Mal posicionamiento de háptica como causa de sorpresa refractivaastigmática / Haptic Poor Positioning as a Cause of Astigmatic RefractiveSurprise

Un resultado refractivo no esperado luego de una cirugía de catarata puede tener múltiples causas, ya sean preoperatorias, operatorias y posoperatorias. Como las más importantes se han descrito los errores en el cálculo biométrico en el preoperatorio y también las menos probables o infrecuentes como: inadecuada selección del poder del LIO, ausencia de precisión en la manufactura de los LIOs, intervención quirúrgica en paciente equivocado o en el ojo equivocado y el uso de un lente de contacto blando al momento de la biometría. Presentamos el caso de un paciente operado de catarata por facoemulsificación con implante de lente intraocular (LIO) monofocal plegable en saco capsular, que a los 30 días posoperatorios presentó un astigmatismo total o refractivo de - 1.00 dioptrías (D) x 110° pero a los 90 días de la cirugía, regresó por disminución de la agudeza visual con un astigmatismo refractivo de -5.50 D x 165° que no se relacionaba con el astigmatismo corneal medido por queratometría y topografía (-0.94 D x 82°). El ojo tenía medios transparentes y sin reportes de complicaciones posoperatorias inmediatas y mediatas. En este caso encontramos un mecanismo de inclinación del LIO provocado por una háptica deficientemente desplegada al momento de la inserción del LIO que no se evidenció en el acto quirúrgico asociado a desplazamiento de este, ocasionado por la fibrosis y contracción pupilar manifestando un efecto astigmático de manera tardía. Esto fue corroborado por ecografía con ultrabiomicroscopía y reposición quirúrgica del LIO logrando solucionar el caso(AU)

An unexpected refractive outcome after cataract surgery may have multiple causes, whether preoperative, operative or postoperative. The most important ones have been described as errors in the preoperative biometric calculation and also the less probable or infrequent ones such as: inadequate selection of IOL power, lack of precision in the manufacture of IOLs, surgical intervention in the wrong patient or in the wrong eye and the use of a soft contact lens at the time of the biometry test. We present the case of a patient who underwent cataract surgery by phacoemulsification with a monofocal foldable intraocular lens (IOL) implantation in the capsular bag, who 30 days after the operation presented a total or refractive astigmatism of - 1.00 diopters (D) x 110°. Sometime later, 90 days after surgery, he returned due to decreased visual acuity with a refractive astigmatism of -5.50 D x 165° which was not related to the corneal astigmatism measured by keratometry and topography (-0.94 D x 82°). The eye had clear mediums and showed no reports of immediate and gradual postoperative complications. In this case we found a mechanism of IOL tilt caused by a poorly deployed haptic at the time of IOL insertion that was not evident at the time of surgery associated with IOL displacement caused by fibrosis and pupillary contraction, which generated a late astigmatic effect. This was corroborated by ultrasound with ultrabiomicroscopy and surgical repositioning of the IOL, which allowed the case to be solved(AU)

Sorpresa refractiva tras la cirugía de catarata en paciente con lente fáquica / Refractive surprise after cataract surgery in a patient with a phakic lens implant

El implante de una lente intraocular fáquica puede resultar una opción lógica para los pacientes sumamente miopes que buscan liberarse de las gafas y de los lentes de contacto. Esta es una alternativa para corregir los grados de miopía extremos, y se diseñaron para permanecer dentro del ojo por muchos años. Con el cursar del tiempo, fisiológicamente comienza a opacarse el cristalino. Ante la necesidad de removerlo y de calcular una lente de potencia adecuada para el saco capsular y así conseguir la emetropía, surge un nuevo reto. El cálculo inexacto de la potencia dióptrica de la lente a implantar en la intervención quirúrgica es un problema y con él aparece la sorpresa refractiva; de ahí el objetivo de presentar con este caso la causa más frecuente de sorpresa refractiva tras la cirugía de catarata en un paciente miope con lente fáquica implantada. Se destaca la importancia de la longitud axil, sobre todo si esta se modifica después del implante de la lente fáquica para el correcto cálculo de la lente a implantar, así como el método ideal para su obtención: la interferometría óptica, sin olvidar la historia clínica previa al implante de la lente fáquica(AU)

Phakic intraocular lens implantation may be a logical option for extremely myopic patients who wish to get rid of their eyeglasses and contact lenses. This alternative was developed to correct extremely high degrees of myopia and remain inside the eye for many years. However, with the passing of time and due to physiological processes, the crystalline lens tends to become opaque. A new challenge is posed by the need to remove it and select a lens with an optical power appropriate to the capsular sac, thus achieving emmetropia. Inaccurate calculation of the dioptric power of the lens to be implanted in the surgical intervention is a problem leading to refractive surprise. Hence the interest in presenting a case illustrating the most common cause of refractive surprise after cataract surgery in a myopic patient with a phakic lens implant. The importance of axial length is highlighted, particularly whether it is modified after phakic lens implantation for accurate calculation of the lens to be implanted and the ideal method to obtain it: optical interferometry, without disregarding the medical record data preceding the phakic lens implantation(AU)

Coreografías, cartografías, trazos. El cuerpo en juego en la figuración / Choreographies, cartographies, strokes The body at stake in figuration

La situación clínica de un taller de expresión para niños nos permite aquí problematizar el estatuto de lo informe en psicoanálisis. La clínica infantil, en su manera de confrontarnos a la violencia del caos pulsional y los procesos de búsqueda de organización de la pulsionalidad en torno a un objeto, establece la base para la comprensión del trabajo efectuado en torno a la vectorización de la pulsión en la relación al otro (materno, transferencial). El lugar del fantasma, en el niño como en el analista que se deja jugar y sorprender, abre nuevas vías, ficcionales y compartidas, de representación de sí, del otro, del mundo. La función de la sorpresa y de lo desconocido parece, así, fundamental en este trabajo en el que el fantasma se organiza en la discontinuidad que se establece habitualmente entre lo real y nuestra construcción de una continuidad imaginaria de nosotros mismos. Esta experiencia con niños nos permite finalmente establecer algunos elementos necesarios en la cura de adultos en los que lo informe aparece al centro de la relación transferencial. El trabajo de una coreógrafa y de un músico minimalistas nos permite avanzar sobre la pista del rol del fantasma en el analista en la aproximación de las manifestaciones arcaicas de lo no puede manifestarse, sino a través de lo actuado/informe

The clinical situation experienced during a therapeutic workshop for children allows us here to problematize the approach to the manifestation of unshaped affects in the psychoanalytical setting. The child psychoanalysis, which confronts us to the violence and the chaos of the drives and to the processes through which they organize around an object, helps us understand the vectorization of the drives in the relationship to the other (maternal, transferential). The role of the phantasm, in the child as in the analyst who lets himself play and be surprised, opens up new forms of representation of ourselves, of the other, of the world. The function of surprise and of the unknown seems, thus, fundamental in this work in which the phantasm is organized in the discontinuity that is usually established between the real and our construction of an imaginary continuity of ourselves. This clinical experience with children allows us to finally establish some necessary elements in the psychoanalysis of adults in which the problem of shapelessness seem to organize the transferential relationship. The work of a choreographer and a minimalist musician allows us to further understand the role of the phantasm in the analyst, in his/her approach to the archaic manifestations of affects that cannot be manifested, except through an act, shapelessly

Lessons Learned From Performance Of Students Of Pharmacology In Self Coded Surprise Test With Negative Marking

Introduction: The present study aims to find the effect of instruction of negative marking in a self-coded MCQ examination on the performance of students in the subject of Pharmacology concerning the raw score, correct score and negative score. Methodology: This longitudinal study was conducted in the Department of Pharmacology. The Second MBBS students were exposed to a self-coded MCQ test twice by surprise. The first test (T1) was given without instructions of negative marking, while during the second test (T2) instructions for negative marking were given. The parameters of the raw score, negative score, corrected score and number of students who did not attempt respective MCQs was calculated. The number of students passing with modified Minimum Passing Level was calculated was compared with conventional Minimum Passing Level. Results:Sixty-seven students participated in the study. There was a statistically significant decrease in the raw score in the T2, while an increase in the negative score when compared with T1. The number of non-attempted questions was increased in T2. There was a statistically significant difference in the number of students passed concerning raw score in T1 and T2, while no such difference was seen concerning Negative score and Corrected score. Conclusion:The Corrected score and Negative score are not affected by the minimum passing level, indicating a better parameter of scoring than the raw score. Hence, the use of Negative score or Corrected score should be encouraged rather than the use of conventional Raw score.

Catarata y queratocono: una sorpresa refractiva / Cataract and keratoconus: a refractive surprise

RESUMEN El queratocono es una ectasia corneal bilateral en la cual la córnea asume una forma cónica irregular teniendo en cuenta su afinamiento y protrusión. Su etiología es probablemente multifactorial. Está considerada una enfermedad rara por su baja incidencia; no obstante, se considera que esta incidencia sea mucho más variable y probablemente mayor tras la expansión en el uso de los topógrafos. Se presenta un paciente masculino, blanco, de 68 años de edad, quien acudió a la consulta de catarata en el Centro de Microcirugía Ocular del Instituto Cubano de Oftalmología Ramón Pando Ferrer en mayo del año 2017, por disminución lenta y progresiva de la agudeza visual de ambos ojos, mayor del ojo derecho, con antecedente de uso prolongado de lentes de contacto. Se identificó la presencia de catarata en ambos ojos; se realizaron exámenes preoperatorios y se programó cirugía de facoemulsificación del ojo derecho. Se calculó el lente a implantar para una refracción esperada dentro del rango de la emetropía. Se obtuvo como resultado refractivo final una sorpresa refractiva posoperatoria hipermetrópica y se decidió realizar un piggy back secundario. El resultado refractivo final estuvo cercano a los valores de la emetropía. Como consecuencia de la gran inestabilidad de los valores queratométricos en pacientes con ectasias corneales, constituye un reto para el cirujano de catarata decidir cuál es el lente ideal a implantar para obtener un resultado refractivo adecuado(AU)

ABSTRACT Keratoconus is a bilateral corneal ectasia in which the cornea takes on an irregular conical shape due to its thinning and protrusion. The etiology of keratoconus is probably multifactorial. The disease has been classed as rare because of its low incidence. However, it is considered that such incidence will be much more variable and probably greater after expansion of the use of topographs. A male white 68-year-old patient who had attended cataract consultation at the Ocular Microsurgery Center of Ramón Pando Ferrer Cuban Institute of Ophthalmology in May 2017, presents with slow progressive visual acuity reduction in both eyes, greater in the right eye, and an antecedent of prolonged use of contact lenses. Examination revealed the presence of cataracts in both eyes. Preoperative tests were performed and right eye phacoemulsification surgery was planned. Calculation was made of the lens to be implanted to achieve an expected refraction within the range of emmetropia. The final outcome obtained was a postoperative refractive hyperopic surprise, and it was decided to perform a secondary piggy back. The final refractive outcome was close to emmetropia. Because of the great instability of keratometric values in patients with corneal ectasias, the cataract surgeon is faced with the challenge of deciding which is the ideal lens to be implanted to obtain an adequate refractive outcome(AU)

Utilidad de las fórmulas Barrett Suite para el cálculo de lentes intraoculares / Usefulness of the Barrett Suite formulas for intraocular lens calculation

RESUMEN El cálculo del poder de la lente intraocular es un tema discutido, en el cual no existe un consenso general acerca de la fórmula más exacta. Durante los últimos años ha mejorado de manera impresionante la precisión de la lente a implantar con el uso de los nuevos equipos biométricos. La evolución y el desarrollo de estas nuevas generaciones han abierto un diapasón de múltiples opciones para su uso. Se realizó una revisión bibliográfica con el objetivo de describir las aplicaciones de la Barrett Suite (que incluyen la Universal II, True-K y las tóricas), así como sus nuevos usos. Para efectuar la revisión fueron consultadas las bases de datos de infomed, específicamente la Biblioteca Virtual de Salud. Dentro de los beneficios descritos encontramos que proporcionan el menor riesgo de sorpresas refractivas en todas las longitudes axiales. Además, utiliza un factor de lente que considera tanto la posición física como la ubicación de los planos principales del lente intraocular y tiene el error de predicción absoluto medio más bajo que otras fórmulas similares, aunque las variables de esta fórmula aún se desconocen según lo describe la bibliografía consultada(AU)

ABSTRACT Intraocular lens power calculation is a much-debated topic. General consensus has not been achieved about which is the most accurate formula. Recent years have witnessed impressive improvement in the precision of the lens to be implanted with the use of novel biometric equipment. Evolution and development of these new generations of devices provide a wide range of options for their use. A bibliographic review was conducted with the purpose of describing the Barrett Suite applications (including Universal II, True-K and toric), as well as their new uses. The review was based on a search in Infomed databases, particularly the Virtual Health Library. The benefits described in the literature include a lower risk of refraction surprises at all axial longitudes. Additionally, the lens factor used considers both the physical position and the location of the main planes of the intraocular lens, and has the lowest mean absolute prediction error among similar formulas, though the variables of this one formula are still unknown, according to the bibliography consulted(AU)

Prognostic value of a modified surprise question designed for use in the emergency department setting

OBJECTIVE: Few reliable and valid prognostic tools are available to help emergency physicians identify patients who might benefit from early palliative approaches. We sought to determine if responses to a modified version of the surprise question, “Would you be surprised if this patient died in the next 30 days” could predict in-hospital mortality and resource utilization for hospitalized emergency department patients.METHODS: For this observational study, emergency physicians responded to the modified surprise question with each admission over a five-month study period. Logistic regression analyses were completed and standard test characteristics evaluated.RESULTS: 6,122 visits were evaluated. Emergency physicians responded negatively to the modified surprise question in 918 (15.1%). Test characteristics for in-hospital mortality were: sensitivity 32%, specificity 85%, positive predictive value 6%, negative predictive value 98%. The risk of intensive care unit use (relative risk [RR], 1.87; 95% confidence interval [CI], 1.45 to 2.40), use of ‘comfort measures’ orders (RR, 3.43; 95% CI, 2.81 to 4.18), palliative-care consultation (RR, 3.06; 95% CI, 2.62 to 3.56), and in-hospital mortality (RR, 2.18; 95% CI, 1.72 to 2.76) were greater for patients with negative responses.CONCLUSION: The modified surprise question is a simple trigger for palliative care needs, accurately identifying those at greater risk for in-hospital mortality and resource utilization. With a negative predictive value of 98%, affirmative responses to the modified surprise question provide reassurance that in-hospital death is unlikely.

Ensinamentos dos esquizofrênicos para o tratamento institucional das psicoses / Learnings from schizophrenics on the institutional treatment of psychosis / Las enseñanzas de los esquizofrénicos para el tratamiento institucional de las psicosis

Este artigo aborda alguns ensinamentos da clínica com esquizofrênicos para o tratamento institucional no que tange à importância da abertura à surpresa, da permeabilidade à diferença e à mudança em contraposição aos mecanismos de fobia institucional de medo do outro, de fechamento da significação e da lógica narcísica-paranoica. O texto se ancora no trabalho institucional desenvolvido por Jean Oury e suas elaborações a respeito da esquizofrenia para debater a importância da circulação discursiva na instituição.

This article adresses certain learnings from the clinical work with schizophrenia concerning the institutional treatment of psychosis, in regard to the importance of being open to surprise and permeable to difference and change in opposition to mechanisms of institutional phobia, fear of the other, narrowing of significance and narcisistic/paranoid logic. The text is anchored on the institutional work developed by Jean Oury and on his elaborations regarding schizophrenia in order to debate the importance of discourse dynamics in institutions.

En este texto se abordarán algunas enseñanzas de la clínica con esquizofrénicos para el tratamiento institucional de la psicosis, en lo que atañe a la importancia de la apertura a la sorpresa, de la permeabilidad a la diferencia y al cambio, en contraste con los mecanismos de fobia institucional del miedo al otro, de cierre a la significación y de la lógica narcisista paranoide. En base al trabajo institucional desarrollado por Jean Oury y en sus razonamientos en torno a la esquizofrenia, el texto discutirá la importancia de la circulación discursiva en la institución.

Recent progress on study of the selection of intraocular lens in the bilateral sequential cataract surgery / 中华实验眼科杂志

Bilateral sequential cataract surgery is very common in clinical,but the ophthalmologists often ignore how to choose the timing of operation and whether the first eye can be used to improve the intraocular lens (IOL) power calculation for the second one.Despite the refinements in IOL selection with the use of third-generation IOL formulas,5％ of eyes still result in a postoperative refractive surprise of ± 1.00 D or more.This paper introduced the methods of using refraction error of the first eye to improve the IOL power calculation for the second eye,and the refractive error of the second eye can be improved by modifying the IOL power to correct up to 50％ of the error from the first eye in details.Because of the variation of the postoperative refractive surprise within a month,the interval of three to four weeks between two eyes cataract surgery is highly recommended.These conclusions may provide the advantageous guidance for us in the selection of IOL in bilateral cataract surgery.

A criança e o psicanalista. Acontecimentos iniciais / ­The child and the psychoanalyst. Initial events / El niño y el psicoanalista. Eventos iniciales

Se análise é a prática diária de um psicanalista, as primeiras entrevistas são o prólogo inevitável desse trabalho. Elas podem ser também um prólogo maior do que a própria análise e até constituir-se no único contato, sem continuidade. Para além de abordar, neste artigo, o método psicanalítico operando desde os primeiros encontros com o paciente - atenção utuante a todo e qualquer material surgido, busca por um tipo de interação que propicie a construção de algum significado analítico, comunicação ao paciente de algo desconhecido de si -, procurei desenvolver as especificidades no atendimento da criança, ilustrando minhas considerações com vinhetas clínicas.

If analysis is the daily practice of the psychoanalyst, the first interviews are the inevitable prologue to this work. They can be a prologue bigger than analysis itself and even be the only contact, in the case of non-continuity Further than approaching, in this article, the psychoanalytic method in operation since the first encounters with the patient - fluctuating attention to any and every bit of material which shows up, the search for a kind of interaction which will provide the construction of some analytic meaning, communicating to the patient something unknown to himself -1 attempted to develop the specificities when treating children, illustrating my considerations with clinical vignettes.

Si el análisis es la práctica diaria de un psicoanalista, las primeras entrevistas son el prólogo inevitable de este trabajo. Ellas pueden ser también un prólogo mayor que el propio análisis e incluso constituir un único contacto, sin continuidad. Para además de abordar en este artículo el método psicoanalítico operando desde los primeros encuentros con el paciente - la atención fluctuante a todo y cualquier material surgido, busca un tipo de interacción que propicie la construcción de algún significado analítico, comunicación al paciente de algo desconocido de sí mismo - intenté desarrollar las especificidades en la atención a los niños, ilustrando mis consideraciones con casos clínicos.

Baluarte, surpresa e comunicação no campo analítico / Bastion, surprise and communication in the analytic filed / Baluarte, sorpresa y comunicación en el campo analítico

Os autores refletem acerca do conceito de campo analítico e do exame do valor comunicativo de um de seus elementos, a surpresa, a partir de uma vinheta clínica.

The authors reflect on the concept of the analytic field and exam the communicative value of one of its elements - surprise - based on a clinical vignette.

Los autores reflexionan sobre el concepto de campo analítico y el examen del valor comunicativo de uno de sus elementos, la sorpresa, a partir de una viñeta clínica.

Piggy back en el tratamiento de la sorpresa refractiva hipermetrópica / Piggy Back in the treatment of the hypermetropic refractive surprise

La técnica de piggy back o el implante de dos lentes intraoculares se plantea principalmente cuando se precisa la corrección de más de 30 dioptrías en la cirugía del cristalino. Lentes por encima de 34 dioptrías no están disponibles comercialmente, a la vez que lentes de más de 30 dioptrías no se recomiendan por la aberración esférica que produce una superficie óptica con un radio de curvatura demasiado pequeño. Se presenta un paciente de 47 años de edad con antecedentes de cirugía refractiva corneal previa en ambos ojos, pero portador de una hipermetropía elevada en su ojo derecho y, por tanto, una anisometropía hipermetrópica para lo cual se decide, como opción terapéutica, realizar la extracción del cristalino del ojo derecho y el implante de dos lentes: uno en saco capsular y otro en sulcus ciliar. Se obtuvo corrección del defecto refractivo del paciente sin complicaciones

The Piggy Back technique or the implant of two lens is proposed mainly when it is necessary the correction of more than 30 diopters in crystalline lens surgery. The lens above 34 diopters are not available in the market at the same time that the lens of more than 30 diopters are not recommendable due to the spherical aberration producing an optical surface with a very small curvature.radius. This is the case of a patient aged 47 with backgrounds of previous corneal refractive surgery in both eyes, but carrier of a high hypermetropia in his right eye and thus, a hypermetropic anisometropia leading to as therapeutical option, to carried out the crystalline extraction of right eye and the implant of both lens: one in capsular sac and other in ciliary sulcus. The correction of the refractive defect of this patient was achieved without complications

Single-neuron encoding of surprise in auditory processing.

The main role of structures in ascending sensory systems is to extract raw features of sensory input and compartmentalize the information-bearing elements for use by the brain. Information-bearing elements can be apparent, as in the case of stimulus frequency or intensity (Ehret and Merzenich 1988; Tramo et al. 2002; Yu et al. 2010). The features of sound that drive neuronal fi ring at higher auditory centers, however, remain elusive. In their exciting article, Gill and colleagues (2008) show how “surprise” is a dimension of auditory experience that alters fi ring patterns of central auditory neurons. By elaborating the method for calculating and extracting spectro-temporal receptive fi elds (STRFs), the authors demonstrate that auditory neurons, mainly those from hierarchically higher-order areas, modulate their discharge rates in response to sound elements that deviate from expected values. This work is the fi rst to capture and separate encoding due to surprise from the ongoing encoding of spectral and temporal elements of acoustic cues (Theunissen et al. 2004). The coding of auditory information was studied in a highly social songbird species, the zebra fi nch (Taeniopygia guttata), which frequently engages in vocal exchange as part of its normal behaviour (for reviews, see Zeigler and Marler 2004). On the receiving (sensory) end of this exchange, the acoustic elements of the incoming birdsong, including notes and syllables, are encoded by auditory neurons (for reviews, see Mello et al. 2004; Gentner 2004). As with words in human speech, for a song to be recognizable over repeated use, the order of all of its individual sound elements must also be largely preserved across time. Consequently, songbirds naturally generate expectations not only for specifi c songs but also for the general structural rules, internal correlations or probability statistics that apply to song elements. To determine if surprise was predictive of altered neuronal activity, electrophysiological recordings were made in key structures of the ascending auditory pathway, including the songbird analogue of the mammalian inferior colliculus (nucleus MLd), the primary auditory forebrain area (Field L2) or an association auditory forebrain area (CLM) (Vates et al. 1996; Mello et al. 1998). One of the main goals of this work was to isolate the impact of surprise on auditory encoding for different cells (Gill et al. 2008). To this end, different forms of STRF were compared, including a STRF that was specifi cally developed to capture the impact of fi ring due to unmet expectations in stimulus structure (a surprise-STRF). In order to drive neuronal fi ring by surprise, Gill and colleagues generated song stimuli in which certain song elements were louder or softer than expected. Deviations were only introduced as changes in power for a particular element given a brief sample of “stimulus history”. This manipulation allowed for the measured and elegant application of “surprise” embedded on the song elements without having to interpret surprise in the context of the entire song. The authors show that surprise-STRF had far greater predictive strength relative to other STRF metrics and, therefore, was useful to parse out and quantify changes in fi ring given the probability of that change occurring based on prior experience. Surprise-STRFs were shown to have provided improvement in predictive power for select neurons at all three levels of the auditory pathway that were tested. Great gains in prediction were, however, frequently made by surprise-STRFs in the higher-order auditory area CLM, for two dominant cell types named by the authors as off-set and complex auditory neurons. Interestingly, in neurons that are surprise-responsive, Gill and colleagues found that the degree of altered fi ring was relatable, in linear terms, to the magnitude of change introduced. In addition, surprise coding was directionally sensitive; surprises to augmented stimulus power could be encoded at an entirely different sub-set of neurons than cells tuned to the surprise of a lower than expected stimulus power.

Resultados del implante múltiple de lentes intraoculares en la cirugía de catarata en el Instituto Cubano de Oftalmología Ramón Pando Ferrer / Results of the multiple intraocular lenses implantation in the cataract surgery performed at Ramón Pando Ferrer Cuban Institute of Ophthalmology

OBJETIVO: Valorar los resultados visuales de los pacientes operados con la técnica de piggy back o implantes múltiples de lentes intraoculares. MÉTODOS: Se realizó un estudio descriptivo retrospectivo de corte transversal en el que se tomaron 32 ojos de 30 pacientes del universo operado de catarata, con la técnica antes descrita, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido entre enero de 2000 hasta diciembre de 2006. Fueron evaluadas algunas variables demográficas, como edad y sexo, así como agudeza visual y refracción preoperatorio y posoperatoria con cristales y sin ellos. Reportamos las complicaciones transquirúrgicas y posquirúrgicas asociadas a las diferentes técnicas quirúrgicas empleadas para la extracción del cristalino. RESULTADOS: La edad promedio obtenida fue mayor de 50 años, y predominó el sexo femenino. Parte de los pacientes tuvieron una agudeza visual corregida superior a 20/40. La complicación más frecuente fue la opacidad de la cápsula posterior y solo en la tercera parte de los pacientes se obtuvo una buena corrección refractiva. CONCLUSIONES: La técnica de piggy back permitió la recuperación de cuatro líneas en la cartilla de Snellen en la agudeza visual corregida, mientras que en la agudeza visual sin corrección solo aumentó en dos líneas. Se encontró igual número de pacientes hipocorregidos y bien corregidos

OBJECTIVE: To asses the visual results of patients operated on by piggy back technique or multiple implantation of intraocular lenses METHODS: A retrospective cross-sectional descriptive study was conducted in 32 eyes from 30 patients operated on from cataract, using the above-mentioned technique, at Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period January 2000 through December 2006. Some demographic variables as age and sex as well as visual acuity and preoperative and postoperative refraction with/without lenses were evaluated. Trans-surgical and post-surgical complications associated with the various surgical techniques for the crystalline extraction were reported. RESULTS: Average age was 50 years, being the females predominant. One part of the patients had corrected visual acuity over 20/40. The most frequent complication was posterior capsule opacity and only one third of patients showed good refractive correction. CONCLUSIONS: Piggy back technique allowed recovering four lines in corrected visual acuity in Snellen´s chart whereas uncorrected visual acuity increased two lines only. The number of hypocorrected and well-corrected patients was the same

Development of the Korean Affective Word List / 신경정신의학

OBJECTIVES: As interest in the field of affective science continues to increase, research into the arousal of emotions by the use of facial stimuli, event pictures, and stimulus words is now being actively pursued. The purpose of this study was to develop a Korean Affective Word List for eliciting emotional reactions. METHODS: The preliminary selection process was more carefully divided into the primary process when the words were extracted which the author thought elicited the emotions of happiness, sadness, fear, anger, and disgust from the Korean-Language Dictionary according to vocabulary frequency, the secondary process when the words were extracted which the Affective Words Selection Committee judged elicited only a single category of emotion. The affective words selected in the two-stage preliminary process were then presented to normal, young subjects, who were asked to allocate each word on the basis of their emotional reaction to one of the following emotional categories: happiness, sadness, fear, anger, disgust, and surprise. After the selected words caused the intended-emotional response with inter-rater agreement in more than 80%, a total of 166 words were selected except surprise. The complementary selection process was carried out following the preliminary process in order to make up for the lack of surprise words and the relative want of anger words. RESULTS: A total of 184 words were finally selected: 83 words for happiness, 36 for sadness, 24 for fear, 10 for anger, 20 for disgust, and 11 for surprise. CONCLUSION: These Korean affective words are expected to be widely used for eliciting emotions in future Korean research on emotion.

Sorpresa refractiva por rotulación inadecuada / Refractive surprise due to incorrect labelling

En los últimos años la cirugía de catarata ha evolucionado el desarrollo de las fórmulas avanzadas para el cálculo del lente intraocular y las herramientas de medición cada día más exactas, en el contexto mundial actual, permiten alcanzar los resultados refractivos posoperatorios óptimos para el paciente, que de manera general es la emetropía. Sin embargo, aún con las mejores técnicas de medición y el mejor entrenamiento del cirujano, no estamos exentos de un resultado refractivo posquirúrgico no esperado por el paciente y por el cirujano, es decir, de una sorpresa refractiva. Se presenta un caso, de una paciente operada de catarata por facoemulsificación con implante de lente intraocular con una sorpresa refractiva, donde todas las causas de la misma son descartada y se demuestra un error en la rotulación del lente, lo cual no es frecuente, pero puede pasar

The cataract surgery has evolved in the last few years. The development of advanced formulas for the calculation of the intraocular lens and the ever increasingly accurate measuring tools worldwide allow reaching good postoperative refractive results for the patient that, as a rule, is emetropia. However, even with the best measuring techniques and the best trained surgeons, we are not exempted from unwanted postsurgical result for the patient and the surgeon as well, which is known as refractive surprise. This paper presented the case of a patient operated on from cataract using phacoemulsification with implantation and the occurrence of refractive surprise the causes of which were ruled out. Finally, wrong lens labeling was shown, which is an infrequent event that might occur

LASIK-LASEK en defectos refractivos poscirugías de catarata / LASIK-LASEK in refractive defects after cataract surgeries

El tratamiento de la catarata es quirúrgico, se logran muy buenos resultados en la recuperación visual de los pacientes; no obstante, después de ella pueden encontrarse resultados inesperados. El propósito de este estudio fue evaluar las características de las personas estudiadas según su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, la cirugía refractiva, y la técnica de excímer láser empleada en los pacientes operados, desde mayo de 2005 a julio de 2007, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer. Se realizó un estudio descriptivo, longitudinal y prospectivo de los pacientes operados de catarata que tuvieron un defecto refractivo residual -error o sorpresa refractiva-, a los cuales se les realizó cirugía por láser excímer. Se evaluaron las características de las personas estudiadas según su edad, los valores biométricos y queratométricos previos a la cirugía por catarata, y a la cirugía refractiva, así como la técnica de excímer láser empleada. En este estudio se obtuvo un predominio de las edades entre 40 y 59 años, la sorpresa refractiva más frecuente fue la miopía, la longitud axial indujo una sorpresa refractiva, coadyuvada por el error queratométrico, el LASIK prevaleció como técnica refractiva y logró corregir las sorpresas refractivas halladas. La sorpresa refractiva presente en todos los pacientes fue la miopía. Se demostró que la longitud axial indujo una sorpresa refractiva y que esta fue la más importante en nuestros resultados, derivada del error queratométrico, a pesar de ser este último poco significativo.

The treatment of cataract is surgical, very good results in visual recovery of patients are achieved; however, some unexpected results may appear after surgery. The purpose of this study was to evaluate the characteristics of the studied persons by their age, the biometric and keratometric values before the cataract surgery, the refractive surgery and the excimer laser technique used in patients who were operated on from May 2005 to July 2007 at Ramón Pando Ferrer Cuban Institute of Ophthalmology. A prospective, longitudinal and descriptive study was conducted in those patients operated on from cataract, who developed a residual refractive defect - error or refractive surprise- and were performed an excimer laser surgery. The characteristics of the studied persons by their age, the biometric and keratometric values prior to the cataract surgery and the refractive surgery as well as the used excimer laser technique were evaluated. This study revealed the prevalence of the 40-59 years-old age group, the most frequent refractive error was myopia, the axial length induced a refractive surprise contributed by the keratometric error; LASIK was the refractive technique that managed to correct the found refractive surprises. The refractive surprise present in all the patients was myopia. It was shown that the axial length induced a refractive surprise that was the most important outcome derived from a keratometric error, despite the latter being not significant.