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Grado de concordancia y diferencias entre valores maculares en niños mediante dos tipos de tomografía de coherencia óptica espectral
Agreement and differences between macular values in children using two types of spectral optical coherence tomography
J.M. Ruiz Caro Larrea
Autor para correspondencia
drivertad@hotmail.com

Autor para correspondencia.
, L. Cabrejas Martínez, M.A. Alonso Peralta, I. Mahíllo Fernández, I. Jiménez-Alfaro Morote
Servicio de Oftalmología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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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">Desde su desarrollo en 1991<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">1</span></a> y su introducci&#243;n al mercado comercial en 1996<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">2</span></a>&#44; la tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; se ha convertido en un instrumento esencial en oftalmolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">3</span></a>&#46; Su capacidad de obtener im&#225;genes no invasivas y detalladas de las estructuras oculares as&#237; como de su microvasculatura con alta resoluci&#243;n ha revolucionado el manejo del paciente<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">4-7</span></a>&#46; Particularmente las OCT de dominio espectral son ampliamente reconocidas por su r&#225;pida adquisici&#243;n de m&#250;ltiples im&#225;genes<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">8-10</span></a>&#46; Hoy en d&#237;a se cuenta con varios modelos de OCT espectral<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">11&#44;12</span></a>&#44; incluyendo las OCT Spectralis y Cirrus&#44; las cuales son ampliamente usadas en la pr&#225;ctica cl&#237;nica diaria tanto en adultos como en ni&#241;os<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">13</span></a>&#46; Estos sistemas poseen cada uno una base de datos procedentes de estudios independientes<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">14&#44;15</span></a>&#44; aunque en ninguno de ellos se incluyeron pacientes menores de 18<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">16&#44;17</span></a>&#46; Adem&#225;s&#44; en comparaci&#243;n con la poblaci&#243;n adulta&#44; pocos estudios han sido llevados a cabo en ni&#241;os haciendo uso de Cirrus o Spectralis<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">18-25</span></a>&#46; Estos estudios no hallaron correlaci&#243;n entre el grosor macular y la edad&#44; el sexo<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> y la refracci&#243;n<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a>&#44; aunque otros s&#237; hallaron diferencias seg&#250;n el sexo<a class="elsevierStyleCrossRefs" href="#bib0340"><span class="elsevierStyleSup">17&#44;20&#44;21</span></a>&#46; Se cuenta con cuatro estudios que realizaron la segmentaci&#243;n intrarretiniana con OCT Spectralis en ni&#241;os&#44; pero o bien usaron un software de propia configuraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">26</span></a>&#44; mencionan solo algunas de las capas o bien incluyeron ni&#241;os con amplios rangos de poder di&#243;ptrico<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">28&#44;49&#44;50</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Seg&#250;n nuestra b&#250;squeda bibliogr&#225;fica&#44; no hemos hallado un estudio previo publicado que compare los valores maculares en ni&#241;os con estos dos instrumentos&#44; y tampoco un estudio previo publicado que mencione la segmentaci&#243;n de la mayor&#237;a de las capas intrarretinianas usando el software propio de Spectralis en ni&#241;os&#46; Debido a que la OCT es una herramienta confiable no invasiva y nos permite obtener medidas en ni&#241;os&#44; nuestro prop&#243;sito fue determinar el grado de concordancia entre los valores maculares de OCT Cirrus y Spectralis en ni&#241;os y proponer valores de normalidad en la poblaci&#243;n pedi&#225;trica&#44; as&#237; como evaluar las diferencias seg&#250;n sexo&#44; raza&#44; edad&#44; lateralidad y etnia de origen&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materiales y m&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participantes</span><p id="par0015" class="elsevierStylePara elsevierViewall">Realizamos un estudio descriptivo&#44; transversal&#44; comparativo y observacional que fue previamente aprobado por el Comit&#233; de &#201;tica del Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#46; Los datos obtenidos de los pacientes fueron manejados con la mayor confidencialidad y se siguieron estrictamente las normas de la Declaraci&#243;n de Helsinki&#46; Los ni&#241;os mayores de 12<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; as&#237; como sus padres o tutores legales&#44; otorgaron su autorizaci&#243;n de forma escrita&#44; habi&#233;ndoseles explicado y comprendido los procedimientos que se iban a realizar&#46; Igualmente los pacientes menores de 12<span class="elsevierStyleHsp" style=""></span>a&#241;os dieron su consentimiento verbal y sus tutores legales o los padres consintieron de forma escrita su participaci&#243;n&#46; Tuvimos como criterios de inclusi&#243;n&#58; edad entre 5 y 15<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; no patolog&#237;a ocular previa o patolog&#237;a sist&#233;mica que pudiera influir a nivel ocular&#44; adecuada edad gestacional &#40;entre las semanas 37 y 42&#41; y adecuado peso al nacer &#40;entre 2&#46;500 y 4&#46;000<span class="elsevierStyleHsp" style=""></span>g&#41;&#44; agudeza visual mejor corregida adecuada para su edad &#40;agudeza visual decimal &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;8 en ni&#241;os de 5<span class="elsevierStyleHsp" style=""></span>a&#241;os y 1&#44;0 en &#62;<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; mediante los optotipos de la tabla de Snellen o la &#171;E&#187; direccional de Snellen&#44; los valores de equivalente esf&#233;rico entre &#8722;3D y &#43;3D&#44; y valores de astigmatismo menores a 2<span class="elsevierStyleHsp" style=""></span>dioptr&#237;as&#46; Los criterios de exclusi&#243;n fueron los siguientes&#58; presi&#243;n intraocular &#40;PIO&#41; &#62;<span class="elsevierStyleHsp" style=""></span>21<span class="elsevierStyleHsp" style=""></span>mmHg &#40;obtenida mediante neumoton&#243;metro&#59; en caso de valores por encima de 20<span class="elsevierStyleHsp" style=""></span>mmHg se volvi&#243; a medir con el ton&#243;metro de Perkins&#41;&#44; im&#225;genes con se&#241;al menor de 5&#47;10 &#40;Cirrus&#41; o menor a 20<span class="elsevierStyleHsp" style=""></span>dB &#40;Spectralis&#41;&#44; y pacientes no colaboradores&#46; Inicialmente 112<span class="elsevierStyleHsp" style=""></span>ni&#241;os cumplieron los criterios de inclusi&#243;n&#44; pero 12<span class="elsevierStyleHsp" style=""></span>pacientes fueron excluidos por mala calidad de la se&#241;al o mala colaboraci&#243;n&#44; teniendo una muestra final de 100 pacientes &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46; A todos los pacientes se les realiz&#243; una exploraci&#243;n oftalmol&#243;gica completa&#44; incluyendo mejor agudeza visual corregida&#44; motilidad ocular extr&#237;nseca&#44; test de estereopsis&#44; PIO y observaci&#243;n de polo anterior y posterior mediante l&#225;mpara de hendidura&#46; Se obtuvo la refracci&#243;n ocular previa cicloplejia&#44; posteriormente se administr&#243; ciclopentolato al 1&#37; en tres oportunidades con intervalos de 10<span class="elsevierStyleHsp" style=""></span>min&#44; y a los 15 a 20<span class="elsevierStyleHsp" style=""></span>min de la &#250;ltima aplicaci&#243;n se repiti&#243; la autorrefracci&#243;n&#46; La longitud axial ocular se midi&#243; mediante el IOLMaster &#40;Carl Zeiss Meditec&#41;&#46; Se obtuvieron las medidas de ambos ojos&#44; pero debido a la semejanza hallada en el an&#225;lisis estad&#237;stico&#44; en los resultados solo consideramos los ojos derechos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Tomograf&#237;a de coherencia &#243;ptica</span><p id="par0020" class="elsevierStylePara elsevierViewall">El modelo de OCT Cirrus utilizado fue el 4000 &#40;software 7&#46;0&#46;3&#46;19&#41; y el protocolo para la obtenci&#243;n de los valores maculares fue el Macular Cube 512<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>128&#46; Hicimos uso del mismo protocolo con la OCT Spectralis &#40;software 6&#46;3&#46;2&#46;0&#41;&#46; Aqu&#237; debe mencionarse que aunque el borde interno de la segmentaci&#243;n intrarretiniano para ambas OCT es el mismo &#40;la interfase vitreorretiniana&#41;&#44; el borde externo difiere&#44; siendo el epitelio pigmentario de la retina &#40;EPR&#41; la l&#237;nea de referencia para la OCT Cirrus y la membrana de Bruch para la OCT Spectralis&#46; Esta diferencia es la responsable de la variaci&#243;n en las mediciones maculares de ambas OCT&#44; como ha sido documentado en la poblaci&#243;n adulta&#59; sin embargo&#44; esto no ha sido demostrado en ni&#241;os por no contar con un estudio previo en esta poblaci&#243;n&#46; Por otro lado&#44; ambas OCT han demostrado gran reproducibilidad<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">30-38</span></a>&#44; pero Spectralis mostr&#243; mejor repetibilidad en las medidas maculares entre varias OCT<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">29</span></a>&#44; y en comparaci&#243;n a Cirrus fue m&#225;s confiable en la detecci&#243;n de patolog&#237;a retiniana<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">39</span></a>&#46; Las im&#225;genes fueron obtenidas por un mismo investigador y se realiz&#243; la revisi&#243;n manual de cada imagen&#44; excluyendo los pacientes que tuvieran errores de segmentaci&#243;n&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0025" class="elsevierStylePara elsevierViewall">Con el prop&#243;sito de mantener en estricta confidencialidad los datos de los participantes del estudio&#44; se otorgaron c&#243;digos a cada uno y se incluyeron en una base de datos en la cual se introdujeron los datos de las variables&#46; El an&#225;lisis estad&#237;stico se llev&#243; a cabo mediante la versi&#243;n 23&#46;0 del paquete estad&#237;stico SPSS&#46; Primeramente se hizo uso del test de Kolmogorov-Smirnov para evaluar la normalidad de las variables&#44; y debido a que no todas las variables eran normales&#44; optamos por el uso de test no param&#233;tricos con la finalidad de obtener resultados m&#225;s uniformes en el contraste de hip&#243;tesis&#46; El nivel de significaci&#243;n estad&#237;stica que tomamos en cuenta fue de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#44; con un intervalo de confianza &#40;IC&#41; del 95&#37;&#46; Se obtuvo la media&#44; la desviaci&#243;n est&#225;ndar&#44; la mediana y los percentiles 1&#44; 5 y 95 &#40;para variables continuas&#41; y se llev&#243; a cabo el an&#225;lisis de frecuencias para variable categ&#243;ricas&#46; El coeficiente de correlaci&#243;n intraclase &#40;CCI&#41; de tipo absoluto se utiliz&#243; para calcular el grado de concordancia entre los valores de ambas OCT&#46; Los valores &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;2 fueron considerados de &#171;muy bajo grado de concordancia&#187;&#44; valores entre 0&#44;2 y 0&#44;5&#44; fueron interpretados como de &#171;bajo grado de concordancia&#187;&#44; valores entre 0&#44;5 y 0&#44;7 como de &#171;moderado grado de concordancia&#187;&#44; valores &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;7 y 0&#44;9 como de &#171;buen grado de concordancia&#187;&#44; y valores &#62;<span class="elsevierStyleHsp" style=""></span>0&#44;9 como de &#171;concordancia excelente&#187;&#46; La gr&#225;fica de Bland-Altman fue utilizada para representar el grado de concordancia entre los valores maculares de ambas OCT&#46; El coeficiente de correlaci&#243;n de Spearman evalu&#243; la correlaci&#243;n entre la longitud axial y los valores del disco &#243;ptico&#46; El test de Mann-Whitney <span class="elsevierStyleItalic">U</span> nos permiti&#243; valorar las diferencias seg&#250;n sexo y etnia de origen y el test de Wilcoxon las diferencias interoculares y aquellas entre los valores de ambas OCT&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Participantes</span><p id="par0030" class="elsevierStylePara elsevierViewall">Doce pacientes fueron excluidos debido a mala calidad de imagen o falta de cooperaci&#243;n&#44; teniendo una muestra final de 200 ojos y 100 pacientes&#59; sin embargo&#44; debido a la alta correlaci&#243;n entre los ojos derechos &#40;OD&#41; y los ojos izquierdos &#40;OI&#41; al llevar a cabo el an&#225;lisis estad&#237;stico&#44; tuvimos en cuenta solo los resultados de los OD&#46; Las edades de los pacientes fueron entre 5 a 15<span class="elsevierStyleHsp" style=""></span>a&#241;os y una media de edad de 10&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Las ni&#241;as representaron un 60&#37; y los varones un 40&#37;&#46; La mayor&#237;a fue de etnia europea &#40;72&#37;&#41;&#44; seguido de pacientes de etnia latinoamericana &#40;20&#37;&#41;&#44; asi&#225;tica &#40;6&#37;&#41;&#44; y de &#193;frica del Norte &#40;2&#37;&#41;&#46; La media de la longitud axial fue de 23&#44;1<span class="elsevierStyleHsp" style=""></span>mm&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Par&#225;metros maculares</span><p id="par0035" class="elsevierStylePara elsevierViewall">La media del grosor macular central &#40;GMC&#41; fue de 244&#44;2<span class="elsevierStyleHsp" style=""></span>&#956;m con Cirrus y de 261&#44;7<span class="elsevierStyleHsp" style=""></span>&#956;m Spectralis &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#44; y el volumen medio del GMC fue de 0&#44;21<span class="elsevierStyleHsp" style=""></span>&#956;m<span class="elsevierStyleSup">3</span> &#40;Spectralis&#41;&#46; En el anillo externo el grosor mayor fue para el sector nasal con ambos instrumentos&#46; En el anillo interno tambi&#233;n fue para el sector nasal con Cirrus&#44; mientras con Spectralis fue el sector superior&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> muestra los valores de las capas intrarretinianas de los OD&#44; OI y la media aritm&#233;tica de ambos&#46; Los valores del epitelio pigmentario de la retina &#40;EPR&#41; fueron los m&#225;s altos &#40;sin tomar en cuenta la suma de las capas internas&#41; y los de la capa de fibras nerviosas de la retina macular &#40;CFNRm&#41; fueron los m&#225;s bajos&#46; La correlaci&#243;n entre los sectores inferior externo y temporal externo &#40;Cirrus&#41; y la longitud axial fue negativa y baja&#44; aunque esta fue estad&#237;sticamente significativa&#46; Los valores de los sectores externos &#40;Spectralis&#41; tuvieron correlaci&#243;n negativa significativamente estad&#237;stica con la longitud adxial &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; El grado de concordancia absoluto entre los valores maculares fue desde moderado &#40;CCI&#58; 0&#44;66&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37; &#8722;0&#44;06 a 0&#44;90&#41; a muy bajo para los vol&#250;menes maculares &#40;CCI&#58; 0&#44;11&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; &#8722;0&#44;01 a 0&#44;39&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Los gr&#225;ficos de Bland-Altman para los valores de GMC se muestran en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a> y para el volumen macular central en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Diferencias seg&#250;n edad&#44; sexo&#44; etnia de origen&#44; lateralidad y tipo de OCT</span><p id="par0045" class="elsevierStylePara elsevierViewall">Al evaluar las diferencias entre los valores maculares se observ&#243; que el GMC fue mayor en ni&#241;os que en ni&#241;as&#44; y esta diferencia fue estad&#237;sticamente significativa &#40;ni&#241;os&#58; 253<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; ni&#241;as&#58; 242<span class="elsevierStyleHsp" style=""></span>&#956;m&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;037&#59; Cirrus&#41; &#40;ni&#241;os&#58; 266<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; ni&#241;as&#58; 258<span class="elsevierStyleHsp" style=""></span>&#956;m&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#59; Spectralis&#41;&#46; En relaci&#243;n con las diferencias seg&#250;n edad&#44; dividimos la muestra en dos grupos etarios&#58; grupo<span class="elsevierStyleHsp" style=""></span>1 &#40;pacientes &#60;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>48&#41; y grupo<span class="elsevierStyleHsp" style=""></span>2 &#40;pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>52&#41; con la finalidad de contar con dos grupos de cifras similares&#46; No hubo diferencias significativas en el GMC seg&#250;n la edad con ninguna de las OCT&#44; pero s&#237; se observaron diferencias en los sectores&#58; nasal &#40;grupo<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>318&#44; grupo<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>322&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;017&#41;&#44; temporal &#40;grupo<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>303&#44; grupo<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>309&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;020&#41; y superior &#40;grupo<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>313&#44; grupo<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>319&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41; del anillo interno &#40;Cirrus&#41;&#46; Estas diferencias no se hallaron con la OCT Spectralis&#46; El an&#225;lisis seg&#250;n etnia de origen revel&#243; diferencias en el GMC &#40;europea<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>249&#44; latinoamericana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>238&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#59; Cirrus&#41; &#40;europea<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>264&#44; latinoamericana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>249&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#59; Spectralis&#41;&#46; En el an&#225;lisis de la discrepancia interocular no se hallaron diferencias en el GMC &#40;OD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>246&#44; OI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>245&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;862&#59; Cirrus&#41; &#40;OD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>262&#44; OI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>263&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;119&#59; Spectralis&#41;&#46; Los &#250;nicos sectores que fueron significativamente diferentes fueron el nasal interno &#40;OD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>320&#44; OI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>322&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#59; Cirrus&#41; &#40;OD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>340&#44; OI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>342&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#59; Spectralis&#41; y el superior externo &#40;OD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>306&#44; OI<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>309&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;024&#59; Spectralis&#41;&#46; Por &#250;ltimo&#44; todos los valores maculares de la OCT Spectralis fueron diferentes a los de la OCT Cirrus &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En relaci&#243;n con las capas intrarretinianas &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#44; los ni&#241;os tuvieron valores m&#225;s altos de CFNRm &#40;ni&#241;os&#58; 12&#44; ni&#241;as&#58; 11&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;034&#41;&#44; de capa de c&#233;lulas ganglionares &#40;CCG&#41; &#40;ni&#241;os&#58; 15&#44;5&#59; ni&#241;as&#58; 14&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41;&#44; de capa plexiforme interna &#40;CPI&#41; &#40;ni&#241;os&#58; 21&#44; ni&#241;as&#58; 19&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#44; de capa nuclear interna &#40;CNI&#41; &#40;ni&#241;os&#58; 17&#44;5&#59; ni&#241;as&#58; 16&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;029&#41; y de capas internas &#40;ni&#241;os&#58; 180&#44; ni&#241;as&#58; 170&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;026&#41;&#46; No se obtuvieron diferencias seg&#250;n edad o lateralidad ocular&#46; Seg&#250;n la etnia de origen solo se observaron diferencias en las capas internas &#40;europea<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>176&#44; latinoamericana<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>163&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;043&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discusi&#243;n</span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Valores normativos</span><p id="par0055" class="elsevierStylePara elsevierViewall">Nuestro estudio incluy&#243; 100 ojos de ni&#241;os normales entre las edades de 5 a 15<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Los estudios de valores maculares en ni&#241;os normales que consideran mayores muestras incluyeron 318 ojos<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">25</span></a> y 283 ojos<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">27</span></a> &#40;Cirrus&#41; y 162 ojos <a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> &#40;Spectralis&#41;&#46; Los valores m&#225;s altos reportados fueron en ni&#241;os europeos<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">23&#44;27</span></a> &#40;Cirrus&#41; y en ni&#241;os norteamericanos<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a> &#40;Spectralis&#41; y los m&#225;s delgados en ni&#241;os indios<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">24</span></a> &#40;Cirrus&#41; y en ni&#241;os turcos<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">18</span></a> &#40;Spectralis&#41;&#46; En comparaci&#243;n con estos estudios&#44; nuestros valores pueden ser considerados medios&#44; probablemente por la heterogeneidad de la muestra&#46; Por otro lado&#44; en nuestra muestra los valores del anillo interno con cirrus fueron los m&#225;s altos&#44; hallazgos similares a lo mencionado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0380"><span class="elsevierStyleSup">25&#44;27</span></a>&#46; En relaci&#243;n con las medidas de Spectralis&#44; el sector superior interno fue el m&#225;s grueso&#44; resultado tambi&#233;n obtenido por P&#233;rez<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">40</span></a> y Yanni et al&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a>&#46; En nuestro caso el sector nasal externo fue el m&#225;s grueso&#44; y esto coincidi&#243; con los hallazgos de otros autores<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">18&#44;20&#44;22</span></a>&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Respecto a los valores de las capas intrarretinianas&#44; como se mencion&#243; previamente&#44; no pudimos realizar comparaciones con estudios previos realizados con Spectralis&#44; ya que o bien usaron un software de propia configuraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">20</span></a> o bien incluyeron en sus hallazgos ni&#241;os con altos valores refractivos<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">28&#44;49</span></a>&#46; Debido a ello realizaremos la discusi&#243;n con dos estudios en adultos normales<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">41&#44;42</span></a> que utilizaron el software propio de Spectralis&#44; como en nuestro caso&#46; En comparaci&#243;n con adultos de procedencia asi&#225;tica&#44; los grosores fueron variables&#59; las CFNRm&#44; CCG&#44; CPI&#44; capa plexiforme externa &#40;CPE&#41; y capas internas fueron mayores en nuestros pacientes que en estos adultos<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">42</span></a>&#46; La CNI&#44; la capa nuclear externa &#40;CNE&#41;&#44; la capa del EPR y las externas fueron m&#225;s delgadas en nuestros ni&#241;os&#46; Cabe mencionar que las capas plexiformes tendieron a ser mayores en ni&#241;os que en adultos&#44; y lo inverso sucedi&#243; en las capas nucleares&#46; Este hallazgo podr&#237;a estar en relaci&#243;n con el desarrollo de las sinapsis y conexiones neuronales en ni&#241;os mientras alcanzan la madurez de la edad adulta&#44; y adem&#225;s podr&#237;a estar relacionado con mayor prevalencia de patolog&#237;a retiniana en adultos que en ni&#241;os&#46; Al realizar la comparaci&#243;n con el segundo estudio se puede ver que sus valores de CFNRm y CPI fueron mayores en comparaci&#243;n a los de nuestros pacientes<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">41</span></a>&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Grado de concordancia</span><p id="par0065" class="elsevierStylePara elsevierViewall">Nuestra b&#250;squeda bibliogr&#225;fica no encontr&#243; art&#237;culos previos publicados comparando los valores maculares entre estas dos OCT en poblaci&#243;n pedi&#225;trica&#46; Cirrus y Spectralis han sido comparadas en adultos por Folgar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">45</span></a>&#44; que evaluaron los valores foveales y parafoveales&#44; y Polo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">48</span></a> utilizaron los gr&#225;ficos de Bland-Altman para evaluar la concordancia&#46; Sin embargo&#44; al ser este un m&#233;todo subjetivo&#44; no podr&#237;amos compararlos con nuestros gr&#225;ficos&#46; En relaci&#243;n con el grado de concordancia&#44; el valor m&#225;s alto de CCI correspondi&#243; al GMC &#40;0&#44;66&#41;&#44; aunque este se interpret&#243; como moderado&#46; El resto de valores se interpretaron como grado bajo a muy bajo de concordancia&#46; Esto estar&#237;a relacionado al nivel de segmentaci&#243;n interna considerado para cada instrumento&#44; habiendo sido esto previamente mencionado en poblaci&#243;n adulta&#46; Seg&#250;n nuestra b&#250;squeda bibliogr&#225;fica&#44; este ser&#237;a el primer estudio en ni&#241;os que evidencie esta falta de concordancia entre las medidas maculares de Cirrus y Spectralis&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Diferencias seg&#250;n sexo&#44; edad&#44; etnia de origen&#44; lateralidad y tipo de OCT</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las diferencias obtenidas seg&#250;n sexo en el GMC&#44; donde los valores fueron mayores en varones que en mujeres&#44; se asemeja a lo mencionado por otros autores<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">18&#44;21&#44;25&#44;27</span></a>&#44; aunque estas diferencias no fueron halladas en otros estudios<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">20&#44;24&#44;40&#44;43</span></a>&#44; a pesar de que en algunos de estos estudios se consideraron m&#225;s ni&#241;os que ni&#241;as en sus muestras&#46; Es particularmente interesante enfatizar las diferencias estad&#237;sticamente significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; en los valores de grosor de la CFNRm&#44; CCG&#44; CPI&#44; CPE y capas internas&#44; donde los valores fueron mayores en varones&#46; A nuestro conocimiento&#44; este ser&#237;a el primer art&#237;culo en mencionar esta tendencia en las capas intrarretinianas&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Respecto a la edad&#44; obtuvimos diferencias en todos los sectores del anillo interno &#40;Cirrus&#41;&#44; de la misma forma que lo expresado por Molnar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a>&#44; G&#252;ra&#287;a&#231; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">25</span></a> y Barrio et al&#46;<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">27</span></a>&#46; Sin embargo&#44; estos autores fueron los &#250;nicos en obtener diferencias en el GMC con Cirrus seg&#250;n la edad&#46; En relaci&#243;n con los valores de Spectralis&#44; ning&#250;n autor mencion&#243; diferencias en el GMC seg&#250;n grupo etario&#46; Al evaluar las discrepancias seg&#250;n lateralidad&#44; tampoco evidenciamos diferencias interoculares&#44; a excepci&#243;n del sector nasal interno&#44; hallazgo que fue tambi&#233;n mencionado por Molnar et al&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">23</span></a>&#46; Al comparar los valores seg&#250;n etnia de origen&#44; no hallamos estudios previos que reportaran la tendencia en los ni&#241;os de origen europeo de tener mayor GMC que los ni&#241;os de origen latinoamericano&#46; Finalmente&#44; los valores de GMC haciendo uso de la OCT Spectralis fueron mayores que los de Cirrus &#40;d<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; siendo esto similar a las diferencias en adultos mencionadas por Sander et al&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">46</span></a> &#40;d<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; Heussen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">47</span></a> &#40;d<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>18&#44;6<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#44; Pierro et al&#46;<a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">37</span></a> &#40;d<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44;2<span class="elsevierStyleHsp" style=""></span>&#956;m&#41; y Han y Jaffe<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">44</span></a> &#40;d<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44;4<span class="elsevierStyleHsp" style=""></span>&#956;m&#41;&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conclusi&#243;n</span><p id="par0080" class="elsevierStylePara elsevierViewall">En base a nuestros hallazgos con OCT Cirrus y Spectralis&#44; los valores no deber&#237;an ser intercambiables en el diagn&#243;stico&#44; el manejo y el seguimiento en la poblaci&#243;n pedi&#225;trica&#44; ya que podr&#237;a llevar a interpretaciones err&#243;neas&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Financiaci&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">La presente investigaci&#243;n no ha recibido ayudas espec&#237;ficas provenientes de agencias del sector p&#250;blico&#44; sector comercial o entidades sin &#225;nimo de lucro&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicto de intereses</span><p id="par0090" class="elsevierStylePara elsevierViewall">Los autores declaramos que no existe ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Agradecimientos</span><p id="par0105" class="elsevierStylePara elsevierViewall">Estamos realmente agradecidos a Oliver Shaw&#44; PhD &#40;IIS-FJD&#41;&#44; por llevar a cabo la revisi&#243;n y la correcci&#243;n en formato idioma ingl&#233;s&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar el grado de concordancia y las diferencias entre los par&#225;metros maculares en funci&#243;n de sexo&#44; edad&#44; lateralidad&#44; etnia y tipo de tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; en pacientes pedi&#225;tricos&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materiales y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo&#44; transversal y comparativo&#46; Se hizo uso de la OCT Spectralis y la OCT Cirrus para obtener los valores maculares de ambos ojos en 100 pacientes entre 5 y 15<span class="elsevierStyleHsp" style=""></span>a&#241;os sin patolog&#237;a ocular&#46; Debido a la semejanza entre los valores de ambos ojos&#44; en la muestra final solo consideramos los ojos derechos &#40;OD&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La media del grosor macular central &#40;GMC&#41; fue de 244&#44;2<span class="elsevierStyleHsp" style=""></span>&#956;m con Cirrus y 261&#44;7<span class="elsevierStyleHsp" style=""></span>&#956;m con Spectralis&#46; El grado de concordancia para el GMC fue moderado &#40;coeficiente de correlaci&#243;n intraclase&#58; 0&#44;66&#41; y de bajo a muy bajo en el resto de cuadrantes&#46; Los valores de GMC de ambos sistemas fueron significativamente mayores en varones que en mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La capa de fibras nerviosas de la retina macular &#40;CFNRm&#41;&#44; la capa de c&#233;lulas ganglionares &#40;CCG&#41;&#44; la capa plexiforme interna &#40;CPI&#41; y la capa nuclear interna &#40;CNI&#41; tuvieron valores significativamente mayores en varones que en mujeres &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; No hubo diferencias estad&#237;sticamente significativas en el GMC seg&#250;n edad y lateralidad&#59; sin embargo&#44; fue significativamente mayor en ni&#241;os de etnia europea que en ni&#241;os de etnia latinoamericana&#59; Cirrus &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;042&#41; y Spectralis &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;033&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los par&#225;metros maculares obtenidos mediante OCT Spectralis y OCT Cirrus no deber&#237;an ser intercambiables en pacientes pedi&#225;tricos&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
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          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
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      "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 determine the degree of agreement and differences between macular parameters according to sex&#44; age&#44; laterality&#44; ethnicity and type of optical coherence tomography &#40;OCT&#41; in paediatric patients&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Prospective&#44; transversal&#44; and comparative study&#46; OCT Spectralis and OCT Cirrus were used to obtain the macular values of both eyes in 100 patients between 5 and 15<span class="elsevierStyleHsp" style=""></span>years without ocular pathology&#46; Due to the similarity between the values of both eyes&#44; in the final sample we only considered the right eyes &#40;OD&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The average central macular thickness &#40;CMT&#41; was 244&#46;2<span class="elsevierStyleHsp" style=""></span>&#956;m with Cirrus and 261&#46;7<span class="elsevierStyleHsp" style=""></span>&#956;m with Spectralis&#46; The degree of agreement for the GMC was moderate &#40;intraclass correlation coefficient&#58; 0&#46;66&#41; and from low to very low in the other quadrants&#46; The GMC values of both systems were significantly higher in men than in women &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; The macular retinal nerve fibre layer &#40;mRNC&#41;&#44; ganglion cell layer &#40;GCC&#41;&#44; the inner plexiform layer &#40;IPLC&#41;&#44; and the inner nuclear layer &#40;INFL&#41; had significantly higher values in men than in women &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; There were no statistically significant differences in the GMC by age and laterality&#44; however it was significantly higher in ethnic European children than in ethnic Latin American children&#59; Cirrus &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;042&#41; and Spectralis &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;033&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Macular parameters obtained by OCT Spectralis and OCT Cirrus should not be interchangeable in pediatric patients&#46;</p></span>"
        "secciones" => array:4 [
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            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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        ]
      ]
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Presentado parcialmente en la obtenci&#243;n del t&#237;tulo de Doctor en Medicina otorgado por la Universidad Aut&#243;noma de Madrid&#46;</p>"
      ]
    ]
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fico de Bland-Altman para la concordancia entre valores de grosor macular OCT Spectralis frente a OCT Cirrus&#46; Valores en &#956;m&#46; Desviaci&#243;n t&#237;pica&#58; 7&#44;05<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Gr&#225;fico de Bland-Altman para la concordancia entre valores de volumen macular OCT Spectralis frente a OCT Cirrus&#46; Valores en &#956;m<span class="elsevierStyleSup">3</span>&#46; Desviaci&#243;n t&#237;pica&#58; 0&#44;23<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;</p>"
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        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Segmentaci&#243;n de capas de la retina OCT Spectralis &#40;Li et al&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">42</span></a>&#41;&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">GCL&#58; capa de c&#233;lulas ganglionares&#59; ILM&#58; membrana limitante interna&#59; INL&#58; capa nuclear interna&#59; IPL&#58; capa plexiforme interna&#59; OLM&#58; membrana limitante externa&#59; OPL&#58; capa plexiforme externa&#59; PR&#58; capas de fotorreceptores&#59; RNFL&#58; capa de fibras nerviosas de la retina&#59; RPE&#58; epitelio pigmentario de la retina&#46;</p>"
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">OCT&#58; tomograf&#237;a de coherencia &#243;ptica&#59; V&#58; volumen&#46;</p>"
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                  \t\t\t\t" scope="col">Valores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Media&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil</th><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Media&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil</th><th class="td" title="\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">Media&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="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentil</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\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
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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">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&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">95&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
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                  \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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&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">95&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
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                  \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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">1&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">5&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
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&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
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Macular central&nbsp;\t\t\t\t\t\t\n
                  \t\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">244&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">197&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">213&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">273&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">228&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nasal interno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;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">288&#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">298&#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">344&#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">340&#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">309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;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">360&#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;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;49&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">313&#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">272&#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">291&#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">338&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">337&#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">312&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">317&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">364&#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;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;49&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">305&#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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">327&#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">326&#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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">349&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;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">0&#44;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;47&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">320&#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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;50&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">301&#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
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">324&#44;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</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</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</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</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</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;58&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&nbsp;\t\t\t\t\t\t\n
                  \t\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</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">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</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</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</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</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">323&#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">1&#44;46&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Temporal externo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;42&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">280&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">283&#44;9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;51&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
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Volumen macular total&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">9&#44;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#44;8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Capas externas&#58; grosor desde la membrana limitante externa hasta la membrana de Bruch&#59; capas internas&#58; grosor desde la membrana limitante interna hasta la membrana limitante externa&#59; CFNRm&#58; capa de fibras nerviosas de la retina macular&#59; EPR&#58; epitelio pigmentario de la retina&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Expresado en &#956;m&#46;</p>"
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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" scope="col">Capas intrarretinianas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col">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><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><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
                  \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">1&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">5&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">95&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">1&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">5&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">95&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">1&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">5&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">95&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">C&#233;lulas ganglionares&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Plexiforme interna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nuclear interna&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Plexiforme externa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nuclear externa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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ISSN: 03656691
Idioma original: Español
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