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Bases de datos normativas en edad pediátrica para tomografía de coherencia óptica: una clara necesidad
Paediatric optical coherence tomography normative databases: A real need
A. Muñoz-Gallegoa,
Autor para correspondencia
amunozg@salud.madrid.org

Autor para correspondencia.
, M. Rodríguez-Salgadob, J. de la Cruzc, C. López-Lópeza, I. Cañas-Zamarraa, P. Tejada-Palaciosa,c
a Oftalmología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, España
b Atención Primaria, Servicio Madrileño de Salud (SERMAS), Madrid, España
c Instituto de investigación i+12. ISCIII, SAMID, Hospital Universitario 12 de Octubre, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Hasta hace muy pocos a&#241;os las herramientas disponibles en una consulta de oftalmolog&#237;a pedi&#225;trica eran limitadas&#58; l&#225;mpara de hendidura&#44; oftalmoscopios directo e indirecto&#44; retinoscopio y autorrefract&#243;metro&#46; El campo visual&#44; en el caso de los ni&#241;os&#44; tiene una aplicaci&#243;n muy limitada debido&#44; sobre todo&#44; a la dificultad que supone obtener pruebas v&#225;lidas&#44; ya que necesita de la atenci&#243;n continuada y sin pausas durante un per&#237;odo relativamente largo de tiempo y esto&#44; en general&#44; solo es posible en casos seleccionados&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Sin embargo&#44; desde la aparici&#243;n de la tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; en nuestras consultas&#44; el abordaje diagn&#243;stico y terap&#233;utico de muchas enfermedades se ha visto modificado&#46; Hasta el momento la OCT es la &#250;nica prueba capaz de estudiar las estructuras oculares de manera objetiva con la necesidad de un tiempo muy corto de atenci&#243;n continuada del paciente&#46; Adem&#225;s&#44; al no precisar contacto con el ojo<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">1&#44;2</span></a> a&#241;ade ventajas a su aplicaci&#243;n en poblaci&#243;n pedi&#225;trica&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pese a que la primera OCT de retina fue realizada en el a&#241;o 1989 por David Huang en el laboratorio James Fujimoto&#44; no fue hasta el a&#241;o 1996 cuando comenz&#243; a comercializarse la OCT 100&#44; la primera OCT disponible en el mercado<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; Sin embargo&#44; esta tecnolog&#237;a se criticaba porque era muy sensible a peque&#241;os movimientos oculares y parpadeos y&#44; con el objetivo de minimizar el tiempo de captura en la im&#225;genes surgi&#243; en el a&#241;o 2001 la OCT de dominio espectral &#40;SD-OCT&#41;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; Estos nuevos dispositivos permit&#237;an realizar capturas de imagen con mucha m&#225;s velocidad<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; Desde entonces&#44; con los a&#241;os&#44; se ha ido reduciendo el tiempo de procesamiento de las im&#225;genes&#44; as&#237; como la calidad de las mismas<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La b&#250;squeda de los par&#225;metros normales en la poblaci&#243;n pedi&#225;trica siempre ha sido imprescindible a la hora de la interpretaci&#243;n de diferentes pruebas en la consulta de pediatr&#237;a&#46; De sobra es conocido en el &#225;mbito pedi&#225;trico que los valores de referencia de adultos no son aplicables en ni&#241;os&#46; De hecho&#44; en cualquier consulta general de pediatr&#237;a se utilizan&#44; por ejemplo&#44; gr&#225;ficas de medidas antropom&#233;tricas en el seguimiento del ni&#241;o sano para la evaluaci&#243;n de su crecimiento&#46; Su objetivo principal es determinar la prevalencia de valores antropom&#233;tricos anormales&#44; ya que la posici&#243;n de los percentiles extremos es de gran valor<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#46; Las gr&#225;ficas m&#225;s referenciadas en Espa&#241;a son las extra&#237;das del estudio de la Fundaci&#243;n Orbegozo<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">3</span></a>&#44; que se realiz&#243; en una muestra de ni&#241;os espa&#241;oles&#46; Tambi&#233;n&#44; por ejemplo&#44; los valores de referencia pedi&#225;tricos del hemograma son diferentes a los del adulto y var&#237;an seg&#250;n la edad y el sexo del paciente<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a>&#46; Se consideran los rangos de referencia los que incluyen al 95&#37; de la poblaci&#243;n &#171;normal&#187;&#44; es decir&#44; la media poblacional<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>2 desviaciones est&#225;ndar<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Por tanto&#44; si as&#237; es como se trabaja en el mundo pedi&#225;trico en general&#44; en oftalmolog&#237;a pedi&#225;trica tambi&#233;n se deber&#237;an revisar los valores de referencia utilizados con la OCT y&#44; las bases de datos normativas utilizadas deber&#237;an ser realizadas preferiblemente con poblaci&#243;n pedi&#225;trica espa&#241;ola&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Desarrollo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Aplicaciones de la tomograf&#237;a de coherencia &#243;ptica en la oftalmolog&#237;a pedi&#225;trica</span><p id="par0030" class="elsevierStylePara elsevierViewall">Ya existen en la literatura trabajos en los que se utiliza la OCT para el diagn&#243;stico y seguimiento de enfermedades como el glaucoma pedi&#225;trico<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">5&#44;6</span></a>&#44; los gliomas de la v&#237;a &#243;ptica<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">7</span></a>&#44; la neuropat&#237;a &#243;ptica no glaucomatosa<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">8</span></a>&#44; la ambliop&#237;a<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">9</span></a> y el retinoblastoma<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Tanto en las neuropat&#237;as &#243;pticas glaucomatosas y no glaucomatosas como en las enfermedades neurol&#243;gicas la OCT se est&#225; convirtiendo en la prueba objetiva de elecci&#243;n en la poblaci&#243;n pedi&#225;trica ya que&#44; con el campo visual solo se pueden obtener pruebas fiables en casos seleccionados y en ni&#241;os relativamente mayores&#46; As&#237;&#44; por ejemplo&#44; el grosor de capa de fibras nerviosas peripapilares &#40;CFNRp&#41; puede utilizarse en el seguimiento de pacientes con papiledema&#44; habi&#233;ndose encontrado en estudios realizados en poblaci&#243;n adulta una correlaci&#243;n entre la p&#233;rdida de CFNRp y la p&#233;rdida de campo visual<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">11</span></a>&#46; Tambi&#233;n se ha correlacionado el incremento en el grosor en la CFNRp con el aumento en la presi&#243;n intracraneal en el caso de la hipertensi&#243;n intracraneal idiop&#225;tica en adultos<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">12</span></a>&#46; Actualmente la OCT del complejo de c&#233;lulas ganglionares &#40;CCG&#41; se est&#225; utilizando como indicador del da&#241;o neuronal precoz en la hipertensi&#243;n intracraneal idiop&#225;tica<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; dada la calidad de la imagen que se obtiene y la gran informaci&#243;n que nos da sobre la estructura macular&#44; es una herramienta de apoyo imprescindible en el diagn&#243;stico y manejo de enfermedades retinianas tales como la secundaria a las uve&#237;tis y la retinosquisis ligada al cromosoma X&#44; entre otras&#44; ya que se puede evaluar con relativa rapidez el estado de la m&#225;cula&#46; Esto&#44; adem&#225;s&#44; permite un seguimiento y monitorizaci&#243;n de la respuesta al tratamiento mucho m&#225;s fiable&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">En el caso de la imagen de la OCT papilar esta se ha convertido en un instrumento realmente &#250;til y r&#225;pido para diferenciar el papiledema del pseudopapiledema en casos tales como las drusas del nervio &#243;ptico<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">14&#8211;16</span></a>&#44; que cada vez con m&#225;s frecuencia se diagnostican en la edad pedi&#225;trica&#46; Esta calidad de imagen ha mejorado a&#250;n m&#225;s con la OCT de dominio espectral&#44; que incluye la tecnolog&#237;a <span class="elsevierStyleItalic">enhanced depth imaging</span><a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Definici&#243;n e importancia de las bases normativas pedi&#225;tricas</span><p id="par0050" class="elsevierStylePara elsevierViewall">Pese a que con los a&#241;os la captura y calidad de la imagen de los diferentes dispositivos&#44; as&#237; como los sistemas de segmentaci&#243;n y los softwares&#44; ha mejorado sustancialmente&#44; se han incluido pocos cambios en las bases de datos normativas<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; Tanto es as&#237; que&#44; hasta el momento actual&#44; no existe ning&#250;n modelo comercializado de OCT que incluya una base de datos normativa para poblaci&#243;n pedi&#225;trica&#44; lo que limita mucho su uso y&#44; sobre todo&#44; su interpretaci&#243;n en este grupo de edad<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Todas las bases de datos normativas que se encuentran incluidas en los diferentes modelos de OCT que existen actualmente en el mercado est&#225;n realizadas con pacientes de 18 a&#241;os o m&#225;s<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El objetivo principal de las bases de datos normativas es permitir comparar los par&#225;metros obtenidos con la normalidad&#44; y as&#237; poder obtener un informe con c&#243;digo de colores que nos oriente en el diagn&#243;stico<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; Esto tambi&#233;n nos permite monitorizar los cambios que pudieran aparecer a lo largo del tiempo<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">1</span></a>&#46; En general&#44; las OCT suelen asignar el color verde a los valores de grosor situados entre los percentiles 5 y 95&#44; utilizando estos valores como valores de referencia de normalidad<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">21</span></a>&#46; Esta limitaci&#243;n implica que&#44; pese a que obtendremos un mapa de grosor en las OCT realizadas a ni&#241;os&#44; los c&#243;digos de colores que aparecer&#225;n en los informes de an&#225;lisis se asignar&#225;n comparando los resultados obtenidos con la base de datos normativa de adultos&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ante esta situaci&#243;n&#44; la primera pregunta que nos deber&#237;amos hacer es si los valores de referencia de adultos y ni&#241;os son similares&#46; Con respecto a este punto existen en la bibliograf&#237;a estudios que apuntan a que esto no es as&#237;&#44; sino todo lo contrario<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; Con respecto a la OCT macular varios autores han concluido que el grosor en algunas &#225;reas maculares es mayor en adultos<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">19&#44;22</span></a>&#46; El grosor de CFNRp es mayor en ni&#241;os que en adultos seg&#250;n algunos autores<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">19&#44;23</span></a>&#44; aunque otros encontraron resultados muy similares<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; Bhoiwala et al&#46; concluyeron que el grosor de CFNRp y del CCG es mayor en ni&#241;os que en adultos de 55-60 a&#241;os y que los nervios &#243;pticos est&#225;n menos excavados en ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">25</span></a>&#46; En un estudio realizado por nuestro grupo de investigaci&#243;n con ni&#241;os espa&#241;oles de 5 a 18 a&#241;os con OCT Topcon 3D-2000 &#40;Topcon Corporation&#44; Tokyo&#44; Jap&#243;n&#41; para el an&#225;lisis del CCG&#44; observamos que&#44; si esta OCT tuviese incluida una base de datos normativa para ni&#241;os se detectar&#237;an m&#225;s casos de grosores anormalmente bajos de CCG<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; Totan et al&#46; tambi&#233;n encontraron un grosor de CFNRp y CCG mayor en ni&#241;os que en adultos<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Por tanto&#44; los mapas de grosor que actualmente muestran las OCT no ser&#237;an v&#225;lidos en el examen oftalmol&#243;gico de un paciente menor de 18 a&#241;os&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Bases de datos normativas para tomograf&#237;a de coherencia &#243;ptica en poblaci&#243;n pedi&#225;trica espa&#241;ola</span><p id="par0070" class="elsevierStylePara elsevierViewall">A continuaci&#243;n haremos referencia a los estudios que hay publicados en la bibliograf&#237;a realizados con poblaci&#243;n pedi&#225;trica sana espa&#241;ola y diferentes modelos de OCT&#44; ya que son las bases de datos que deber&#237;amos utilizar en nuestra pr&#225;ctica cl&#237;nica diaria&#46; En su ausencia lo recomendable ser&#237;a utilizar bases normativas realizadas con poblaci&#243;n pedi&#225;trica europea&#44; ya que en la bibliograf&#237;a a&#250;n no hay un claro consenso sobre si el origen del paciente pudiera influir en los diferentes grosores obtenidos con OCT<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">23&#44;27&#8211;32</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Por otro lado&#44; es muy importante destacar que las bases de datos normativas no son intercambiables entre los distintos dispositivos de OCT<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;34</span></a> debido a que cada modelo de OCT utiliza un algoritmo de segmentaci&#243;n diferente y&#44; adem&#225;s&#44; la superficie de retina analizada no es la misma con cada uno de ellos<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1&#46;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Cirrus OCT &#40;Carl Zeiss Meditec&#41;&#46;</p></li></ul><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">a&#46;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Grosor de CFNRp&#46;</p></li></ul><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Estudio de Barrio-Barrio et al&#46; realizado con una muestra de 301 ni&#241;os espa&#241;oles de 4 a 17 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Los autores encontraron una correlaci&#243;n positiva entre el grosor de CFNRp y el equivalente esf&#233;rico &#40;EE&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; El grosor del cuadrante inferior fue el m&#225;s grueso y el del cuadrante temporal el m&#225;s fino<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; No hubo diferencias de grosor seg&#250;n la edad o el sexo<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">Estudio de El&#237;a et al&#46; realizado con una muestra de 344 ni&#241;os espa&#241;oles de 6 a 13 a&#241;os &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46; Estos autores encontraron que el cuadrante m&#225;s grueso fue el inferior&#44; seguido del superior&#44; del nasal y temporal &#40;ISNT&#41;&#44; patr&#243;n que ya ha sido reportado en estudios previos<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">35-37</span></a>&#46; No hubo diferencias de grosor seg&#250;n la edad o el sexo<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li></ul><ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">b&#46;</span><p id="par0100" class="elsevierStylePara elsevierViewall">Grosor macular&#46; Estudio de Barrio-Barrio et al&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Los autores encontraron que el &#225;rea central era la m&#225;s fina y el anillo interno fue m&#225;s grueso que el externo<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Las &#225;reas temporales eran m&#225;s finas que las nasales en ambos anillos<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Los ni&#241;os ten&#237;an el grosor central mayor que las ni&#241;as<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Se encontr&#243; una correlaci&#243;n positiva entre la edad y el grosor promedio y el volumen macular<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46; Asimismo&#44; estos 2 par&#225;metros demostraron una correlaci&#243;n positiva con el EE<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></li></ul><ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">2&#46;</span><p id="par0105" class="elsevierStylePara elsevierViewall">OCT Topcon 3D-2000&#46; Estudio realizado por nuestro grupo de investigaci&#243;n con una muestra de 126 ni&#241;os de 5 a 18 a&#241;os para el grosor del complejo de c&#233;lulas ganglionares con OCT &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; Se encontr&#243; una correlaci&#243;n positiva entre el grosor de capa de fibras nerviosas retinianas maculares y la edad y una correlaci&#243;n positiva entre el grosor de la capa de c&#233;lulas ganglionares-capa plexiforme interna y el EE<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; El cuadrante inferior de fibras nerviosas retinianas maculares fue m&#225;s grueso que el superior<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; Este es el primer estudio que investiga qu&#233; ocurrir&#237;a si la OCT incluyese una base de datos pedi&#225;trica y si podr&#237;a haber diferencias en cuanto a la clasificaci&#243;n de grosores &#40;menor o igual al percentil 5 se considera anormal y mayor a este&#44; normal&#41; en los pacientes incluidos en el estudio&#46; Se concluy&#243; que&#44; pese a haber un acuerdo bastante alto en general entre ambas bases de datos&#44; existe un riesgo de no detectar mediciones anormales utilizando la base de datos de adultos<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46; El software que incluye la base de datos de adultos clasific&#243; solo uno de los 126 ojos con capa de c&#233;lulas ganglionares-capa plexiforme interna anormal &#40;0&#44;85&#37;&#41;&#44; mientras que la base de datos pedi&#225;trica habr&#237;a clasificado 7 ojos con valores anormales &#40;5&#44;5&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;031&#41;&#44; lo que significa que la sensibilidad fue de uno de cada 7 &#40;14&#37;&#44; 0&#44;4 a 57&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">3&#46;</span><p id="par0110" class="elsevierStylePara elsevierViewall">Spectralis &#40;Heidelberg Engineering&#44; Heidelberg&#44; Alemania&#41;&#46; Estudio de P&#233;rez-Garc&#237;a et al&#46; realizado con una muestra de 162 ni&#241;os de 3 a 14 a&#241;os para grosor macular y de CFNRp &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46; Los autores encontraron una correlaci&#243;n positiva entre el EE y los cuadrantes nasal&#44; inferior y el sector inferonasal de CFNRp<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46; El patr&#243;n encontrado para CFNRp fue&#44; de nuevo&#44; el ISNT&#44; con peque&#241;as diferencias entre los cuadrantes nasal y temporal<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46; Se encontr&#243; una correlaci&#243;n positiva entre el EE y el grosor de CFNRp nasal&#44; inferior e inferonasal<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46; En cuanto al grosor macular se encontr&#243; una correlaci&#243;n positiva entre la edad y el volumen macular&#44; el grosor foveolar y el grosor macular central<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46; Los sectores temporales&#44; de nuevo&#44; fueron m&#225;s finos que los nasales y el anillo interno fue m&#225;s grueso que el externo<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">39</span></a>&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></li></ul></p><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Bases de datos normativas para tomograf&#237;a de coherencia &#243;ptica en poblaci&#243;n pedi&#225;trica europea</span><p id="par0115" class="elsevierStylePara elsevierViewall">En la bibliograf&#237;a existen 3 estudios realizados con ni&#241;os suecos&#44; 2 de grosor macular<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;40</span></a> &#40;el primero con ni&#241;os de 5-6 a&#241;os con OCT 3 Stratus de Carl Zeiss&#44; versi&#243;n 4&#46;0&#46;1&#59; y el segundo con ni&#241;os de 6-15 a&#241;os con OCT Cirrus versi&#243;n 6&#46;0&#46;2&#46;81 y Stratus OCT 3 versi&#243;n 4&#46;0&#46;1&#44; ambas de Carl Zeiss&#41; y uno de CFNRp con ni&#241;os de 5-16 a&#241;os con Stratus OCT 3 versi&#243;n 4&#46;0&#46;1 de Carl Zeiss y HRT-II&#47;III de Heidelberg<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">34</span></a>&#46; Adem&#225;s&#44; hay un estudio realizado en ni&#241;os portugueses de 4 a 17 a&#241;os para grosor macular y CFNRp con OCT Cirrus HD&#44; modelo 4000 de Carl Zeiss<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En el grosor macular&#44; de nuevo&#44; el &#225;rea foveolar fue la m&#225;s fina y el anillo interno el m&#225;s grueso<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;40&#44;41</span></a>&#46; Las &#225;reas temporales fueron m&#225;s finas que las nasales<a class="elsevierStyleCrossRefs" href="#bib0350"><span class="elsevierStyleSup">33&#44;40&#44;41</span></a>&#46; La f&#243;vea fue significativamente m&#225;s gruesa en ni&#241;os que en ni&#241;as seg&#250;n Queir&#243;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a>&#44; aunque Eriksson et al&#46; encontraron esta misma tendencia pero sin ser estad&#237;sticamente significativa<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">40</span></a>&#46; Molnar et al&#46; no encontraron correlaci&#243;n entre los grosores maculares y el EE<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a>&#44; mientras que Queir&#243;s et al&#46; encontraron una correlaci&#243;n negativa entre el EE y el grosor foveolar<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a>&#46; En cuanto a la edad&#44; Eriksson et al&#46; no encontraron correlaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">40</span></a>&#44; sin embargo&#44; tanto el grupo de Molnar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> como el de Queir&#243;s et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a> encontraron respectivamente una correlaci&#243;n positiva entre el grosor del anillo interno y la edad<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">33</span></a> y entre el grosor foveolar y la edad<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En cuanto al grosor de CFNRp&#44; de nuevo&#44; Queir&#243;s et al&#46; y Larsson et al&#46; encontraron el patr&#243;n ISNT&#44; aunque no hubo diferencias estad&#237;sticamente significativas entre el cuadrante inferior y superior<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">34&#44;41</span></a>&#46; Tanto el estudio sueco como el portugu&#233;s no encontraron correlaci&#243;n del CFNRp con la edad o el sexo<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">34&#44;41</span></a> Queir&#243;s et al&#46; describieron una correlaci&#243;n positiva entre el EE y el grosor global de CFNRp y del cuadrante superior e inferior<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">41</span></a>&#46;</p></span></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Actualmente&#44; para el uso de la OCT en el ejercicio de la oftalmolog&#237;a pedi&#225;trica&#44; es fundamental el conocimiento y el manejo de las bases normativas realizadas con poblaci&#243;n pedi&#225;trica para OCT&#44; dado que esto puede condicionar de manera importante la toma de decisiones en la pr&#225;ctica cl&#237;nica diaria&#46; Aun as&#237;&#44; no olvidemos que no es suficiente con una OCT aislada&#44; sino que es fundamental tener en cuenta la historia cl&#237;nica&#44; la anamnesis y exploraci&#243;n del paciente &#40;teniendo en cuenta siempre el EE&#44; la edad y el sexo&#44; ya que son factores que pueden alterar el grosor de diferentes par&#225;metros&#41;&#46; Sin embargo&#44; dado que utilizando las bases de datos de adultos que actualmente est&#225;n integradas en todos los dispositivos se podr&#237;an considerar como dentro de la normalidad algunos valores que en realidad no lo ser&#237;an al utilizar una base de datos pedi&#225;trica&#44; ser&#237;a de gran inter&#233;s disponer de estos datos en los diferentes dispositivos que se utilizan en la actualidad&#46; Dentro de los estudios publicados en la literatura tendr&#237;an preferencia los realizados con poblaci&#243;n pedi&#225;trica espa&#241;ola y&#44; en su ausencia&#44; los realizados con poblaci&#243;n pedi&#225;trica europea &#40;teniendo en cuenta que los valores no son intercambiables entre los distintos modelos y marcas de OCT&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0135" class="elsevierStylePara elsevierViewall">Instituto Nacional de Salud Carlos III &#40;subvenci&#243;n PI 17&#47;01073&#44; Instituto de Salud Carlos III&#44; Ministerio de Econom&#237;a&#44; Industria y Competitividad&#44; Espa&#241;a&#41; y cofinanciado por el Fondo Europeo de Desarrollo Regional&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0140" class="elsevierStylePara elsevierViewall">Ninguno de los autores de esta revisi&#243;n tiene conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Definici&#243;n e importancia de las bases normativas pedi&#225;tricas"
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              "titulo" => "Bases de datos normativas para tomograf&#237;a de coherencia &#243;ptica en poblaci&#243;n pedi&#225;trica espa&#241;ola"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; se ha convertido en una herramienta imprescindible en las consultas de oftalmolog&#237;a pedi&#225;trica&#46; Sin embargo&#44; las OCT disponibles en la actualidad no incluyen ninguna base de datos normativa para poblaci&#243;n pedi&#225;trica&#44; lo que puede conllevar errores importantes de interpretaci&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Realizar una revisi&#243;n bibliogr&#225;fica sobre las bases de datos normativas para OCT realizadas en poblaci&#243;n pedi&#225;trica&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Material y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se revisan las aplicaciones e implicaciones del uso de las bases de datos normativas pedi&#225;tricas para OCT&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se referencian varios estudios realizados para extraer estas bases de datos con diferentes modelos de OCT en poblaci&#243;n espa&#241;ola y europea con el fin de disponer de ellos de manera resumida&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En nuestra pr&#225;ctica cl&#237;nica diaria es muy importante el conocimiento y manejo de las bases de datos normativas pedi&#225;tricas para la correcta interpretaci&#243;n de los mapas de grosores de OCT&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Optical coherence tomography &#40;OCT&#41; has become an essential tool in paediatric ophthalmology&#46; However&#44; none of the currently available OCT devices include any kind of normative database for the paediatric population&#44; which can lead to important interpretation errors&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To review the paediatric OCT normative databases&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The applications and implications of the use of paediatric OCT normative databases are reviewed&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055"><span class="elsevierStyleItalic">Results</span></span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The paediatric normative databases that have been published so far in scientific literature with different OCT devices for Spanish and European population are presented&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The knowledge and interpretation of paediatric OCT normative databases in our daily clinical practice is crucial in order for the correct interpretation of OCT thickness maps&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Promedio &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">113&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Superior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">89&#44;0&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">98&#44;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">152&#44;0&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">Temporal &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;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">48&#44;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">51&#44;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">83&#44;3&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">Inferior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#44;0&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">89&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#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">154&#44;7&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">Nasal &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;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">43&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;0&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">89&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Valores de referencia de grosor de capa de fibras nerviosas peripapilares para poblaci&#243;n pedi&#225;trica espa&#241;ola de 4 a 17 a&#241;os con OCT Cirrus<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p>"
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                  <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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Grosor de capa de fibras nerviosas peripapilares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Promedio &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">116&#44;0&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">Superior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#44;0&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">154&#44;0&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">Temporal &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#44;0&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">Inferior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#44;8&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">Nasal &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#44;0&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">93&#44;8&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">&#193;rea del anillo &#40;mm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">2&#44;2&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">&#193;rea de disco &#40;mm<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;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">2&#44;7&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">Ratio excavaci&#243;n-disco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;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">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2674841.png"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Valores de referencia de grosor de capa de fibras nerviosas peripapilares para poblaci&#243;n pedi&#225;trica espa&#241;ola de 6 a 13 a&#241;os con OCT Cirrus<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">24</span></a></p>"
        ]
      ]
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        "mostrarDisplay" => false
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        "tabla" => array:1 [
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              "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-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Grosor macular&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">Media&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p1&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">p5&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">p95&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">Grosor macular central &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">253&#44;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">206&#44;0&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">220&#44;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">287&#44;4&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">Grosor promedio &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">283&#44;6&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">235&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">230&#44;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">308&#44;0&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">Volumen macular &#40;&#956;m<span class="elsevierStyleSup">3</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;2&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">9&#44;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">9&#44;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">11&#44;1&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">Inferior externo &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278&#44;2&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">243&#44;0&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">252&#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">308&#44;0&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">Nasal externo &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">302&#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">256&#44;6&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">275&#44;0&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">331&#44;0&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">Superior externo &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">291&#44;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">238&#44;6&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">263&#44;0&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">323&#44;0&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">Temporal externo &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">268&#44;0&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">233&#44;9&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">243&#44;0&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">294&#44;1&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">Inferior interno &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">319&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">263&#44;9&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">290&#44;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">347&#44;0&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">Nasal interno &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">324&#44;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">280&#44;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">298&#44;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">354&#44;0&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">Superior interno &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">316&#44;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">257&#44;9&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">279&#44;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">351&#44;8&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">Temporal interno &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">311&#44;0&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">274&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">284&#44;6&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">338&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2674840.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Valores de referencia de grosor macular para poblaci&#243;n pedi&#225;trica espa&#241;ola de 4 a 17 a&#241;os con OCT Cirrus<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">19</span></a></p>"
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      3 => array:8 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CCG-CPI&#58; grosor de capa de c&#233;lulas ganglionares y capa plexiforme interna&#59; CFNRm&#58; grosor de capa de fibras nerviosas maculares&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Grosor del complejo de c&#233;lulas ganglionares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Media &#40;DS&#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  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&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">p1&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">p5&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">p95&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">p99&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">CFNRm superior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;6 &#40;3&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#44;0&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">29&#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">41&#44;0&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">42&#44;0&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">CFNRm inferior &#40;&#956;m&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;1 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  """
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Valores de referencia de grosor del complejo de c&#233;lulas ganglionares para poblaci&#243;n pedi&#225;trica espa&#241;ola de 5 a 18 a&#241;os con OCT Topcon 3D-2000<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">18</span></a></p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nasal interno&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</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior interno&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">311&#44;8&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"><span class="elsevierStyleHsp" style=""></span>Temporal interno&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior externo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nasal externo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior externo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Temporal externo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grosor de capa de fibras nerviosas peripapilares &#40;&#956;m&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Global&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Temporal superior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Temporal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Temporal inferior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">196&#44;0&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Inferior&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">130&#44;3 &#40;2&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nasal inferior&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">175&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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