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Hallazgos oftalmológicos en pacientes con leucemia en una población colombiana
Ophthalmological findings in patients with leukaemia in a Colombian population
C.M. Rangela, Á. Ortizb, R. Sánchez-Ávilac, C. Varóna, P.L. Cárdenasb, L.C. Escafd,
Autor para correspondencia
Lescaf@gmail.com

Autor para correspondencia.
, D. Jaramillod, H. Rodriguezd
a Retina y Vítreo, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lülle (FOSCAL), Floridablanca, Colombia
b Neurooftalmología, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lülle (FOSCAL), Floridablanca, Colombia
c Oftalmología, Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, Universidad de Oviedo, Oviedo, España
d Oftalmología, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lülle (FOSCAL), Floridablanca, Colombia
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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">Las neoplasias malignas de los tejidos hematopoy&#233;ticos y linfoides &#40;leucemias&#44; linfomas&#44; des&#243;rdenes mieloproliferativos&#44; discrasias de c&#233;lulas plasm&#225;ticas&#44; tumores histioc&#237;ticos y neoplasias de c&#233;lulas dendr&#237;ticas&#41;&#44; son enfermedades potencialmente letales&#44; las cuales est&#225;n caracterizadas por su tendencia a diseminar e infiltrar otros &#243;rganos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; Las leucemias se definen como un grupo de trastornos neopl&#225;sicos malignos hematol&#243;gicos en los cuales una anormalidad gen&#233;tica en una c&#233;lula hematopoy&#233;tica causa una proliferaci&#243;n clonal de las c&#233;lulas blancas sangu&#237;neas&#46; M&#250;ltiples esquemas de clasificaci&#243;n han sido empleados para estas enfermedades con el paso de los a&#241;os&#44; pero en t&#233;rminos generales&#44; la leucemia puede ser clasificada como mieloide y linfoide&#44; aguda o cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Aunque los pacientes cl&#225;sicamente se presentan con anemia&#44; fatiga&#44; trombocitopenia y sangrados&#44; fiebre&#44; s&#237;ntomas constitucionales&#44; linfadenopat&#237;as y esplenomegalia&#44; entre otros&#44; a nivel ocular las manifestaciones cl&#237;nicas pueden ocurrir hasta en el 90&#37; de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#44;5</span></a>&#46; El objetivo del presente estudio es describir los hallazgos oftalmol&#243;gicos en una serie de pacientes diagnosticados con leucemia evaluados durante su hospitalizaci&#243;n en nuestra instituci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0010" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio observacional&#44; descriptivo&#44; retrospectivo en el cual el espectro de las manifestaciones oculares fue evaluado en pacientes con leucemia&#44; este estudio fue realizado en la Fundaci&#243;n Oftalmol&#243;gica de Santander-Cl&#237;nica Carlos Ardila L&#252;lle &#40;FOSCAL&#41;&#44; Floridablanca&#44; Colombia&#44; entre enero 2015 y diciembre 2015&#46; El estudio fue conducido en acuerdo con la declaraci&#243;n de Helsinki y las regulaciones del comit&#233; de &#233;tica de la instituci&#243;n&#46; Todos los pacientes firmaron el consentimiento informado para los procedimientos m&#233;dicos de rutina&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Un examen oftalmol&#243;gico completo &#40;l&#225;mpara de hendidura&#44; presi&#243;n intraocular con ton&#243;metro de Goldmann&#44; fondo de ojo bajo dilataci&#243;n pupilar&#41; fue realizado por el servicio de retina y neurooftalmolog&#237;a&#44; se realizaron ex&#225;menes complementarios como tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41;&#44; angiograf&#237;a fluoresce&#237;nica &#40;AGF&#41; y&#47;o ecograf&#237;a ocular&#46; Los datos fueron obtenidos de las historias cl&#237;nicas&#44; fueron analizadas las variables demogr&#225;ficas &#40;edad&#44; g&#233;nero&#44; tipo de leucemia&#41;&#44; la agudeza visual mejor corregida &#40;AVMC&#41; en Snellen y convertida a escala logMAR &#40;logaritmo de m&#237;nimo &#225;ngulo de resoluci&#243;n&#41; fue evaluada antes y despu&#233;s de la quimioterapia&#44; adem&#225;s fueron evaluados los hallazgos del fondo de ojo&#44; as&#237; como el mejoramiento o empeoramiento anat&#243;mico luego de la quimioterapia&#46; El resultado sist&#233;mico luego de quimioterapia fue registrado como estabilidad o muerte&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Las variables categ&#243;ricas fueron presentadas como n&#250;meros y porcentajes&#44; las variables continuas como promedios y desviaciones est&#225;ndar&#46; La AVMC fue transformada a escala logMAR para realizar an&#225;lisis estad&#237;stico&#46; Se us&#243; el test de Wilcoxon para variables no param&#233;tricas&#44; la significaci&#243;n estad&#237;stica fue fijada como valor de <span class="elsevierStyleItalic">p</span> menor de 0&#44;5&#46; Para todos los an&#225;lisis estad&#237;sticos se us&#243; el <span class="elsevierStyleItalic">software</span> SPSS&#174; v19&#46;0 para Windows &#40;SPSS&#174;&#44; Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46; UU&#46;&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0025" class="elsevierStylePara elsevierViewall">Fueron evaluados un total de 14 ojos correspondientes a 8 pacientes &#40;5 mujeres y 3 varones&#41; diagnosticados con leucemia&#46; La edad promedio al diagn&#243;stico fue de 43 a&#241;os &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41; &#40;rango&#58; 31-76&#41;&#44; el tiempo medio de seguimiento fueron 3&#44;5 meses&#46; De los 14 ojos con manifestaciones por leucemia&#44; 8 fueron ojos derechos&#46; Del total de ojos&#44; 6 ojos &#40;42&#44;87&#37;&#41; correspond&#237;an a leucemia mieloide aguda &#40;LMA&#41;&#44; 4 ojos &#40;28&#44;57&#37;&#41; a leucemia linfoide aguda &#40;LLA&#41;&#44; 2 ojos &#40;14&#44;28&#37;&#41; a leucemia mieloide cr&#243;nica &#40;LMC&#41; y 2 ojos &#40;14&#44;28&#37;&#41; a leucemia de c&#233;lulas peludas &#40;LCP&#41; una forma especial de neoplasia linfoide de c&#233;lulas B que tambi&#233;n se conoce en la literatura como leucemia pro-linfoc&#237;tica B&#46; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todos los pacientes recibieron quimioterapia sist&#233;mica e intratecal durante el seguimiento&#46; El principal hallazgo ocular fue la infiltraci&#243;n coroidea en 12 ojos &#40;85&#44;7&#37;&#41;&#44; seguido de 4 ojos &#40;28&#44;6&#37;&#41; con compromiso retiniano y 4 ojos &#40;28&#44;6&#37;&#41; con manifestaciones neuro-oftalmol&#243;gicas &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En algunos casos&#44; los pacientes presentaban varios hallazgos oftalmol&#243;gicos en el mismo ojo&#46; La presentaci&#243;n cl&#237;nica m&#225;s frecuente fue el compromiso coroideo &#40;infiltrados subretinianos &#40;&#91;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#93; y desprendimiento seroso de la retina neurosensorial <a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#93;&#41;&#44; infiltraci&#243;n retiniana &#40;invasi&#243;n retiniana y manchas de Roth &#91;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#93;&#41; y alteraciones neuro-oftalmol&#243;gicas &#40;infiltraci&#243;n del nervio &#243;ptico <a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#93;&#46; Dentro de las manifestaciones secundarias&#44; encontramos hemorragias retinianas a diferentes profundidades &#91;<a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 5</a>&#93;&#41;&#44; hemorragias en el disco &#243;ptico&#44; edema macular y pliegues retinianos &#40;<a class="elsevierStyleCrossRef" href="#fig0030">fig&#46; 6</a>&#41;&#46; Adem&#225;s se encontr&#243; un caso de uve&#237;tis anterior bilateral con seudohipopi&#243;n y un caso de desprendimiento total de retina de tipo exudativo &#40;<a class="elsevierStyleCrossRef" href="#fig0035">fig&#46; 7</a>&#41;&#46; El hallazgo m&#225;s frecuente en la OCT en nuestro estudio fue el desprendimiento seroso de la retina neurosensorial&#44; el cual&#44; se localiz&#243; tanto a nivel macular como extramacular&#46; El grosor coroideo promedio fue de 256&#44;3<span class="elsevierStyleHsp" style=""></span>um&#44; sin diferencia estad&#237;sticamente significativa al groso retiniano promedio&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><elsevierMultimedia ident="fig0030"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">El promedio de la AVMC inicial fue de 0&#44;689 logMAR &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;724&#41; en el momento de presentaci&#243;n &#40;rango&#58; 0&#44;0-1&#44;778&#41; y luego de quimioterapia sist&#233;mica y&#47;o intratecal mejor&#243; a 0&#44;449 &#40;DE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;665&#41; &#40;rango&#58; 0-1&#44;778&#41; con un valor de <span class="elsevierStyleItalic">p</span> de 0&#44;012&#46; De los 14 ojos que recibieron manejo&#44; 3 ojos &#40;21&#44;4&#37;&#41; empeoraron&#44; un ojo &#40;7&#44;1&#37;&#41; present&#243; mejor&#237;a parcial y 10 ojos &#40;71&#44;4&#37;&#41; mejoraron cl&#237;nicamente&#46; De los 8 pacientes&#44; 4 &#40;50&#37;&#41; murieron por complicaciones sist&#233;micas secundarias a su enfermedad de base&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las leucemias son un grupo heterog&#233;neo de neoplasias hematol&#243;gicas en donde un clon de cualquier linaje celular del sistema hematopoy&#233;tico prolifera de manera descontrolada&#46; Las leucemias se clasifican seg&#250;n el linaje celular que prolifera&#58; mieloide cuando el clon pertenece a la m&#233;dula &#243;sea o sistema hematopoy&#233;tico y linfoide cuando se trata de las l&#237;neas celulares B y T&#46; Por otro lado&#44; los t&#233;rminos agudo o cr&#243;nico tradicionalmente hac&#237;an referencia al curso temporal de la enfermedad &#40;como lo es en el resto de las especialidades m&#233;dicas&#41;&#46; Sin embargo&#44; en hematolog&#237;a se usa el t&#233;rmino &#171;agudo&#187; cuando las clonas celulares que proliferan son en su mayor&#237;a inmaduras &#40;blastos&#41; y &#171;cr&#243;nico&#187; cuando son maduras<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; Las leucemias suelen presentarse con s&#237;ntomas sist&#233;micos inespec&#237;ficos que pueden ser insidiosos o abruptos&#44; y son consecuencia de la anemia&#44; trombocitopenia o leucocitosis&#47;leucopenia o disfunci&#243;n leucocitaria como son fatiga o intolerancia al ejercicio &#40;50&#37;&#41;&#44; sangrado excesivo o en sitio inusual&#44; fiebre con o sin infecci&#243;n y s&#237;ntomas constitucionales&#46; Adicionalmente al examen f&#237;sico suelen evidenciarse linfadenopat&#237;as&#44; esplenomegalia y hepatomegalia&#44; entre otros<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Cualquier estructura a nivel ocular puede estar comprometida&#44; nervio &#243;ptico&#44; coroides&#44; retina&#44; iris&#44; cuerpo ciliar y c&#225;mara anterior&#44; y su compromiso puede sugerir infiltraci&#243;n del sistema nervioso central<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">4&#8211;20</span></a>&#46; Estos hallazgos pueden ser uni o bilaterales y pueden ser la manifestaci&#243;n inicial de la enfermedad o la manifestaci&#243;n de una reca&#237;da de esta&#46; Algunos autores consideran el compromiso ocular como la tercera manifestaci&#243;n extramedular despu&#233;s de las meninges<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a> y los test&#237;culos<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Los estudios de autopsia muestran una prevalencia de compromiso ocular por leucemia variable entre el 28-80&#37;&#44; la cual es mucho mayor de la reportada en estudios cl&#237;nicos<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">11&#44;17&#44;21&#44;22</span></a>&#46; Reddy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#44; encontraron que el 10&#37; de los pacientes eran sintom&#225;ticos oculares con hallazgos oculares en el 35&#37; de los mismos&#44; estos hallazgos fueron m&#225;s comunes en adultos &#40;49&#37;&#41; que en los ni&#241;os &#40;16&#37;&#41; y fueron m&#225;s frecuentes en la leucemia mieloide &#40;41&#37;&#41; que en la leucemia linfoide &#40;29&#37;&#41;&#46; Russo et al&#46;&#44; encontraron manifestaciones oculares en el 66&#37; de los ni&#241;os con LMA comparado con el 11&#37; en ni&#241;os con LLA&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Las manifestaciones oculares de la leucemia se pueden dividir en manifestaciones directas &#40;infiltrados leuc&#233;micos&#41;&#44; posibles manifestaciones directas &#40;hemorragias con centro blanco&#41;&#44; manifestaciones de las complicaciones de la leucemia &#40;anemia&#44; trombocitopenia&#44; estados de hiperviscosidad&#41;&#44; infecciones oportunistas y aquellas relacionadas con el manejo m&#233;dico<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46; Los infiltrados leuc&#233;micos pueden encontrarse a nivel del humor v&#237;treo&#44; en el espacio pre-retiniano&#44; retiniano y coroideo<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a> y representan un signo de mal pron&#243;stico&#44; ya que est&#225;n relacionados con alto recuento leucocitario&#44; enfermedad fulminante y muerte temprana<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#46; La afectaci&#243;n coroidea con desprendimiento de la retina neurosensorial secundaria a nivel macular fue el hallazgo m&#225;s frecuente en nuestro estudio&#44; as&#237; como la principal causa de disminuci&#243;n de agudeza visual en nuestros pacientes&#46; Las hemorragias con centro blanco se consideran sospechosas de compromiso directo intraocular&#44; debido a que se han reportado leucocitos neopl&#225;sicos en el centro de dichas hemorragias<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; Su presencia no es tan frecuente en nuestro estudio &#40;14&#44;3&#37;&#41;&#44; as&#237; como en la literatura &#40;11&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> y no se relacionan con riesgo aumentado de hemorragia intracraneana<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46; Las complicaciones secundarias a anemia&#44; trombocitopenia e hiperviscosidad sangu&#237;nea&#44; se conocen con el t&#233;rmino de retinopat&#237;a por leucemia y son m&#225;s comunes en las leucemias aguda&#46; Dentro de estas complicaciones se encuentran las hemorragias retinianas&#44; las manchas blanco-algodonosas&#44; oclusiones venosas retinianas&#44; microaneurismas retinianos y neovascularizaci&#243;n retiniana perif&#233;rica&#44; estas tres &#250;ltimas secundarias a hiperviscosidad sangu&#237;nea<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46; Las hemorragias retinianas se pueden presentar a nivel subretiniano&#44; entre las capas externas de la retina&#44; las capas internas de la retina o a nivel pre-retiniano<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#44; son secundarias a anemia o trombocitopenia&#44; y son el hallazgo retiniano m&#225;s frecuente en varios estudios<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">27&#44;29</span></a> adem&#225;s&#44; su presencia a nivel macular&#44; se asocia con mayor riesgo de hemorragia intracraneana<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46; En nuestro estudio&#44; la frecuencia de las hemorragias intrarretinianas fue del 49&#44;9&#37;&#46; Las manchas blanco-algodonosas son causadas por c&#233;lulas neopl&#225;sicas que ocluyen las arteriolas retinianas y pueden ser la manifestaci&#243;n cl&#237;nica inicial de la leucemia<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Est&#225;n presentes en el 16&#37; de los casos en la literatura<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#44; muy similar a nuestro estudio &#40;14&#44;3&#37;&#41; y su presencia est&#225; relacionada con el pron&#243;stico de vida de los pacientes&#44; ya que los pacientes presentan 8 veces m&#225;s probabilidades de morir&#44; posiblemente por falla medular<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En las leucemias los hallazgos a nivel oftalmol&#243;gico con la OCT dependen de varias variables&#58; edad de presentaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">32-35</span></a>&#44; tipo de leucemia &#40;aguda vs cr&#243;nica&#41;&#44; fase aguda vs convalecencia &#40;luego del tratamiento&#41;<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">36&#44;37</span></a> y de la presencia de fen&#243;menos vasculares relacionados con el n&#250;mero de leucocitos &#40;leucoestasis&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Yalcinbayir et al&#46;&#44; encontraron que los ni&#241;os con LLA en tratamiento presentaban espesores coroideos en el polo posterior y a nivel peripapilar m&#225;s delgados comparados con el grupo control&#44; y este efecto podr&#237;a ser secundario al efecto curativo de la quimioterapia<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">32</span></a>&#46; En nuestro estudio el promedio de grosor coroideo no fue inferior en el polo posterior y regi&#243;n peripapilar</p><p id="par0065" class="elsevierStylePara elsevierViewall">Otros hallazgos cl&#237;nicos y en la OCT poco frecuente en las leucemias son los infiltrados retinianos a nivel foveal&#44; los cuales se caracterizan por ser lesiones hiperreflectivas que comprometen todas las capas de la retina a nivel foveal&#44; sin embargo&#44; ellos tienden a mejorar con el tratamiento&#44; pero la visi&#243;n no siembre mejora debido a las secuelas que dejan en las capas externas de la retina &#40;perdida de la capa elipsoides y zona de interdigitaci&#243;n&#41;&#46; En nuestro estudio&#44; virtualmente todos los pacientes que sobrevivieron presentaron recuperaci&#243;n visual sin evidentes secuelas en las capas externas de retina&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; la disminuci&#243;n de la agudeza visual estuvo relacionada con las manifestaciones a nivel del polo posterior&#44; siendo la infiltraci&#243;n coroidea con desprendimiento exudativo de la retina neurosensorial la principal causa&#44; por lo cual&#44; es importante considerar a la leucemia dentro del diagn&#243;stico diferencial de los desprendimientos serosos de la retina a nivel macular&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Dentro de las limitaciones de nuestro estudio&#44; se encuentra su naturaleza retrospectiva&#44; n&#250;mero reducido de pacientes&#44; seguimiento corto y variable&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la leucemia es una patolog&#237;a que puede llegar a comprometer el globo ocular hasta en el 80-90&#37; de los casos&#44; con pocos s&#237;ntomas y manifestaciones cl&#237;nicas variables&#44; por lo tanto&#44; se debe realizar un examen oftalmol&#243;gico de rutina a los pacientes con diagn&#243;stico reciente de leucemia est&#233;n o no sintom&#225;ticos&#46; Debemos tener en cuenta que estos hallazgos pueden ser la manifestaci&#243;n inicial de la patolog&#237;a sist&#233;mica&#44; est&#225;n relacionados con compromiso del SNC y tambi&#233;n pueden indicar reca&#237;da de la enfermedad de base&#46; Adem&#225;s&#44; queremos hacer &#233;nfasis en la importancia de considerar las neoplasias hematol&#243;gicas dentro del diagn&#243;stico diferencial de los desprendimientos exudativos de la retina&#46; Proponemos realizar estudios cl&#237;nicos multi-c&#233;ntricos en nuestra regi&#243;n para conocer la epidemiolog&#237;a y evaluar el impacto de los diferentes tratamientos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Financiaci&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Loa autores declaran no haber recibido financiaci&#243;n para la realizaci&#243;n de este trabajo</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicto de intereses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2019-10-20"
    "fechaAceptado" => "2020-05-22"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1366270"
          "palabras" => array:5 [
            0 => "Leucemia"
            1 => "Infiltraci&#243;n de leucemia"
            2 => "Retina"
            3 => "Tomograf&#237;a de coherencia &#243;ptica"
            4 => "Angiograf&#237;a de fluorescencia"
          ]
        ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1366269"
          "palabras" => array:5 [
            0 => "Leukaemia"
            1 => "Leukaemia infiltration"
            2 => "Retina"
            3 => "Optical coherence tomography"
            4 => "Fluorescence angiography"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Publicar las manifestaciones oculares en paciente con leucemia&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional anal&#237;tico de corte transversal&#44; en pacientes con manifestaciones oculares por leucemia&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se evaluaron 14 ojos de 8 pacientes &#40;5 mujeres y 3 varones&#41; con leucemia&#46; La edad promedio al diagn&#243;stico de leucemia fue de 43 a&#241;os &#40;31-76 a&#241;os&#41;&#46; Seis ojos correspond&#237;an a pacientes con leucemia mieloide aguda &#40;LMA&#41;&#44; 4 ojos a pacientes con leucemia linfoide aguda &#40;LLA&#41;&#44; 2 ojos a pacientes con leucemia mieloide cr&#243;nica &#40;LMC&#41; y 2 ojos a pacientes con leucemia de c&#233;lulas peludas &#40;LCP&#41;&#46; Los hallazgos oculares primarios fueron&#58; invasi&#243;n coroidea en 12 ojos &#40;85&#44;7&#37;&#41;&#44; infiltraci&#243;n retiniana en 4 ojos &#40;28&#44;6&#37;&#41; y des&#243;rdenes neuroftalmol&#243;gicos en 4 ojos &#40;28&#44;6&#37;&#41;&#46; La agudeza visual promedio mejor&#243; de 0&#44;689 a 0&#44;449 logMAR &#40;p 0&#44;012&#41; luego del tratamiento con quimioterapia sist&#233;mica e intratecal&#46; De los 8 pacientes&#44; 4 murieron debido a complicaciones de su enfermedad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Este es el primer art&#237;culo de m&#250;ltiples manifestaciones oculares secundaria a leucemia en una poblaci&#243;n colombiana&#46; Es importante tener en cuenta que este tipo de manifestaciones hacen parte de los s&#237;ndromes de enmascaramiento por lo tanto es primordial hacer un diagn&#243;stico y manejo precoz ya que en ocasiones est&#225; en riesgo la vida del paciente&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To report the ocular manifestations in patients with leukaemia&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This is a retrospective&#44; descriptive and observational study in patients with ocular manifestations of leukaemia&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 14 eyes were evaluated corresponding to 8 patients &#40;5 women and 3 men&#41; with ocular manifestations of leukaemia&#46; The mean age at diagnosis was 43 years &#40;31-76 years&#41;&#46; Six eyes corresponded to patients with acute myeloid leukaemia &#40;AML&#41;&#44; four eyes to acute lymphoid leukaemia &#40;ALL&#41;&#44; two eyes to chronic myeloid leukaemia &#40;CML&#41;&#44; and the remaining two belonged to patients with hairy cell leukaemia &#40;HCL&#41;&#46; The primary ocular findings were choroidal invasion in 12 eyes &#40;85&#46;7&#37;&#41;&#44; retinal infiltration in 4 eyes &#40;28&#46;6&#37;&#41;&#44; and neuro-ophthalmic disorders in 4 eyes &#40;28&#46;6&#37;&#41;&#46; The mean visual acuity improved from 0&#46;689 to 0&#46;449 &#40;logMAR&#41; &#40;<span class="elsevierStyleItalic">P&#61;&#46;012</span>&#41; after the systemic and intrathecal chemotherapy&#46; Of the eight patients&#44; four died from systemic complications of the underlying disease&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This is the first report of multiple ocular manifestations secondary to leukaemia in a Colombian population&#46; It is important to keep in mind that this disease is included within the masquerade syndromes and that the ophthalmological findings that&#44; while subtle&#44; can also be devastating and be signs of a life-threatening disease&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Results"
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            "titulo" => "Conclusions"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Desprendimientos serosos de la retina en ambos ojos&#46; A&#41; Fotograf&#237;a a color que muestra m&#250;ltiples desprendimientos serosos de la retina con cambios asociados del EPR &#40;flechas blancas&#41;&#46; B&#41; Angiograf&#237;a fluoresce&#237;nica en etapas tard&#237;as con m&#250;ltiples puntos de hiperfluorescencia por fuga del medio de contraste &#40;flechas azules&#41;&#46; C&#41; Mapa de la OCT de grosor macular central que muestra engrosamiento en varios niveles a nivel macular&#46; D&#41; B-<span class="elsevierStyleItalic">scan</span> horizontal a nivel macular que muestra l&#237;quido subrretiniano a nivel perifoveal temporal en el ojo derecho y parafoveal nasal en el ojo izquierdo &#40;flechas rojas&#41;&#46;</p>"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hemorragias intrarretinianas&#46; A y B&#41; Fotograf&#237;a a color del ojo derecho e izquierdo&#44; que muestra hemorragias con centro blanco &#40;flechas blancas&#41;&#44; hemorragias intrarretinianas en punto y en mancha&#46; C y D&#41; Angiograf&#237;a fluoresce&#237;nica del ojo derecho e izquierdo&#44; que muestra hipofluorescencia por bloqueo secundario a las hemorragias &#40;flechas amarillas&#41;&#46;</p>"
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Infiltraci&#243;n del nervio &#243;ptico&#46; A y B&#41; Fotograf&#237;a a color del ojo derecho e izquierdo&#44; que muestra borramiento de los bordes del disco &#243;ptico &#40;flechas azules&#41;&#46; C y D&#41; Angiograf&#237;a fluoresce&#237;nica del ojo derecho e izquierdo&#44; que muestra en etapas tard&#237;as hiperfluorescencia del disco &#243;ptico &#40;flechas amarillas&#41;&#46;</p>"
        ]
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        "identificador" => "fig0025"
        "etiqueta" => "Figura 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr5.jpeg"
            "Alto" => 453
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            "Tamanyo" => 86490
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hemorragias intrarretinianas&#46; Fotograf&#237;a a color de diferentes pacientes que muestran hemorragias intrarretinianas a diferentes niveles&#58; A&#41; superficiales &#40;flecha blanca&#41;&#44; B&#41; pre-retinianas &#40;flecha azul&#41; e intrarretinianas en mancha &#40;flechas verdes&#41; y C&#41; intrarretinianas en punto &#40;flechas amarillas&#41;&#46;</p>"
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        "identificador" => "fig0030"
        "etiqueta" => "Figura 6"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr6.jpeg"
            "Alto" => 874
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            "Tamanyo" => 169989
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Desprendimiento seroso de la retina&#46; Imagen compuesta que muestra correlaci&#243;n entre&#58; A&#41; Fotograf&#237;a a color&#44; B&#41; Tomograf&#237;a de coherencia &#243;ptica y C&#41; Angiograf&#237;a fluoresce&#237;nica en el ojo derecho&#46; Se muestra desprendimiento de la retina neurosensorial &#40;flechas blancas&#41;&#44; pliegues retinianos &#40;flechas azules&#41; e infiltrados subrretinianos &#40;flechas amarillas&#41;&#46;</p>"
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        "identificador" => "fig0035"
        "etiqueta" => "Figura 7"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr7.jpeg"
            "Alto" => 534
            "Ancho" => 1250
            "Tamanyo" => 64542
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Desprendimiento seroso de la retina&#46; A&#41; Fotograf&#237;a a color&#46; B&#41; Angiograf&#237;a fluoresce&#237;nica del ojo derecho de un paciente con desprendimiento de la retina de tipo exudativo&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">AVMC&#58; agudeza visual mejor corregida&#59; LCP&#58; leucemia c&#233;lulas peludas&#59; LLA&#58; leucemia linfoide aguda&#59; LMA&#58; leucemia mieloide aguda&#59; LMC&#58; leucemia mieloide cr&#243;nica&#59; M&#58; mujer&#59; OD&#58; ojo derecho&#59; OI&#58; ojo izquierdo&#59; V&#58; var&#243;n&#46;</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" 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">Paciente&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">G&#233;nero&nbsp;\t\t\t\t\t\t\n
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                  \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 primaria&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">Enfermedad ocular&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">AVMC inicial &#40;logMAR&#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">AVMC final &#40;logMAR&#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">Resultado sist&#233;mico&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">Resultado oftalmol&#243;gico&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">LMA&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">Infiltraci&#243;n retiniana&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;778&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;699&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">Falleci&#243;&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">Deterioro&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">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
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                  \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
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                  \t\t\t\t">LMA&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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                  \t\t\t\t">47&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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                  \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">Infiltraci&#243;n coroidea&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;000&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;000&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">Falleci&#243;&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">Mejor&#237;a&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="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">LMA&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">47&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">Infiltraci&#243;n coroidea&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;097&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;000&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">Falleci&#243;&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">Mejor&#237;a&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">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">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">LMA&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">58&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">Infiltraci&#243;n retiniana&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;176&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;000&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">Estable&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">Mejor&#237;a&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">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">LLA&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">31&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">Infiltraci&#243;n retiniana y coroidea&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;778&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;778&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">Falleci&#243;&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">Deterioro&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="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">LLA&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">31&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">Infiltraci&#243;n retiniana y coroidea&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;778&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;875&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">Falleci&#243;&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">Mejor&#237;a parcial&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">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">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">LLA&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">38&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">Infiltraci&#243;n coroidea&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;477&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;097&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">Estable&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">Mejor&#237;a&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="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">LLA&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">38&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">Infiltraci&#243;n coroidea&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;398&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;097&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">Estable&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">Mejor&#237;a&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
                  \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">LMC&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">36&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">Par&#225;lisis VI nervio&#44; infiltraci&#243;n nervio &#243;ptico&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;301&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;097&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">Falleci&#243;&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">Mejor&#237;a&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
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                  \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">LMC&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">36&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">Par&#225;lisis VI nervio&#44; infiltraci&#243;n nervio &#243;ptico&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;301&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;301&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">Falleci&#243;&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">Deterioro&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">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">LCP&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&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">Infiltraci&#243;n coroidea&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;398&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;176&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">Estable&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">Mejor&#237;a&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="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">LCP&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&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">Infiltraci&#243;n coroidea&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;176&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;176&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">Estable&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">Mejor&#237;a&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">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">LMA&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">31&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">Infiltraci&#243;n coroidea&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;000&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;000&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">Estable&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">Mejor&#237;a&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="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">LMA&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">31&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">Infiltraci&#243;n coroidea&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;000&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;000&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">Estable&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">Mejor&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab2586268.png"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Presentaci&#243;n cl&#237;nica y tratamiento en pacientes con manifestaciones oftalmol&#243;gicas secundarias a leucemia</p>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Hallazgos oculares directos</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infiltraci&#243;n coroidea&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">12 &#40;85&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;57&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Infiltrados subrretinianos&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</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><span class="elsevierStyleHsp" style=""></span>Infiltraci&#243;n retiniana&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;28&#44;6&#41;&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"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Invasi&#243;n retiniana&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hemorragias con centro blanco&#59; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Des&#243;rdenes neuro-oftalmol&#243;gicos&#59; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;28&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;14&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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ISSN: 03656691
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