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Nemcova I, Pasta J, Hladikova K, Komarc M, Pospisilova D, Nemec P, Tesar J, Kratky V, Sin M. Myopic Correction with Iris-Fixated Phakic Intraocular Lenses: Twelve-Year Results. J Ophthalmol 2021; 2021:7027793. [PMID: 34659825 PMCID: PMC8516571 DOI: 10.1155/2021/7027793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate a 12-year follow-up of myopic patients after iris-fixated phakic intraocular lenses (IF pIOLs) implantation. Setting. Ophthalmology Department, Military University Hospital in Prague (Czech Republic). DESIGN Single-center retrospective cohort study. METHODS We describe the results of a cohort study that included 85 eyes of 46 myopic patients who underwent implantation of Verisyse myopia, Veriflex, and Verisyse myopia toric (all Abbott Medical Optics, Inc.) intraocular lenses. Refractive functions and adverse events were assessed preoperatively, at 6 months, and 1, 2, 5, and 12 years after IF pIOL implantation. RESULTS Mean spherical equivalent was measured as -9.37 ± 2.87 D, 0.14 ± 0.61 D, and -0.42 ± 1.08 D, preoperatively, at 6 months and 12 years postoperatively, respectively. There was a significant reduction in the cylinder after surgery. At 12 years postoperatively, 90% of eyes had uncorrected distance visual acuity (UDVA) of 20/40 and 64% of 20/20. The safety index was 1.10 for the whole postoperative follow-up period. We found cataract formation in 3 eyes (3.5%). The endothelial cells loss (EC loss) directly caused by IF pIOL implantation was 6.0%, 8.10%, 12.8%, and 11.9%, at 1, 2, 5, and 12 years, respectively. In our cohort, 95% of eyes lost a higher percentage of EC than would be expected from a physiological loss at 12 years postoperatively. We found a significant negative interaction between preoperative pachymetry and EC loss, indicating that the lower pachymetry leads to a faster decline in endothelial cells density (ECD). IF pIOL re-enclavation was found in 28% of eyes. 7% of subluxations were caused by trauma. The mean time of nontraumatic re-enclavation was 6 years postoperatively. CONCLUSIONS The study confirmed the advantages of IF pIOL implantation due to rapid visual recovery and stable visual function over the 12-year follow-up and also showed the influence of lower corneal pachymetry regarding EC loss.
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Affiliation(s)
- Iveta Nemcova
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Jiri Pasta
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Katerina Hladikova
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Martin Komarc
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Darina Pospisilova
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
| | - Pavel Nemec
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Jan Tesar
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
| | - Vladimir Kratky
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
- Health Sciences Centre, Queen's University, Kingston, Canada
| | - Martin Sin
- Department of Ophthalmology, Military University Hospital Prague, Prague, Czech Republic
- 1st Faculty of Medicine of Charles University, Prague, Czech Republic
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Jbara D, Achiron A, Antman G, Buhbut O, Hecht I, Tuuminen R, Bahar I, Elbaz U. Agreement of Corneal Endothelial Cell Analysis Between Konan-Noncon Robo SP-6000 and Tomey EM-3000 Specular Microscopes in Healthy Subjects. Eye Contact Lens 2021; 47:191-195. [PMID: 32443012 DOI: 10.1097/icl.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To compare corneal endothelium parameters taken by two common noncontact specular microscopes in healthy subjects. METHODS Healthy participants visiting the outpatient eye clinic at the Rabin Medical Center, Petah Tikva, Israel, were recruited prospectively. All participants underwent three consecutive corneal endothelial cell photographs with both the Konan-Noncon Robo SP-6000 and the Tomey EM-3000 specular microscopes. Endothelial cell density (ECD) was evaluated using the manual center technique in both machines. Bland-Altman graphs were used to assess the agreement between the devices, and intraclass correlation coefficient (ICC) served to assess intraobserver variability for each device. RESULTS Recruited were 49 healthy subjects with a mean age of 48.9±15.6 years, 49 right eyes were included. The mean ECD was comparable between the Tomey EM-3000 and the Konan-Noncon Robo SP-6000 (2,713.2±242.4 vs. 2,700.8±300.5 cells/mm2, respectively, P=0.47) with a mean difference of 12.4 cells/mm2 (0.67%), a mean ECD absolute difference of 93.3 cells/mm2, and low 95% limits of agreement of -222.0 to +246.9 cells/mm2. A folded empirical distribution function curve showed that all differences fell within 525.4 cells/mm2, centered around a median of 13.3 cells/mm2. Intraclass correlation coefficient was high for both the Konan-Noncon Robo SP-6000 (0.93, 95% confidence interval [CI]: 0.89-0.95) and the Tomey EM-3000 (0.88, 95% CI: 0.82-0.93). CONCLUSIONS The difference in endothelial cell measurements between the Konan SP-6000 and the Tomey EM-3000 specular microscopes through the center and the L-count analyzing techniques, respectively, is clinically small and not statistically significant. Nevertheless, caution should be taken when used interchangeably because ECD difference between the two machines can be as high as 525.4 cells/mm2.
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Affiliation(s)
- Doha Jbara
- Department of Ophthalmology (D.J., G.A., I.B., U.E.), Rabin Medical Center, Petah-Tikva, Israel; Department of Ophthalmology, (D.J., A.A., G.A., I.H., I.B., U.E.), Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Department of Ophthalmology (A.A.), Edith Wolfson Medical Center, Holon, Israel ; Department of Ophthalmology (O.B.), Soroka University Medical Center, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Ophthalmology (I.H.), Shamir Medical Center, Be'er Ya'akov, Israel ; Department of Ophthalmology (R.T.), Helsinki Retina Research Group, University of Helsinki, Helsinki, Finland ; and Eye Centre (R.T.), Kymenlaakso Central Hospital, Kotka, Finland
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Tran THC, Zaier D, Proença J, Rouland JF. Posterior segment Intra-Ocular Implant (IOL) dislocation: Predisposing factors, surgical management, outcome analysis. J Fr Ophtalmol 2020; 43:1062-1068. [PMID: 32811657 DOI: 10.1016/j.jfo.2020.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/17/2019] [Accepted: 01/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the predisposing factors, management and visual prognosis of intraocular Lens (IOL) dislocation into the posterior segment. METHODS The cases of posterior IOL dislocation from January 2012 to May 2017 at 2 centers were reviewed. Only eyes with dislocations requiring IOL explantation or repositioning were included. Predisposing factors, interval between cataract surgery and IOL dislocation, circumstances of onset, management, and postoperative complications are reported. RESULTS 72 eyes of 72 patients were included. The mean age was 67.6 years. 47 patients (68%) were men. The mean time interval from cataract surgery to IOL dislocation was significantly shorter in the out-of-the bag group than the in-the-bag IOL dislocation group (3.8 months vs 132 months, P=0.002). Predisposing factors for out-of-the-bag IOL dislocation were mainly capsular rupture and/or zonular dehiscence (83%) after complicated cataract surgery. The predisposing factors for in-the-bag IOL dislocation were high myopia (40%), pseudoexfoliation syndrome (40%), previous vitrectomy (38%), or Marfan syndrome (3%) with uneventful cataract surgery. The type of luxated implant was mainly a 3-piece foldable IOL (50%), followed by foldable one-piece IOL (28%) and a rigid one-piece IOL (17%). Most cases of posterior chamber IOL dislocation occurred spontaneously (80%) without a trigger event. Management consisted of a posterior approach in 24 cases (33%) or an anterior approach in 48 cases (67%), associated with IOL repositioning in 20 eyes (28%), and IOL replacement in 34 eyes (47%). Finally, 18 eyes (25%) were left aphakic. Postoperative complications occurred in 7 cases (9.7%). CONCLUSIONS Predisposing factors and time from cataract surgery to IOL dislocation were different for out-of-the bag versus in-the-bag IOL dislocation. Management of IOL dislocation varied considerably, depending on surgeon preference and experience. Surgery for IOL dislocation significantly improved best corrected visual acuity and was associated with a low complication rate.
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Affiliation(s)
- T H C Tran
- Ophthalmology department, Lille Catholic hospitals, Lille Catholic university, Lille, France.
| | - D Zaier
- Ophthalmology department, Lille Catholic hospitals, Lille Catholic university, Lille, France
| | - J Proença
- Ophthalmology department, Claude-Huriez hospital, Lille II university, Lille, France
| | - J F Rouland
- Ophthalmology department, Claude-Huriez hospital, Lille II university, Lille, France
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Boyer D, Freund KB, Regillo C, Levy MH, Garg S. Long-term (60-month) results for the implantable miniature telescope: efficacy and safety outcomes stratified by age in patients with end-stage age-related macular degeneration. Clin Ophthalmol 2015; 9:1099-107. [PMID: 26124633 PMCID: PMC4476474 DOI: 10.2147/opth.s86208] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this study was to evaluate the long-term results of an implantable miniature telescope (IMT) in patients with bilateral, end-stage, age-related macular degeneration (AMD). Methods A prospective, open-label, multicenter clinical trial with fellow eye controls enrolled 217 patients (mean age 76 years) with AMD and moderate-to-profound bilateral central visual acuity loss (20/80–20/800) resulting from untreatable geographic atrophy, disciform scars, or both. A subgroup analysis was performed with stratification for age (patient age 65 to <75 years [group 1; n=70] and patient age ≥75 years [group 2; n=127]), with a comparative evaluation of change in best-corrected distance visual acuity (BCDVA), quality of life, ocular complications from surgery, adverse events, and endothelial cell density (ECD). Follow-up in an extension study was 60 months. Results Data were available for 22, 38, and 31 patients in group 1 and 42, 46, and 32 patients in group 2 at 36, 48, and 60 months, respectively. Mean BCDVA improvement from baseline to 60 months was 2.41±2.69 lines in all patients (n=76), with 2.64±2.55 lines in group 1 and 2.09±2.88 lines in group 2. Quality of life scores were significantly higher in group 1. The most common significant surgery-related ocular complications in group 1 were iritis >30 days after surgery (7/70; 10%) and persistent corneal edema (3/70; 4.3%); and in group 2 were a decrease in BCDVA in the implanted eye or IMT removal (10/127 each; 7.9%), corneal edema >30 days after surgery (9/127; 7.1%), and persistent corneal edema (6/127; 4.7%). Significant adverse events included four corneal transplants, comprising two (2.9%) in group 1 and two (1.6%) in group 2. At 60 months, one patient in group 1 (3.2%) and three patients in group 2 (9.4%) had lost ≥2 lines of vision. The IMT was removed in one (1.4%) and ten (7.9%) patients in group 1 and group 2, respectively. Mean ECD loss was 20% at 3 months. Chronic loss was 3% per year. ECD loss was less in group 1 than in group 2 (35% versus 40%, respectively) at 60 months. Conclusion Long-term results show substantial retention of improvement in BDCVA. Chronic ECD loss was consistent with that reported for conventional intraocular lenses. The IMT performed as well in group 1 (the younger group) as it did in group 2 through month 60. Younger patients retained more vision than their older counterparts and had fewer adverse events. Although not a specified outcome for this study, patients younger than 65 years also fared better than those in group 2 and retained more vision with fewer adverse events through month 60.
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Affiliation(s)
- David Boyer
- Retina-Vitreous Associates Medical Group, Beverly Hills, CA, USA
| | - K Bailey Freund
- Vitreous-Retina-Macula Consultants of New York, New York, NY, USA
| | | | - Marc H Levy
- Sarasota Retina Institute, Sarasota, FL, USA
| | - Sumit Garg
- The Gavin Herbert Eye Institute (University of California, Irvine) Irvine, CA, USA
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Brockmann T, Gonnermann J, Brockmann C, Torun N, Joussen AM, Bertelmann E. Morphologic alterations on posterior iris-claw intraocular lenses after traumatic disenclavation. Br J Ophthalmol 2014; 98:1303-7. [DOI: 10.1136/bjophthalmol-2014-305364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moran S, Kirwan C, O'Keefe M, Leccisotti A, Moore T. Incidence of dislocated and subluxed iris-fixated phakic intraocular lens and outcomes following re-enclavation. Clin Exp Ophthalmol 2014; 42:623-8. [DOI: 10.1111/ceo.12310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 01/06/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Moran
- Eye Laser Department; Mater Private Hospital; Dublin Ireland
| | | | - Michael O'Keefe
- Eye Laser Department; Mater Private Hospital; Dublin Ireland
| | - Antonio Leccisotti
- School of Biomedical Sciences; University of Ulster; Coleraine UK
- Siena Eye Laser; Monteriggioni Siena Italy
| | - Tara Moore
- School of Biomedical Sciences; University of Ulster; Coleraine UK
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Na KS, Jeon S, Joo CK. Effect of intraoperative manipulation during iris-claw phakic IOL implantation on endothelium. Can J Ophthalmol 2013; 48:259-64. [DOI: 10.1016/j.jcjo.2013.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 02/11/2013] [Indexed: 12/13/2022]
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Hypermotility of an iris-fixated anterior chamber phakic intraocular lens due to nontraumatic iris laxity. Eur J Ophthalmol 2011; 22:481-4. [PMID: 21959679 DOI: 10.5301/ejo.5000059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Permanent immovability of phakic intraocular lenses (pIOLs) for the correction of high myopia is crucial in avoiding injury to the corneal endothelium and maintaining visual acuity. Unstable position of iris-fixated pIOLs due to traumatic or nontraumatic disenclavation of the haptic has been described previously. METHODS AND RESULTS We report a different mechanism of repeated excessive implant motility in both eyes of a young woman who developed late nontraumatic elongation of the iris fibers to which an iris-claw pIOL was fixated. This led to increased motility of the pIOLs with blinking causing mild iritis. Subsequent bilateral successful re-enclavation to other iris fibers ameliorated these symptoms. After 2.5 years, these iris fibers, too, were elongated, causing excessive movements of the pIOLs and consecutive endothelial cell loss necessitating removal of the pIOLs. The etiology of this iris fiber laxity remains unclear. CONCLUSIONS Surgeons should be aware of this rare potential complication.
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Abstract
PURPOSE OF REVIEW To report on the accumulating peer-reviewed data of phakic intraocular lens (pIOL) implantation in the pediatric population. I evaluate and compare the published peer-reviewed articles for the reported efficacy and complications of phakic intraocular lens implantations in children for correction of clinically significant high refractive errors. RECENT FINDINGS Multiple studies have shown the relevancy and effectiveness of pIOL implantation as an alternative surgical management for highly significant pediatric ametropia in selective patients who are noncompliant with medical treatment. SUMMARY In the management of clinically significant severe pediatric ametropic and/or anisometropic myopia or hyperopia and in the event of nonadherence to traditional medical treatment, phakic anterior chamber IOL implantation is currently considered an effective modality of treatment. Long-term follow-up of pediatric patients following pIOL implantation is necessary. Future clinical trials should focus on children of various age groups to assess the variables of visual acuity gain or loss, stereopsis, contrast sensitivity, high-order aberrations, corneal physiology, and long-term complications to accurately and properly address the safety and efficacy of the type of and the best time for pIOL implantation in treatment and/or prevention of amblyopia in children.
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Kohnen T, Klaproth OK. Three-year stability of an angle-supported foldable hydrophobic acrylic phakic intraocular lens evaluated by Scheimpflug photography. J Cataract Refract Surg 2010; 36:1120-6. [PMID: 20610089 DOI: 10.1016/j.jcrs.2010.01.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Revised: 01/02/2010] [Accepted: 01/05/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the postoperative positional stability of a new angle-supported, hydrophobic acrylic phakic intraocular lens (pIOL). SETTING Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany. METHODS In this prospective nonrandomized clinical trial, eyes with moderate to high myopia had implantation of an angle-supported pIOL (AcrySof Cachet). Scheimpflug imaging was performed preoperatively and postoperatively at 1, 3, 6 to 12, and 24 to 36 months. The main outcome measures were the distance between the corneal endothelium and the IOL and between the IOL and the crystalline lens. The overall significance threshold was P = .05. RESULTS Twenty-one of the 26 eyes (26 patients) evaluated were included in the statistical analysis. Analysis of variance showed no statistically significant differences in absolute endothelium-IOL or IOL-crystalline lens measurements at any postoperative visit. The mean endothelium-IOL distance was 2.05 mm +/- 0.25 (SD) at 1 month and 2.15 +/- 0.29 mm at 24 to 36 months and the mean IOL-crystalline distance, 0.92 +/- 0.23 mm and 0.86 +/- 0.22 mm, respectively. A 1-way t test showed a small but significant difference compared with zero in the overall change in the endothelium-IOL distance (mean 0.08 +/- 0.16 mm) and thus in the overall calculated anterior chamber depth (mean 0.07 +/- 0.08 mm); the difference was not significant for the IOL-crystalline lens change (mean -0.05 +/- 0.13 mm). CONCLUSION The angle-supported foldable hydrophobic pIOL maintained adequate central clearance distances to the corneal endothelium and the natural crystalline lens over 3 years. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes.
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Affiliation(s)
- Thomas Kohnen
- Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany.
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Glass fragment in the anterior chamber caused corneal endothelial dysfunction eight years after penetrating trauma. Jpn J Ophthalmol 2010; 54:358-9. [DOI: 10.1007/s10384-010-0820-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Accepted: 02/02/2010] [Indexed: 11/25/2022]
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Liu A, Manche EE. Late-onset nontraumatic dislocation of anterior chamber phakic intraocular lens. J Cataract Refract Surg 2010; 36:854-6. [PMID: 20457382 DOI: 10.1016/j.jcrs.2010.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2009] [Revised: 11/11/2009] [Accepted: 11/11/2009] [Indexed: 10/19/2022]
Abstract
Long-term stability of the position of phakic intraocular lenses (pIOLs) is important in maintaining visual acuity as well as avoiding injury to the local tissues. We report a case of late nontraumatic dislocation of an iris-fixated pIOL, with subsequent successful repositioning.
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Affiliation(s)
- Anthony Liu
- Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California 94305, USA
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Titiyal JS, Sharma N, Mannan R, Pruthi A, Vajpayee RB. Outcomes of reenclavation of subluxated iris-fixated phakic intraocular lenses: Comparison with primary surgery outcomes. J Cataract Refract Surg 2010; 36:577-81. [DOI: 10.1016/j.jcrs.2009.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 11/02/2009] [Accepted: 11/03/2009] [Indexed: 11/30/2022]
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