos los autores declaran no tener conflictos de inter&#233;s relacionados con este trabajo&#46;</p></span></span>"
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              "titulo" => "Background and purpose"
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            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Results"
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            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Discussion"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1473278"
          "titulo" => "Keywords"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introducci&#243;n"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Material y m&#233;todos"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Resultados"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discusi&#243;n"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Financiaci&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicto de intereses"
        ]
        10 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-08-25"
    "fechaAceptado" => "2021-02-03"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1473277"
          "palabras" => array:3 [
            0 => "Extensi&#243;n extraocular"
            1 => "Melanoma uveal"
            2 => "Ecograf&#237;a oftalmol&#243;gica"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1473278"
          "palabras" => array:3 [
            0 => "Extraocular extensi&#243;n"
            1 => "Uveal melanoma"
            2 => "Ophthalmic ultrasound"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Antecedentes y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El melanoma uveal es el tumor primario maligno intraocular m&#225;s frecuente en la poblaci&#243;n adulta&#44; con una tasa de supervivencia del 50&#37; a pesar de los avances en el tratamiento y conocimiento de esta enfermedad&#46; La presencia de extensi&#243;n extraocular &#40;EE&#41; empeora el pron&#243;stico de estos pacientes&#44; por lo que su correcta identificaci&#243;n puede asegurar su manejo e intervenci&#243;n temprana&#46; La ecograf&#237;a oftalmol&#243;gica es la t&#233;cnica de elecci&#243;n para el diagn&#243;stico y seguimiento de estos pacientes&#44; tanto de la EE anterior mediante biomicroscop&#237;a ultras&#243;nica &#40;UBM&#41;&#44; como de la EE posterior mediante ecograf&#237;a A y B&#46; El objetivo de este estudio es describir las caracter&#237;sticas ecogr&#225;ficas de la UBM y de la ecograf&#237;a A y B&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiza un estudio descriptivo y retrospectivo de los pacientes diagnosticados de melanoma uveal &#40;UM&#41; y EE desde 2003 hasta 2019&#46; Las caracter&#237;sticas ecogr&#225;ficas de la enfermedad local y el seguimiento luego del tratamiento se registraron de manera</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">completa y en cada visita&#46; En caso de EE anteriores se realizaron fotograf&#237;as de segmento anterior y BMU&#44; por el contrario las que involucran el segmento posterior se exploraron bajo ecograf&#237;a modo A y B&#46; Todos los ojos enucleados se enviaron para su estudio anatomopatol&#243;gico&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 10 pacientes con una edad media de 72&#44;3 a&#241;os&#46; La mayor proporci&#243;n de ellos eran tumores de tama&#241;o medio&#44; seguidos de los grandes y peque&#241;os&#46; La morfolog&#237;a m&#225;s frecuente del tumor primario fue la cupuliforme&#46; Todos los EE presentaban una reflectividad interna inferior a la del tumor primario&#46; No se encontraron puentes de conexi&#243;n transescleral entre el tumor primario y el EE en los estudios ecogr&#225;ficos&#46; El 50&#37; de los pacientes fueron sometidos a enucleaci&#243;n primaria en el momento del diagn&#243;stico del MU intraocular debido a la presencia de la EE&#44; y el 50&#37; restante present&#243; la EE tras el tratamiento inicial del tumor primario con braquiterapia I125&#46; El 60&#37; de los pacientes presentaron EE posterior&#44; por lo que fueron diagnosticados con ecograf&#237;a A y B&#46; El patr&#243;n histopatol&#243;gico m&#225;s frecuente con el 87&#44;5&#37; de los pacientes fue el patr&#243;n epitelioide&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a en pacientes con MU es obligatoria para el diagn&#243;stico y seguimiento de la EE&#46; La BMU y la ecograf&#237;a A y B son las pruebas de elecci&#243;n para las EE anteriores y posteriores&#44; respectivamente&#46; Las EE tienen caracter&#237;sticas ecogr&#225;ficas particulares como la baja reflectividad interna&#44; la regularidad de su contorno y su localizaci&#243;n generalmente adyacente a la base del tumor intraocular primario&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Discusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Background and purpose</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Uveal melanoma is the most common primary malignant intraocular tumour in the adult population&#44; with a survival rate of 50&#37; despite advances in treatment and knowledge of this disease&#46; The presence of extraocular extension &#40;EE&#41; worsens the prognosis of these patients&#44; so its proper identification can ensure its management and early intervention&#46; Ophthalmological ultrasound is the technique of choice for the diagnosis and follow-up of these patients&#44; both of the anterior EE using ultrasonic biomicroscopy &#40;UBM&#41;&#44; and the posterior EE using A and B ultrasound&#46; The aim of this study is to describe the ultrasound characteristics of the BMU and the A and B ultrasound&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A descriptive and retrospective study is carried out on patients diagnosed with uveal melanoma &#40;UM&#41; and EE from 2003 to 2019&#46; The ultrasound characteristics of the local disease and the follow-up after treatment were recorded completely and at each visit&#46; In the case of anterior EE&#44; photographs of the anterior segment and UBM were taken&#44; while those involving the posterior segment were explored under A and B mode ultrasound&#46; All enucleated eyes were sent for anatomopathological study&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ten patients with an average age of 72&#46;3 years were included&#46; The largest proportion of them were medium-sized tumours&#44; followed by large and small ones&#46; The most frequent morphology of the primary tumour was cupuliform&#46; All the EE presented lower internal reflectivity compared to the primary tumour&#46; No trans-scleral connection bridges were found between the primary tumour and the EE in the ultrasound studies&#46; 50&#37; of patients underwent primary enucleation at the time of diagnosis of intraocular MU due to the presence of the EE&#44; and the remaining 50&#37; presented the EE after initial treatment of the primary tumour with I125 brachytherapy&#46; Sixty percent of the patients presented with posterior EE&#44; and were therefore diagnosed with ultrasound A and B&#46; The most frequent histopathological pattern with 87&#46;5&#37; of patients was the epithelioid pattern&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ultrasound scanning in patients with MU is mandatory for diagnosis and follow-up of EE&#46; BMU and A and B ultrasound are the test of choice for anterior and posterior EE&#44; respectively&#46; EE have particular ultrasound characteristics such as low internal reflectivity&#44; regularity of their contour and their location usually adjacent to the base of the primary intraocular tumor&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Background and purpose"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Discussion"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1324
            "Ancho" => 1750
            "Tamanyo" => 237955
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Proyecciones ecogr&#225;ficas de los seis casos caracterizados por EE posteriores &#40;casos 2&#44; 4&#44; 6&#44; 7&#44; 8 y 9&#41;&#46; Las ecograf&#237;as representadas son las proyecciones obtenidas en el momento del diagn&#243;stico de la EE y el corte en el cual se centra la misma lesi&#243;n&#46; Las dimensiones del MU que se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> son las originales en el diagn&#243;stico inicial de la enfermedad&#44; y la dimensi&#243;n del EE corresponder&#237;a a la extensi&#243;n en el diagn&#243;stico de la misma&#46; La flecha blanca representa el &#225;pex de la masa intraocular y la flecha gris la EE&#46; Es importante fijarse en la diferencia de tama&#241;o&#44; localizaci&#243;n y reflectividad de las EE con relaci&#243;n a la masa intraocular&#46; El caso 8 representaba una morfolog&#237;a de champi&#241;&#243;n irregular&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso&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">Sexo&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">Edad&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">Ojo&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">Morfolog&#237;a tumor primario&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">Dimensi&#243;n de MU &#40;mm&#41; Bl x Bt x A&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">Tama&#241;o COMS&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">Tratamiento inicial&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">Tratamiento final&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">Detecci&#243;n de EE&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">Dimensi&#243;n de EE &#40;mm&#41;&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">Morfolog&#237;a de EE&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">Localizaci&#243;n de EE&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">Enfermedad Sist&#233;mica&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">Anatom&#237;a patol&#243;gica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&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">76&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">OI&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">Nodular&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&#44;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">G1&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">Enucleaci&#243;n&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><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">Al diagn&#243;stico&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><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">Cupuliforme&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">Anterior&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">No&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">Epitelioide&nbsp;\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="" 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="" 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="" 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="" 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="" 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
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                  \t\t\t\t">Fallecimiento sin enucleaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">I<span class="elsevierStyleSup">125</span>&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">Enucleaci&#243;n&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">5 meses tras I<span class="elsevierStyleSup">125</span>&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><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">Cupuliforme&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">Anterior&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">No&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">Epitelioide&nbsp;\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="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;22&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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  " 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  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;89&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  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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  " align="" valign="\n
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                  \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="" valign="\n
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                  \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="" valign="\n
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                  \t\t\t\t">&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  " 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  " 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  " align="" valign="\n
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                  \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="" valign="\n
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                  \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">4&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">M&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">76&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">OD&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">Nodular&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">14&#44;5&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">G1&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">Enucleaci&#243;n&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><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">Al diagn&#243;stico&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">5 x 5&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">Cupuliforme&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">Posterior&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">No&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">Epitelioide&nbsp;\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="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;8&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  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t</td><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">10&#44;82&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65&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">OI&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">Nodular&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&#44;02&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">M&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">I<span class="elsevierStyleSup">125</span>&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">Enucleaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">48 meses tras I<span class="elsevierStyleSup">125</span>&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
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Cupuliforme&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Anterior&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">H&#237;gado Piel&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">Epitelioide &#43; Fusocelular B&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">14&#44;10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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">6&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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&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">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">OD&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">Champi&#241;&#243;n&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&#44;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">G2&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">Enucleaci&#243;n&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><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">Al diagn&#243;stico&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 x 4&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">Cupuliforme&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">Posterior&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">H&#237;gado&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">Epitelioide&nbsp;\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="" 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  " align="left" valign="\n
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                  \t\t\t\t">15&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;72&nbsp;\t\t\t\t\t\t\n
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                  \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">7&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">M&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">77&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">OD&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">Nodular&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&#44;99&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">M&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">I<span class="elsevierStyleSup">125</span>&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">Quimioterapia&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">14 meses tras I<span class="elsevierStyleSup">125</span>&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">11&#44;98 x 5&#44;04&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">Cupuliforme&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">Posterior&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">H&#237;gado&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">Fallecimiento sin enucleaci&#243;n&nbsp;\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="" valign="\n
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                  \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  " align="" valign="\n
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                  \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">12&#44;20&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  " align="left" valign="\n
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                  \t\t\t\t">4&#44;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&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  " align="" valign="\n
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                  \t\t\t\t">&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  " align="" valign="\n
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                  \t\t\t\t">&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  " align="" valign="\n
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                  \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="" valign="\n
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                  \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">8&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">V&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">82&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">OI&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">Champi&#241;&#243;n&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&#44;60&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">M&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">Enucleaci&#243;n&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><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">Al diagn&#243;stico&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&#44;6 x 7&#44;09&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">Nodular&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">Posterior&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">No&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">Epitelioide&nbsp;\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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">OI&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">Champi&#241;&#243;n&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">12&#44;21&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">G1&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">Enucleaci&#243;n&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><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">Al diagn&#243;stico&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><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">Cupuliforme&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">Anterior&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">No&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">Epitelioide&nbsp;\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="" 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="" 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="" 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="" 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="" 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">10&#44;67&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><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><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><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><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><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><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><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><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
                  \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><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><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><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><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><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">11&#44;37&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><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><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><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><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><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><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><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><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2822262.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los pacientes incluidos en el estudio</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Melanomas Of The Eye And Other Noncutan Eous Sites&#58; Epidemiologic Aspects"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Scotto"
                            1 => "J&#46; Fraumeni"
                            2 => "J&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/jnci/56.3.489"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst&#46;"
                        "fecha" => "1976"
                        "volumen" => "56"
                        "paginaInicial" => "489"
                        "paginaFinal" => "491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1255781"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
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            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Uveal melanoma&#58; Trends in incidence&#44; treatment&#44; and survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;D&#46; Singh"
                            1 => "M&#46;E&#46; Turell"
                            2 => "A&#46;K&#46; Topham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2011.01.040"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology &#91;Internet&#93;&#46;"
                        "fecha" => "2011"
                        "volumen" => "118"
                        "paginaInicial" => "1881"
                        "paginaFinal" => "1885"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21704381"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International validation of the American Joint Committee on Cancer&#39;s 7 th edition classification of uveal melanoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Rand Simpson"
                            1 => "B&#46;L&#46; Gallie"
                            2 => "S&#46; Saakyan"
                            3 => "A&#46; Amiryan"
                            4 => "P&#46;T&#46; Finger"
                            5 => "K&#46;J&#46; Chin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamaophthalmol.2014.5395"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA Ophthalmol&#46;"
                        "fecha" => "2015"
                        "volumen" => "133"
                        "paginaInicial" => "376"
                        "paginaFinal" => "383"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25555246"
                            "web" => "Medline"
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            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of Sarcoma of the Uveal Tract"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46; Byers"
                            1 => "J&#46; Macmillan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med J&#46;"
                        "fecha" => "1924"
                        "volumen" => "2"
                        "paginaInicial" => "397"
                        "paginaFinal" => "398"
                        "itemHostRev" => array:3 [
                          "pii" => "S0016508505022742"
                          "estado" => "S300"
                          "issn" => "00165085"
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            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extrascleral extension and orbital recurrence of malignant melanomas of the choroyd and ciliary body"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46; Starr"
                            1 => "L&#46; Zimmerman"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int Ophthalmol Clin&#46;"
                        "fecha" => "1962"
                        "volumen" => "2"
                        "paginaInicial" => "369"
                        "paginaFinal" => "385"
                      ]
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            5 => array:3 [
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              "etiqueta" => "6"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malignant melanomas of the human uvea&#46; Recent follow up of cases in Denmark 1943-1952"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "O&#46; Jenssen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Ophthalmol&#46;"
                        "fecha" => "1970"
                        "volumen" => "48"
                        "paginaInicial" => "1113"
                        "paginaFinal" => "1128"
                      ]
                    ]
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            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Orbital Extension of Choroidal and Ciliary Body Melanomas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "H&#46;F&#46; Shammas"
                            1 => "F&#46;C&#46; Blodi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.1977.04450110096010"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Ophthalmol&#46;"
                        "fecha" => "1977"
                        "volumen" => "95"
                        "paginaInicial" => "2002"
                        "paginaFinal" => "2005"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/921579"
                            "web" => "Medline"
                          ]
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                      ]
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                ]
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            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis in Uveal Melanoma With Extrascleral Extension"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;C&#46; Affeldt"
                            1 => "D&#46;S&#46; Minckler"
                            2 => "S&#46;P&#46; Azen"
                            3 => "L&#46; Yeh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/archopht.1980.01020040827006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Ophthalmol&#46;"
                        "fecha" => "1980"
                        "volumen" => "98"
                        "paginaInicial" => "1975"
                        "paginaFinal" => "1979"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7436829"
                            "web" => "Medline"
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            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An Australian choroidal melanoma survey&#58; factors affecting survival following enucleation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Greer"
                            1 => "C&#46; Buckley"
                            2 => "J&#46; Buckley"
                            3 => "R&#46; Ramsay"
                            4 => "J&#46; La Nauze"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1442-9071.1981.tb00918.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Aust J Ophthalmol&#46;"
                        "fecha" => "1981"
                        "volumen" => "9"
                        "paginaInicial" => "255"
                        "paginaFinal" => "261"
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