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Espesor macular y coroideo en el síndrome de Down mediante swept-source tomografía de coherencia óptica (SS-OCT)
Macular and choroidal thickness in Down syndrome by swept-source optical coherence tomography (SS-OCT)
O. Estebana,b,
Autor para correspondencia
oliviaestebanfloria@hotmail.com

Autor para correspondencia.
, C. Marcuelloc, M. Martinezd, L. Lavillae, S. Marcoa, F.J. Ascasoa,b
a Departamento de Oftalmología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
b Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
c Departamento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, España
d Hospital San Pedro, Logroño, España
e Hospital Universitario Miguel Servet, Zaragoza, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El s&#237;ndrome de Down &#40;SD&#41; est&#225; asociado a determinados trastornos estructurales y funcionales en todo el sistema visual&#44; como errores de refracci&#243;n significativos&#44; ambliop&#237;a&#44; estrabismo&#44; nistagmo&#44; glaucoma&#44; queratocono&#44; cataratas y anomal&#237;as retinianas<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>&#46; Sin embargo&#44; tambi&#233;n puede presentar una funci&#243;n visual deficiente en ausencia de patolog&#237;as oculares&#46; No se puede atribuir la causa de la disminuci&#243;n del rendimiento visual en algunos sujetos con SD a selecci&#243;n individual&#44; atenci&#243;n o factores motivantes<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aunque la tomograf&#237;a de coherencia &#243;ptica &#40;OCT&#41; ofrece una herramienta objetiva para evaluar las caracter&#237;sticas estructurales retinianas y coroideas&#44; muy pocos estudios la han utilizado en sujetos con SD&#46; La <span class="elsevierStyleItalic">swept-source-</span>OCT o de fuente de barrido &#40;SS-OCT&#41; proporciona una mejor visualizaci&#243;n&#44; una penetraci&#243;n m&#225;s profunda bajo el epitelio pigmentario de la retina &#40;EPR&#41;&#44; aumenta nuestro conocimiento de las estructuras coroideas y realiza una segmentaci&#243;n automatizada de los bordes coroideos&#46; El prop&#243;sito de este estudio es explorar la retina y el grosor coroideo en sujetos con SD utilizando SS-OCT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Material y m&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Este estudio transversal recoge datos de 100 ojos de 52 participantes con SD&#46; El grupo de control est&#225; formado por 78 ojos de 39 sujetos con edad y longitud axial emparejadas en cada caso&#46; Todos los individuos fueron inscritos entre octubre y noviembre de 2019 basados en an&#225;lisis citogen&#233;ticos&#46; Los criterios de inclusi&#243;n admiten a cualquier sujeto con SD con un tutor legal capaz de dar un consentimiento informado&#46; Los criterios de exclusi&#243;n fueron las patolog&#237;as retinianas como degeneraci&#243;n macular&#44; oclusi&#243;n de la vena retiniana o retinopat&#237;a diab&#233;tica y opacidades corneales como cataratas o hemorragia v&#237;trea&#44; que dificultan el examen ocular&#46; El protocolo de investigaci&#243;n se adhiere a la Declaraci&#243;n de Helsinki y el estudio obtuvo la aprobaci&#243;n del comit&#233; de &#233;tica local &#40;CEICA&#41;<span class="elsevierStyleItalic">&#46;</span> Se obtuvo el consentimiento informado de todos los sujetos y de sus padres o representantes legalmente autorizados&#46; Los sujetos con SD y controles fueron remitidos entre las 15&#58;00 y las 18&#58;00<span class="elsevierStyleHsp" style=""></span>h para minimizar la variaci&#243;n coroidea al Departamento de Oftalmolog&#237;a del Hospital Cl&#237;nico Universitario Lozano Blesa de Zaragoza&#44; Espa&#241;a&#46; El examen oftalmol&#243;gico incluye&#58; historia m&#233;dica general y el uso de medicamentos con receta&#44; mejor agudeza visual corregida &#40;MAVC&#41; utilizando un gr&#225;fico de ETDRS&#59; examen de refractometr&#237;a&#44; motilidad ocular&#44; examen de biomicroscopia con l&#225;mpara de hendidura y medici&#243;n de la presi&#243;n intraocular mediante tonometr&#237;a de aplanaci&#243;n de Goldmann&#46; La OCT se realiz&#243; con el SS-OCT &#40;DRI OCT Triton&#44; Topcon&#44; Jap&#243;n&#41;&#46; Repetimos el proceso hasta obtener im&#225;genes de alta calidad &#40;intensidad de se&#241;al &#8805;<span class="elsevierStyleHsp" style=""></span>7&#41;&#46; Cada participante se someti&#243; a un protocolo de barrido de rasterizaci&#243;n 3<span class="elsevierStyleHsp" style=""></span>D con resoluci&#243;n axial de 3<span class="elsevierStyleHsp" style=""></span>&#956;m y una velocidad de 100&#46;000<span class="elsevierStyleHsp" style=""></span>A-scans por segundo para obtener un mapa del grosor retiniano y coroideo enfocado en la m&#225;cula &#40;12<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>9<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; Los mapas de grosor se superpusieron a la cuadr&#237;cula EDTRS &#40;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm&#41; para obtener valores de cada sector&#46; Se utiliz&#243; un software integrado para calcular autom&#225;ticamente los valores de grosor en la cuadr&#237;cula EDTRS&#59; los anillos internos y externos&#44; con semidi&#225;metros de 1500<span class="elsevierStyleHsp" style=""></span>&#956;m y 3000<span class="elsevierStyleHsp" style=""></span>&#956;m&#44; respectivamente&#44; se segmentaron en 4 cuadrantes &#40;superior&#44; inferior&#44; nasal y temporal&#41;&#46; El sector central estaba definido dentro de los 1000<span class="elsevierStyleHsp" style=""></span>&#956;m del centro foveal&#46; Los grosores medios de la capa de c&#233;lulas ganglionares&#44; retina y coroides en la regi&#243;n macular de los sujetos con SD fueron adquiridos autom&#225;ticamente y comparados con los de los controles para evaluar el cambio macular&#46; Incluyen grosor retiniano foveal &#40;rFT&#41;&#44; grosor ganglionar foveal &#40;gFT&#41; y grosor coroideo foveal &#40;cFT&#41;&#46; Adem&#225;s&#44; el grosor de los anillos retinianos internos y externos se analizaron en 4 cuadrantes utilizando el software de segmentaci&#243;n del equipo&#46; El an&#225;lisis estad&#237;stico de los datos se complet&#243; utilizando el software SPSS versi&#243;n 19&#46;0 &#40;IBM-SPSS&#44; Inc&#44; Chicago&#44; Illinois&#44; EE&#46;UU&#46;&#41;&#46; Las diferencias cualitativas se compararon mediante la prueba de chi-cuadrado de Pearson&#46; Se realiz&#243; un an&#225;lisis de distribuci&#243;n normal mediante la prueba de Kolmogorov-Smirnov&#46; Como los datos mostraron una distribuci&#243;n no param&#233;trica&#44; se emple&#243; una prueba <span class="elsevierStyleItalic">U</span> de Mann-Whitney para comparar ambos grupos&#46; Se utiliz&#243; el coeficiente de correlaci&#243;n de Spearman Rank para evaluar las correlaciones bivariadas&#46; Un valor de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 se considera estad&#237;sticamente significativo&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Resultados</span><p id="par0020" class="elsevierStylePara elsevierViewall">El an&#225;lisis constaba de 91 sujetos&#58; 100 ojos de 52 sujetos con SD &#40;M&#47;H 38&#44;5&#37;&#47;61&#44;5&#37;&#44; edad media de 26&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;8<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41; y 78 ojos de 39 controles &#40;M&#47;H 25&#44;6&#37;&#47;74&#44;4&#37;&#44; edad media de 28&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;4<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;072&#44; prueba <span class="elsevierStyleItalic">U</span> de Mann-Whitney&#41; y el equivalente esf&#233;rico &#40;SEQ&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;167&#41; no mostraron diferencias estad&#237;sticas significativas entre ambos grupos&#46; Sin embargo&#44; la MAVC era menor en el grupo con SD que en el grupo control &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;015&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Todos los sujetos del grupo con SD presentaban una estructura macular reconocible&#44; incluyendo una fosa foveal&#46; La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra datos demogr&#225;ficos y cl&#237;nicos de ambos grupos&#46; El grosor de los anillos interiores y exteriores no muestra diferencias significativas entre SD y el grupo de control&#44; ya sea en la capa de c&#233;lulas ganglionares o en la retina &#40;prueba <span class="elsevierStyleItalic">U</span> de Mann-Whitney&#44; todos p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Sin embargo&#44; rFT y gFT eran significativamente mayores en sujetos con SD que en controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La capa coroidea&#44; cFT y el grosor coroideo en los cuadrantes temporal e inferior &#40;anillos retinianos internos y externos&#41; eran significativamente menores en sujetos con SD que en el grupo control agrupado por edad y longitud axial &#40;prueba <span class="elsevierStyleItalic">U</span> de Mann-Whitney&#44; todos p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La MAVC en el grupo con SD no mostraba correlaci&#243;n con el grosor retiniano o coroideo &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Encontramos una rFT m&#225;s gruesa en el grupo con SD &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#59; un hallazgo consistente con los datos obtenidos en otros estudios de ni&#241;os con SD<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> y adultos con SD<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> relacionados con desarrollo macular diferente sin cambios en los anillos exteriores alrededor de la f&#243;vea&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se ha sugerido que el grosor de la capa de fibras nerviosas de la retina &#40;CFNR&#41; peripapilar es un biomarcador de la p&#233;rdida axonal&#44; lo que refleja la p&#233;rdida axonal en el sistema nervioso central&#46; Mientras que la medici&#243;n del grosor de la CFNR muestra los axones y permite la cuantificaci&#243;n de la p&#233;rdida axonal&#44; la medici&#243;n del grosor macular refleja los cuerpos de c&#233;lulas neuronales y permite cuantificar la p&#233;rdida neuronal&#46; Esto se debe a que la regi&#243;n macular contiene principalmente el cuerpo de c&#233;lulas ganglionares&#44; ya que las fibras nerviosas se encuentran alrededor de la m&#225;cula para evitar oscurecer el &#225;rea m&#225;s sensible para la visi&#243;n&#46; Por tanto&#44; la medici&#243;n del grosor macular puede presentar una forma no invasiva de evaluar si se produce degeneraci&#243;n neuronal junto a p&#233;rdida axonal<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a>&#46; Se decidi&#243; estudiar la capa de c&#233;lulas ganglionares en el &#225;rea macular mediante SS-OCT&#46; Nuestros resultados muestran una gFT m&#225;s gruesa en el grupo con SD que en los controles&#46; Walpert et al&#46; observaron resultados similares en la capa de c&#233;lulas ganglionares en poblaci&#243;n con SD &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>49&#41;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a>&#46; Estos investigadores tambi&#233;n encontraron en contra de su hip&#243;tesis un aumento de grosor en la CFNR global y CFNR en cuadrantes &#40;temporal&#44; superior e inferior&#41; en el grupo con SD en comparaci&#243;n con los controles de la misma edad &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>36&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#46; Sin embargo&#44; se&#241;alaron que estos hallazgos no estaban presentes en un peque&#241;o grupo de participantes con SD de alrededor de 50<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Recientemente&#44; Ugurlu et al&#46; tambi&#233;n encontraron cuadrantes de la CFNR m&#225;s gruesos en ni&#241;os con SD en comparaci&#243;n con controles<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#46; Estos resultados son consistentes con nuestros hallazgos de gFT dado que solo 2 sujetos con SD ten&#237;an m&#225;s de 50<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Este hecho lleva a plantear la hip&#243;tesis de la existencia de una CFNR m&#225;s gruesa a partir de los 40<span class="elsevierStyleHsp" style=""></span>a&#241;os y una CFNR m&#225;s delgada cuando la prote&#237;na beta-amiloide cerebral &#40;A&#223;P&#41; aparece a los 50<span class="elsevierStyleHsp" style=""></span>a&#241;os en sujetos con SD&#46; El gen A&#223;P se hereda por triplicado en sujetos con SD&#46; La sobreproducci&#243;n de A&#223;P genera placas seniles en el cerebro&#46; Se observan en aproximadamente el 100&#37; de los individuos con SD mayores de 40<span class="elsevierStyleHsp" style=""></span>a&#241;os&#46; Estas placas tambi&#233;n se encuentran en el deterioro cognitivo leve &#40;DCL&#41; antes de la demencia y en demencia como la enfermedad de Alzheimer &#40;EA&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha descubierto un papel vascular en el deterioro cognitivo o la demencia&#46; La angiopat&#237;a amiloide cerebral &#40;AAC&#41; es un factor de disfunci&#243;n vascular en EA&#46; Head et al&#46; estudiaron la presencia de AAC en biopsias de EA&#44; SD y controles&#46; Encontraron una probabilidad de AAC severa en SD mayor que en el resto de grupos<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a>&#46; En un estudio reciente de este &#225;mbito se observa el adelgazamiento coroideo en una muestra de EA y DCL en comparaci&#243;n con controles de la misma edad<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>&#46; Estos hallazgos fueron relacionados con el papel de la afectaci&#243;n vascular cerebral en la patogenia de la enfermedad&#46; Estos autores tambi&#233;n concluyen que el grosor coroideo se correlaciona con el deterioro cognitivo y podr&#237;a ser un nuevo biomarcador para el diagn&#243;stico temprano de DCL&#46; Otros autores afirman que el adelgazamiento coroideo en la EA puede relacionarse con la hipoperfusi&#243;n de la coroides y podr&#237;a estar asociado a lo observado en el cerebro con EA<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a>&#46; Se ha hipotetizado incluso que el adelgazamiento coroideo podr&#237;a depender de la toxicidad A&#223;P que coincide con el mecanismo de da&#241;o coroideo en la degeneraci&#243;n macular asociada a la edad &#40;DMAE&#41; donde tambi&#233;n se ha encontrado acumulaci&#243;n de A&#223;P<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>&#46; En contraste con otros estudios que analizan el grosor coroideo por SD-OCT en ni&#241;os con SD<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>&#44; descubrimos cFT y coroides m&#225;s delgadas en los cuadrantes temporal e inferior &#40;anillos retinianos internos y externos alrededor de la f&#243;vea&#41; por SS-OCT en sujetos con SD que en controles con edad y longitud axial coincidentes &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La poblaci&#243;n de nuestro estudio es mayor en comparaci&#243;n con los estudios realizados con ni&#241;os&#44; por lo que puede que sea consistente con la hip&#243;tesis del papel vascular&#46; Se necesitan estudios con grupos m&#225;s grandes de adultos con SD que incluyan el grosor coroideo por SS-OCT para validar los hallazgos observados en este estudio&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Es prudente analizar las limitaciones de la medici&#243;n del grosor coroideo&#46; Se cree que algunos factores oculares y sist&#233;micos pueden afectarlo&#46; Los criterios de exclusi&#243;n evitan los principales trastornos oculares&#46; Los medicamentos con receta y las enfermedades sist&#233;micas que podr&#237;an influir fueron descartados por la historia cl&#237;nica&#46; Sin embargo&#44; no se controlaron los h&#225;bitos de tabaquismo o ingesti&#243;n de cafe&#237;na de los participantes&#46; Tampoco se descart&#243; en espec&#237;fico la presi&#243;n sangu&#237;nea como otro posible factor de confusi&#243;n&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Este es el primer estudio transversal con un n&#250;mero mayor de participantes con SD que eval&#250;a caracter&#237;sticas de la coroides por SS-OCT corrigiendo por edad y longitud axial del grupo control&#46; Planteamos la hip&#243;tesis de un posible papel vascular en el sistema visual de SD&#46; La coroides es uno de los tejidos m&#225;s vascularizados del cuerpo y proporciona ox&#237;geno y nutrici&#243;n al tejido retiniano externo&#46; El adelgazamiento del tejido coroideo en individuos con SD podr&#237;a estar relacionado con hipoperfusi&#243;n&#44; cambios en la retina y evoluci&#243;n neuronal&#44; sumado al adelgazamiento asociado con envejecimiento prematuro&#46; Es posible que una mayor gravedad del SD provoque un adelgazamiento coroideo mayor&#46; No obstante&#44; futuros estudios deber&#237;an analizar la progresi&#243;n y correlaci&#243;n entre las caracter&#237;sticas oculares y la evoluci&#243;n asociada a la edad en personas con SD&#46; Los cambios en los par&#225;metros de SS-OCT observados en grupos con SD pueden ser una herramienta &#250;til para comprender la funci&#243;n visual disminuida inexplicable observada en algunos pacientes con SD en ausencia de patolog&#237;as oculares&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Cumplimiento de est&#225;ndares &#233;ticos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Aprobaci&#243;n &#233;tica&#58; Todos los procedimientos realizados en estudios con participantes humanos estaban en concordancia con los est&#225;ndares &#233;ticos del comit&#233; de investigaci&#243;n institucional y&#47;o nacional y con la declaraci&#243;n de Helsinki de 1964 y sus enmiendas posteriores o est&#225;ndares &#233;ticos comparables&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El estudio obtuvo la aprobaci&#243;n de la <span class="elsevierStyleItalic">comisi&#243;n de &#233;tica local de Arag&#243;n &#40;Espa&#241;a&#41;&#58;</span> Comit&#233; de &#201;tica de la Investigaci&#243;n de la Comunidad Aut&#243;noma de Arag&#243;n&#58; <span class="elsevierStyleItalic">CEICA&#46;</span> N&#250;mero de referencia del estudio&#58; PI16&#47;00030&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se obtuvo el consentimiento informado de todos los sujetos y de sus padres o un representante legalmente autorizado&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Financiaci&#243;n</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ninguno de los autores recibi&#243; subvenci&#243;n o beca para este estudio&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Este estudio se realiz&#243; sin ninguna subvenci&#243;n o beca de apoyo&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Este trabajo no se present&#243; en ning&#250;n encuentro nacional o internacional&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflicto de intereses</span><p id="par0080" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Agradecimientos</span><p id="par0085" class="elsevierStylePara elsevierViewall">Agradecimientos a todas las personas que han participado en la elaboraci&#243;n de este trabajo y a sus familares por la predisposici&#243;n para colaborar&#46;</p></span></span>"
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            0 => "Macular thickness"
            1 => "Choroidal thickness"
            2 => "Swept-source optical coherence tomography"
            3 => "SS-OCT"
            4 => "Down syndrome"
          ]
        ]
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El s&#237;ndrome de Down &#40;SD&#41; se asocia a diversos trastornos estructurales y funcionales en la totalidad del sistema visual&#46; El prop&#243;sito del estudio fue comparar el grosor retiniano y coroideo utilizando tomograf&#237;a de coherencia &#243;ptica <span class="elsevierStyleItalic">swept-source</span> &#40;SS-OCT&#41; en sujetos con SD y controles&#46; Este estudio transversal incluye 100 ojos de 52 sujetos SD y 78 ojos de 39 controles de edad y longitud axial concordantes&#46; Los resultados mostraron que el grosor retiniano interno o externo y el grosor ganglionar no presentaron diferencias significativas entre los sujetos con SD y el grupo de control &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Sin embargo&#44; el grosor retiniano foveal &#40;rFT&#41; y el grosor ganglionar foveal &#40;gFT&#41; fueron significativamente superiores en el grupo SD que en los controles&#44; mientras que el grosor foveal coroideo &#40;cFT&#41; y algunos cuadrantes coroideos de los anillos interno y externo fueron significativamente inferiores &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Este es el primer estudio piloto que proporciona informaci&#243;n sobre los grosores macular y coroideo en SD utilizando SS-OCT comparado con controles&#46; Es necesario realizar an&#225;lisis adicionales con grupos mayores de sujetos para confirmar estos resultados&#46;</p></span>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Down syndrome &#40;DS&#41; is associated with certain structural and functional disorders in the whole visual system&#46; The purpose was to compare retinal and choroidal thickness using swept-source optical coherence tomography &#40;SS-OCT&#41; in DS subjects with controls&#46; This cross-sectional study included 100 eyes of 52 DS subjects and 78 eyes of 39 matching age and axial length controls&#46; Our results showed that inner or outer retinal and ganglionar thickness showed no significant differences between DS and control group &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; However&#44; retinal foveal thickness &#40;rFT&#41;&#44; ganglion foveal thickness &#40;gFT&#41; were significantly higher in DS group than in controls&#44; whereas choroidal foveal thickness &#40;cFT&#41; and some choroidal quadrants of inner and outer rings were significantly lower &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; This the first pilot study to provide information about macular and choroidal thicknesses in SD using SS-OCT compared to controls&#46; Further analyses with larger numbers of subjects are needed to confirm our results&#46;</p></span>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes de <span class="elsevierStyleItalic">swept-source</span>-OCT del ojo derecho de un sujeto de 40<span class="elsevierStyleHsp" style=""></span>a&#241;os con s&#237;ndrome de Down &#40;arriba&#41; y control &#40;abajo&#41;&#46; Los mapas de grosor se superpusieron a la cuadr&#237;cula EDTRS &#40;6<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>mm&#41; para obtener valores para cada sector de la coroides&#46;</p>"
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      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">cFT&#58; grosor foveal coroideo&#59; gFT&#58; grosor foveal ganglionar&#59; MAVC&#58; mejor agudeza visual corregida&#59; rFT&#58; grosor foveal retiniano&#59; SE&#58; equivalente esf&#233;rico&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">308&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>22&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;341&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="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>37&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">310&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;336&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Capa externa</span></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="elsevierStyleHsp" style=""></span>Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">264&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#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">261<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;182&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="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">281&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">275&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#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">0&#44;063&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="elsevierStyleHsp" style=""></span>Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">294&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;710&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="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">271&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">267&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;182&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Coroides</span></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">cFT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">287&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>112&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">311&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>78&#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;000&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Capa interna</span></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="elsevierStyleHsp" style=""></span>Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">286&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">310<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;012&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="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>106&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">313&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;072&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="elsevierStyleHsp" style=""></span>Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">270<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>108&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;173&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="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">279&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>100&#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">305&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>79&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;021&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  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Capa externa</span></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="elsevierStyleHsp" style=""></span>Temporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">278&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>90&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">298&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#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">0&#44;018&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="elsevierStyleHsp" style=""></span>Superior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">292&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>99&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">307&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>76&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;297&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="elsevierStyleHsp" style=""></span>Nasal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">226&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>99&#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">236&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>76&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;444&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="elsevierStyleHsp" style=""></span>Inferior&nbsp;\t\t\t\t\t\t\n
                  \t\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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          "es" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">MAVC y correlaci&#243;n con grosores de las capas de c&#233;lulas retinianas y coroideas &#40;&#956;m&#41; en &#225;reas seccionales para el grupo con s&#237;ndrome de Down</p>"
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ISSN: 03656691
Idioma original: Español
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