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Yamane S, Kamei M, Sakimoto S, Inoue M, Arakawa A, Suzuki M, Matsumura N, Kadonosono K. Matched control study of visual outcomes after arteriovenous sheathotomy for branch retinal vein occlusion. Clin Ophthalmol 2014; 8:471-6. [PMID: 24600201 PMCID: PMC3942218 DOI: 10.2147/opth.s58681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to evaluate visual outcomes of arteriovenous sheathotomy for macular edema due to branch retinal vein occlusion (BRVO). Methods The medical records of 45 eyes from 45 patients who had undergone vitrectomy surgery with arteriovenous sheathotomy for BRVO were studied. Forty-five eyes of 45 patients with a BRVO but without intervention were studied as the control group. The best-corrected visual acuity and central macular thickness were compared between the two groups at baseline and at 1, 3, 6, and 12 months postoperatively. Results Improvement of best-corrected visual acuity was 0.42 logarithm of the minimum angle of resolution (logMAR) units in the sheathotomy group and 0.22 logMAR units in the control group (P=0.007). The mean postoperative central macular thickness was significantly thinner in the sheathotomy group at 1 month (P=0.01), but not at 3, 6, and 12 months (P=0.75, P=0.81, and P=0.46, respectively). Improvement of best-corrected visual acuity at 12 months was significantly correlated with baseline best-corrected visual acuity, age, duration of symptoms, and sheathotomy (P<0.05). Conclusion Arteriovenous sheathotomy for BRVO improves best-corrected visual acuity significantly more than the natural course of the BRVO disease process.
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Affiliation(s)
- Shin Yamane
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Susumu Sakimoto
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maiko Inoue
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Akira Arakawa
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
| | - Mihoko Suzuki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nagakazu Matsumura
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama, Japan
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Chatziralli IP, Jaulim A, Peponis VG, Mitropoulos PG, Moschos MM. Branch retinal vein occlusion: treatment modalities: an update of the literature. Semin Ophthalmol 2013; 29:85-107. [PMID: 24171809 DOI: 10.3109/08820538.2013.833271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, our purpose is to update the literature about the treatment alternatives for branch retinal vein occlusion. METHODS Eligible papers were identified by a comprehensive literature search of PubMed, using the terms "branch retinal vein occlusion," "therapy," "intervention," "treatment," "vitrectomy," "sheathotomy," "laser," "anti-VEGF," "pegaptanib," "bevacizumab," "ranibizumab," "triamcinolone," "dexamethasone," "corticosteroids," "non-steroids," "diclofenac," "hemodilution," "fibrinolysis," "tPA," and "BRVO." Additional papers were also selected from reference lists of papers identified by the electronic database search. RESULTS Treatment modalities were analyzed. CONCLUSIONS There are several treatment modalities for branch retinal vein occlusion and specifically for its complications, such as macular edema, vitreous hemorrhage, retinal neovascularization, and retinal detachment, including anti-aggregative therapy and fibrinolysis, isovolemic hemodilution, vitrectomy with or without sheathotomy, peripheral scatter and macular grid retinal laser therapy, non-steroid agents, intravitreal steroids, and intravitreal anti-vascular endothelial growth factors (anti-VEGFs).
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Yuan A, Kaiser PK. Branch Vein Occlusion. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00053-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
PURPOSE To report the clinical experience and results of using a microsurgical technique to decompress the arteriovenous connection in complicated branch retinal vein occlusion (BRVO) combined with haemorrhage, oedema and ischaemia. METHODS We carried out a retrospective, non-randomized, interventional case study of the surgical sheathotomy decompression procedure. We enrolled 12 patients (seven women, five men; median age 64 years) with BRVO and decreased visual acuity (VA) caused by haemorrhage, oedema and ischaemia. The mean duration of thrombosis was 7 months (2-15 months). The patients were examined for pre- and postoperative best corrected VA (BCVA), intraocular pressure (IOP) and fundus photography. Ten patients were examined with fluorescein angiography and eight with ocular coherence tomography (OCT). Postoperative progression of cataract was recorded, as were other complications. The mean follow-up time was 20 months (8-39 months). RESULTS Best corrected VA had improved in nine patients, was unchanged in one patient and had deteriorated in two patients at the last follow-up. Noted complications were venous haemorrhage at surgery in five patients, retinal detachment in one patient and progression of cataract in four patients. CONCLUSIONS Microsurgical treatment with sheathotomy of BRVO is a technically feasible procedure with few complications. Postoperative increased reperfusion could explain the resolution of macular haemorrhage, oedema and ischaemia, and may improve visual function in patients with this common vascular eye disease.
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Affiliation(s)
- Sven Crafoord
- Department of Ophthalmology, Orebro University Hospital, Orebro, Sweden.
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Rehak J, Rehak M. Branch retinal vein occlusion: pathogenesis, visual prognosis, and treatment modalities. Curr Eye Res 2008; 33:111-31. [PMID: 18293182 PMCID: PMC2430176 DOI: 10.1080/02713680701851902] [Citation(s) in RCA: 276] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Accepted: 12/08/2007] [Indexed: 01/04/2023]
Abstract
In branch retinal vein occlusion (BRVO), abnormal arteriovenous crossing with vein compression, degenerative changes of the vessel wall and abnormal hematological factors constitute the primary mechanism of vessel occlusion. In general, BRVO has a good prognosis: 50-60% of eyes are reported to have a final visual acuity (VA) of 20/40 or better even without treatment. One important prognostic factor for final VA appears to be the initial VA. Grid laser photocoagulation is an established treatment for macular edema in a particular group of patients with BRVO, while promising results for this condition are shown by intravitreal application of steroids or new vascular endothelial growth factor inhibitors. Vitrectomy with or without arteriovenous sheathotomy combined with removal of the internal limiting membrane may improve vision in eyes with macular edema which are unresponsive to or ineligible for laser treatment.
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Affiliation(s)
- Jiri Rehak
- Department of Ophthalmology, University Hospital, Palacky University, Olomouc, Czech Republic.
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Sohn JH, Song SJ. Arteriovenous sheathotomy for persistent macular edema in branch retinal vein occlusion. KOREAN JOURNAL OF OPHTHALMOLOGY 2007; 20:210-4. [PMID: 17302205 PMCID: PMC2908853 DOI: 10.3341/kjo.2006.20.4.210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the efficacy of arteriovenous (AV) sheathotomy with internal limiting membrane peeling for persistent or recurrent macular edema after intravitreal triamcinolone injection and/or laser photocoagulation in branch retinal vein occlusion. Methods Twenty-two eyes with branch retinal vein occlusion (BRVO) with recurrent macular edema underwent vitrectomy with AV sheathotomy and internal limiting membrane peeling. All eyes had previous intravitreal triamcinolone injection and/or laser photocoagulation for macular edema. The best corrected visual acuity (BCVA), fluorescein angiography and optical coherence tomography (OCT) before and after surgery were compared. Results The mean preoperative BCVA (log MAR) were 0.79±0.29 and postoperative BCVA (log MAR) at 3 months was 0.57±0.33. And improvement of visual acuity ≥2 lines was observed in 10 eyes (45%). The mean preoperative fovea thickness measured by OCT was 595.22±76.83 µm (510-737 µm) and postoperative fovea thickness was 217.60±47.33 µm (164-285 µm). Conclusions Vitrectomy with AV sheathotomy can be one treatment option for the patients with recurrent macular edema in BRVO.
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Kumagai K, Furukawa M, Ogino N, Uemura A, Larson E. Long-term outcomes of vitrectomy with or without arteriovenous sheathotomy in branch retinal vein occlusion. Retina 2007; 27:49-54. [PMID: 17218915 DOI: 10.1097/01.iae.0000221996.77421.69] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the long-term effect of vitrectomy with or without arteriovenous sheathotomy for macular edema secondary to branch retinal vein occlusion (BRVO). METHODS The study was a prospective, randomized, comparative, interventional case series of 36 patients (36 eyes) who underwent pars plana vitrectomy with or without arteriovenous sheathotomy for macular edema due to BRVO of <or=8 weeks' duration of symptoms. Eighteen eyes with arteriovenous sheathotomy (sheathotomy group) were compared with 18 eyes without sheathotomy (vitrectomy group). Main outcomes measures were best-corrected visual acuity and central foveal thickness as evaluated by optical coherence tomography. RESULTS Baseline demographic characteristics of the groups were similar. Postoperative follow-up period ranged from 12 months to 45 months (31 months). Median best-corrected visual acuity significantly improved from 0.4 at baseline to 1.0 at the final visit in both groups, and there was no significant difference in best-corrected visual acuity at any postoperative period between the groups. Of 16 patients with duration of symptoms of <4 weeks, those with arteriovenous sheathotomy had a tendency toward better visual outcomes than those without arteriovenous sheathotomy (P = 0.064). The central foveal thickness also significantly decreased after surgery in both groups, but the differences were not significant for the two groups at each time point. No patients had severe intraoperative and/or postoperative complications. CONCLUSIONS Our findings suggest that vitrectomy with or without arteriovenous sheathotomy may improve the long-term functional and tomographic outcomes for patients with macular edema secondary to BRVO. Although additional arteriovenous sheathotomy did not lead to a distinct functional benefit in this series, early surgical intervention may result in better visual outcomes.
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Wrigstad A, Algvere P. Arteriovenous adventitial sheathotomy for branch retinal vein occlusion: report of a case with longterm follow-up. ACTA ACUST UNITED AC 2006; 84:699-702. [PMID: 16965505 DOI: 10.1111/j.1600-0420.2006.00697.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To report the longterm follow-up of a case of branch retinal vein occlusion (BRVO) treated with vitrectomy and adventitial sheathotomy. METHODS A three-port vitrectomy was performed in a 55-year-old man with symptoms of BRVO of about 3 months' duration. After a core vitrectomy, the adventitial sheath of the affected arteriovenous crossing was dissected so that the anterior surface of the arteriole was freely exposed. RESULTS On the second postoperative day, visual acuity (VA) in the affected left eye had increased from preoperative 0.3 to 0.6. Within 6 months the fundus had almost normalized and vision improved to 1.0. Cataract surgery was performed about 2 years after the vitrectomy. At a follow-up 4 years and 11 months after the sheathotomy, VA was 1.0 and no signs of recurrence were seen. CONCLUSIONS Adventitial sheathotomy may improve vision in selected cases of BRVO. Further studies are necessary to determine the role of sheathotomy in the management of cases with BRVO.
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Affiliation(s)
- Anders Wrigstad
- Department of Ophthalmology, University Hospital, Linköping, Sweden.
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Avci R, Inan UU, Kaderli B. Evaluation of arteriovenous crossing sheathotomy for decompression of branch retinal vein occlusion. Eye (Lond) 2006; 22:120-7. [PMID: 17072289 DOI: 10.1038/sj.eye.6702633] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the effects of arteriovenous adventitial sheathotomy on anatomical and functional improvements in patients with macular oedema due to branch retinal vein occlusion (BRVO). METHODS Pars plana vitrectomy and arteriovenous sheathotomy was performed on 11 patients with BRVO who had vision loss due to macular oedema. Ten patients with macular oedema due to BRVO and who have been treated with grid laser photocoagulation were included in the control group. The measurement of visual acuity with ETDRS chart was taken preoperatively and at 1, 3, 6, and 9 months follow-up in the study group and at 1, 3, 6, and 9 months after grid laser in the control group. RESULTS The mean preoperative logMAR visual acuity was 0.84+/-0.3 in the surgical group and 1.06+/-0.4 in the control group. The postoperative mean logMAR visual acuity was 0.41+/-0.2, 0.40+/-0.2, 0.40+/-0.3, and 0.36+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. In the control group the postlaser mean logMAR visual acuity was 0.92+/-0.3, 0.87+/-0.4, 0.85+/-0.3, and 0.82+/-0.3 at 1, 3, 6, and 9 months follow-up, respectively. The improvements of visual acuity in both groups were statistically significant when compared to pretreatment (P=0.003 and P=0.007 at 9 months in the study and control group, respectively). CONCLUSION Arteriovenous sheathotomy for decompression of BRVO in patients who have vision loss due to macular oedema was safe and effective for anatomical and functional improvement and resulted in significantly better visual outcomes than a matched control group of laser-treated eyes.
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Affiliation(s)
- R Avci
- Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey.
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Jaissle GB, Ziemssen F, Petermeier K, Szurman P, Ladewig M, Gelisken F, Völker M, Holz FG, Bartz-Schmidt KU. Bevacizumab zur Therapie des sekundären Makulaödems nach venösen Gefäßverschlüssen. Ophthalmologe 2006; 103:471-5. [PMID: 16763863 DOI: 10.1007/s00347-006-1355-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Application of VEGF inhibitors represents a treatment option for macular edema secondary to retinal vein occlusion that targets the disease at the causal molecular level. First reports on intravitreal injections of bevacizumab show promising morphological and functional effects and demonstrate that bevacizumab is a potent antiedematous agent in this context. A significant reduction of the central retinal thickness followed by a rapid improvement of visual acuity may be achieved within days. In a pilot study with a review period of 3 months, we found a significant improvement of one or more lines in 93% and four or more lines in 27% of eyes. This was associated with a concomitant significant reduction in central retinal thickness, which, however, was not sustained by a single injection (64% reduction after 1 month and 28% after 3 months). No relevant adverse events were noted. The duration of action after intravitreal bevacizumab administration is currently unknown. Reinjections will be necessary to maintain a lasting beneficial effect. Prospective, controlled long-term studies are mandatory to develop standardized treatment protocols that allow a safe and effective application of this off-label therapy.
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Affiliation(s)
- G B Jaissle
- Abt. I, Universitätsaugenklinik Tübingen, Schleichstrasse 12, 72076 Tübingen.
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Branch Retinal Vein Occlusion. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50077-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Feltgen N, Herrmann J, Agostini H, Sammain A, Hansen LL. Arterio-venous dissection after isovolaemic haemodilution in branch retinal vein occlusion: a non-randomised prospective study. Graefes Arch Clin Exp Ophthalmol 2005; 244:829-35. [PMID: 16341702 DOI: 10.1007/s00417-005-0171-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Revised: 09/12/2005] [Accepted: 09/22/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The rationale for this pilot study was to add arterio-venous dissection (AVD) after unsuccessful medical treatment in a well-defined group of patients with branch retinal vein occlusion (BRVO). METHODS In this prospective, interventional case series 35 consecutive patients with a visual acuity (VA) of 0.4 (logMar) or worse were scheduled for surgery within the first 3 months of the onset of BRVO. The study endpoint was VA 1 year after AVD. Secondary study endpoints were: correlation of VA and successful vessel dissection; complication rate; and number of additional surgical procedures within the first year of AVD. RESULTS Preoperative VA (logMar) was 0.82+/-0.05 (range 0.2-1.6). VA 6 weeks postoperatively was 0.54+/-0.06 (range 0-1.6), 3 months postoperatively 0.61+/-0.07 (0-1.56), 6 months postoperatively 0.74+/-0.08 (range 0-2) and 12 months postoperatively 0.55+/-0.07 (range 0.1-1.5). VA improved 1 year after AVD (p=0.0004). An improvement in VA did not depend on successful separation of the artery and the vein. Four patients had a retinal detachment, 19 patients needed cataract surgery within the first year of AVD. A total of 24 additional surgical procedures were needed. CONCLUSIONS Patients with BRVO may profit from AVD compared with a historical control group. Visual improvement was found irrespective of the successful dissection of vessels. The cataract formation rate and additional surgery was a shortcoming of the AVD procedure.
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Affiliation(s)
- Nicolas Feltgen
- Department of Ophthalmology, University of Freiburg, Killianstrasse 5, 79106 Freiburg, Germany.
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Lakhanpal RR, Javaheri M, Equi RA, Humayun MS. Improvement after transvitreal limited arteriovenous crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25 gauge instrumentation. Br J Ophthalmol 2005; 89:922-3. [PMID: 15965182 PMCID: PMC1772717 DOI: 10.1136/bjo.2004.061739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lakhanpal RR, Javaheri M, Ruiz-Garcia H, De Juan E, Humayun MS. Transvitreal limited arteriovenous-crossing manipulation without vitrectomy for complicated branch retinal vein occlusion using 25-gauge instrumentation. Retina 2005; 25:272-80. [PMID: 15805902 DOI: 10.1097/00006982-200504000-00004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate a new technique, 25-gauge transvitreal limited arteriovenous-crossing manipulation without vitrectomy (LAM), for the treatment of branch retinal vein occlusion (BRVO) complicated by macular hemorrhage and/or macular edema recalcitrant to grid laser photocoagulation. METHODS Twelve eyes of 12 patients underwent LAM for BRVO performed by a single surgeon (M.S.H.) using the 25-gauge nitinol flexible-extendable blunt pick. The presence or absence of intraoperative reperfusion visualization, pre- and postoperative visual acuity, macular thickness as measured by optical coherence tomography, intraocular pressure, and lens status were evaluated. RESULTS Restoration of blood flow was noted in all patients and was based on intraoperative reestablishment of a red column of erythrocytes through the previously closed vessel. Mean visual acuity improved from 20/200 (logarithm of the minimal angle of resolution [LogMAR] +/- SD, 1.00 +/- 0.32) preoperatively to 20/70 (LogMAR +/- SD, 0.56 +/- 0.28) (P = 0.0003) at the final visit. Eleven (92%) of 12 eyes had >or=2 lines of visual improvement. Five eyes (45%) had final visual acuity of 20/50 or better. Mean macular thickness +/- SD improved from 401.0 +/- 73.2 to 178.7 +/- 19.6 microm (P < 0.0001) at the final visit. No statistically significant difference was noted in cataract progression or intraocular pressure. Mean follow-up +/- SD was 49.9 +/- 19.6 weeks. All patients were observed for at least 12 weeks. CONCLUSION LAM may achieve outcomes comparable with those of arteriovenous adventitial sheathotomy for complicated BRVO.
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Affiliation(s)
- Rohit R Lakhanpal
- Microsurgery Advanced Design Laboratory, Doheny Retina Institute, Doheny Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles 90033, USA
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