Evaluation of astigmatism-correcting efficiency and clinical effects after phacoemulsification with bifocal Toric intraocular lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To assess the astigmatism-correcting efficiency and clinical effects of cataract phacoemulsification combined with bifocal Toric intraocular lens(IOL)implantation. METHODS: Retrospective analysis. The clinical data of 46 patients(46 eyes)with cataract complicated with regular corneal astigmatism by the treatment of cataract phacoemulsification and bifocal Toric IOL implantation in our hospital from August 2020 to September 2021 were included. The patients were followed up for 3mo after operation, and the changes of uncorrected distant visual acuity(UDVA), uncorrected near visual acuity(UNVA), best corrected distant visual acuity(BCDVA), best corrected near visual acuity(BCNVA)and astigmatism before and 1, 3mo after operation were evaluated. The IOL axial rotation was measured and calculated, and a questionnaire was conducted to investigate the necessity of using glasses at different distances and overall satisfaction.RESULTS:After operation at 1 and 3mo, there were significant differences in UDVA, BCDVA, UNVA and BCNVA compared with those before operation(all P<0.001), and there was no significant difference in UDVA, BCDVA, UNVA and BCNVA at 1mo after operation and 3mo after operation(all P>0.0167). At 3mo after operation, 46 eyes(100%)of UDVA reached 0.20(LogMAR), 40 eyes(87.0%)of UNVA reached 0.20(LogMAR). Astigmatism vector analysis showed that the mean preoperative corneal astigmatism in this group was 1.88±0.70D, and the centroid value was 0.61D@177°±1.93D, the mean residual astigmatism at 3mo postoperatively was 0.33±0.30D, and the centroid value was 0.03D@34°±0.45D. After operation at 3mo, the axial rotation of IOL was 3°(0°, 5°). Only 5 eyes(11%)required some degree of refractive correction for near or intermediate distances. 83%(38 eyes)were satisfied or very satisfied with the surgical results CONCLUSION: The implantation of bifocal Toric IOL during cataract surgery could effectively correct corneal regular astigmatism, improve uncorrected distance and near vision, and had high patient satisfaction.

Desarrollo de los lentes intraoculares para la cirugía de catarata por facoemulsificación / Development of intraocular lenses for phacoemulsification cataract surgery

RESUMEN La tecnología de los lentes intraoculares se desarrolla constantemente, por las necesidades visuales cada vez mayores de los pacientes después de operados de catarata; de ahí que nos propusimos realizar una búsqueda acerca de los diferentes modelos de lentes, como los monofocales, los bifocales, los trifocales, los trifocales tóricos y los de foco extendido. Esta nueva tecnología exige exámenes preoperatorios cada vez de más calidad y precisión, para que los resultados quirúrgicos respondan al concepto de cirugía refractiva del cristalino, por lo que concluimos que en el futuro la tecnología de las lentes intraoculares debe estar encaminada a recuperar la visión funcional. En este sentido, cada uno tiene puntos fuertes y débiles; por lo tanto, no hay una solución universal. Se debe crear un reporte de las ventajas y desventajas para trabajar en los puntos a mejorar, sobre todo en la estandarización de la curva de desenfoque, el modulation transfer function y la sensibilidad al contraste, así como trabajar conjuntamente entre los pacientes, cirujanos y fabricantes(AU)

ABSTRACT Intraocular lens technology is in a process of permanent development, due to the increasing visual needs of patients undergoing cataract surgery. That is why we set out to do a search about the different lens models of lenses are offered, including the monofocal, bifocal, trifocal, toric trifocal and extended focus types. This new technology requires rigorous and accurate preoperative tests, so that surgical results respond to the concept of refractive crystalline lens surgery. We therefore conclude that future intraocular lens technology should be aimed at recovering functional vision. Each of the lens types has its own strengths and weaknesses, and so a universal solution does not exist. A report should be developed of advantages and disadvantages, so that work can be done on aspects requiring improvement, mainly the standardization of the improper focusing curve, the modulation transfer function and contrast sensitivity, as well as the implementation of actions to be performed jointly by patients, surgeons and manufacturers(AU)

Measuring Defocus Curves of Monofocal, Multifocal and Extended Depth-of-focus Intraocular Lenses Using Optical Bench Test

PURPOSE: To determine the through-focus optical bench test performance of monofocal, bifocal, and extended depth-of-focus intraocular lenses (IOLs), and to measure their defocus curves.METHODS: A model eye was placed on an optical bench to test three different IOLs (TECNIS ZXR00, ZMB00, and ZCB00; Abbott Medical Optics, Santa Ana, CA, USA). The focus was changed by inserting trial lenses from +1.00 diopters to −4.00 diopters, in increments of +0.25 diopters. The 1951 United States Air Force Resolution chart was used to determine the quality of the images. The degree of similarity with reference images was given by the cross-correlation coefficient, and defocus curves were drawn and compared.RESULTS: Bifocal IOLs showed lower image quality with the addition of minus diopter trial lenses, but showed good image quality at near distance. Bifocal IOLs also showed a ‘double peak’ in their defocus curve. Monofocal IOLs showed a lower image quality and cross-correlation coefficient with addition of lower-diopter trial lenses. The extended depth of focus IOLs showed a single peak in their defocus curve, but had a wider range of diopters and better image quality than monofocal IOLs.CONCLUSIONS: Bifocal IOLs showed a double peak defocus curve, and extended depth of focus IOLs showed a wider diopter range and better image quality than monofocal IOLs.

Effect of different types of intraocular lens implantation on visual quality after cataract surgery / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the visual quality and visual related quality of life in cataract patients after implantation of diffractive aspheric bifocal IOL and single focus aspheric IOL. <p>METHODS: Retrospective non-randomized study was implemented. In clinical application 110 patients(176 eyes)underwent phacoemulsification combined with IOL from October 2016 to December 2017. In details, 56 cases(82 eyes)with diffractive aspheric bifocal IOL(ZEISS AT LISE 809M)and 54 cases(94 eyes)with single focus aspheric IOL(ZEISS CTA 603P), respectively. Three months after surgeries, the main evaluation indices were successively collected, which included visual, the optical quality analysis system(OQAS)of the MTF cutoff, the Strehl ratio, the OSI, the 100% visual acuity(VA), the 20% VA and the 9% VA, as well as the visual function related quality of life scale(NEI-VFQ-25).<p>RESULTS: 1)VA: there was no significant difference in the corrected distance visual acuity(CDVA)between the two groups(<i>P</i>>0.05). However, there existed significant difference in the near vision(<i>P</i><0.05); 2)Objective quality visual analysis(OQAS): there was significant difference in the OSI. Regarding the visual acuity of simulated contrast sensitivity between two groups, the 20% VA and 9% VA expressed significant difference(<i>P</i><0.01); 3)NEI-VFQ-25 questionnaire: there were no significant differences in overall health, general vision, eye pain, distant vision, peripheral vision, social function, color vision, dependence and mental health between the two groups(<i>P</i>=0.88, 0.08, 0.60, 0.36, 0.80, 0.18, 0.41, 0.07, 0.95). But there was significant difference in near vision and social role limitation between the two groups(<i>P</i><0.05).<p>CONCLUSION: The 809M intraocular lenses and the 603P intraocular lenses can improve the optical quality of patients after the surgeries. The former one can provide better near vision, but the OSI was higher than the latter one, which may cause some visual interference. There was no significant difference in visual related quality of life after the surgeries generally.

Tracheostomy and mandibular distraction in acute sleep apnea

Severe restriction of airway volume in the orofacial region, caused by temporomandibular joint (TMJ) ankylosis, may lead to obstructive sleep apnea (OSA). If the TMJ ankylosis is progressive, rarely, the caregivers may fail to notice the problem. Such patients may have only symptoms of snoring, daytime sleepiness, fatigue, inability to concentrate, and irritability. At times, emergency tracheostomy may be needed to increase the oxygen supply. Distraction osteogenesis (DO) is a less invasive surgical technique in the management of such OSA by correcting the reduced airway space. In DO, the angulation of the distractors and the pace of activation determine the success of the neo-generation of segments of bone. The formation of a well-corticated mandibular canal (MC) in the newly generated bone is an evidence of the success of the procedure. Such bilateral formation of the MC is not reported from this part of the world. We report a case of a 4-year-old boy who was struggling with OSA due to TMJ ankylosis. He was successfully treated by bilateral mandibular DO. The formation and cortication of the MC is discussed with emphasis on the neural regeneration.

Can your eye glasses lead to future neck pain and disability? Relation of eyeglasses with neck muscle endurance and posture

Background: Use of spectacles is common for people having vision problems. Unifocal and bifocal are usually the commonly used lenses for vision correction. The aim of the present study was to compare the effect of type of lenses in eyeglasses on the neck muscles endurance and neck posture.Methods: A sample of 132 subjects were recruited and divided in three groups according to use of unifocal, bifocal or no glasses. Normal healthy subjects using eyeglasses for a minimum of 2 years and as per selection criteria were assessed for their deep neck flexor endurance (DNF) and craniovertebral angle (CVA).Results: Females had less DNF endurance than males in all groups. DNF endurance was also least reported in subjects using bifocal lenses followed by unifocal and no glasses. These results were similar for both males and females. Bifocal group also had least CVA amongst both sexes.Conclusions: Use of bifocal lenses reduces the DNF endurance and leads to forward head posture over time. These two factors are commonly associated with development of neck pain and disability. Assessment for the type of lens in eyeglasses should be added in diagnosing musculoskeletal problems in neck. Appropriate neck exercises, corrective postures and advise for correct eyeglasses at an early stage could maintain DNF endurance and therefore, prevent faulty neck postures and associated pain. This small check could be a big step towards reducing the financial and psychological burden on the patient and an affordable and less invasive public health solution to neck related problems.

Clinical Outcomes of Patients Implanted with Bifocal and Extended Depth of Focus Intraocular Lenses

PURPOSE: To compare the postoperative clinical outcomes after cataract surgery with implantation of bifocal intraocular lenses (IOLs) and extended depth of focus (EDOF) IOLs. METHODS: A total of 60 patients were divided into three groups, and each group included 20 patients of 40 eyes: group A with a +3.25 D bifocal IOL in both eyes, group B with an EDOF IOL in both eyes, and group C with a +3.25 D bifocal in one eye and an EDOF IOL in the other eye. We retrospectively reviewed the patients' medical charts to analyze their binocular uncorrected visual acuities (UCVAs; distant, intermediate, and near) and refraction at postoperative 3 months. RESULTS: The binocular distant UCVAs were 0.04 ± 0.01, 0.05 ± 0.02, and 0.04 ± 0.01 in groups A, B, and C, respectively, and there were no differences between the groups (p > 0.05). The intermediate UCVAs were 0.16 ± 0.01, 0.10 ± 0.01, and 0.10 ± 0.01, respectively, and group A was the lowest (A–B, p = 0.031; A–C, p = 0.018; B–C, p = 1.000). The near UCVAs were 0.05 ± 0.01, 0.24 ± 0.01, and 0.13 ± 0.01, respectively, and there were significant differences between the groups (A–B, p < 0.001, A–C: p = 0.009; B–C, p = 0.003). CONCLUSIONS: There were no significant differences among the three groups in binocular distant UCVA, and groups B and C showed better intermediate UCVAs than group A. Near UCVA was ranked in the order of groups A, C, B.

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

BACKGROUND: We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation. METHODS: Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method. RESULTS: We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of −0.5, −1.0, −1.5, and −2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], −0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], −0.07, −0.01; P = 0.006 and MD, −0.07 logMAR; 95% CI, −0.13, −0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other. CONCLUSION: The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Clinical efficacy of segmented bifocal intraocular lens SBL-3 / 国际眼科杂志(Guoji Yanke Zazhi)

·AMI:To evaluate the clinical efficacy of the segmented bifocal intraocular lens (MIOL) SBL-3. ·METHODS:Totally 26 cases (26 eyes) of age-related cataract who received phacoemulsification and implantation of MIOL SBL-3 were enrolled from February 2016 to June 2017 in our hospital as the SBL-3 group. And 28 cases (28 eyes) of age-related cataract who received phacoemulsification and implantation of single focus intraocular lens intraocular lens TecnisZA9003 were enrolled as control group. At postoperative 3mo, the uncorrected visual acuity, corrected visual acuity, contrast sensitivity and patient satisfaction were compared between two groups. ·RESULTS: At preoperative, there was no statistical difference in uncorrected distance, intermediate and near visual acuity between two groups (P > 0. 05). At postoperatively 3mo, the uncorrected distance, intermediate and near visual acuity in patients of both groups were significantly improved (P < 0. 05). At postoperative 3mo,the uncorrected intermediate and near visual acuity, distance-corrected intermediate and near visual acuity, contrast sensitivity at different spatial frequencies (3, 6, 12, 18c/d) and patient satisfaction in SBL- 3 group were significantly better than those of control group (P<0.05). ·CONCLUSION:The MIOL SBL-3 not only could provide preferable distance visual acuity, but also could provide better intermediate visual acuity, near visual acuity and contrast sensitivity,and greatly increase the visual quality and satisfaction at postoperative in cataract patients.

¿Cómo llenar un continente no diferenciado con un determinado contenido? Abordaje psicodinámico de un síntoma alimentario / How to fill an undifferentiated continent with a determined content? Psychodynamic approach of an eating symptom

Resumen El objetivo del presente trabajo fue establecer, a través del análisis de un caso clínico, que la falta de distinción entre el adentro y el afuera de la paciente era uno de los factores centrales de su síntoma alimentario: los «atracones¼ con lechuga. Para tal fin se presentan viñetas del proceso terapéutico que, bajo un enfoque psicodinámico y un dispositivo bifocal, fue llevado a cabo con Rosa a lo largo de 10 años, con énfasis en la relación transferencia-contratransferencia. Viñetas y aspectos evocados del caso se teorizan a partir de los planteamientos de diversos autores. El proceso terapéutico permitió construir-reconstruir lo que falló en el desarrollo temprano de Rosa, a través del cual fue edificando una imagen corporal y psíquica de sí misma, enriqueciendo su Self y sus relaciones interpersonales. Esta experiencia clínica invita a pensar que las fallas tempranas se presentan a través de múltiples expresiones -con predominio en cuerpo o en psique- y su tratamiento requirió el abordaje de múltiples aspectos y, en ello, el dispositivo bifocal usado mostró ser una opción pertinente.

Abstract The aim of this study was to establish that the lack of distinction between inside and outside of the patient presented was one of the nuclear factors in Rosa's eating symptom. For this purpose we present the clinical materials issued from the psychotherapeutic process carried on with Rosa during 10 years -one of the two components of the bifocal therapy-emphasizing the transference-countertransference relation. The comprehension achieved from clinical materials is enriched by means of discussing approaches of several authors on relevant concepts. Results showed that what had failed during Rosa's early development was built-rebuilt throughout therapy. She worked on building a bodily and mental image, enriched her self and her relationships with others. This clinical experience is an invitation to think about the great variety of expressions -sometimes by means of the body and sometimes of the psyche- of early failures and also, that treatments must include various aspects, with bifocal therapy being an option.

Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

PURPOSE: To evaluate and compare visual outcomes and optical quality after implantation of a bifocal (Acrysof ReSTOR® SN6AD1) or trifocal (AT LISA® tri 839MP) diffractive intraocular lens (IOL). METHODS: Fifty-one eyes of 43 patients undergoing cataract surgery were enrolled and assigned to one of two groups: the trifocal group, comprising 24 eyes implanted with the trifocal diffractive IOL (AT LISA® tri 839MP), and the bifocal group, comprising 27 eyes implanted with the bifocal diffractive IOL (Acrysof ReSTOR® SN6AD1). Visual acuity (distant, intermediate, and near vision) and refractive postoperative outcomes were evaluated at one and three months postoperatively. Measurements of optical quality (using OQAS II®), contrast sensitivity (using CGT-2000®), automated visual field examination, and evaluation of defocus curve were performed three months postoperatively. RESULTS: No statistically significant differences between the two groups were found in three-month postoperative distant and near (40 cm) visual acuities and optical quality. However, intermediate (63 cm, 80 cm, and 100 cm) visual acuities were significantly better in the trifocal group. Distant contrast sensitivity (5 m) under mesopic conditions was significantly better with the bifocal lens, whereas near contrast sensitivity (30 cm) under mesopic and scotopic conditions was significantly better with trifocal lens. There was no statistical difference between the groups under photopic conditions. In the defocus curve, the visual acuity was significantly better at intermediate distance in the trifocal group. CONCLUSIONS: Trifocal diffractive IOLs provide significantly better intermediate vision than bifocal IOLs, with equivalent postoperative levels of distant and near vision and ocular optical quality. Further, they provide better near contrast sensitivity under scotopic condition compared to diffractive bifocal IOLs.

El equipo I-terminal: una ayuda valiosa en la adaptación de lentes progresivos de sexta generación en pacientes usuarios de lentes bifocales / The I-terminal: a valuable aid in sixth-generation progressive lens fitting for bifocal lens wearing patients

El confort visual de los présbitas ha mejorado considerablemente con la evolución en el diseño y la fabricación de los lentes progresivos. Para que la adaptación a estos sea inmediata, es necesaria la elección adecuada del lente progresivo y la toma de medidas exactas como lo permite hacer el I-Terminal. Objetivo:evaluar la adaptación de lentes progresivos de sexta generación en pacientes présbitas usuarios de lentes bifocales tradicionales por más de dos años, utilizando el I-terminal para la toma de medidas. Método: se realizó un estudio de tipo observacional descriptivo, con una muestra de 20 pacientes usuarios de lentes bifocales durante más de dos años. Para la toma de medidas de la adaptación del lente progresivo se utilizó el equipo I-Terminal de la casa Carl Zeiss Vision. La adaptación se evaluó usando la encuesta afa2’q y afa4q. Resultados: se encontró que el 100 % de los pacientes obtuvieron una adaptación inmediata con los lentes progresivos. Conclusión se observó una adaptación inmediata de los lentes progresivos y a la toma de medidas con el I-Terminal; además, se demostró, al evaluar la visión y el confort, que los pacientes usuarios de lentes bifocales por mucho tiempo son buenos candidatos para el uso de lentes progresivos.

Presbyopic visual comfort has improved considerably with the evolution in the design and manufacture of progressive lenses. Adapting to these immediately requires a proper choice of progressive lens and making accurate measurements, which the I-Terminal allows. Objective: To evaluate the sixth-generation progressive lens fitting for presbyopic patients who have worn traditional bifocal lens for over two years, using the I-terminal for taking measurements. Method: A descriptive observational study with a sample of 20 patients who have used bifocals for over two years. The computer-I-Terminal Carl Zeiss Vision house was used for taking measurements of the adaptation to progressive lenses. The adaptation was evaluated using the survey afa2’q y afa4q. Results: We found that 100% of the patients had an immediate adaptation to progressive lenses. Conclusion: There was an immediate adaptation to progressive lenses and taking measurements with the ITerminal. Also, in assessing vision and comfort, it was demonstrated hat patients using bifocals for a long time are good candidates for progressive lenses.

Bifocal distraction in patient with rheumatoid arthritis and severe condylar degeneration: report of case / Distracción bifocal en paciente con artritis reumatoide y degeneración condilar severa: reporte de un caso

Facial involvement in patients with rheumatoid arthritis is variable depending on the type, onset, and duration of the disease. The treatment of patients with open bite resulting from degenerative changes on the condyles can be a challenge for the surgeon. Rheumatoid arthritis is a systemic disorder of unknown etiology characterized by chronic inflammation and proliferation of synovial tissue. Studies showed that patients with rheumatoid arthritis can developed progressive osteoarthrosis that result in gross radiographic changes in the condyles. With the development of distraction osteogénesis for treatment of mandible hypoplasia a new chapter has been opened in the surgical management of patients with rheumatoid arthritis associated with skeletal deficiency. The aim of this paper is to evaluate osteogenesis distraction for treatment of anterior open bite in patients with rheumatoid arthritis and severe condylar degeneration.

El compromiso facial en pacientes con artritis reumatoide es variable dependiendo del inicio, tipo y duración de la enfermedad. El tratamiento del paciente con mordida abierta resultante de procesos degenerativos condilares son desafiantes para los cirujanos. La artritis reumatoide es una enfermedad sistémica de etiología desconocida caracterizada por inflamación crónica y proliferación del tejido sinovial. Algunos estudios han demostrado que pacientes con artritis reumatoide pueden desarrollar osteoartrosis progresiva que resulta en importantes cambios condilares. Con el desarrollo de la distracción osteogénica para el tratamiento de la hipoplasia mandibular se abrió un nuevo capítulo en el manejo quirúrgico de pacientes con artritis reumatoide asociada a deficiencias esqueletales. El objetivo de este artículo es evaluar la aplicación de distracción osteogénica en un caso de mordida abierta anterior en paciente con artritis reumatoide y degeneración condilar severa.

Meta-analysis of bifocal lenses for retarding myopia progression in school-aged myopic children / 中华实验眼科杂志

Background Whether the wearing of bifocal lenses can delay the development of myopia in school childhood is in controversy.To assess the effect of bifocal lenses using evidence-based medicine method is of important significance.Objective Present study was to compare the effect of bifocal lenses with single vision lenses in retarding myopia progression in school-aged myopic children.Methods This was a evidence-based medicine study.The systematical literature search was performed from MEDLINE(1966 to October 2010),EMBASE(1974 to October 2010),Cochrane Library,Chinese Biomedical Database(1978 to October 2010),and Chinese Clinical Trial Registry combined with hand searching of related bibliographies of journals and books were applied to collect the randomized-controlled clinical trial about bifocal lenses.Screening,evaluation and data extraction of the retrieved literature were performed by two investigators independently.Mata-analysis was used to assess the progression of refraction and axial length among included randomized clinical trials.Results Three high-quality randomized-controlled clinical trials meeting the inclusion criterion were included in this meta-analysis.The results showed that the weighted mean difference in progression of refraction was 0.22D between bifocal lenses and single vision lenses(95% CI:-0.24-0.67),and the difference was statistical insignificance(P=0.35).The weighted mean difference in progression of refraction during the follow-up durations of 6,12,18,24 and ＞30 months were 0.15(95% CI:-0.09-0.38),0.17(95% CI:-0.05-0.39),0.42(95% CI:-0.14-0.98),0.23(95% CI:-0.21-0.66) and 0.03(95% CI:-0.40-0.46),respectively without statistical significance.The weighted mean difference in elongation of axial length between two interventions was -0.17mm(95% CI:-0.26-0.08) with a statistically significance(P=0.000).Conclusion Based on currently available studies,bifocal lenses could not significantly slow the progression of myopia in myopic school-aged children in comparison with single vision lenses.Because only few high-quality studies are currently available,this conclusion need to be supported by more large-sample-size clinical trials.

Anotaciones sobre la noción de terapia bifocal en la adolescencia / Bifocal Therapy in Adolescence

Introducción: A partir de la reflexión alrededor de las especificidades del funcionamiento psíquico en la adolescencia han surgido propuestas novedosas sobre la posibilidad de elaborar un marco terapéutico igualmente específico. La terapia bifocal (propuesta por Jeammet y desarrollada por el autor de este artículo) es una de estas respuestas. Intervienen en ella dos terapeutas, cada uno en un tiempo y un lugar diferentes: un psiquiatra consultante (o referente) y un psicoterapeuta. Desarrollo: El autor propone una serie de hipótesis sobre el porqué de la no adaptación a la adolescencia de los enfoques psicoterapéuticos tradicionales, particularmente cuando existen fallas en las capacidades de mentalización, dificultades para mantener la diferenciación entre realidad externa y realidad interna y una clara tendencia a la actuación. Recorre, además, el difícil territorio de la participación del entorno, en particular familiar, en las vicisitudes que rodean al adolescente que requiere de un tratamiento y cómo éstas dan testimonio de la inevitable intrincación de elementos de la realidad externa con aquellos que pertenecen al marco de la relación terapéutica. Define y sustenta, finalmente, las funciones que en el marco de la terapia bifocal asumen el psiquiatra consultante y el psicoterapeuta.

Introduction: Stemming from musings around the specificities of psychic functioning in adolescence, novel proposals have emerged regarding the possibility of a just as specific therapeutic framework. Bifocal therapy (proposed by Ph. Jeammet and developed by the author of this article) exemplifies one of these proposals. Two therapists intervene, each one in a different time and place: a consultant psychiatrist and a psychotherapist. Development: The author proposes a series of hypothesis on why adolescence does not adapt to traditional psychotherapeutic approaches, particularly when failures exist in the ability to mentalize, to maintain a differentiation between inner and outer realities and a tendency to act is clearly present. He also explores the difficult territory of the environment’s concurrence, specially the family, and the vicissitudes that surround the adolescent that requires treatment,shedding evidence on the inevitable intrication of elements from external reality with those that belong to the therapeutic relationship. Finally, he defines and explains the functions of the consultant psychiatrist and the psychotherapist in bifocal therapy.

Análisis comparativo del comportamiento motor sobre la efectividad entre el bifocal flat top y el lente progresivo en endotropias acomodativas con Ac/A alto / Comparative analysis of the motor behavior regarding the effectiveness between bifocal flat top and progressive lens in easy-going endotropy with high AC/A

El efecto de los anteojos bifocales en niños con tasas AC/A elevadas es un método eficaz para controlar la endodesviación de cerca; pero hoy en día con el avance de la tecnología, aparecen los lentes progresivos, que son multifocales, especialmente diseñados para compensar las alteraciones visuales de cerca producidas por el exceso de acomodación y de convergencia. La potencia del lente progresivo varía sin discontinuidades, desde una potencia adecuada para visión de lejos, la intermedia y la visión de cerca. La potencia en éste multifocal proporciona un mayor campo visual, no interrumpe la percepción espacial visual; éstos cambios de potencia son graduales y continuos en todas las direcciones con una mínima distorsión.Los lentes progresivos alteran la longitud de progresión y descentración para visión próxima, de acuerdo con los diferentes valores dióptricos del paciente, por lo tanto habrá más garantía para el niño con endotropia acomodativa con AC/A alto, puede fusionar las imágenes a cualquier distancia y por ende el desarrollo de la visión binocualar.En Colombia es la primera investigación que se realiza con éste tipo de lente, proporcionando un aporte valioso para la Optometría, especialmente para el campo de la Ortóptica en los tratamientos de estrabismos convergentes con AC/A alto en niños, ya que el progresivo brinda mejor calidad de vida y un buen confort visual.

Unilateral bone Transport System using Bifocal Monofixator / 대한정형외과학회잡지

Limb lengthening with any kind of lengthening apparatus is accepted as a standard method to correct leg length discrepancy. And furthermore, the deformity accompanying shortening is corrected by multifocal lengthener. twenty two patients have undergone lower limb reconstruction by the technique of unilateral bone transport for diaphyseal bone defect, nonunion or deformity in the presence of shortening from May 1990 to August 1993 in Wilson Leprosy Center & Rehabilitation Hospital. All Patients had bifocal procedure using bifocal monofixator(Orthofix) and bone defects were graduaily filled by bone transport. Average healing index(days/cm)was 61. Average bone defect was 7,4cm, and average transported length was 5.4cm. In conclusion, the unilateral bone transport system using bifocal monofixator has satisfactory outcome, and salvaged limbs where amputation has been previously the only option.