Correlation between type 2 diabetes, dry eye and Meibomian glands dysfunction

array:24 ["pii" => "S1888429619300214" "issn" => "18884296" "doi" => "10.1016/j.optom.2019.02.003" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "294" "copyright" => "Spanish General Council of Optometry" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Optom. 2019;12:256-62" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2383 "formatos" => array:3 [ "EPUB" => 134 "HTML" => 1717 "PDF" => 532 ] ] "itemSiguiente" => array:19 [ "pii" => "S1888429619300196" "issn" => "18884296" "doi" => "10.1016/j.optom.2019.02.002" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "292" "copyright" => "Spanish General Council of Optometry" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Optom. 2019;12:263-71" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1354 "formatos" => array:3 [ "EPUB" => 85 "HTML" => 1034 "PDF" => 235 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "263" "paginaFinal" => "271" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implicaciones sobre seguridad microbiana de los fármacos oftálmicos diagnósticos tópicos utilizados en las clínicas oftalmológicas de Gana" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3269 "Ancho" => 2333 "Tamanyo" => 301106 ] ] "descripcion" => array:1 [ "en" => "A map showing the means±SEM levels of contamination by region by with blue indicating the region with the least contamination and the red the region with the most contamination. One-way ANOVA (multiple comparisons) indicated Volta and Eastern Region had less contaminations compared to Ashanti and Central Regions. *Indicates p≤0.005)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Samuel Kyei, Eric Appiah, Eunice Ampadubea Ayerakwa, Clara Bemmah Antwi, Kofi Asiedu" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Samuel" "apellidos" => "Kyei" ] 1 => array:2 [ "nombre" => "Eric" "apellidos" => "Appiah" ] 2 => array:2 [ "nombre" => "Eunice Ampadubea" "apellidos" => "Ayerakwa" ] 3 => array:2 [ "nombre" => "Clara Bemmah" "apellidos" => "Antwi" ] 4 => array:2 [ "nombre" => "Kofi" "apellidos" => "Asiedu" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300196?idApp=UINPBA00004D" "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300196/v1_201910291446/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1888429619300202" "issn" => "18884296" "doi" => "10.1016/j.optom.2019.03.001" "estado" => "S300" "fechaPublicacion" => "2019-10-01" "aid" => "293" "copyright" => "Spanish General Council of Optometry" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Optom. 2019;12:248-55" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1538 "formatos" => array:3 [ "EPUB" => 104 "HTML" => 1064 "PDF" => 370 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original articles" "titulo" => "Ocular surface response and subjective symptoms associated to lens care solutions in Palestine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "248" "paginaFinal" => "255" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Respuesta de la superficie ocular y síntomas subjetivos asociados a las soluciones para el cuidado de las lentillas en Palestina" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 919 "Ancho" => 1495 "Tamanyo" => 75987 ] ] "descripcion" => array:1 [ "en" => "Extent of corneal staining (mean±SD) after 2h of contact lens wear with tested solutions (n=50). P-values compared the extent of corneal staining after 2h of CL wear and at baseline. PAPB, polyaminoprpyl biguanide; PHMB, polyheamethylene biguanide hydrochloride; Phx, polyhexanide; PQ-1, polyquaternium-1." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ithar M. Beshtawi, Jamal Qaddomi, Hanady Khuffash, Safa El-Titi, Malak Ghannam, Reema Otaibi" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Ithar M." "apellidos" => "Beshtawi" ] 1 => array:2 [ "nombre" => "Jamal" "apellidos" => "Qaddomi" ] 2 => array:2 [ "nombre" => "Hanady" "apellidos" => "Khuffash" ] 3 => array:2 [ "nombre" => "Safa" "apellidos" => "El-Titi" ] 4 => array:2 [ "nombre" => "Malak" "apellidos" => "Ghannam" ] 5 => array:2 [ "nombre" => "Reema" "apellidos" => "Otaibi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300202?idApp=UINPBA00004D" "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300202/v1_201910291446/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Correlation between type 2 diabetes, dry eye and Meibomian glands dysfunction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "256" "paginaFinal" => "262" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Garzón P. Sandra Johanna, López-Alemany Antonio, Gené-Sampedro Andrés" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Garzón P." "apellidos" => "Sandra Johanna" "email" => array:1 [ 0 => "decano.optometria@uan.edu.co" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "López-Alemany" "apellidos" => "Antonio" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] 2 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "Gené-Sampedro" "apellidos" => "Andrés" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Faculty of Optometry, research group of optometry, University Antonio Nariño, Tr 3 este 47 a 15, 11001, Bogotà, Colombia" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University of Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Research Group in Ocular Surface, Cornea and Contact Lenses “Miguel Refojo”, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Vision Sciences Department, Office 1.49 Laboratory 1.50 A, Research Building. C/ Dr. Moliner, 50-50 Dr. Moliner St., 46100 Burjassot, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Vision Sciences Department, Research Group INTRAS (Instituto de Tráfico y Seguridad Vial), C/ Dr. Moliner, 50, 46100 Burjassot, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: School of Optometry, research group of optometry, University Antonio Nariño, Tr 3 este 47 a 15, 11001, Bogotà, Colombia" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Correlación entre diabetes tipo 2, ojo seco y disfunción de las glándulas de Meibomio" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 1497 "Tamanyo" => 67895 ] ] "descripcion" => array:1 [ "en" => "Correlation between OSDI and Hb1Ac in diabetic participants." ] ] ] "textoCompleto" => "IntroductionThe international workshop on Meibomian gland dysfunction (MGD) has defined this condition as “a chronic and diffuse anomaly of Meibomian glands, commonly characterized by obstruction of the terminal duct and/or qualitative/quantitative changes in glandular secretion”. This can cause an alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation and ocular surface diseases.<a class="elsevierStyleCrossRefs" href="#bib0195">1,2</a>Diabetes is a very common chronic disease first cause of mortality. The prevalence of type 2 diabetes has increased significantly in recent decades.<a class="elsevierStyleCrossRef" href="#bib0205">3</a> Ocular disorders are common in diabetic patients, such as retinopathy, corneal epithelial erosions, and dry eye. The current report in dry eye, the workshop (DEWS II) indicated that diabetes may be a risk factor of dry eye<a class="elsevierStyleCrossRef" href="#bib0210">4</a> and the symptoms are worse than nondiabetic people.<a class="elsevierStyleCrossRef" href="#bib0215">5</a> The Meibomian gland produces lipids and proteins which form the outer layer of the tear film; these lipids decrease evaporation in MGD and promote instability of the tear film, increasing cause of evaporative dry eye and may play an important role in the severity of the symptoms according with the International Workshop on Meibomian Gland Dysfunction<a class="elsevierStyleCrossRefs" href="#bib0195">1,2,5</a> and the DEWS II.<a class="elsevierStyleCrossRefs" href="#bib0220">6,7</a> Meibomian gland secretion is affected by the abnormality of insulin secretion<a class="elsevierStyleCrossRef" href="#bib0230">8</a> in spite insulin resistance/deficiency and hyperglycemia impacts the sterols and lipid receptors in the glands. MGD prevalence is almost 60% of male population, with abnormal function in the gland, and dry eye symptoms.<a class="elsevierStyleCrossRefs" href="#bib0235">9,10</a> In Colombia we don’t have enough clinical evidence about the relationship between diabetes and Meibomian gland dysfunction, so we conducted a prospective study that aimed to investigate Meibomian gland and tear film function in type 2 diabetic patients.Materials and methodsSubjectsThe study was approved by the Ethical committee of the Valencia University in Spain and the Ethical committee of the Salle University, Optometry department, Bogotá-Colombia. All subjects enrolled gave informed consent prior to their inclusion in the study. All the participants must show the blood glucose levels; the normal limit of glycemia<110mg/dl was considered in all the individuals. The hemoglobin Hb1Ac more than 6.4% was associated with autonomic neuropathy.<a class="elsevierStyleCrossRefs" href="#bib0245">11–13</a>Thirty-seven men with type 2 diabetes and thirty-six non-diabetic, were recruited into the study. Both eyes of each patient were evaluated. There was no significant difference in age and gender between the two study groups. The inclusion criteria were as follows: at least 40 years old males to participate in the study, Hb1Ac and glycemia test value (last month). The exclusion criteria were as follows: active ocular infection or inflammation, previous ocular surgery, no permanent topical use of ophthalmic drugs or artificial tears, and a history of cranial nerve injury or any other diseases known to affect the tear film.Each patient completed an ocular surface disease index (OSDI) questionnaire for the assessment of ocular surface symptoms. Subjects were considered symptomatic if the value was ≥13.5.<a class="elsevierStyleCrossRef" href="#bib0260">14</a>All patients underwent a series of ocular surface examinations in the following order: lipid layer thickness (LLT), noninvasive breakup time (NIBUT), tear meniscus height (TMH), corneal fluorescein staining, green lisammine dye, border lid morphology, Marx's line staining, grading of meibomian gland loss, and expression of meibum. All the patients were examined by the same physicians.Evaluation of tear filmThe lipid layer tear and the NIBUT score was made with interferometry, through a portable tearscope Polaris. The Lipid Layer Thickness (LLT) was determined with the Guillon score<a class="elsevierStyleCrossRefs" href="#bib0265">15,16</a> based in interferometric images, with colors patterns associated to thickness of the tear film. The shape and color of the interferential patterns will define the thickness of the lipid layer. In this way, lipid patterns corresponding to increasing lipid layer thickness were subsequently assigned numerical lipid layer grades 0–5, for the purpose of statistical analysis, as 0 (absent), 1 (open meshwork), 2 (closed meshwork), 3 (wave), 4 (amorphous), or 5 (colored fringes).The non-invasive tear film break up time (NIBUT) was calculated in seconds after placing the placid pattern of polaris® last complete blink. The analysis of the results was based in the value below 10s, considered abnormal.<a class="elsevierStyleCrossRefs" href="#bib0270">16,23</a>TMH measurements were performed using a commercial AS-OCT (SS-1000; Tomey Corp, Nagoya, Japan). Cross-sectional images of the lower TMH were taken vertically, across the central cornea, in every subject. TMH was defined as the line distance from the fluid surface of the meniscus junction to the lower eyelid–meniscus junction. The lower TMH values were calculated using the cross-sectional AS-OCT images. The normal values considered was >200μm.<a class="elsevierStyleCrossRef" href="#bib0275">17</a>The exposed ocular surface area was graded using the Van Bijsterveld scheme with Fluorescein Staining (FL). The ocular surface area was divided into 3 regions (central, nasal and temporal), and each zone was scored on a scale of 0–3, according to the number of staining points observed.<a class="elsevierStyleCrossRef" href="#bib0280">18</a> The score obtained for each region was added to obtain the final score. The total score was maximum 9, and scores greater than 3.5 were considered abnormal. Conjunctival staining using lissamine green was performed grading of each temporal and nasal conjunctival staining according to the Oxford score (0–5), evaluating the whole areas of temporal conjunctival, corneal and nasal conjunctiva.<a class="elsevierStyleCrossRef" href="#bib0285">19</a>Diagnosis of Meibomian Gland dysfunctionThe morphology of meibomian glands was evaluated with the Marx's line through the yamaguchi score grading.<a class="elsevierStyleCrossRef" href="#bib0290">20</a> For the study, the Marx's line represented a clinical parameter of glandular inflammation; strips of lissamine green were applied to the lower tarsal fornix (GreenGlo®, HUB Pharmaceuticals, LLC) previously moistened with 0.9% physiological saline solution.<a class="elsevierStyleCrossRef" href="#bib0295">21</a> The inflammation parameter was analyzed based on the observation of the line and its displacement according to the meibomian orifices.<a class="elsevierStyleCrossRef" href="#bib0290">20</a> The presence of continuity in the line along the holes, symbolizes a normal state of these, while the more displacement toward the Meibomian orifices until penetrating them, mean the greater degree of glandular inflammation.To graduate the score, the palpebral margin is divided into three portions: external portion, middle portion and internal portion, and each portion was evaluated separately from 0 to 3 points, for a total of 9 points.<a class="elsevierStyleCrossRefs" href="#bib0290">20,21</a> The clinical significance of this test is an indication of the degree of meibomian inflammation and is determined by the score: <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Between 0 and 3 points: Absent or mild meibomian glandular inflammation</li><li class="elsevierStyleListItem" id="lsti0010">•Between 4 and 6 points: moderate meibomian glandular inflammation</li><li class="elsevierStyleListItem" id="lsti0015">•Between 7 and 9 points: severe meibomian glandular inflammation</li></ul>The number of expressible meibomian glands was quantified using a double cotton applicator. A stable pressure was applied to the temporal, the central, and the nasal third of the lower eyelid, and the number of secretable glands was recorded.<a class="elsevierStyleCrossRef" href="#bib0275">17</a> The degree of ease in expressing meibomian secretion was evaluated semi-quantitatively on a scale from 0 to 3: Grade 0, clear meibum is easily expressed; Grade 1, cloudy meibum is expressed with a mild pressure; Grade 2, cloudy meibum is expressed with more than moderate pressure; and Grade 3, meibum cannot be expressed even with hard pressure.<a class="elsevierStyleCrossRef" href="#bib0300">22</a> The meibum quality was graded as follows: grade 0, clear; grade 1, cloudy; grade 2, cloudy with granular debris; and grade 3, thick and toothpaste-like.<a class="elsevierStyleCrossRef" href="#bib0315">25</a>Lid margin abnormalities were scored according to the following 4 signs: telangiectasies, lid margin irregularity, obstructed meibomian gland orifices, and anterior or posterior displacement of the muco-cutaneous junction.<a class="elsevierStyleCrossRefs" href="#bib0305">23,24</a>Statistical analysisThe data were analyzed using SPSS 20.0 (SPSS, Chicago, IL). Results of the descriptive statistics are presented as the mean±standard deviation or median. For data that were normally distributed, the independent-samples t-test was employed to compare the results of the diabetic group and non-diabetic subjects. The correlations between the duration of diabetes, meibomian gland function, and tear film variables in the diabetic group were studied using Pearson's correlation coefficient. For data that were not normally distributed, the Mann–Whitney test was used to compare the results of the two groups. The correlations between the duration of diabetes, meibomian gland function, and tear film variables were studied using Spearman's correlation coefficient.ResultsEighty males were recruited and 73 were included; 37 with type 2 diabetes and 36 controls. The mean age was 59±8 years, with no significant difference in age distribution between groups: diabetes mean age 59±7.7 and control group mean age 58.5±7.4. The disease time progression was 7.2±5 years; the HbA1c mean was 6.5% with statistically significant differences between groups, higher in type 2 diabetes (6.8±0.7; p=0.002). The mean of blood glucose was 123mg/dl, higher in type 2 diabetes (171±29mg/dl; p=0.007).Dry eye disease was higher in the type 2 diabetes group, with 76.31% with a significant difference between the 2 groups; OSDI were significantly higher in the diabetic group (p=0.0002). Compared with control group, the OSDI was significantly higher in diabetes group (22.2±7.93; p<0.01), while the NIBUT was non significantly lower (2.6±1.2; p>0.05). The corneal fluorescein staining present minimum staining points less than 3.5 on the Van Bijsterveld scale, higher in diabetic group (1.16±2.18), than in control group (0.92±2.09) with not significative differences between groups (p>0.05). There was significant differences in conjunctival staining grade between diabetic (2.1±1.0) and control group (1.7±1.0) (p=0.005). All subjects underwent clinical assessment are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The Marx's line, evaluated the palpebral marginal zone, with moderate irregularity and retroplacement of orifices in most of the participants (mean 3.0±2.3), higher in patients with diabetes (3.8±2.1) than control group (1.4±0.7) with significant differences (p<0.05) between groups.The glandular orifices with keratinization and obliteration observed in the group of diabetics were higher (64.3–67.9%) than control group (29.3–45.1%) with statistically significant differences (p<0.000) between groups (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The viscosity of meibomian secretion was type toothpaste (grade 4) in the majority of participants with diabetes 56.7% and 41.6% granular viscosity (grade 3) in control group; there were differences between groups with statistical significance (K–W: p=0.0001). The non-expressability in meibomian orifices denotes the degree of obstruction of the glands, as long as the ease of Meibomian expression is less. The results of the study show a mean score of 1.56 (SD±1.0) with clinically significance of obstruction. The group of diabetics presented the highest degree of obstruction in 27.1% of the participants, with no expressive gland. The differences between groups show statistical significance (K–W: p=0.0001).<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the distribution of clinical features for evaluation of Meibomian glands. 52 participants presented MGD (71.23%) higher in diabetic participants (75.6%) than control group (66.66%) with statistically significant differences between groups (p<0.005).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Correlations of Meibomian gland dysfunctionSpearman correlation analysis showed a positive correlation between glycemia and OSDI (r=0.350; p=0.034) in 60–64 years old subjects (p=0.0005). OSDI in diabetes group presented a significant correlation with the Hb1Ac (r=0. 27; p=0.003) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>The highest level of Hb1Ac presented positive and significant correlation coefficient with the Marx's line in the lids of diabetics participants (r=0.33; p=0.006). The lid margin abnormality (hyperkeratinisation, retroplacement of Meibomian orifices, irregularity of lid margin and obliteration score, was significantly higher in the diabetic group than in the nondiabetic group (p=0.0005) with toothpaste's type secretions (75%); meibomian secretion type toothpaste was significant correlated with the greatest degree of severity of MGD (r=0.76; p<0.001). Diabetes had a significant and strong correlation between viscosity meibum secretion and clogging of the meibomians holes (r=0.66; p<0.001).<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a> represents significant and inverse correlation between NIBUT and Marx's line (r=−0.569; p=0.000), meaning the asociation between lid border‘s irregularity and the decrease in break up time. NIBUT showed moderate correlation with fluorescein staining in diabetics participants (r=−0.27; p=0.022).<elsevierMultimedia ident="fig0015"></elsevierMultimedia>Meibomian secretion tooth paste's type in diabetics participants presented significative correlation with conjunctival staining with lissamine green expressing inflammation of conjunctival epithelium (r=0.32; p=0.006).DiscussionThese results suggest high correlation between type 2 diabetes and Meibomian gland dysfunction, with evaporative dry eye. The participants diagnosed with MGD showed lid margin abnormalities, meibum expressibility abnormal, conjunctival stain with lissamine green and keratitis were found more significantly worse in patients with type 2 diabetes.<a class="elsevierStyleCrossRef" href="#bib0360">34</a>Diabetes is a metabolic and chronic disease with a current high global prevalence of 422 million of people (WHO, 2016). Nevertheless the angiopathic and neuropathic damage, not only affects the retina of the eye, but also it is associated with inflammation of the ocular surface, dry eye, persistent corneal defects and alterations in the lacrimal glands; these alteration are associated to the hypoxia and oxidative stress by glucose alterations. Abnormalities in innervation causes dysfunction in tear production, and decrease in parasympathetic motor and vegetative stimulus<a class="elsevierStyleCrossRef" href="#bib0245">11</a> producing inflammatory processes at the ocular surface.<a class="elsevierStyleCrossRefs" href="#bib0250">12,13</a> The results show that diabetes is related to the presence of MGD, dry eye, and alterations in the ocular surface, because of agreement with the implemented methodology, frequency of MGD was of 75.6% in diabetic participants, with statistically significant differences between the group of diabetics and the group control (p<0.005).The prevalence of MGD reported in the international Workshop on MGD ranged from 20% to 60%<a class="elsevierStyleCrossRef" href="#bib0240">10</a> according with the report of Mathers<a class="elsevierStyleCrossRef" href="#bib0320">26</a> (3.5–69.3%), being higher in Asian populations; however by the strong association found between diabetes and MGD,<a class="elsevierStyleCrossRefs" href="#bib0200">2,9,27,28</a> is imperative the association between MGD with evaporative dry eye; Hom et al.<a class="elsevierStyleCrossRef" href="#bib0335">29</a> reported a prevalence of 38.9% of MGD in diabetic patients, with alteration in meibum expressibility and viscosity, as same as Korb et al.<a class="elsevierStyleCrossRef" href="#bib0340">30</a> with increase in symptoms according to the viscosity of the meibum; this prevalence is higher in this study 66.6%, associated with processes of aging in males (mean age 59±8 years), while most studies presents the MGD in men as in women with the ages range between 51 and 52 years old.<a class="elsevierStyleCrossRefs" href="#bib0230">8,27,28</a>In this way, and coincident with the study of Ding et al.,<a class="elsevierStyleCrossRef" href="#bib0230">8</a> atrophy of the meibomian glands produces keratinization, retroplacement of orifices and obliteration, associated with age; our study has limitations in the method, so it is recommended for future research do scan meibography, to distinguish a true hyperkeratinized of glandular atrophy associated with processes of aging. However, on the results, found strong correlations between the meibomians holes hyperkeratinized and the MGD (r=0.66; p=0.000).The type 2 diabetic participants diagnosed with MGD (75.6%) were found with phase 3 (46.4%) and phase 4 (42.85%) with significant differences between the groups (p=0.04); the viscosity was tooth paste type (76.6%), with clogged in meibomians holes (76.6%) and alterations in the Marx's line. Shamsheer et al.<a class="elsevierStyleCrossRef" href="#bib0325">27</a> reported alterations in volume and viscosity of the meibum according with this study. From Korb and Henriquez,<a class="elsevierStyleCrossRefs" href="#bib0315">25,30</a> it has been understood that mechanisms of blockade or stasis of meibum, lead to the displacement of the gland and its orifice and subsequently its hyperkeratinized, partnering with symptomatology.<a class="elsevierStyleCrossRef" href="#bib0345">31</a> This explains the Marx's line retroplacement (76.6%) associated with processes of hyperkeratinized (67.9%) according with Ibrahim et al.<a class="elsevierStyleCrossRef" href="#bib0365">35</a> associated to aging and decrease in nerves factors in diabetes.The strong correlation between meibum viscosity and lissamine green staining in the ocular surface (r=0.57; p<0.001) explains the association between MGD and tear film,<a class="elsevierStyleCrossRefs" href="#bib0280">18,36</a> with increase in symptoms (r=0.413; p=0.001).In accordance with the publication of Finis et al., in 2013,<a class="elsevierStyleCrossRefs" href="#bib0375">37,38</a> there is significant correlation (r=0.36; p<0.0001) between MGD and the thickness of the lipid layer tear, and inverse correlation between symptoms and the lipid pattern (r=−0. 13; p<0.08), corresponding with the results in this study (r=0. 018; p<0.08).NIBUT presented inverse and significant correlation with lid margin irregularity (r=−0. 56; p=0.000) higher in diabetic patients; the NIBUT values (<5s) suggests a compromise of the lipid layer, due to the stasis of the meibum, associated with high degree of viscosity in diabetic patients (r=0.88; p<0.001); other important factor is hyperkeratinized and obliteration in the orifices, fact had been reported in TFOS DEWS II.<a class="elsevierStyleCrossRef" href="#bib0200">2</a>TMH normal values in both groups indicate not aqueous deficient association with MGD.<a class="elsevierStyleCrossRef" href="#bib0275">17</a> However, the results found no significant correlation between diabetic and non-diabetic subjects.A limitation of this study is the relatively small sample size and the selection of only men could be a bias factor, so longitudinal studies are required to understand the association between gender, diabetes and MGD. Another limitation was access to the meibography in order to study the deep morphology of the glands. In addition, the measurements of the palpebral conjunctiva required eversion of the eyelid uncomfortable for patients. Glandular expression with a cotton-tip applicator does not control of force and area, could be improved for futures studies with specials paddles.ConclusionsIn summary, this study concludes, MGD is more significant in patients with type 2 diabetes compared with nondiabetic patients, with significative morphological changes, viscosity secretion and inflammatory staining in the conjunctiva, correlated with diabetes and compared with normal control participants.Conflicts of interestThis study has no commercial or propriety interest. The authors report no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1259619" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1166736" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1259618" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1166735" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Subjects" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Evaluation of tear film" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis of Meibomian Gland dysfunction" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Correlations of Meibomian gland dysfunction" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-15" "fechaAceptado" => "2019-02-16" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1166736" "palabras" => array:5 [ 0 => "Meibomian gland dysfunction" 1 => "Diabetes" 2 => "Dry eye" 3 => "NIBUT" 4 => "Marx's line" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1166735" "palabras" => array:5 [ 0 => "Disfunción de la glándula de Meibomio" 1 => "Diabetes" 2 => "Ojo seco" 3 => "NIBUT" 4 => "Línea de Marx" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "PurposeTo assess the Meibomian glands, ocular surface and tear function in patients with type 2 diabetes, and study the correlation between these conditions. MethodsProspective study of 76 males, 37 with type 2 diabetes with an average of duration between 7±5 years, and 36 males from control group. After completing an ocular surface disease index (OSDI) questionnaire, the non-invasive tear film break-up time (NIBUT) and the tear lipid layer pattern was performed using interferometry system and tear meniscus height/TMH. Ocular surface was studied with lissamine green staining and morphology of the glands with evaluation of Marx's line (lid margin abnormalities); meibomian secretion was expressed and was also assessed the quality. The results were analyzed using the statistical Kruskal–Wallis and Mann–Whitney, and correlations by Spearman Rho. ResultsThe mean age was 59±8 years; 71% of participants presented MGD (76% diabetics and 67% controls). OSDI were significantly higher (p=0.01) in the diabetic group. A positive correlation was found between glycemia and symptoms (p=0.0005) and strong correlation between Hb1Ac and OSDI in MGD. NIBUT was lower in the control group (2.47±1.2s) than for the diabetic group (2.9±1.2s), with a significant inverse correlation (52.22%) with MG inflammation. ConclusionsMGD in type 2 diabetic patients is more severe compared with nondiabetic patients. Longer duration of diabetes is associated with major symptoms and changes in MG. Diabetic group showed major changes in lids and tear function, accounting for evaporative dry eye and presenting a high degree of correlation with MG inflammation and obstruction." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Purpose" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar las glándulas de Meibomio, la superficie ocular y la función de la lágrima en pacientes con diabetes tipo 2, y estudiar la correlación entre estas situaciones. MétodosEstudio prospectivo de 76 varones, 37 de ellos con diabetes tipo 2, con una media de duración de entre 7±5 años, y 36 mujeres como grupo control. Tras completar el cuestionario del índice de enfermedad de la superficie ocular (OSDI), se obtuvieron el tiempo de ruptura lagrimal no invasivo (NIBUT) y el patrón de la capa lipídica de la lágrima utilizando interferometría y altura del menisco lagrimal/AML. Se estudió la superficie ocular con tinción verde de lisamina y la morfología de las glándulas con evaluación de la línea de Marx (anomalías del margen del párpado); se expresó la secreción de las glándulas de Meibomio, así como su calidad. Los resultados se analizaron utilizando la pruebas estadísticas Kruskal-Wallis y Mann-Witney, y las correlaciones con Rho de Spearman. ResultadosLa edad media fue de 59±8 años; el 71% de los participantes presentaron DGM (76% diabéticos y 67% controles). OSDI fue significativamente superior(p=0,01) en el grupo diabético. Se encontró una correlación positiva entre glucemia y síntomas (p=0,0005), y una fuerte correlación entre Hb1Ac y OSDI en DGM. NIBUT fue inferior en el grupo control (2,47±1,2s) que en el grupo diabético (2,9±1,2s), con una correlación inversa significativa (52,22%) con la irregularidad del borde palbebral y queratinización del OM. ConclusionesDGM en los pacientes con diabetes tipo 2 es más grave, en comparación con los pacientes no diabéticos. La mayor duración de la diabetes se asocia a síntomas mayores y cambios en la GM. El grupo diabético reflejó cambios mayores en los párpados y la función de la lágrima, lo cual supone ojo seco evaporativo, y un alto grado de correlación con irregularidad del margen palpebral y obstrucción de la GM." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 949 "Ancho" => 1255 "Tamanyo" => 194026 ] ] "descripcion" => array:1 [ "en" => "Lid margin. (a) Extension of green lissamine toward meibomian orifices: Marx's line; (b) red filter show irregularity of lid margin; (c) retroplacement of Meibomian orifices; (d) obliteration. The punctum of the orifice may not be visible and vascular invasion is visible." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1299 "Ancho" => 1497 "Tamanyo" => 67895 ] ] "descripcion" => array:1 [ "en" => "Correlation between OSDI and Hb1Ac in diabetic participants." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1415 "Ancho" => 1550 "Tamanyo" => 60232 ] ] "descripcion" => array:1 [ "en" => "Correlation between NIBUT and Marx’ line in diabetic participants." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes group</th><th class="td" title="\n \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">Control group</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"> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean±SD<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dry eye diagnosis (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean±SD<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dry eye diagnosis (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p value \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">OSDI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.2±7.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (78.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16.2±10.60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (47.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.016 \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">TMH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">207±83.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (59.45%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">212±70.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (47.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.86 \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">Lissamine staining<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.1±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (72.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.7±1.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (66.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \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">Fluorescein staining<a class="elsevierStyleCrossRef" href="#tblfn0015">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.16±2.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (29.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.92±2.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">08 (22.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.465 \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">NIBUT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.9±1.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (94.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.47±1.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (94.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.351 \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">Total DED \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (76.31%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (63.86%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2154593.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Standard deviation SD is represented with±." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Lissamine staining with oxford score." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "Fluorescein staining score of the ocular surface according with the Van Bijsterveld scale." ] ] ] "descripcion" => array:1 [ "en" => "Diagnosis of dry eye." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evaluation of Meibomian glands</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"> \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Marx's line retroplacement>3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Keratinization (cicatricial) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Viscosity \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obstruction \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">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (76.67%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (48.64%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (76.67%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (76.67%) \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">Controls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (11.11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (47.22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (75.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (66.66%) \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="5" align="left" valign="\n \t\t\t\t\ttop\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">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (43.83%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (47.94%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (75.34%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52 (71.23%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2154594.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Results of classification of DGM." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.D. Nelson" 1 => "J. Shimazaki" 2 => "J.M. Benitez-del-Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-6997b" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "1930" "paginaFinal" => "1937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450914" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0200" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TFOS DEWS II. Definition and classification report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.P. Craig" 1 => "K.K. Nichols" 2 => "E.K. Akpek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtos.2017.05.008" "Revista" => array:6 [ "tituloSerie" => "Ocul Surf" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "276" "paginaFinal" => "283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28736335" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0205" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and control of diabetes in Chinese adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "Y. Xu" 1 => "L. Wang" 2 => "L. He" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "310" "paginaInicial" => "948" "paginaFinal" => "959" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0210" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TFOS DEWS II: pathophysiology report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.A. Bron" 1 => "S. Chauan" 2 => "S. Jain" 3 => "Y. Ogawa" 4 => "N. Yokoi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtos.2017.05.011" "Revista" => array:6 [ "tituloSerie" => "Ocul Surf" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "438" "paginaFinal" => "510" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28736340" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0215" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international workshop on Meibomian Gland Dysfunction: report of the subcommittee on anatomy, physiology and pathophysiology of the meibomian gland" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Knop" 1 => "N. Knop" 2 => "T. Millar" 3 => "H. Obata" 4 => "D. Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-6997c" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "1938" "paginaFinal" => "1978" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450915" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0220" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report of the inaugural meeting of the TFOS i2=initiation innovation series: targeting the unmet need for the eye dry treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "W. Chao" 1 => "C. Belmonte" 2 => "J. Benitez del Castillo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jtos.2015.11.003" "Revista" => array:6 [ "tituloSerie" => "Ocul Surf" "fecha" => "2016" "volumen" => "14" "paginaInicial" => "264" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26774910" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0225" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TFOS DEWS II: tear film report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "M. Willcox" 1 => "P. Argüeso" 2 => "G. Georgiev" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ocul Surf" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "369" "paginaFinal" => "406" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0230" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of insulin and high glucose on human meibomian gland epithelial cells" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Ding" 1 => "L. Yang" 2 => "D. Sullivan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2015" "volumen" => "56" "paginaInicial" => "7814" "paginaFinal" => "7820" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0235" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.A. Schaumberg" 1 => "J.J. Nichols" 2 => "E.B. Papas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-6997e" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "1994" "paginaFinal" => "2005" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450917" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0240" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of meibomian gland dysfunction in an elderly population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y.A. Alghamdi" 1 => "C. Mercado" 2 => "A.L. McClellan" 3 => "H. Batawi" 4 => "C.L. Karp" 5 => "A. Galor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO0000000000000815" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2016" "volumen" => "35" "paginaInicial" => "731" "paginaFinal" => "735" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27027919" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0245" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dry eye syndrome in subjects with Diabetes and association with neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "V. Achtsidis" 1 => "I. Eleftheriadou" 2 => "E. Kozanidou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2337/dc13-1169" "Revista" => array:6 [ "tituloSerie" => "Diabetes Care" "fecha" => "2014" "volumen" => "37" "paginaInicial" => "210" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23939544" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0250" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meta-analysis and review on the changes of tear function and corneal sensitivity in diabetics patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Lu" 1 => "A. Li" 2 => "X. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/aos.12063" "Revista" => array:6 [ "tituloSerie" => "Acta Ophthalmol" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "e96" "paginaFinal" => "e104" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23782539" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0255" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Autonomic pheripheral neuropathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Freeman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)74815-7" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2005" "volumen" => "365" "paginaInicial" => "1259" "paginaFinal" => "1270" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15811460" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0260" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TFOS DEWS II: diagnostic methodology report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.S. Wolffsohn" 1 => "R. Arita" 2 => "R. Chalmers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ocul Surf" "fecha" => "2017" "volumen" => "15" "paginaInicial" => "539" "paginaFinal" => "574" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0265" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tear film examination of the contact lens patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Guillon" 1 => "M. Guillon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Optician" "fecha" => "1993" "volumen" => "206" "paginaInicial" => "21" "paginaFinal" => "29" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0270" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-invasive Tearscope Plus routine for contact lens fitting" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Guillon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cont Lens Ant Eye" "fecha" => "1998" "volumen" => "21" "numero" => "Suppl." "paginaInicial" => "S31" "paginaFinal" => "S40" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0275" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anterior segment optical coherence tomography for tear meniscus evaluation and its correlation with other tear variables in healthy individuals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Raj" 1 => "R. Dhasmana" 2 => "R.C. Nagpal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7860/JCDR/2016/18717.7722" "Revista" => array:3 [ "tituloSerie" => "JCDR" "fecha" => "2016" "volumen" => "10" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0280" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Report of the National Eye Institute/Industry Workshop on clinical trials in dry eyes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Lemp" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "CLAO" "fecha" => "1995" "volumen" => "21" "paginaInicial" => "221" "paginaFinal" => "223" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0285" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparison of conjunctival staining between lissamine green and yellow filtered fluorescein sodium" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Y. Eom" 1 => "J.S. Lee" 2 => "H. Lee" 3 => "H. Kim" 4 => "J. Song" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Can J Opthal" "fecha" => "2015" "volumen" => "50" "paginaInicial" => "273" "paginaFinal" => "277" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0290" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Marx line: fluorescein staining line on the inner lid as indicator of Meibomian Gland Disfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Yamaguchi" 1 => "M. Kutsuna" 2 => "U. Toshihiko" 3 => "Z. Xiaodong" 4 => "T. Kodama" 5 => "Y. Ohashi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2006" "volumen" => "141" "paginaInicial" => "669" "paginaFinal" => "675" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0295" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Visualisation of “Marx's line” along the marginal eyelid conjunctiva of human subjects with lissamine green dye" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Doughty" 1 => "T. Naase" 2 => "C. Donald" 3 => "L. Hamilton" 4 => "N. Button" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1046/j.1475-1313.2003.00160.x" "Revista" => array:5 [ "tituloSerie" => "Ophthal Physiol Opt" "fecha" => "2004" "volumen" => "24" "paginaInicial" => "1" "paginaFinal" => "7" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0300" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Definition and diagnostic criteria for meibomian gland dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "S. Amano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Eye" "fecha" => "2010" "volumen" => "27" "paginaInicial" => "627" "paginaFinal" => "631" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0305" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Tomlinson" 1 => "A.J. Bron" 2 => "D.R. Korb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1167/iovs.10-6997f" "Revista" => array:6 [ "tituloSerie" => "Invest Ophthalmol Vis Sci" "fecha" => "2011" "volumen" => "52" "paginaInicial" => "2006" "paginaFinal" => "2049" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450918" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0310" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Development of definitive and reliable grading scales for meibomian gland dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Arita" 1 => "I. Minoura" 2 => "N. Morishige" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2016" "volumen" => "169" "paginaInicial" => "125" "paginaFinal" => "137" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0315" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meibomian gland diagnostic expressibility: correlation with dry eye symptoms and gland location" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Korb" 1 => "C.A. Blackie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e3181814cff" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2008" "volumen" => "27" "paginaInicial" => "1142" "paginaFinal" => "1147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19034129" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0320" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.D. Mathers" 1 => "D. Choi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Ophtholmol" "fecha" => "2004" "volumen" => "122" "paginaInicial" => "1700" "paginaFinal" => "1704" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0325" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A clinical study of meibomian gland dysfunction in patients with diabetes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.P. Shamsheer" 1 => "C. Arunachalam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0974-9233.167827" "Revista" => array:6 [ "tituloSerie" => "Middle East Afr J Ophthalmol" "fecha" => "2015" "volumen" => "22" "paginaInicial" => "462" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26692718" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0330" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meibomian gland dysfunction in type 2 diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "X. Lin" 1 => "B. Xu" 2 => "Y. Zheng" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Ophthalmol" "fecha" => "2017" "volumen" => "2017" "paginaInicial" => "3047867" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0335" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Self-reported dry eyes and diabetic history" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Hom" 1 => "P. De Land" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Optometry" "fecha" => "2006" "volumen" => "77" "paginaInicial" => "554" "paginaFinal" => "558" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0340" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meibomian gland dysfunction and contact lens intolerance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Korb" 1 => "A.S. Henriquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Optom Assoc" "fecha" => "1980" "volumen" => "51" "paginaInicial" => "243" "paginaFinal" => "251" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6154727" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0345" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetic keratopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Schultz" 1 => "D. Van Horn" 2 => "M. Peters" 3 => "K. Klewin" 4 => "W. Schutten" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Trans Am Ophthalmol Soc" "fecha" => "1981" "volumen" => "79" "paginaInicial" => "180" "paginaFinal" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7342400" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0360" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dry eye in diabetic patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Kaiserman" 1 => "N. Kaiserman" 2 => "S. Nakar" 3 => "S. Vinker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajo.2004.10.022" "Revista" => array:6 [ "tituloSerie" => "Am J Ophthalmol" "fecha" => "2005" "volumen" => "139" "paginaInicial" => "498" "paginaFinal" => "503" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15767060" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0365" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The efficacy, sensitivity, and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "O.M. Ibrahim" 1 => "Y. Matsumoto" 2 => "M. Dogru" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ophtha.2009.12.029" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2010" "volumen" => "117" "paginaInicial" => "665" "paginaFinal" => "672" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20189653" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0370" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tear function and ocular surface changes in non-insulin dependent diabetes mellitus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Dogru" 1 => "C. Katakami" 2 => "M. Inoue" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0161-6420(00)00599-6" "Revista" => array:6 [ "tituloSerie" => "Ophthalmology" "fecha" => "2001" "volumen" => "108" "paginaInicial" => "586" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237914" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0375" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Meibomian gland dysfunction in chronic blepharitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W. Mathers" 1 => "W. Shields" 2 => "M. Sachdev" 3 => "W. Petroll" 4 => "J. Jester" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Cornea" "fecha" => "1991" "volumen" => "10" "paginaInicial" => "277" "paginaFinal" => "283" ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0380" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of lipid layer thickness measurement of the tear film as a diagnostic tool for meibomian gland dysfunction" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "D. Finis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ICO.0b013e3182a7f3e1" "Revista" => array:6 [ "tituloSerie" => "Cornea" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "1549" "paginaFinal" => "1553" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24097185" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300214/v1_201910291446/en/main.assets" "Apartado" => array:4 [ "identificador" => "3963" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/18884296/0000001200000004/v1_201910291446/S1888429619300214/v1_201910291446/en/main.pdf?idApp=UINPBA00004D&text.app=https://www.journalofoptometry.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300214?idApp=UINPBA00004D"]

Statistics

Original Article

Correlación entre diabetes tipo 2, ojo seco y disfunción de las glándulas de Meibomio

Garzón P. Sandra Johannaa,

Corresponding author

decano.optometria@uan.edu.co

Corresponding author at: School of Optometry, research group of optometry, University Antonio Nariño, Tr 3 este 47 a 15, 11001, Bogotà, Colombia

, López-Alemany Antoniob,c,d, Gené-Sampedro Andrésb,e

a Faculty of Optometry, research group of optometry, University Antonio Nariño, Tr 3 este 47 a 15, 11001, Bogotà, Colombia

b University of Valencia, Spain

c Research Group in Ocular Surface, Cornea and Contact Lenses “Miguel Refojo”, Spain

d Vision Sciences Department, Office 1.49 Laboratory 1.50 A, Research Building. C/ Dr. Moliner, 50-50 Dr. Moliner St., 46100 Burjassot, Spain

e Vision Sciences Department, Research Group INTRAS (Instituto de Tráfico y Seguridad Vial), C/ Dr. Moliner, 50, 46100 Burjassot, Spain

Read

10497

Times
was read the article

3856

Total PDF

6641

Total HTML

Share statistics

 array:24 [
  "pii" => "S1888429619300214"
  "issn" => "18884296"
  "doi" => "10.1016/j.optom.2019.02.003"
  "estado" => "S300"
  "fechaPublicacion" => "2019-10-01"
  "aid" => "294"
  "copyright" => "Spanish General Council of Optometry"
  "copyrightAnyo" => "2019"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "J Optom. 2019;12:256-62"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2383
    "formatos" => array:3 [
      "EPUB" => 134
      "HTML" => 1717
      "PDF" => 532
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1888429619300196"
    "issn" => "18884296"
    "doi" => "10.1016/j.optom.2019.02.002"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "292"
    "copyright" => "Spanish General Council of Optometry"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Optom. 2019;12:263-71"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1354
      "formatos" => array:3 [
        "EPUB" => 85
        "HTML" => 1034
        "PDF" => 235
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Microbial safety implications of in-use topical diagnostic ophthalmic medications in eye clinics in Ghana"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "263"
          "paginaFinal" => "271"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Implicaciones sobre seguridad microbiana de los f&#225;rmacos oft&#225;lmicos diagn&#243;sticos t&#243;picos utilizados en las cl&#237;nicas oftalmol&#243;gicas de Gana"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3269
              "Ancho" => 2333
              "Tamanyo" => 301106
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A map showing the means<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SEM levels of contamination by region by with blue indicating the region with the least contamination and the red the region with the most contamination&#46; One-way ANOVA &#40;multiple comparisons&#41; indicated Volta and Eastern Region had less contaminations compared to Ashanti and Central Regions&#46; <span class="elsevierStyleSup">&#42;</span>Indicates <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Samuel Kyei, Eric Appiah, Eunice Ampadubea Ayerakwa, Clara Bemmah Antwi, Kofi Asiedu"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "Samuel"
              "apellidos" => "Kyei"
            ]
            1 => array:2 [
              "nombre" => "Eric"
              "apellidos" => "Appiah"
            ]
            2 => array:2 [
              "nombre" => "Eunice Ampadubea"
              "apellidos" => "Ayerakwa"
            ]
            3 => array:2 [
              "nombre" => "Clara Bemmah"
              "apellidos" => "Antwi"
            ]
            4 => array:2 [
              "nombre" => "Kofi"
              "apellidos" => "Asiedu"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300196?idApp=UINPBA00004D"
    "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300196/v1_201910291446/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1888429619300202"
    "issn" => "18884296"
    "doi" => "10.1016/j.optom.2019.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2019-10-01"
    "aid" => "293"
    "copyright" => "Spanish General Council of Optometry"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "J Optom. 2019;12:248-55"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1538
      "formatos" => array:3 [
        "EPUB" => 104
        "HTML" => 1064
        "PDF" => 370
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original articles</span>"
      "titulo" => "Ocular surface response and subjective symptoms associated to lens care solutions in Palestine"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "248"
          "paginaFinal" => "255"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Respuesta de la superficie ocular y s&#237;ntomas subjetivos asociados a las soluciones para el cuidado de las lentillas en Palestina"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 919
              "Ancho" => 1495
              "Tamanyo" => 75987
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Extent of corneal staining &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41; after 2<span class="elsevierStyleHsp" style=""></span>h of contact lens wear with tested solutions &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>50&#41;&#46; <span class="elsevierStyleItalic">P</span>-values compared the extent of corneal staining after 2<span class="elsevierStyleHsp" style=""></span>h of CL wear and at baseline&#46; PAPB&#44; polyaminoprpyl biguanide&#59; PHMB&#44; polyheamethylene biguanide hydrochloride&#59; Phx&#44; polyhexanide&#59; PQ-1&#44; polyquaternium-1&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ithar M&#46; Beshtawi, Jamal Qaddomi, Hanady Khuffash, Safa El-Titi, Malak Ghannam, Reema Otaibi"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Ithar M&#46;"
              "apellidos" => "Beshtawi"
            ]
            1 => array:2 [
              "nombre" => "Jamal"
              "apellidos" => "Qaddomi"
            ]
            2 => array:2 [
              "nombre" => "Hanady"
              "apellidos" => "Khuffash"
            ]
            3 => array:2 [
              "nombre" => "Safa"
              "apellidos" => "El-Titi"
            ]
            4 => array:2 [
              "nombre" => "Malak"
              "apellidos" => "Ghannam"
            ]
            5 => array:2 [
              "nombre" => "Reema"
              "apellidos" => "Otaibi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300202?idApp=UINPBA00004D"
    "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300202/v1_201910291446/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Correlation between type 2 diabetes&#44; dry eye and Meibomian glands dysfunction"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "256"
        "paginaFinal" => "262"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Garz&#243;n P&#46; Sandra Johanna, L&#243;pez-Alemany Antonio, Gen&#233;-Sampedro Andr&#233;s"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Garz&#243;n P&#46;"
            "apellidos" => "Sandra Johanna"
            "email" => array:1 [
              0 => "decano.optometria@uan.edu.co"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "L&#243;pez-Alemany"
            "apellidos" => "Antonio"
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Gen&#233;-Sampedro"
            "apellidos" => "Andr&#233;s"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Faculty of Optometry&#44; research group of optometry&#44; University Antonio Nari&#241;o&#44; Tr 3 este 47 a 15&#44; 11001&#44; Bogot&#224;&#44; Colombia"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "University of Valencia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Research Group in Ocular Surface&#44; Cornea and Contact Lenses &#8220;Miguel Refojo&#8221;&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Vision Sciences Department&#44; Office 1&#46;49 Laboratory 1&#46;50 A&#44; Research Building&#46; C&#47; Dr&#46; Moliner&#44; 50-50 Dr&#46; Moliner St&#46;&#44; 46100 Burjassot&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Vision Sciences Department&#44; Research Group INTRAS &#40;Instituto de Tr&#225;fico y Seguridad Vial&#41;&#44; C&#47; Dr&#46; Moliner&#44; 50&#44; 46100 Burjassot&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author at&#58; School of Optometry&#44; research group of optometry&#44; University Antonio Nari&#241;o&#44; Tr 3 este 47 a 15&#44; 11001&#44; Bogot&#224;&#44; Colombia"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Correlaci&#243;n entre diabetes tipo 2&#44; ojo seco y disfunci&#243;n de las gl&#225;ndulas de Meibomio"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1299
            "Ancho" => 1497
            "Tamanyo" => 67895
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Correlation between OSDI and Hb1Ac in diabetic participants&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The international workshop on Meibomian gland dysfunction &#40;MGD&#41; has defined this condition as &#8220;<span class="elsevierStyleItalic">a chronic and diffuse anomaly of Meibomian glands&#44; commonly characterized by obstruction of the terminal duct and&#47;or qualitative&#47;quantitative changes in glandular secretion</span>&#8221;&#46; This can cause an alteration of the tear film&#44; symptoms of eye irritation&#44; clinically apparent inflammation and ocular surface diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Diabetes is a very common chronic disease first cause of mortality&#46; The prevalence of type 2 diabetes has increased significantly in recent decades&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> Ocular disorders are common in diabetic patients&#44; such as retinopathy&#44; corneal epithelial erosions&#44; and dry eye&#46; The current report in dry eye&#44; the workshop &#40;DEWS II&#41; indicated that diabetes may be a risk factor of dry eye<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a> and the symptoms are worse than nondiabetic people&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> The Meibomian gland produces lipids and proteins which form the outer layer of the tear film&#59; these lipids decrease evaporation in MGD and promote instability of the tear film&#44; increasing cause of evaporative dry eye and may play an important role in the severity of the symptoms according with the International Workshop on Meibomian Gland Dysfunction<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;2&#44;5</span></a> and the DEWS II&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">6&#44;7</span></a> Meibomian gland secretion is affected by the abnormality of insulin secretion<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> in spite insulin resistance&#47;deficiency and hyperglycemia impacts the sterols and lipid receptors in the glands&#46; MGD prevalence is almost 60&#37; of male population&#44; with abnormal function in the gland&#44; and dry eye symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">9&#44;10</span></a> In Colombia we don&#8217;t have enough clinical evidence about the relationship between diabetes and Meibomian gland dysfunction&#44; so we conducted a prospective study that aimed to investigate Meibomian gland and tear film function in type 2 diabetic patients&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Subjects</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was approved by the Ethical committee of the Valencia University in Spain and the Ethical committee of the Salle University&#44; Optometry department&#44; Bogot&#225;-Colombia&#46; All subjects enrolled gave informed consent prior to their inclusion in the study&#46; All the participants must show the blood glucose levels&#59; the normal limit of glycemia<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>110<span class="elsevierStyleHsp" style=""></span>mg&#47;dl was considered in all the individuals&#46; The hemoglobin Hb1Ac more than 6&#46;4&#37; was associated with autonomic neuropathy&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#8211;13</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Thirty-seven men with type 2 diabetes and thirty-six non-diabetic&#44; were recruited into the study&#46; Both eyes of each patient were evaluated&#46; There was no significant difference in age and gender between the two study groups&#46; The inclusion criteria were as follows&#58; at least 40 years old males to participate in the study&#44; Hb1Ac and glycemia test value &#40;last month&#41;&#46; The exclusion criteria were as follows&#58; active ocular infection or inflammation&#44; previous ocular surgery&#44; no permanent topical use of ophthalmic drugs or artificial tears&#44; and a history of cranial nerve injury or any other diseases known to affect the tear film&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Each patient completed an ocular surface disease index &#40;OSDI&#41; questionnaire for the assessment of ocular surface symptoms&#46; Subjects were considered symptomatic if the value was &#8805;13&#46;5&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients underwent a series of ocular surface examinations in the following order&#58; lipid layer thickness &#40;LLT&#41;&#44; noninvasive breakup time &#40;NIBUT&#41;&#44; tear meniscus height &#40;TMH&#41;&#44; corneal fluorescein staining&#44; green lisammine dye&#44; border lid morphology&#44; Marx&#39;s line staining&#44; grading of meibomian gland loss&#44; and expression of meibum&#46; All the patients were examined by the same physicians&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluation of tear film</span><p id="par0035" class="elsevierStylePara elsevierViewall">The lipid layer tear and the NIBUT score was made with interferometry&#44; through a portable tearscope Polaris&#46; The Lipid Layer Thickness &#40;LLT&#41; was determined with the Guillon score<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15&#44;16</span></a> based in interferometric images&#44; with colors patterns associated to thickness of the tear film&#46; The shape and color of the interferential patterns will define the thickness of the lipid layer&#46; In this way&#44; lipid patterns corresponding to increasing lipid layer thickness were subsequently assigned numerical lipid layer grades 0&#8211;5&#44; for the purpose of statistical analysis&#44; as 0 &#40;absent&#41;&#44; 1 &#40;open meshwork&#41;&#44; 2 &#40;closed meshwork&#41;&#44; 3 &#40;wave&#41;&#44; 4 &#40;amorphous&#41;&#44; or 5 &#40;colored fringes&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The non-invasive tear film break up time &#40;NIBUT&#41; was calculated in seconds after placing the placid pattern of polaris<span class="elsevierStyleSup">&#174;</span> last complete blink&#46; The analysis of the results was based in the value below 10<span class="elsevierStyleHsp" style=""></span>s&#44; considered abnormal&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#44;23</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">TMH measurements were performed using a commercial AS-OCT &#40;SS-1000&#59; Tomey Corp&#44; Nagoya&#44; Japan&#41;&#46; Cross-sectional images of the lower TMH were taken vertically&#44; across the central cornea&#44; in every subject&#46; TMH was defined as the line distance from the fluid surface of the meniscus junction to the lower eyelid&#8211;meniscus junction&#46; The lower TMH values were calculated using the cross-sectional AS-OCT images&#46; The normal values considered was &#62;200<span class="elsevierStyleHsp" style=""></span>&#956;m&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">The exposed ocular surface area was graded using the Van Bijsterveld scheme with Fluorescein Staining &#40;FL&#41;&#46; The ocular surface area was divided into 3 regions &#40;central&#44; nasal and temporal&#41;&#44; and each zone was scored on a scale of 0&#8211;3&#44; according to the number of staining points observed&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> The score obtained for each region was added to obtain the final score&#46; The total score was maximum 9&#44; and scores greater than 3&#46;5 were considered abnormal&#46; Conjunctival staining using lissamine green was performed grading of each temporal and nasal conjunctival staining according to the Oxford score &#40;0&#8211;5&#41;&#44; evaluating the whole areas of temporal conjunctival&#44; corneal and nasal conjunctiva&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Diagnosis of Meibomian Gland dysfunction</span><p id="par0055" class="elsevierStylePara elsevierViewall">The morphology of meibomian glands was evaluated with the Marx&#39;s line through the yamaguchi score grading&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> For the study&#44; the Marx&#39;s line represented a clinical parameter of glandular inflammation&#59; strips of lissamine green were applied to the lower tarsal fornix &#40;GreenGlo<span class="elsevierStyleSup">&#174;</span>&#44; HUB Pharmaceuticals&#44; LLC&#41; previously moistened with 0&#46;9&#37; physiological saline solution&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a> The inflammation parameter was analyzed based on the observation of the line and its displacement according to the meibomian orifices&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> The presence of continuity in the line along the holes&#44; symbolizes a normal state of these&#44; while the more displacement toward the Meibomian orifices until penetrating them&#44; mean the greater degree of glandular inflammation&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To graduate the score&#44; the palpebral margin is divided into three portions&#58; external portion&#44; middle portion and internal portion&#44; and each portion was evaluated separately from 0 to 3 points&#44; for a total of 9 points&#46;<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">20&#44;21</span></a> The clinical significance of this test is an indication of the degree of meibomian inflammation and is determined by the score&#58; <ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">Between 0 and 3 points&#58; Absent or mild meibomian glandular inflammation</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Between 4 and 6 points&#58; moderate meibomian glandular inflammation</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Between 7 and 9 points&#58; severe meibomian glandular inflammation</p></li></ul></p><p id="par0080" class="elsevierStylePara elsevierViewall">The number of expressible meibomian glands was quantified using a double cotton applicator&#46; A stable pressure was applied to the temporal&#44; the central&#44; and the nasal third of the lower eyelid&#44; and the number of secretable glands was recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a> The degree of ease in expressing meibomian secretion was evaluated semi-quantitatively on a scale from 0 to 3&#58; Grade 0&#44; clear meibum is easily expressed&#59; Grade 1&#44; cloudy meibum is expressed with a mild pressure&#59; Grade 2&#44; cloudy meibum is expressed with more than moderate pressure&#59; and Grade 3&#44; meibum cannot be expressed even with hard pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> The meibum quality was graded as follows&#58; grade 0&#44; clear&#59; grade 1&#44; cloudy&#59; grade 2&#44; cloudy with granular debris&#59; and grade 3&#44; thick and toothpaste-like&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Lid margin abnormalities were scored according to the following 4 signs&#58; telangiectasies&#44; lid margin irregularity&#44; obstructed meibomian gland orifices&#44; and anterior or posterior displacement of the muco-cutaneous junction&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#44;24</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">The data were analyzed using SPSS 20&#46;0 &#40;SPSS&#44; Chicago&#44; IL&#41;&#46; Results of the descriptive statistics are presented as the mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation or median&#46; For data that were normally distributed&#44; the independent-samples <span class="elsevierStyleItalic">t</span>-test was employed to compare the results of the diabetic group and non-diabetic subjects&#46; The correlations between the duration of diabetes&#44; meibomian gland function&#44; and tear film variables in the diabetic group were studied using Pearson&#39;s correlation coefficient&#46; For data that were not normally distributed&#44; the Mann&#8211;Whitney test was used to compare the results of the two groups&#46; The correlations between the duration of diabetes&#44; meibomian gland function&#44; and tear film variables were studied using Spearman&#39;s correlation coefficient&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">Eighty males were recruited and 73 were included&#59; 37 with type 2 diabetes and 36 controls&#46; The mean age was 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 years&#44; with no significant difference in age distribution between groups&#58; diabetes mean age 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;7 and control group mean age 58&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;4&#46; The disease time progression was 7&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5 years&#59; the HbA1c mean was 6&#46;5&#37; with statistically significant differences between groups&#44; higher in type 2 diabetes &#40;6&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; The mean of blood glucose was 123<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; higher in type 2 diabetes &#40;171<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>29<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Dry eye disease was higher in the type 2 diabetes group&#44; with 76&#46;31&#37; with a significant difference between the 2 groups&#59; OSDI were significantly higher in the diabetic group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0002&#41;&#46; Compared with control group&#44; the OSDI was significantly higher in diabetes group &#40;22&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;93&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41;&#44; while the NIBUT was non significantly lower &#40;2&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The corneal fluorescein staining present minimum staining points less than 3&#46;5 on the Van Bijsterveld scale&#44; higher in diabetic group &#40;1&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;18&#41;&#44; than in control group &#40;0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;09&#41; with not significative differences between groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; There was significant differences in conjunctival staining grade between diabetic &#40;2&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&#41; and control group &#40;1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; All subjects underwent clinical assessment are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The Marx&#39;s line&#44; evaluated the palpebral marginal zone&#44; with moderate irregularity and retroplacement of orifices in most of the participants &#40;mean 3&#46;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;3&#41;&#44; higher in patients with diabetes &#40;3&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;1&#41; than control group &#40;1&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;7&#41; with significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; between groups&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The glandular orifices with keratinization and obliteration observed in the group of diabetics were higher &#40;64&#46;3&#8211;67&#46;9&#37;&#41; than control group &#40;29&#46;3&#8211;45&#46;1&#37;&#41; with statistically significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41; between groups &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The viscosity of meibomian secretion was type toothpaste &#40;grade 4&#41; in the majority of participants with diabetes 56&#46;7&#37; and 41&#46;6&#37; granular viscosity &#40;grade 3&#41; in control group&#59; there were differences between groups with statistical significance &#40;K&#8211;W&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The non-expressability in meibomian orifices denotes the degree of obstruction of the glands&#44; as long as the ease of Meibomian expression is less&#46; The results of the study show a mean score of 1&#46;56 &#40;SD<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&#41; with clinically significance of obstruction&#46; The group of diabetics presented the highest degree of obstruction in 27&#46;1&#37; of the participants&#44; with no expressive gland&#46; The differences between groups show statistical significance &#40;K&#8211;W&#58; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the distribution of clinical features for evaluation of Meibomian glands&#46; 52 participants presented MGD &#40;71&#46;23&#37;&#41; higher in diabetic participants &#40;75&#46;6&#37;&#41; than control group &#40;66&#46;66&#37;&#41; with statistically significant differences between groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Correlations of Meibomian gland dysfunction</span><p id="par0125" class="elsevierStylePara elsevierViewall">Spearman correlation analysis showed a positive correlation between glycemia and OSDI &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;350&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;034&#41; in 60&#8211;64 years old subjects &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0005&#41;&#46; OSDI in diabetes group presented a significant correlation with the Hb1Ac &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46; 27&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">The highest level of Hb1Ac presented positive and significant correlation coefficient with the Marx&#39;s line in the lids of diabetics participants &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;33&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46; The lid margin abnormality &#40;hyperkeratinisation&#44; retroplacement of Meibomian orifices&#44; irregularity of lid margin and obliteration score&#44; was significantly higher in the diabetic group than in the nondiabetic group &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0005&#41; with toothpaste&#39;s type secretions &#40;75&#37;&#41;&#59; meibomian secretion type toothpaste was significant correlated with the greatest degree of severity of MGD &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;76&#59; <span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001</span>&#41;&#46; Diabetes had a significant and strong correlation between viscosity meibum secretion and clogging of the meibomians holes &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> represents significant and inverse correlation between NIBUT and Marx&#39;s line &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;569&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#44; meaning the asociation between lid border&#8216;s irregularity and the decrease in break up time&#46; NIBUT showed moderate correlation with fluorescein staining in diabetics participants &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;27&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;022&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">Meibomian secretion tooth paste&#39;s type in diabetics participants presented significative correlation with conjunctival staining with lissamine green expressing inflammation of conjunctival epithelium &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;32&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0145" class="elsevierStylePara elsevierViewall">These results suggest high correlation between type 2 diabetes and Meibomian gland dysfunction&#44; with evaporative dry eye&#46; The participants diagnosed with MGD showed lid margin abnormalities&#44; meibum expressibility abnormal&#44; conjunctival stain with lissamine green and keratitis were found more significantly worse in patients with type 2 diabetes&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Diabetes is a metabolic and chronic disease with a current high global prevalence of 422 million of people &#40;WHO&#44; 2016&#41;&#46; Nevertheless the angiopathic and neuropathic damage&#44; not only affects the retina of the eye&#44; but also it is associated with inflammation of the ocular surface&#44; dry eye&#44; persistent corneal defects and alterations in the lacrimal glands&#59; these alteration are associated to the hypoxia and oxidative stress by glucose alterations&#46; Abnormalities in innervation causes dysfunction in tear production&#44; and decrease in parasympathetic motor and vegetative stimulus<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> producing inflammatory processes at the ocular surface&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">12&#44;13</span></a> The results show that diabetes is related to the presence of MGD&#44; dry eye&#44; and alterations in the ocular surface&#44; because of agreement with the implemented methodology&#44; frequency of MGD was of 75&#46;6&#37; in diabetic participants&#44; with statistically significant differences between the group of diabetics and the group control &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The prevalence of MGD reported in the international Workshop on MGD ranged from 20&#37; to 60&#37;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> according with the report of Mathers<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> &#40;3&#46;5&#8211;69&#46;3&#37;&#41;&#44; being higher in Asian populations&#59; however by the strong association found between diabetes and MGD&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;9&#44;27&#44;28</span></a> is imperative the association between MGD with evaporative dry eye&#59; Hom et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a> reported a prevalence of 38&#46;9&#37; of MGD in diabetic patients&#44; with alteration in meibum expressibility and viscosity&#44; as same as Korb et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> with increase in symptoms according to the viscosity of the meibum&#59; this prevalence is higher in this study 66&#46;6&#37;&#44; associated with processes of aging in males &#40;mean age 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 years&#41;&#44; while most studies presents the MGD in men as in women with the ages range between 51 and 52 years old&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">8&#44;27&#44;28</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In this way&#44; and coincident with the study of Ding et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> atrophy of the meibomian glands produces keratinization&#44; retroplacement of orifices and obliteration&#44; associated with age&#59; our study has limitations in the method&#44; so it is recommended for future research do scan meibography&#44; to distinguish a true hyperkeratinized of glandular atrophy associated with processes of aging&#46; However&#44; on the results&#44; found strong correlations between the meibomians holes hyperkeratinized and the MGD &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;66&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The type 2 diabetic participants diagnosed with MGD &#40;75&#46;6&#37;&#41; were found with phase 3 &#40;46&#46;4&#37;&#41; and phase 4 &#40;42&#46;85&#37;&#41; with significant differences between the groups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#59; the viscosity was tooth paste type &#40;76&#46;6&#37;&#41;&#44; with clogged in meibomians holes &#40;76&#46;6&#37;&#41; and alterations in the Marx&#39;s line&#46; Shamsheer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">27</span></a> reported alterations in volume and viscosity of the meibum according with this study&#46; From Korb and Henriquez&#44;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">25&#44;30</span></a> it has been understood that mechanisms of blockade or stasis of meibum&#44; lead to the displacement of the gland and its orifice and subsequently its hyperkeratinized&#44; partnering with symptomatology&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">31</span></a> This explains the Marx&#39;s line retroplacement &#40;76&#46;6&#37;&#41; associated with processes of hyperkeratinized &#40;67&#46;9&#37;&#41; according with Ibrahim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> associated to aging and decrease in nerves factors in diabetes&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The strong correlation between meibum viscosity and lissamine green staining in the ocular surface &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;57&#59; <span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001</span>&#41; explains the association between MGD and tear film&#44;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">18&#44;36</span></a> with increase in symptoms &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;413&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In accordance with the publication of Finis et al&#46;&#44; in 2013&#44;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">37&#44;38</span></a> there is significant correlation &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;36&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; between MGD and the thickness of the lipid layer tear&#44; and inverse correlation between symptoms and the lipid pattern &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46; 13&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#41;&#44; corresponding with the results in this study &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46; 018&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;08&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">NIBUT presented inverse and significant correlation with lid margin irregularity &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46; 56&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#41; higher in diabetic patients&#59; the NIBUT values &#40;&#60;5<span class="elsevierStyleHsp" style=""></span>s&#41; suggests a compromise of the lipid layer&#44; due to the stasis of the meibum&#44; associated with high degree of viscosity in diabetic patients &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;88&#59; <span class="elsevierStyleItalic">p<span class="elsevierStyleHsp" style=""></span>&#60;0&#46;001</span>&#41;&#59; other important factor is hyperkeratinized and obliteration in the orifices&#44; fact had been reported in TFOS DEWS II&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">TMH normal values in both groups indicate not aqueous deficient association with MGD&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a> However&#44; the results found no significant correlation between diabetic and non-diabetic subjects&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">A limitation of this study is the relatively small sample size and the selection of only men could be a bias factor&#44; so longitudinal studies are required to understand the association between gender&#44; diabetes and MGD&#46; Another limitation was access to the meibography in order to study the deep morphology of the glands&#46; In addition&#44; the measurements of the palpebral conjunctiva required eversion of the eyelid uncomfortable for patients&#46; Glandular expression with a cotton-tip applicator does not control of force and area&#44; could be improved for futures studies with specials paddles&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">In summary&#44; this study concludes&#44; MGD is more significant in patients with type 2 diabetes compared with nondiabetic patients&#44; with significative morphological changes&#44; viscosity secretion and inflammatory staining in the conjunctiva&#44; correlated with diabetes and compared with normal control participants&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">This study has no commercial or propriety interest&#46; The authors report no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1259619"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Purpose"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1166736"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1259618"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "M&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1166735"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Evaluation of tear film"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Diagnosis of Meibomian Gland dysfunction"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Correlations of Meibomian gland dysfunction"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-06-15"
    "fechaAceptado" => "2019-02-16"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1166736"
          "palabras" => array:5 [
            0 => "Meibomian gland dysfunction"
            1 => "Diabetes"
            2 => "Dry eye"
            3 => "NIBUT"
            4 => "Marx&#39;s line"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1166735"
          "palabras" => array:5 [
            0 => "Disfunci&#243;n de la gl&#225;ndula de Meibomio"
            1 => "Diabetes"
            2 => "Ojo seco"
            3 => "NIBUT"
            4 => "L&#237;nea de Marx"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Purpose</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the Meibomian glands&#44; ocular surface and tear function in patients with type 2 diabetes&#44; and study the correlation between these conditions&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective study of 76 males&#44; 37 with type 2 diabetes with an average of duration between 7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5 years&#44; and 36 males from control group&#46; After completing an ocular surface disease index &#40;OSDI&#41; questionnaire&#44; the non-invasive tear film break-up time &#40;NIBUT&#41; and the tear lipid layer pattern was performed using interferometry system and tear meniscus height&#47;TMH&#46; Ocular surface was studied with lissamine green staining and morphology of the glands with evaluation of Marx&#39;s line &#40;lid margin abnormalities&#41;&#59; meibomian secretion was expressed and was also assessed the quality&#46; The results were analyzed using the statistical Kruskal&#8211;Wallis and Mann&#8211;Whitney&#44; and correlations by Spearman Rho&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean age was 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 years&#59; 71&#37; of participants presented MGD &#40;76&#37; diabetics and 67&#37; controls&#41;&#46; OSDI were significantly higher &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#41; in the diabetic group&#46; A positive correlation was found between glycemia and symptoms &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0005&#41; and strong correlation between Hb1Ac and OSDI in MGD&#46; NIBUT was lower in the control group &#40;2&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>s&#41; than for the diabetic group &#40;2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;2<span class="elsevierStyleHsp" style=""></span>s&#41;&#44; with a significant inverse correlation &#40;52&#46;22&#37;&#41; with MG inflammation&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">MGD in type 2 diabetic patients is more severe compared with nondiabetic patients&#46; Longer duration of diabetes is associated with major symptoms and changes in MG&#46; Diabetic group showed major changes in lids and tear function&#44; accounting for evaporative dry eye and presenting a high degree of correlation with MG inflammation and obstruction&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Purpose"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar las gl&#225;ndulas de Meibomio&#44; la superficie ocular y la funci&#243;n de la l&#225;grima en pacientes con diabetes tipo 2&#44; y estudiar la correlaci&#243;n entre estas situaciones&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo de 76 varones&#44; 37 de ellos con diabetes tipo 2&#44; con una media de duraci&#243;n de entre 7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5 a&#241;os&#44; y 36 mujeres como grupo control&#46; Tras completar el cuestionario del &#237;ndice de enfermedad de la superficie ocular &#40;OSDI&#41;&#44; se obtuvieron el tiempo de ruptura lagrimal no invasivo &#40;NIBUT&#41; y el patr&#243;n de la capa lip&#237;dica de la l&#225;grima utilizando interferometr&#237;a y altura del menisco lagrimal&#47;AML&#46; Se estudi&#243; la superficie ocular con tinci&#243;n verde de lisamina y la morfolog&#237;a de las gl&#225;ndulas con evaluaci&#243;n de la l&#237;nea de Marx &#40;anomal&#237;as del margen del p&#225;rpado&#41;&#59; se expres&#243; la secreci&#243;n de las gl&#225;ndulas de Meibomio&#44; as&#237; como su calidad&#46; Los resultados se analizaron utilizando la pruebas estad&#237;sticas Kruskal-Wallis y Mann-Witney&#44; y las correlaciones con Rho de Spearman&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La edad media fue de 59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8 a&#241;os&#59; el 71&#37; de los participantes presentaron DGM &#40;76&#37; diab&#233;ticos y 67&#37; controles&#41;&#46; OSDI fue significativamente superior&#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; en el grupo diab&#233;tico&#46; Se encontr&#243; una correlaci&#243;n positiva entre glucemia y s&#237;ntomas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0005&#41;&#44; y una fuerte correlaci&#243;n entre Hb1Ac y OSDI en DGM&#46; NIBUT fue inferior en el grupo control &#40;2&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2s&#41; que en el grupo diab&#233;tico &#40;2&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;2s&#41;&#44; con una correlaci&#243;n inversa significativa &#40;52&#44;22&#37;&#41; con la irregularidad del borde palbebral y queratinizaci&#243;n del OM&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">DGM en los pacientes con diabetes tipo 2 es m&#225;s grave&#44; en comparaci&#243;n con los pacientes no diab&#233;ticos&#46; La mayor duraci&#243;n de la diabetes se asocia a s&#237;ntomas mayores y cambios en la GM&#46; El grupo diab&#233;tico reflej&#243; cambios mayores en los p&#225;rpados y la funci&#243;n de la l&#225;grima&#44; lo cual supone ojo seco evaporativo&#44; y un alto grado de correlaci&#243;n con irregularidad del margen palpebral y obstrucci&#243;n de la GM&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 949
            "Ancho" => 1255
            "Tamanyo" => 194026
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Lid margin&#46; &#40;a&#41; Extension of green lissamine toward meibomian orifices&#58; Marx&#39;s line&#59; &#40;b&#41; red filter show irregularity of lid margin&#59; &#40;c&#41; retroplacement of Meibomian orifices&#59; &#40;d&#41; obliteration&#46; The punctum of the orifice may not be visible and vascular invasion is visible&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1299
            "Ancho" => 1497
            "Tamanyo" => 67895
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Correlation between OSDI and Hb1Ac in diabetic participants&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1415
            "Ancho" => 1550
            "Tamanyo" => 60232
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between NIBUT and Marx&#8217; line in diabetic participants&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Diabetes group</th><th class="td" title="\n
                  \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">Control group</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dry eye diagnosis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Dry eye diagnosis &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value&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">OSDI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;78&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;47&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;016&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">TMH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">207<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>83&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;59&#46;45&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">212<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>70&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;47&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;86&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">Lissamine staining<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;72&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;66&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;005&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">Fluorescein staining<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;29&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;92<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">08 &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;465&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">NIBUT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;94&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;94&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;351&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">Total DED&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;76&#46;31&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;63&#46;86&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2154593.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Standard deviation SD is represented with<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Lissamine staining with oxford score&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Fluorescein staining score of the ocular surface according with the Van Bijsterveld scale&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Diagnosis of dry eye&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Evaluation of Meibomian glands</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Marx&#39;s line retroplacement<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>3&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Keratinization &#40;cicatricial&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Viscosity&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Obstruction&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">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;76&#46;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;48&#46;64&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;76&#46;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;76&#46;67&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Controls&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;11&#46;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;47&#46;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;75&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;66&#46;66&#37;&#41;&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="5" 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-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">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;43&#46;83&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;47&#46;94&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;75&#46;34&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;71&#46;23&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2154594.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Results of classification of DGM&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:36 [
            0 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The international workshop on meibomian gland dysfunction&#58; report of the definition and classification subcommittee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;D&#46; Nelson"
                            1 => "J&#46; Shimazaki"
                            2 => "J&#46;M&#46; Benitez-del-Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.10-6997b"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "1930"
                        "paginaFinal" => "1937"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TFOS DEWS II&#46; Definition and classification report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;P&#46; Craig"
                            1 => "K&#46;K&#46; Nichols"
                            2 => "E&#46;K&#46; Akpek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtos.2017.05.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Surf"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "276"
                        "paginaFinal" => "283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28736335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and control of diabetes in Chinese adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "Y&#46; Xu"
                            1 => "L&#46; Wang"
                            2 => "L&#46; He"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2013"
                        "volumen" => "310"
                        "paginaInicial" => "948"
                        "paginaFinal" => "959"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TFOS DEWS II&#58; pathophysiology report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;A&#46; Bron"
                            1 => "S&#46; Chauan"
                            2 => "S&#46; Jain"
                            3 => "Y&#46; Ogawa"
                            4 => "N&#46; Yokoi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtos.2017.05.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Surf"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "438"
                        "paginaFinal" => "510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28736340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The international workshop on Meibomian Gland Dysfunction&#58; report of the subcommittee on anatomy&#44; physiology and pathophysiology of the meibomian gland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "E&#46; Knop"
                            1 => "N&#46; Knop"
                            2 => "T&#46; Millar"
                            3 => "H&#46; Obata"
                            4 => "D&#46; Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.10-6997c"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "1938"
                        "paginaFinal" => "1978"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450915"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Report of the inaugural meeting of the TFOS i2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>initiation innovation series&#58; targeting the unmet need for the eye dry treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "W&#46; Chao"
                            1 => "C&#46; Belmonte"
                            2 => "J&#46; Benitez del Castillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jtos.2015.11.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ocul Surf"
                        "fecha" => "2016"
                        "volumen" => "14"
                        "paginaInicial" => "264"
                        "paginaFinal" => "316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26774910"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TFOS DEWS II&#58; tear film report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Willcox"
                            1 => "P&#46; Arg&#252;eso"
                            2 => "G&#46; Georgiev"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ocul Surf"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "369"
                        "paginaFinal" => "406"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of insulin and high glucose on human meibomian gland epithelial cells"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Ding"
                            1 => "L&#46; Yang"
                            2 => "D&#46; Sullivan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2015"
                        "volumen" => "56"
                        "paginaInicial" => "7814"
                        "paginaFinal" => "7820"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The international workshop on meibomian gland dysfunction&#58; report of the subcommittee on the epidemiology of&#44; and associated risk factors for&#44; MGD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;A&#46; Schaumberg"
                            1 => "J&#46;J&#46; Nichols"
                            2 => "E&#46;B&#46; Papas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.10-6997e"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "1994"
                        "paginaFinal" => "2005"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450917"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The epidemiology of meibomian gland dysfunction in an elderly population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;A&#46; Alghamdi"
                            1 => "C&#46; Mercado"
                            2 => "A&#46;L&#46; McClellan"
                            3 => "H&#46; Batawi"
                            4 => "C&#46;L&#46; Karp"
                            5 => "A&#46; Galor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICO0000000000000815"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "731"
                        "paginaFinal" => "735"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27027919"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dry eye syndrome in subjects with Diabetes and association with neuropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "V&#46; Achtsidis"
                            1 => "I&#46; Eleftheriadou"
                            2 => "E&#46; Kozanidou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2337/dc13-1169"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetes Care"
                        "fecha" => "2014"
                        "volumen" => "37"
                        "paginaInicial" => "210"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23939544"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meta-analysis and review on the changes of tear function and corneal sensitivity in diabetics patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "H&#46; Lu"
                            1 => "A&#46; Li"
                            2 => "X&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/aos.12063"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Ophthalmol"
                        "fecha" => "2014"
                        "volumen" => "92"
                        "paginaInicial" => "e96"
                        "paginaFinal" => "e104"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23782539"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autonomic pheripheral neuropathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Freeman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)74815-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2005"
                        "volumen" => "365"
                        "paginaInicial" => "1259"
                        "paginaFinal" => "1270"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15811460"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "TFOS DEWS II&#58; diagnostic methodology report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Wolffsohn"
                            1 => "R&#46; Arita"
                            2 => "R&#46; Chalmers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ocul Surf"
                        "fecha" => "2017"
                        "volumen" => "15"
                        "paginaInicial" => "539"
                        "paginaFinal" => "574"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tear film examination of the contact lens patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Guillon"
                            1 => "M&#46; Guillon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Optician"
                        "fecha" => "1993"
                        "volumen" => "206"
                        "paginaInicial" => "21"
                        "paginaFinal" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Non-invasive Tearscope Plus routine for contact lens fitting"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Guillon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cont Lens Ant Eye"
                        "fecha" => "1998"
                        "volumen" => "21"
                        "numero" => "Suppl&#46;"
                        "paginaInicial" => "S31"
                        "paginaFinal" => "S40"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anterior segment optical coherence tomography for tear meniscus evaluation and its correlation with other tear variables in healthy individuals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Raj"
                            1 => "R&#46; Dhasmana"
                            2 => "R&#46;C&#46; Nagpal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7860/JCDR/2016/18717.7722"
                      "Revista" => array:3 [
                        "tituloSerie" => "JCDR"
                        "fecha" => "2016"
                        "volumen" => "10"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Report of the National Eye Institute&#47;Industry Workshop on clinical trials in dry eyes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Lemp"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "CLAO"
                        "fecha" => "1995"
                        "volumen" => "21"
                        "paginaInicial" => "221"
                        "paginaFinal" => "223"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of conjunctival staining between lissamine green and yellow filtered fluorescein sodium"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y&#46; Eom"
                            1 => "J&#46;S&#46; Lee"
                            2 => "H&#46; Lee"
                            3 => "H&#46; Kim"
                            4 => "J&#46; Song"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Can J Opthal"
                        "fecha" => "2015"
                        "volumen" => "50"
                        "paginaInicial" => "273"
                        "paginaFinal" => "277"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Marx line&#58; fluorescein staining line on the inner lid as indicator of Meibomian Gland Disfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Yamaguchi"
                            1 => "M&#46; Kutsuna"
                            2 => "U&#46; Toshihiko"
                            3 => "Z&#46; Xiaodong"
                            4 => "T&#46; Kodama"
                            5 => "Y&#46; Ohashi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2006"
                        "volumen" => "141"
                        "paginaInicial" => "669"
                        "paginaFinal" => "675"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visualisation of &#8220;Marx&#39;s line&#8221; along the marginal eyelid conjunctiva of human subjects with lissamine green dye"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Doughty"
                            1 => "T&#46; Naase"
                            2 => "C&#46; Donald"
                            3 => "L&#46; Hamilton"
                            4 => "N&#46; Button"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1046/j.1475-1313.2003.00160.x"
                      "Revista" => array:5 [
                        "tituloSerie" => "Ophthal Physiol Opt"
                        "fecha" => "2004"
                        "volumen" => "24"
                        "paginaInicial" => "1"
                        "paginaFinal" => "7"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Definition and diagnostic criteria for meibomian gland dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "S&#46; Amano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eye"
                        "fecha" => "2010"
                        "volumen" => "27"
                        "paginaInicial" => "627"
                        "paginaFinal" => "631"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The international workshop on meibomian gland dysfunction&#58; report of the diagnosis subcommittee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Tomlinson"
                            1 => "A&#46;J&#46; Bron"
                            2 => "D&#46;R&#46; Korb"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1167/iovs.10-6997f"
                      "Revista" => array:6 [
                        "tituloSerie" => "Invest Ophthalmol Vis Sci"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "paginaInicial" => "2006"
                        "paginaFinal" => "2049"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21450918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Development of definitive and reliable grading scales for meibomian gland dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "R&#46; Arita"
                            1 => "I&#46; Minoura"
                            2 => "N&#46; Morishige"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2016"
                        "volumen" => "169"
                        "paginaInicial" => "125"
                        "paginaFinal" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meibomian gland diagnostic expressibility&#58; correlation with dry eye symptoms and gland location"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;R&#46; Korb"
                            1 => "C&#46;A&#46; Blackie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICO.0b013e3181814cff"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2008"
                        "volumen" => "27"
                        "paginaInicial" => "1142"
                        "paginaFinal" => "1147"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19034129"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cluster analysis of patients with ocular surface disease&#44; blepharitis&#44; and dry eye"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;D&#46; Mathers"
                            1 => "D&#46; Choi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Ophtholmol"
                        "fecha" => "2004"
                        "volumen" => "122"
                        "paginaInicial" => "1700"
                        "paginaFinal" => "1704"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A clinical study of meibomian gland dysfunction in patients with diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;P&#46; Shamsheer"
                            1 => "C&#46; Arunachalam"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/0974-9233.167827"
                      "Revista" => array:6 [
                        "tituloSerie" => "Middle East Afr J Ophthalmol"
                        "fecha" => "2015"
                        "volumen" => "22"
                        "paginaInicial" => "462"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26692718"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meibomian gland dysfunction in type 2 diabetic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "X&#46; Lin"
                            1 => "B&#46; Xu"
                            2 => "Y&#46; Zheng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Ophthalmol"
                        "fecha" => "2017"
                        "volumen" => "2017"
                        "paginaInicial" => "3047867"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-reported dry eyes and diabetic history"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Hom"
                            1 => "P&#46; De Land"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Optometry"
                        "fecha" => "2006"
                        "volumen" => "77"
                        "paginaInicial" => "554"
                        "paginaFinal" => "558"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meibomian gland dysfunction and contact lens intolerance"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;R&#46; Korb"
                            1 => "A&#46;S&#46; Henriquez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Optom Assoc"
                        "fecha" => "1980"
                        "volumen" => "51"
                        "paginaInicial" => "243"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6154727"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0345"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diabetic keratopathy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Schultz"
                            1 => "D&#46; Van Horn"
                            2 => "M&#46; Peters"
                            3 => "K&#46; Klewin"
                            4 => "W&#46; Schutten"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Trans Am Ophthalmol Soc"
                        "fecha" => "1981"
                        "volumen" => "79"
                        "paginaInicial" => "180"
                        "paginaFinal" => "199"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7342400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0360"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dry eye in diabetic patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "I&#46; Kaiserman"
                            1 => "N&#46; Kaiserman"
                            2 => "S&#46; Nakar"
                            3 => "S&#46; Vinker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajo.2004.10.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Ophthalmol"
                        "fecha" => "2005"
                        "volumen" => "139"
                        "paginaInicial" => "498"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15767060"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0365"
              "etiqueta" => "35"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The efficacy&#44; sensitivity&#44; and specificity of in vivo laser confocal microscopy in the diagnosis of meibomian gland dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "O&#46;M&#46; Ibrahim"
                            1 => "Y&#46; Matsumoto"
                            2 => "M&#46; Dogru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ophtha.2009.12.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2010"
                        "volumen" => "117"
                        "paginaInicial" => "665"
                        "paginaFinal" => "672"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20189653"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0370"
              "etiqueta" => "36"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tear function and ocular surface changes in non-insulin dependent diabetes mellitus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Dogru"
                            1 => "C&#46; Katakami"
                            2 => "M&#46; Inoue"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s0161-6420(00)00599-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ophthalmology"
                        "fecha" => "2001"
                        "volumen" => "108"
                        "paginaInicial" => "586"
                        "paginaFinal" => "592"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11237914"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0375"
              "etiqueta" => "37"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Meibomian gland dysfunction in chronic blepharitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "W&#46; Mathers"
                            1 => "W&#46; Shields"
                            2 => "M&#46; Sachdev"
                            3 => "W&#46; Petroll"
                            4 => "J&#46; Jester"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "1991"
                        "volumen" => "10"
                        "paginaInicial" => "277"
                        "paginaFinal" => "283"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0380"
              "etiqueta" => "38"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of lipid layer thickness measurement of the tear film as a diagnostic tool for meibomian gland dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:1 [
                            0 => "D&#46; Finis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/ICO.0b013e3182a7f3e1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cornea"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "1549"
                        "paginaFinal" => "1553"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24097185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/18884296/0000001200000004/v1_201910291446/S1888429619300214/v1_201910291446/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "3963"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/18884296/0000001200000004/v1_201910291446/S1888429619300214/v1_201910291446/en/main.pdf?idApp=UINPBA00004D&text.app=https://www.journalofoptometry.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888429619300214?idApp=UINPBA00004D"
]

Article information

ISSN: 18884296
Original language: English

DOI:10.1016/j.optom.2019.02.003

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 October	46	45	91
2024 September	76	91	167
2024 August	104	69	173
2024 July	108	72	180
2024 June	94	59	153
2024 May	94	64	158
2024 April	116	63	179
2024 March	77	52	129
2024 February	79	78	157
2024 January	170	87	257
2023 December	66	74	140
2023 November	107	102	209
2023 October	78	77	155
2023 September	51	65	116
2023 August	49	52	101
2023 July	109	62	171
2023 June	77	65	142
2023 May	96	77	173
2023 April	51	55	106
2023 March	73	60	133
2023 February	62	62	124
2023 January	59	59	118
2022 December	102	79	181
2022 November	88	49	137
2022 October	100	58	158
2022 September	79	52	131
2022 August	118	42	160
2022 July	93	47	140
2022 June	67	36	103
2022 May	85	48	133
2022 April	75	33	108
2022 March	94	73	167
2022 February	99	41	140
2022 January	103	55	158
2021 December	83	68	151
2021 November	66	56	122
2021 October	80	89	169
2021 September	60	56	116
2021 August	61	99	160
2021 July	55	41	96
2021 June	37	42	79
2021 May	79	58	137
2021 April	98	112	210
2021 March	175	63	238
2021 February	54	30	84
2021 January	74	48	122
2020 December	69	66	135
2020 November	93	36	129
2020 October	86	35	121
2020 September	111	59	170
2020 August	137	41	178
2020 July	115	51	166
2020 June	99	30	129
2020 May	80	43	123
2020 April	97	49	146
2020 March	104	33	137
2020 February	125	39	164
2020 January	196	67	263
2019 December	526	100	626
2019 November	347	87	434
2019 October	150	41	191
2019 September	116	69	185
2019 August	64	26	90
2019 July	111	32	143
2019 June	113	50	163
2019 May	35	37	72

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter