Original Article
Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study
a Department of Ophthalmology, Kocaeli Health and Technology University, Medical Park Kocaeli Hospital, Kocaeli, Turkey
b Department of Dermatology, Medical Park Kocaeli Hospital, Kocaeli, Turkey
c Department of Ophthalmology, University of Health Sciences, Tepecik Hospital, Izmir, Turkey
d Department of Ophthalmology, Alaaddin Keykubat University, Alanya, Turkey
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Estudo com <span class="elsevierStyleItalic">SD‐OCT</span>" "tienePdf" => "pt" "tieneTextoCompleto" => "pt" "tieneResumen" => "pt" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "786" ] ] "contieneResumen" => array:1 [ "pt" => true ] "contieneTextoCompleto" => array:1 [ "pt" => true ] "contienePdf" => array:1 [ "pt" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1465 "Ancho" => 2508 "Tamanyo" => 375675 ] ] "descripcion" => array:1 [ "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Mapeamento da espessura epitelial corneana média com SD‐OCT. Anel de zona central de 2<span class="elsevierStyleHsp" style=""></span>mm indicado pela seta branca. 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SD-OCT study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "781" "paginaFinal" => "786" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "İrfan Botan Güneş, Berna Aksoy, Hakan Öztürk, Fuat Yavrum, Bediz Özen" "autores" => array:5 [ 0 => array:4 [ "nombre" => "İrfan Botan" "apellidos" => "Güneş" "email" => array:1 [ 0 => "irfanoft@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Berna" "apellidos" => "Aksoy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Hakan" "apellidos" => "Öztürk" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Fuat" "apellidos" => "Yavrum" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Bediz" "apellidos" => "Özen" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Department of Ophthalmology, Kocaeli Health and Technology University, Medical Park Kocaeli Hospital, Kocaeli, Turkey" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Dermatology, Medical Park Kocaeli Hospital, Kocaeli, Turkey" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Ophthalmology, University of Health Sciences, Tepecik Hospital, Izmir, Turkey" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Ophthalmology, Alaaddin Keykubat University, Alanya, Turkey" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1945 "Ancho" => 3341 "Tamanyo" => 519393 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mean corneal epithelial thickness maping with SD-OCT. Central 2-mm zone ring indicated by the white arrow. Mean corneal epithelial thickness in central 2-mm zone used in the analysis of measurements. Unit: μm</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Psoriasis is a chronic inflammatory skin disease with a strong genetic predisposition and autoimmune pathogenic traits characterized by epidermal hyperproliferation and a relatively high epithelial basal turnover rate.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Psoriasis typically affects the skin, but may also affect the joints and has been associated with a number of diseases. Inflammation is not limited to the psoriatic skin and has been shown to affect different organ systems. When compared to control subjects, psoriasis patients exhibit increased hyperlipidemia, hypertension, coronary artery disease, type 2 diabetes, and increased body mass index.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to these systemic diseases, ocular involvement is common, affecting 12% of cases.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> Decreased corrected visual acuities, pterygium, cataract, blepharitis, keratitis, conjunctival hyperemia, and dry eye have been reported as common in patients with psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In addition, punctate keratitis and corneal melting have been reported in psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> In inflammatory processes affecting the ocular surface, the cornea, and conjunctival epithelium are also potentially affected.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The corneal epithelium is a non-keratinized squamous epithelium playing a very important role in protecting the eye and maintaining high optical quality, as it is the outermost layer.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10,11</span></a> It has been found that the epithelium contributes 0.85<span class="elsevierStyleHsp" style=""></span>D alone in corneal refraction at the 3.6<span class="elsevierStyleHsp" style=""></span>mm diameter zone.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Spectral-Domain Optical Coherence Tomography (SD-OCT) is a contactless technique that enables the measurement of corneal epithelial thickness and an accurate assessment of the corneal layers with great reliability and repeatability.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13–15</span></a> SD-OCT is widely used in ophthalmology clinics today.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Psoriasis Area Severity Index (PASI) score is an objective method that scores the severity of psoriasis disease. In determining the PASI score, the affected body surface area, erythema, induration, and scaling are evaluated.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> On the other hand, PASI is a time-consuming and complex tool.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The authors know that the literature contains no studies examining the relationship between the severity of psoriasis and corneal epithelial thickness. In this study, the authors investigated the thickness of the corneal epithelial SD-OCT thickness map in psoriasis patients according to PASI score compared to normal subjects.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Material and methods</span><p id="par0040" class="elsevierStylePara elsevierViewall">This cross-sectional case-control study was performed with the approval of the University of Istinye’s Medical Research Ethical Committee (approval number: 2/2021.K-67) according to the ethical principles of the Declaration of Helsinki. Written consent forms were received from all participants.</p><p id="par0045" class="elsevierStylePara elsevierViewall">175 eyes of 175 patients with psoriasis and 57 eyes of 57 healthy participants (the Control Group [CG]) were included in this study. Only the right eyes of the participants were included in the study. Each participant underwent a complete ocular examination, including Schirmer’s test.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Demographic data and anterior and posterior segment examinations were recorded in all cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The same specialist (Aksoy B) calculated and recorded the PASI score for each patient. Psoriasis patients were divided into three subgroups according to the PASI score: mild subgroup (PASI <10), moderate subgroup (PASI between 10 and 20), and severe subgroup (PASI >20).<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,20</span></a> The study excluded individuals with previous histories of ocular trauma or surgery, individuals having dry eye, corneal and conjunctival pathologies or active ocular diseases, individuals previously using long-term topical eye medications, and individuals using contact lenses.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Measurements of the Corneal Epithelial Thickness (CET) were done by the same SD-OCT device (Optopol Technology sp.zo. Zawiercie Polska). OCT measurements were performed before the ophthalmological examination to avoid potential artifacts. The corneal epithelial thickness map of the patients was obtained using the cornea imaging mode of the SD-OCT device (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Thickness values of the corneal epithelium were examined within a circular area of diameter 4<span class="elsevierStyleHsp" style=""></span>mm. Corneal epithelial thickness value of the central area of 2<span class="elsevierStyleHsp" style=""></span>mm diameter was defined as the Central Corneal Epithelial Thickness (CCET).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The same specialist (Gunes IB) performed all measurements. Measurements were done between 09.00 and 11.00 to avoid the effects of diurnal variation. Mean CCET values of mild, moderate, and severe psoriasis groups were compared with those of the control group. The psoriasis subgroup values were also compared.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The Statistical Package for Social Sciences version 20.0 was used in the statistical analysis of all data. The “Kolmogrov Simirnov” and “Shapiro-Wilk” tests examined the compatibility of numerical data and normal distribution. The “Mann-Whitney <span class="elsevierStyleItalic">U</span>” test was used for two independent groups and “Kruskal-Wallis H” test was used for more than two independent groups that did not show normal distribution. To detect significant differences between more than two independent groups, one of the post-hoc analyses, the Mann-Whitney <span class="elsevierStyleItalic">U</span> test with Bonferroni correction, was used. The Chi-Square test was used in the analysis of categorical variables among themselves. “Spearman Coefficient” was used in correlation tests. The results were analyzed at a 95% Confidence Interval and a p-value <0.05 was considered statistically significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The present study included 232 eyes of 232 participants. The mean age of the participants was 43.60 (min: 17, max: 88), of which 57.8 % were female (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>134) and 42.2% were male (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>98). The patients were divided into 3 groups according to the PASI score. The mild group included 64 eyes (27.6%), the moderate group included 58 eyes (25.0%), and the severe group included 53 eyes (22.8%). The control group included 57 eyes (24.6%). There was no significant difference in age and gender distribution between the groups in the study (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.103, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.242, respectively). <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the demographic data of the patient groups and the control group.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The mean corneal epithelial thickness was 58.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1<span class="elsevierStyleHsp" style=""></span>μm in the mild group, 60.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0<span class="elsevierStyleHsp" style=""></span>μm in the moderate group, 65.38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.8<span class="elsevierStyleHsp" style=""></span>μm in the severe group and 56.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1<span class="elsevierStyleHsp" style=""></span>μm in the control group.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mean CCET values showed a statistically significant difference between the groups (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The mean corneal epithelium thickness in the control group was found to be significantly lower than all psoriasis groups (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). In post hoc analysis performed among psoriasis groups, the mean CCET value was found to be significantly lower in the mild group compared to the moderate group (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018), and the mean CCET value was found to be significantly lower in the mild and moderate groups compared to the severe group (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). In addition, there was a strong positive correlation between the PASI score indicating disease severity and corneal epithelial thickness (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001, <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.519) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The present study aimed to evaluate the thickness of the corneal epithelium in psoriasis patients using SD-OCT. Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> Unlike previous studies, this study evaluates the relationship between corneal epithelial thickness and disease severity in psoriasis patients.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Various studies have shown that the measurement of CCET with SD-OCT, which measures contactless with the eye, is reliable and reproducible.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,22,23</span></a> The mean CCET was examined in previous studies, with the application of impression cytology, in vivo confocal microscopy, or ultrasound.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24–26</span></a> Various studies have widely used SD-OCT, benefitting from its lack of contact, accuracy, stability, and repeatability of results.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27,28</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Ostadian et al. found the average CCET value of the normal population to be 56.64<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.82<span class="elsevierStyleHsp" style=""></span>μm in measurements made with SD-OCT.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> Similar to this study, the mean corneal epithelial thickness was 56.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1<span class="elsevierStyleHsp" style=""></span>μm in this study’s control group.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Kanellopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> reported a positive correlation between corneal epithelial thickness and age. Samy et al. reported that CCET value decreases with age but not according to gender.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The authors found no significant difference in mean corneal epithelial thickness according to gender and age in the patient and control groups.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Previous studies have described the involvement of the cornea in psoriasis as superficial punctate keratitis, opacities, recurrent erosions, ulcers, and scars.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–8</span></a> In addition, Her et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> showed that dry eye is common in patients with psoriasis and that the tear film in these patients is relatively unstable because of ocular surface damage. The etiopathogenic mechanism of psoriasis affecting the ocular surface has not yet been clarified. In this study, corneal epithelial thickening was observed in psoriasis patients without eye involvement with psoriatic plaques. Eye involvement in psoriasis without psoriatic plaque may be a result of the psoriatic phenotype, which can induce immune-mediated inflammatory processes in organs other than the skin.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">PASI scoring is an objective method that shows the severity of psoriasis. When determining the PASI score, the affected body surface area, erythema, induration, and scaling are evaluated.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The present study divided its psoriasis patients into three groups according to mild, moderate, and severe PASI scores. When the authors compared the mean corneal epithelial thickness of the patient groups and the control group, we found that the corneal epithelial thickness was significantly higher in the mild, moderate and severe patient groups compared to the control group. When the patient groups were evaluated among themselves, the average corneal epithelial thickness of the moderate and severe groups was found to be significantly higher than the mild group. In addition, a strong positive correlation was observed between disease severity and corneal epithelial thickness (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001, <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.519).</p><p id="par0120" class="elsevierStylePara elsevierViewall">A study about the trypsin-like serine protease marapsin, emphasizes that marapsin expression is only found in the nonkeratinizing type of squamous epithelium in humans, such as the esophagus, tonsil, larynx, cervix, and cornea.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> These marapsin-expressing epithelia are all relatively thick, have a relatively high turnover rate, and are nonkeratinizing. In addition marapsin is not expressed in the keratinizing epithelium but is strongly induced when the epidermis undergoes hyperplasia and hyperproliferation, such as during wound re-epithelialization and in psoriasis. Marapsin expression is associated with squamous differentiation of keratinocytes, either constitutively in nonkeratinizing epithelia or under conditions of hyperproliferation and hyperplasia in the keratinizing epithelium of the epidermis. Marapsin has been shown to be strongly up-regulated in the hyperplastic and hyperproliferative epidermis in psoriasis.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> More recently, Adachi et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> have identified marapsin in the rat cornea, which agrees with an earlier study by Wong et al.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> showing strong marapsin mRNA expression in the mouse eye. In normal conditions, the epidermal cell cycle is completed in about four weeks. But in psoriasis, the epidermal cell cycle is accelerated. Cell division in the basal layer occurs every 1.5 days, and the migration of keratinocytes to the stratum corneum occurs within approximately 4 days. This results in the hyperproliferation of keratinocytes.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> In addition, Aragona et al.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">37</span></a> showed that squamous metaplasia was present in ocular surface impression cytology specimen in patients with psoriasis without eye involvement.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The present study found thickening of the corneal epithelium without eye involvement to be associated with psoriasis. Although ocular surface involvement is absent, the authors think that increased marapsin expression and squamous metaplasia in psoriasis patients’ eyes may cause corneal epithelium hyperproliferation and thickening due to increased turnover rate.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The limitations of the present study are as follows: it is a cross-sectional study; it includes a relatively small number of participants; and it is unable to evaluate patients due to diagnosis time.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0135" class="elsevierStylePara elsevierViewall">The present study measured corneal epithelial thickness using contactless SD-OCT and demonstrated a positive correlation between the severity of psoriasis and CCET. The authors think that CCET may be one of the indicators of disease severity in psoriasis patients, and believe the present findings will be supported by prospective studies that include a high number of participants in the future.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Financial support</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Authors’ contributions</span><p id="par0145" class="elsevierStylePara elsevierViewall">İrfan Botan Güneş: Material preparation, data collection and analysis; first draft of the manuscript; comments on previous versions of the manuscript; final manuscript approval.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Hakan Öztürk: Material preparation, data collection and analysis; comments on previous versions of the manuscript; final manuscript approval.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Fuat Yavrum: Material preparation, data collection and analysis; comments on previous versions of the manuscript; final manuscript approval.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Bediz Özen: Material preparation, data collection and analysis; comments on previous versions of the manuscript; final manuscript approval.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Bern Aksoy: Material preparation, data collection and analysis; comments on previous versions of the manuscript; final manuscript approval.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2000110" "titulo" => "Abstract" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Study limitations" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1714150" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Financial support" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors’ contributions" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-09-05" "fechaAceptado" => "2022-11-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1714150" "palabras" => array:3 [ 0 => "Epithelium, corneal" 1 => "Psoriasis" 2 => "Tomography, optical coherence" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The mean CCET value was 58.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1<span class="elsevierStyleHsp" style=""></span>μm in the mild group, 60.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0<span class="elsevierStyleHsp" style=""></span>μm in the moderate group, 65.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.3<span class="elsevierStyleHsp" style=""></span>μm in the severe group and 56.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1<span class="elsevierStyleHsp" style=""></span>μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). There was a strong positive correlation between PASI score and CCET (p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001, <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.519).</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional design and a relatively small number of participants.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.</p></span>" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Study limitations" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Conclusions" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Dermatology and Ophthalmology Departments, VMI Medical Park Hospital Kocaeli, Kocaeli, Turkey.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1945 "Ancho" => 3341 "Tamanyo" => 519393 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mean corneal epithelial thickness maping with SD-OCT. Central 2-mm zone ring indicated by the white arrow. Mean corneal epithelial thickness in central 2-mm zone used in the analysis of measurements. Unit: μm</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1303 "Ancho" => 1667 "Tamanyo" => 96141 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Corelation between PASI and CCET</p>" ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">SD; Standard Deviation, n: Number of cases, F/M: Females/Males, PASI: Psoriasis Area Severity Index, CCET: Central Corneal Epithelial Thickness (μm).</p>" "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="left" 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 " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Mild - PASI<10 (1) \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">Moderate - PASI between 10 and 20 (2) \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">Severe - PASI >20 (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">Control (4) \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">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \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">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>64 \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">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>58 \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">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>53 \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">n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>57 \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"> \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">Gender (F/M) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28/30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32/21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.242 \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 rowgroup " rowspan="2" align="left" valign="middle">Mean Age<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD (range) years</td><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">39.69<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.79<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.15<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>14.6 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11.4 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.103 \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">(17‒66) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(27‒72) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(26‒88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(17‒75) \t\t\t\t\t\t\n \t\t\t\t</td><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"> \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 rowgroup " rowspan="2" align="left" valign="middle">PASI score<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD (range)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.85<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13.69<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.29 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.27<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.04 \t\t\t\t\t\t\n \t\t\t\t</td><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"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \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">(1.20‒9.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(10.80‒19.60) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(20.40‒49.20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" 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="left" 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><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 rowgroup " rowspan="6" align="left" valign="middle">CCET±SD μm (range)</td><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">58.06<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60.10<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.0 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.75<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.3 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.16<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1‒2: p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.018<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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 rowgroup " rowspan="5" align="left" valign="middle">(52‒66)</td><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " rowspan="5" align="left" valign="middle">(52‒75)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="middle">(54‒80)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="5" align="left" valign="middle">(51‒66)</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1‒3: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \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">1‒4: p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2‒3: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2‒4: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3‒4: p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3320917.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Two-way comparisons.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demographic data, CCET values and PASI score of the groups</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:37 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis—epidemiology and clinical spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. 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Cannavo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bjophthalmol-2017-310307" "Revista" => array:6 [ "tituloSerie" => "Br J Ophthalmol" "fecha" => "2018" "volumen" => "102" "paginaInicial" => "302" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28689165" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03650596/0000009800000006/v2_202310301240/S036505962300140X/v2_202310301240/en/main.assets" "Apartado" => array:4 [ "identificador" => "89516" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009800000006/v2_202310301240/S036505962300140X/v2_202310301240/en/main.pdf?idApp=UINPBA00008Z&text.app=https://clinics.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S036505962300140X?idApp=UINPBA00008Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 28 | 6 | 34 |
| 2024 October | 185 | 86 | 271 |
| 2024 September | 314 | 106 | 420 |
| 2024 August | 287 | 133 | 420 |
| 2024 July | 256 | 114 | 370 |
| 2024 June | 161 | 82 | 243 |
| 2024 May | 169 | 78 | 247 |
| 2024 April | 190 | 108 | 298 |
| 2024 March | 116 | 81 | 197 |
| 2024 February | 90 | 103 | 193 |
| 2024 January | 104 | 70 | 174 |
| 2023 December | 631 | 309 | 940 |
| 2023 November | 189 | 145 | 334 |
| 2023 October | 210 | 104 | 314 |
| 2023 September | 72 | 77 | 149 |
| 2023 August | 47 | 36 | 83 |
| 2023 July | 39 | 38 | 77 |
| 2023 June | 27 | 18 | 45 |
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