Antonio Ferreras

University of Zaragoza, Caesaraugusta, Aragon, Spain

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Publications (120)173.11 Total impact

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    ABSTRACT: Purpose: To assess the relationship between the retinal nerve fibre layer (RNFL) thickness and the frequency-doubling technology perimetry (FDT) outcome. Methods: Sixty-two healthy individuals and 72 glaucoma patients were prospectively selected. All participants underwent a reliable FDT and optical coherence tomography (OCT). Pearson correlations were calculated between the unlogged threshold values of FDT and RNFL thicknesses measured by OCT. Results: Mild to moderate correlations were found between a few points from FDT and RNFL thicknesses in the vertical axis. The nasal superior area of FDT and the RNFL thickness at the 7-o'clock position had the strongest correlation (0.434, p < 0.001). Conclusions: The poor agreement between FDT and OCT parameters suggests that both instruments assess different characteristics of glaucomatous optic neuropathy. The map obtained validates previously reported clinical findings and contributes to a better understanding of the structure-function relationship in glaucoma. © 2014 S. Karger AG, Basel.
    11/2014;
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    ABSTRACT: To evaluate the visual and anatomical outcomes of dexamethasone intravitreal implant (DXI; 700 μg, Ozurdex; Allergan, Irvine, California, USA) as adjunctive therapy for patients with refractory wet age-related macular degeneration (AMD). Retrospective review of the medical records of seven patients (seven eyes) who initially responded well to intravitreal ranibizumab but subsequently developed persistent intra/sub-retinal fluid (IRF/SRF) and underwent a single injection of DXI, between May 2012 and May 2013. Two weeks after DXI, the patients continued with their monthly ranibizumab injections. Best corrected visual acuity (BCVA) logarithm of the minimum angle of resolution (logMAR) and central retinal thickness (CRT) were recorded at baseline, 2 weeks, 6 weeks, 3 months and 6 months after DXI injection. Complications were recorded too. All patients had at least 24 months of ranibizumab treatment. Mean age was 81.5±5.8 years. At baseline, mean BCVA was 0.53±0.13 logMAR (20/70 Snellen) and mean CRT was 273.14±50.94 μm. BCVA did not change significantly after DXI over the follow-up period. However, all eyes had lost fewer than 0.3 logMAR units. Complete resolution of the persistent IRF/SRF was achieved in five eyes (71.4%) at 6 weeks, and remained stable at 3 months. Two weeks after DXI injection, the mean CRT diminished compared with baseline (248.28±31.8 µm; p=0.03) and the greatest reduction was observed at 3 months after DXI injection (241.5±36.6 µm; p=0.04). Progression of lens opacity was detected in one case (50% of phakic eyes). Retreatment with DXI was performed in two eyes. DXI appears to be effective in vision stabilisation, decreasing IRF/SRF and improvement of CRT in eyes with refractory wet AMD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    The British journal of ophthalmology. 11/2014;
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    ABSTRACT: Purpose: To evaluate the outcomes of standard automated perimetry (SAP) in patients with obstructive sleep apnea (OSA). Methods: Eighty OSA patients and 111 age-matched controls were consecutively and prospectively enrolled. One eye per subject was randomly selected. All participants underwent at least one reliable SAP (24-2 SITA standard algorithm). The peripapillary retinal nerve fiber layer thickness (RNFL) was measured with spectral-domain optical coherence tomography (OCT). OSA patients were classified into three groups according to the apnea/hypopnea index: mild, moderate, or severe OSA. SAP and OCT parameters were compared between healthy controls and OSA patients. Correlation of apnea/hypopnea index with OCT and SAP measurements were calculated. Results: Mean age, best-corrected visual acuity, and central corneal thickness were similar between groups. Intraocular pressure, however, was lower in the OSA group. Mean deviation of SAP was -0.23 ± 0.8 dB in the control group and -1.74 ± 2.8 dB in the OSA group (p<0.001). RNFL thickness measured with OCT did not differ significantly between groups. Patients with OSA showed reduced sensitivity at most points tested by white-on-white perimetry compared with healthy individuals. The threshold values were more depressed in the peripheral visual field. The apnea/hypopnea index was related to the SAP indices: Pearson correlations were -0.432 with mean deviation, 0.467 with pattern standard deviation, and -0.416 with the visual field index (p<0.001). Conclusions: OSA patients exhibited reduced retinal sensitivity measured with SAP compared to healthy controls.
    Investigative ophthalmology & visual science. 10/2014;
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    ABSTRACT: To compare the diagnostic performance of different segmentations of the nerve fiber layer (NFL) thickness measurements using an artificial neural network and to define the optimal number of sectors with best diagnostic ability for glaucoma diagnosis.
    Journal of glaucoma. 07/2014;
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    ABSTRACT: Objective: To compare the 3-year outcomes of two different dosing regimens used for wet age-related macular degeneration patients treated exclusively with ranibizumab. Methods: A Treat and extend (TAE) dosing group (n=30) and a treat and observe (TAO) dosing group (n=30) were retrospectively recorded. Survival rates (SR) based on visual acuity (VA) outcomes were calculated and analyzed. The central retinal thickness measured with spectral domain (SD) optical coherence tomography (OCT) and number of intravitreal injections performed in both groups were also compared. Results: At 36 months, Kaplan-Meier SRs were 90.9% for TAE and 89.7% for TAO (loss<0.3 units logMAR). VA improved in 42.4% and 24.1%, while 33.4% and 62.1% remained stable for TAE and TAO groups, respectively. No final VA differences were found between both therapeutic strategies (p>0.05, log-rank test). No differences were found in the final number of injections received: 20.31±6.6 in TAE group vs. 18.41 ± 7.1 in TAO group (p=0.19). Conclusions: Both approaches showed similar number of injections and visual outcomes.
    Clinical and Experimental Ophthalmology 02/2014; 5. · 1.96 Impact Factor
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    ABSTRACT: Purpose/methods To present the neuro-ophthalmology examination in 5 spastic ataxia of Charlevoix-Saguenay (ARSACS) patients showing significant increases in retinal nerve fiber layer (RNFL) thickness. Results/conclusions All patients showed abnormal visual fields, normal optic discs with increased visibility of RNFL in color stereo-photographs, normal examination with Heidelberg Retina Tomography instrument, and moderate to markedly increased RNFL thickness in Cirrus Optical Coherence Tomography evaluation (average thickness: 119 to 220 microns). We found evidence that RNFL hypertrophy may be an alternative funduscopic finding to the hypermyelinated retinal fibers in previous reports. A revision of ARSACS diagnostic criteria, particularly with regard to retinal alterations, is necessary.
    Archivos de la Sociedad Espanola de Oftalmologia 01/2014; 89(5):207–211.
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    ABSTRACT: To evaluate optic nerve head with spectral domain optical coherence tomography (OCT) in patients with Chiari I malformation (CMI) compared to healthy controls. Methods. Cross-sectional study. OCT of the optic nerve head of 22 patients with CMI and 22 healthy controls was quantitatively analyzed. The healthy controls were matched for age and sex with the study population. Mean retinal nerve fiber layer (RNFL) thickness was calculated for both eyes; the mean thickness value was also registered for each quadrant and for each subfield of the four quadrants. Results. CMI patients showed a reduction of the RNFL thickness in both eyes. This reduction was more statistically significant (𝑃 < 0.05) for the inferior quadrant in the right eye and in each quadrant than nasal one in the left eye. Conclusion. A distress of the retinal nerve fibers could explain the observed reduction of the RNFL thickness in patients with CMI; in our series the reduction of the RNFL thickness seems lower when CMI is associated with syringomyelia.
    BioMed Research International 01/2014; · 2.71 Impact Factor
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    ABSTRACT: Objective. To evaluate the relationship between spectral-domain optical coherence tomography (OCT) and standard automated perimetry (SAP) in healthy and glaucoma individuals. Methods. The sample comprised 338 individuals divided into 2 groups according to intraocular pressure and visual field outcomes. All participants underwent a reliable SAP and imaging of the optic nerve head with the Cirrus OCT. Pearson correlations were calculated between threshold sensitivity values of SAP (converted to linear scale) and OCT parameters. Results. Mean age did not differ between the control and glaucoma groups (59.55 ± 9.7 years and 61.05 ± 9.4 years, resp.; P = 0.15). Significant differences were found for the threshold sensitivities at each of the 52 points evaluated with SAP (P < 0.001) and the peripapillary retinal nerve fiber layer (RNFL) thicknesses, except at 3 and 9 clock-hour positions between both groups. Mild to moderate correlations (ranging between 0.286 and 0.593; P < 0.001) were observed between SAP and most OCT parameters in the glaucoma group. The strongest correlations were found between the inferior RNFL thickness and the superior hemifield points. The healthy group showed lower and weaker correlations than the glaucoma group. Conclusions. Peripapillary RNFL thickness measured with Cirrus OCT showed mild to moderate correlations with SAP in glaucoma patients.
    BioMed Research International 01/2014; 2014:514948. · 2.71 Impact Factor
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    ABSTRACT: Objective. To compare the equivalent optic nerve head (OHN) parameters obtained with confocal scanning laser ophthalmoscopy (HRT3) and spectral-domain optical coherence tomography (OCT) in healthy and glaucoma patients. Methods. One hundred and eighty-two consecutive healthy subjects and 156 patients with open-angle glaucoma were divided into 2 groups according to intraocular pressure and visual field outcomes. All participants underwent imaging of the ONH with the HRT3 and the Cirrus OCT. The ONH parameters and the receiver operating characteristic (ROC) curves were compared between both groups. Results. Mean age did not differ between the normal and glaucoma groups (59.55 ± 9.7 years and 61.05 ± 9.4 years, resp.; P = 0.15). Rim area, average cup-to-disc (C/D) ratio, vertical C/D ratio, and cup volume were different between both instruments (P < 0.001). All equivalent ONH parameters, except disc area, were different between both groups (P < 0.001). The best areas under the ROC curve were observed for vertical C/D ratio (0.980 for OCT and 0.942 for HRT3; P = 0.11). Sensitivities at 95% fixed-specificities of OCT parameters were higher than those of HRT3. Conclusions. Equivalent ONH parameters of Cirrus OCT and HRT3 are different and cannot be used interchangeably. ONH parameters measured with OCT yielded a slightly better diagnostic performance.
    BioMed Research International 01/2014; 2014:275654. · 2.71 Impact Factor
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    ABSTRACT: Background: To represent and interpret the three-dimensional (3D) geometry and the distribution of the axonal damage to the retinal nerve fiber layer (RNFL) in patients with multiple sclerosis (MS) compared with healthy subjects. To analyze alterations in RNFL morphology in eyes of MS patients with or without previous episodes of optic neuritis (ON). Methods: MS patients (n = 122) and age-matched healthy subjects (n = 108) were enrolled. The Spectralis optical coherence tomography system was used to determine the circumpapillary RNFL thickness. The 768 RNFL thickness measurements were used to evaluate thickness measurements in patients with or without antecedent ON and to design a 3D reconstruction of the RNFL thickness representing the mechanobiologic tissue response to neurodegeneration caused by MS and ON episodes. Results: RNFL thickness was decreased in MS patients, and was higher in the MS group with previous ON. Statistical analysis and 3D RNFL reconstruction revealed greater damage to the ganglionar cells in the superonasal RNFL area (101.77 µm in MS vs. 125.47 µm in healthy subjects) and in the inferotemporal RNFL (119.05 µm in MS eyes and 149.26 µm in healthy eyes). Conclusions: The 3D representation of RNFL thickness based on measurements allows physicians to better observe damage in the temporal areas, especially in patients with previous ON.
    Ophthalmic Research 06/2013; 50(1):72-81. · 1.56 Impact Factor
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    ABSTRACT: OBJECTIVE: To study the correlation between the sensitivity threshold values of the different points assessed by the Humphrey visual field analyzer (24-2 Swedish interactive threshold algorithm [SITA] standard strategy) in glaucoma patients. SUBJETS, MATERIAL AND METHODS: Prospective cross-sectorial study. One-hundred and four eyes of 104 glaucoma patients, defined by the appearance of the optic nerve head, were evaluated. Retinal threshold sensitivity points of standard automated perimetry (SA) with SITA standard 24-2 program were obtained. The upper and the lower hemifields were studied separately. Pearson correlation coefficients were calculated between the mean threshold sensitivity value at each point of the visual hemifield and the rest of the threshold points in the same hemifield. RESULTS: Perimetric correlation maps between retinal threshold sensitivity values in the same hemifield were obtained. Most of the points showed moderate to high correlations (r≥0.65. P<0.001) with neighboring points and distant points in the same hemifield. CONCLUSIONS: There is a functional relationship between neighboring and distant points in Humphrey Visual Field Analyzer (SITA Standard 24-2) in glaucoma patients. This correlation is related to the anatomical arrangement of ganglion cell axons. This fact enables perimetric patterns of glaucoma defects to be obtained.
    Archivos de la Sociedad Espanola de Oftalmologia 06/2013; 88(6):223-230.
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    ABSTRACT: To present the neuro-ophthalmology examination in 5 spastic ataxia of Charlevoix-Saguenay (ARSACS) patients showing significant increases in retinal nerve fiber layer (RNFL) thickness. All patients showed abnormal visual fields, normal optic discs with increased visibility of RNFL in color stereo-photographs, normal examination with Heidelberg Retina Tomography instrument, and moderate to markedly increased RNFL thickness in Cirrus Optical Coherence Tomography evaluation (average thickness: 119 to 220 microns). We found evidence that RNFL hypertrophy may be an alternative funduscopic finding to the hypermyelinated retinal fibers in previous reports. A revision of ARSACS diagnostic criteria, particularly with regard to retinal alterations, is necessary.
    Archivos de la Sociedad Espanola de Oftalmologia 04/2013;
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    ABSTRACT: Purpose. To evaluate the ability of frequency-doubling technology (FDT) perimetry in detecting visual field defects in young adults with type I diabetes prior to retinopathy or with minor retinovascular changes. Methods. This comparative cross-sectional study included 30 healthy subjects and 73 age-matched patients with type I diabetes mellitus. All subjects underwent a full ocular examination including an FDT with the threshold C-20-5 strategy. Only one eye per subject was randomly included in the statistical analysis. FDT results and time to perform the test were compared between the groups. Results. The mean age was 27.1 years in the control group and 26.6 years in the diabetic group (P = 0.875). The mean period from the onset of diabetes was 12.6 ± 6.7 years, while minimal retinovascular changes were observed in 18 eyes. Mean deviation of FDT did not differ between the groups. Although global indices of FDT were within normal limits, pattern standard deviation of FDT was higher in the diabetic group (P = 0.035). The area under the receiver operating characteristic curve was 0.647 for pattern standard deviation of FDT (standard error = 0.052; P = 0.017). Conclusion. FDT can detect retinal dysfunctions in diabetic patients prior to the onset of significant vascular complications.
    BioMed research international. 01/2013; 2013:341269.
  • Investigative ophthalmology & visual science 01/2013; 54(3):2011-2. · 3.43 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate and compare the ability of a new method for measuring hemoglobin (Hb) levels at the optic nerve head (ONH) to that of visual field evaluation, scanning laser ophthalmoscopy (HRT), scanning laser polarimetry (GDx), and optical coherence tomography (OCT) for diagnosing glaucoma. Methods: Healthy eyes (n=102) and glaucoma eyes (n=101) underwent reliable Oculus Spark perimetry, and imaging with the HRT, GDx, and Cirrus OCT. In addition, ONH color images were acquired with a non-mydriatic fundus camera. The Laguna ONhE program was then used to calculate the Hb amount in each of 24 sectors of the ONH. Sensitivities at 95% fixed specificity, diagnostic agreement, and linear correlations between parameters with the best diagnostic ability were calculated RESULTS: The Glaucoma Discriminant Function (GDF) of the Laguna program, evaluating Hb in the vertical intermediate sectors and center/periphery Hb amount slope, yielded an 89.1% sensitivity and 95.1% specificity, which was superior or similar to the other tests. The best GDF diagnostic agreement was for the OCT-vertical cup-to-disc (C/D) ratio (kappa = 0.772) and the final phase Spark pattern standard deviation (kappa =0.672). Hb levels strongly correlated with the Spark mean sensitivity (first phase,0.70; final phase, 0.71). Hb also correlated well with the Reinhard OW Burk discriminant function of the HRT (0.56), Nerve Fiber Indicator of GDx (-0.64), and vertical CD ratio of OCT (0.71). Conclusion: Hb levels evaluated by color analysis of ONH photographs had high reproducibility, a high sensitivity-specificity balance, and moderate to strong agreement with other structural and functional tests.
    Investigative ophthalmology & visual science 12/2012; · 3.43 Impact Factor
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    The British journal of ophthalmology 10/2012; · 2.92 Impact Factor
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    ABSTRACT: Purpose To determine the variability of retinal nerve fiber layer (RNFL) parameters measured with scanning laser polarimetry (SLP) with enhanced corneal compensator (GDx ECC) in healthy eyes. Methods Eighty-two healthy individuals were prospectively selected. Only one eye per subject was randomly included in the study. All participants had intraocular pressure less than 21 mmHg and normal standard automated perimetry (Humphrey 24-2 SITA Standard). Peripapillary RNFL parameters were measured using the GDxPRO (Carl Zeiss Meditec, Dublin, CA) 3 consecutive times on the same session. Left eye data were converted to a right eye format. The same operator performed all acquisitions with the same device. Intraclass correlation coefficient (ICC), coefficient of variation (COV), and test-retest variability were calculated for all SLP parameters: TSNIT average, superior average, inferior average, TSNIT standard deviation and the nerve fiber indicator (NFI). Results Mean age was 56.08 ± 9.4 years. The ICC was higher than 0.928 for all SLP parameters. The TSNIT average had the highest ICC (0.967), while the TSNIT standard deviation showed the lowest ICC (0.928). The COVs ranged from 2.4% (TSNIT average) to 21.8% (NFI). Test-retest variability was 6.55 for the NFI and 2.51 for the TSNIT average. Conclusion The reproducibility of RNFL measurements acquired with the GDxPRO was excellent. Variability was higher for NFI than for other SLP parameters.
    Acta ophthalmologica 09/2012; 90(s249). · 2.44 Impact Factor
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    ABSTRACT: Purpose To report our case report with sustained-release dexamethasone 0.7 mg intravitreal implant (Ozurdex®; Allergan, Inc., Irvine, CA) in retinal vein occlusion with macular edema Methods A 81-years old male patient with recent retinal vein occlusion with macular edema treated with sustained-release dexamethasone 0.7 mg intravitreal implant and cataract surgery was performed. On initial examination, the right best-corrected visual acuity (BCVA) was 0,1. Right fundoscopy revealed retinal hemorrhage in the superior quadrant of the retina. The fluorescein retinal angiography showed a delay of filling time and spectral domain optical coherence tomography (Spectralis SD-OCT; Heidelberg Engineering, Heidelberg, Germany) showed macular edema 485 μm Results The patient was treated with two dexamethasone 0.7 mg intravitreal implant and cataract surgery in one year. During the first six months after implant the right BCVA was 0,4 and OCT: 294 μm. At six months the macular edema increased 335 μm and we treated with the second implant, the macular edema improved 280μm but not the BCVA and we realized cataract surgery and BCVA was improved to 0.5. Conclusion The dexamethasone drug delivery system is one of the most recent additions to the armamentarium against macular edema, and is intriguing for its potency, dose consistency, potential for extended duration of action, and favorable safety profile but can accelerate cataract surgery.In patients with macular edema in retinal vein occlusion, sustained-release dexamethasone 0.7 mg intravitreal implant may be an effective treatment option to control macular edema
    Acta ophthalmologica 09/2012; 90(s249). · 2.44 Impact Factor
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    ABSTRACT: Purpose To assess the ability of optic nerve head (ONH) parameters measured with 2 different imaging technologies to discriminate between normal and glaucoma patients with visual field losses. Methods Sixty-seven normal eyes and 43 glaucoma patients were consecutive and prospectively selected. Participants were classified depending on the results of standard automated perimetry (SAP) and intraocular pressure. All of them underwent a comprehensive ophthalmic examination, at least 2 reliable SAP tests, and imaging of the ONH with the Heidelberg Retina Tomograph 3 (HRT; Heidelberg Engineering, Heidelberg, Germany) and with Cirrus OCT (Carl Zeiss Meditec, Dublin, Ca). Only one eye per subject was randomly included in the statistical analysis. The areas under the receiver operating characteristic curve (AUCs) were plotted and sensitivity-specificity pairs compared. Results The mean age was 55.713.6 years for the normal group and 59.16.2 years for the glaucoma group (p=0.133). The mean deviation of SAP was -0.71.2 dB and -5.96.1 dB (p
    Acta ophthalmologica 09/2012; 90(s249). · 2.44 Impact Factor
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    ABSTRACT: Comparison of Keeler Pulsair EasyEye tonometer and Ocular Response Analyzer for measuring intraocular pressure in healthy eyes Carmen Lopez-De La Fuentea,, Ana Sanchez-Canoa, Antonio Ferrerasbc, Isabel Fuertes-Lazarobc a Applied Physics Department, University of Zaragoza, Zaragoza, Spain b Department of Ophthalmology, Miguel Servet University Hospital, Aragon Health Sciences Institute, Zaragoza, Spain c Department of Surgery, Ginecology and Obstetrics, University of Zaragoza, Zaragoza, Spain Keywords Intraocular pressure. Noncontact tonometry. Glaucoma. Corneal biomechanics. Abstract Purpose To evaluate the relationship between intraocular pressure (IOP) measurements obtained with Pulsair EasyEye (PEE) and Ocular Response Analyser (ORA) in healthy patients. Methods Sixty-five eyes from 65 patients underwent a full optometric examination, including central corneal thickness (CCT), and IOP measured with PEE and ORA. Differences between IOP measurements between both tonometers were analyzed. Pearson correlation coefficients between IOP values and ORA corneal biomechanics parameters were also obtained. Results Statistically significant differences were found between IOP of PEE (IOPk) and Goldmann-corrected IOP of ORA (IOPg; p=0.001). IOPk and corneal resistance-corrected IOP of ORA (IOPcc) were also found to differ significantly (p=0.025). Mean differences between IOPg-IOPk, IOPcc-IOPk and IOPg-IOPcc were 0.71±1.66, 0.70±2.46 and 0.01±1.54mmHg (mean±standard deviation), respectively. Pearson correlation coefficients indicated that IOPk, IOPg, and IOPcc were significantly correlated among them (p<0.001): r=0.816 for IOPk-IOPg, r=0.826 for IOPcc-IOPg and r=0.587 IOPcc-IOPk. IOPk and IOPg were linearly associated with corneal resistance factor (CRF; r=0.626 and r=0.619, respectively) and with CCT (r=0.531 and r=0.579, respectively). IOPcc had a linear relationship with corneal hysteresis (CH) (r=−0.482) and similar results were found between CRF and CH (r=0.841), CRF and CCT (r=0.681) or between CH and CCT (r=0.466). Conclusions Differences between mean values of IOP measured with PEE and ORA are statistically significant, with ORA tonometer taking higher IOP values than PEE in most of the cases. IOPk, IOPcc and IOPg have, al least, moderate positive linear correlations and ORA biomechanics parameters CRF, CH and CCT have a linear positive relation between them.
    Journal of Optometry 07/2012; 2012(5):139-46.

Publication Stats

336 Citations
173.11 Total Impact Points

Institutions

  • 2008–2014
    • University of Zaragoza
      • Department of Applied Physics
      Caesaraugusta, Aragon, Spain
    • Istituto di Cura e Cura a Carattere Scientifico Basilicata
      Rionero in Vulture, Basilicate, Italy
  • 2002–2014
    • Hospital Universitario Miguel Servet
      • Servicio de Neurología
      Caesaraugusta, Aragon, Spain
  • 2012–2013
    • Universidad de La Laguna
      San Cristóbal de La Laguna, Canary Islands, Spain
  • 2008–2012
    • Aragon Health Sciences Institute
      Caesaraugusta, Aragon, Spain
  • 2011
    • Azienda Ospedaliera San Paolo - Polo Universitario
      Milano, Lombardy, Italy