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  Access statistics : Table of Contents
   2012| July-August  | Volume 60 | Issue 4  
    Online since July 19, 2012

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Magnetic resonance imaging for the ophthalmologist: A primer
Arathi Simha, Aparna Irodi, Sarada David
July-August 2012, 60(4):301-310
Magnetic resonance imaging (MRI) and computerized tomography (CT) have added a new dimension in the diagnosis and management of ocular and orbital diseases. Although CT is more widely used, MRI is the modality of choice in select conditions and can be complimentary to CT in certain situations. The diagnostic yield is best when the ophthalmologist and radiologist work together. Ophthalmologists should be able to interpret these complex imaging modalities as better clinical correlation is then possible. In this article, we attempt to describe the basic principles of MRI and its interpretation, avoiding confusing technical terms.
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Episcleral plaque brachytherapy using 'BARC I-125 Ocu-Prosta seeds' in the treatment of intraocular tumors: A single-institution experience in India
Parag K Shah, V Narendran, U Selvaraj, P Guhan, Sanjay K Saxena, Ashutosh Dash, Melvin Astrahan
July-August 2012, 60(4):289-295
Context: To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute. AIM: To report our initial experience and learning curve on the use of 'BARC I-125 Ocu-Prosta seeds' for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT). Materials and Methods: We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT. Results: For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy. Conclusion: Plaque radiotherapy using 125 I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous 'BARC I-125 Ocu-Prosta seeds' locally, cost effective ophthalmic brachytherapy can be performed in India.
  6,692 283 -
Effect of preoperative use of topical prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery: A randomized trial
Fernando Roberte Zanetti, Enzo Augusto Medeiros Fulco, Fernando Rodrigo Pedreira Chaves, Alexandre Paashaus da Costa Pinto, Carlos Eduardo Leite Arieta, Rodrigo Pessoa Cavalcanti Lira
July-August 2012, 60(4):277-281
Purpose: To compare the effects of preoperative use of topical anti-inflammatory prednisolone acetate, ketorolac tromethamine, nepafenac and placebo, on the maintenance of intraoperative mydriasis during cataract surgery. Design: Randomized clinical trial. Materials and Methods: This single-center, masked, randomized clinical study comprised 140 patients scheduled for cataract surgery. Patients (35 in each group) were randomized to receive placebo, prednisolone acetate, ketorolac tromethamine 0.4% or nepafenac. These eye drops were administered three times daily for the two days prior to surgery. The pupillary diameters were measured by the surgeon using a compass prior to the corneal section and at the end of surgery. The primary outcome was the number of patients with pupil ≥ 6mm at the end of the surgery; the secondary outcome was the number of patients with pupil ≥ 6mm at the beginning of the surgery. Results: All the patients achieved pupil ≥ 6mm at the beginning of the surgery. The number of patients in the prednisolone (29/35), nepafenac (31/35) and ketorolac (30/35) groups with pupil ≥ 6mm was greater than in the placebo group in the maintenance of intraoperative mydriasis (19/35 - P =0.003). There was no statistical difference among the prednisolone, nepafenac and ketorolac groups in the maintenance of intraoperative mydriasis (P =.791). There were no complications during surgery or related to the preoperative use of the eye drops. Conclusion: Preoperative use of ketorolac, prednisolone and nepafenac was effective in maintaining intraoperative mydriasis when compared with placebo.
  5,973 587 6
Epidemiological and microbiological profile of infective keratitis in Ahmedabad
Aarti Tewari, Nidhi Sood, Mahendra M Vegad, Dipak C Mehta
July-August 2012, 60(4):267-272
Context : Study of patients attending tertiary care ophthalmology institute at Ahmedabad. Aims : To study the microbiological etiology and epidemiological factors associated with suppurative keratitis. Settings and Design : A total of 150 corneal scrapings were evaluated from patients presenting with corneal ulcers at a tertiary ophthalmology center, Ahmedabad from July 2007 to June 2008. Materials and Methods : Scrapings were subjected to Gram stain, potassium hydroxide preparation and culture for bacterial and fungal pathogens. Socio-demographic data and risk factors were recorded. Results : Ninety percent (135/150) people with corneal ulcers had trauma as predisposing factor for keratitis. Trauma due to wooden objects was the leading cause (46/135) followed by vegetable matter and stone injury (23/135). Microbial etiology was established in 59.3% (89/150) of scrapings. Out of 89 positive isolates, 65.1% (58/89) were bacterial while 34.9% (31/89) were fungal. Among the bacterial isolates, 60.3% (35/58) were Gram-positive cocci while 39.7% (23/58) were Gram-negative bacilli. The most common bacterial isolate was Staphylococus aureus (32.7%, 19/58) followed by coagulase-negative Staphylococci (25.8%, 15/58) and Pseudomonas (18.9%, 11/58). Among the 31 fungal pathogens, Aspergillus species was the most common (35.4%11/31), followed by Fusarium species (22.5%, 7/31). Conclusion : Trauma with wooden material is the most common predisposing factor for suppurative keratitis. Males were more affected than females. Bacterial ulcers were more common than fungal in areas in and around Ahmedabad. Staphylococcus aureus and Aspergillus were the commonest bacterial and fungal isolates respectively. Geographical variation persists in microbial etiology of suppurative keratitis.
  5,330 446 6
Intralesional bleomycin for the treatment of periocular capillary hemangiomas
Derrick P Smit, David Meyer
July-August 2012, 60(4):326-328
Periocular infantile capillary hemangiomas do not always respond well to conventional treatment modalities such as systemic or intralesional corticosteroids, radiotherapy or debulking surgery. The authors describe the use of intralesional bleomycin injections (IBIs) to treat potentially amblyogenic lesions in two cases where other modalities have failed. In both cases monthly IBIs successfully cleared the visual axis of the affected eye before the age of 1 year thus preventing permanent sensory deprivation amblyopia. A total of five and nine injections, respectively, were used and no significant side effects were noted. IBI appears to be a useful alternative in the treatment of periocular capillary hemangiomas refractory to more conventional modalities.
  5,410 309 6
Ophthalmic contributions of Raja Serfoji II (1798-1832)
Jyotirmay Biswas, Vasanthi Badrinath, Sengamedu S Badrinath
July-August 2012, 60(4):297-300
Purpose: To investigate and describe the ophthalmic contribution of Raja Serfoji II (1798-1832). Materials and Method: A team of 2 ophthalmologists, director of laboratory services, one archeologist and a photographer visited Sarasvathi Mahal Library, March 2004. Photographs of ophthalmic records were taken and analysed. An interview of the present prince, S Babaji Rajah Bhonsle was taken. Ophthalmologic case sheets of 44 patients, 18 pictures were found. Results: Forty-four patient's ophthalmic records were found. Six records were written in Modi script, 38 were written in English and 18 drawings were found. Conclusion: In Thanjavur, King Serfoji II carried out methodical ophthalmic practices between 1798 and 1832. Both European and Indian medicines were used. Cataract Surgery was performed. Detailed ophthalmic records were maintained. The only evidence of Serfoji's amazing contribution to medicine lies in 50 charts and manuscripts.
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Glaucomatous neurodegeneration: An eye on tumor necrosis factor-alpha
Renu Agarwal, Puneet Agarwal
July-August 2012, 60(4):255-261
Glaucoma, a neurodegenerative disease, is currently being treated by modulation of one of its primary risk factors, the elevated intraocular pressure. Newer therapies that can provide direct neuroprotection to retinal ganglion cells are being extensively investigated. Tumor necrosis factor-α, a cytokine, has been recognized to play an important role in pro and antiapoptotic cellular events. In this paper we review the relevant literature to understand (1) The association of increased expression of tumor necrosis factor-α with glaucomatous neurodegeneraion, (2) Modulation of tumor necrosis factor-α expression by exposure to various risk factors of glaucoma, (3) Downstream cellular signaling mechanisms following interaction of tumor necrosis factor-α with its receptors and (4) Role of tumor necrosis factor-α as a possible target for therapeutic intervention in glaucoma. Literature was reviewed using PubMed search engine with relevant key words and a total of 82 English language papers published from 1990 to 2010 are included in this review.
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Managing patients with retinal vein occlusions: Is there any real step forward?
S Natarajan
July-August 2012, 60(4):251-254
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Desferrioxamine-related ocular toxicity: A case report
Sumu Simon, Paul A Athanasiov, Rajeev Jain, Grant Raymond, Jagjit S Gilhotra
July-August 2012, 60(4):315-317
A 29-year-old lady receiving repeated blood transfusions for β thalassemia since childhood, presented with rapidly deteriorating symptoms of night blindness and peripheral visual field loss. She was recently commenced on high-dose intravenous desferrioxamine for reducing the systemic iron overload. Clinical and investigative findings were consistent with desferrioxamine-related pigmentary retinopathy and optic neuropathy. Recovery was partial following cessation of desferrioxamine. This report highlights the ocular side-effects of desferrioxamine mesylate and the need to be vigilant in patients on high doses of desferrioxamine.
  4,446 268 3
Ranibizumab as an adjunct to laser for macular edema secondary to branch retinal vein occlusion
Rajvardhan Azad, Kumar Vivek, Yograj Sharma, Parijat Chandra, Siddarth Sain, Anusha Venkataraman
July-August 2012, 60(4):263-266
Purpose: To compare the safety, efficacy, and dosing regimen of intravitreal ranibizumab as an adjunct to laser therapy for the treatment of macular edema secondary to branch retinal vein occlusion (BRVO). Materials and Methods: Thirty eyes of 30 patients of BRVO of at least 6 weeks duration were randomized into three groups: Group 1 received grid laser treatment alone, Group 2 received a single dose of intravitreal injection of ranibizumab (0.5 mg / 0.05 ml) followed by grid laser treatment on 7 th day following injection, while Group 3 received three loading doses of intravitreal ranibizumab at monthly interval (i.e. 0, 1, & 2 months) + standard laser treatment 7 days after the 1 st injection. Outcome measure noted at 6 months follow-up were the improvement in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: At 6 months follow-up, there was an average gain of 12 letters (P=0.05), 17.5 letters (P=0.05) and 19 letters (P=0.05) in groups 1, 2, and 3, respectively, with the decrease in CMT being 208.7 μm (P=0.05), 312.9 μm (P= 0.05) and 326.8 μm (P=0.05), respectively, in these groups. Gain in BCVA of more than 3 lines was noted in 1/10 patients in Group 1(10%) as compared to 3/10 (30%) and 4/10 (40%) patients in groups 2 and 3, respectively. Conclusion: The gain in BCVA and reduction in CMT were better with combination therapy (single- and triple- dose regimen) compared to grid laser alone. Single dose of intravitreal ranibizumab with grid laser seems to be an effective therapy.
  4,065 554 5
Efficacy of preoperative injection versus intraoperative application of mitomycin in recurrent pterygium surgery
Khaled S Zaky, Yasser M Khalifa
July-August 2012, 60(4):273-276
Purpose: To determine the efficacy of preoperative subconjunctival injection of mitomycin C a day before surgery in the management of recurrent pterygium. Materials and Methods: Randomized comparative case series. Fifty eyes with recurrent pterygium were randomly divided into two groups; the mitomycin injection group (25 eyes) and the mitomycin application group (25 eyes). The mitomycin injection group underwent preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before bare sclera pterygium excision surgery. The mitomycin application group underwent bare sclera pterygium excision with topical application of mitomycin C (same concentration). Results: At one year of follow-up, 24 of 25 eyes (96%) in the mitomycin injection group and 23 of 25 (92%) eyes in the mitomycin application group were free of recurrence. The difference was statistically insignificant. As regards postoperative complications, delayed epithelization (more than two weeks) occurred in two eyes (8%) in the mitomycin injection group and in one eye (4%) in the mitomycin application group. Scleral thinning was reported in one eye (4%) in the mitomycin application group which resolved within three weeks after surgery, no other serious postoperative complications were reported. Conclusion: Preoperative subconjunctival injection of mitomycin C in low dose (0.1 ml of 0.15 mg/ml) a day before pterygium surgery is a simple and effective modality for management of recurrent pterygium. It has the advantage of low recurrence and complications' rate.
  3,494 476 3
Bilateral acute macular neuroretinopathy in a postpartum, otherwise healthy female: A case report
Prabhat Ranjan, Sanjiv Hansraj
July-August 2012, 60(4):313-315
Acute macular neuroretinopathy (AMN) is a rare, macular disorder which typically affects young women who present with paracentral scotoma in one or both eyes corresponding to red, wedge-shaped parafoveal lesions. A young female presented with the complaints of few black spots (scotomas) in her visual field, which she noticed 1 month after a full-term normal delivery. Fundus examination showed flat, well-demarcated, reddish parafoveal lesions in both eyes, corresponding to the scotoma. Optical coherence tomography (OCT) at the site of lesion showed a well-delineated defect in the reflectivity of outer retinal layer. After 6 months of follow-up, fundus lesions were noted to be fading and repeat OCT revealed the realignment of the defect in the outer retinal reflectivity.
  3,769 188 1
Isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus infection
Sujit Gharai, Pradeep Venkatesh, Anindita Sinha, Satpal Garg, Prapti Ghosh
July-August 2012, 60(4):321-324
We report a case of isolated homonymous hemianopsia due to presumptive cerebral tubercular abscess as the initial manifestation of human immunodeficiency virus (HIV) infection. A 30-year-old man presented to our outpatient department with sudden loss of visibility in his left visual field. He had no other systemic symptoms. Perimetry showed left-sided incongruous homonymous hemianopsia denser above the horizontal meridian. Magnetic resonance imaging revealed irregular well-marginated lobulated lesions right temporo-occipital cerebral hemisphere and left high fronto-parietal cerebral hemisphere suggestive of brain tubercular abscess. Serological tests for HIV were reactive, and the patient was started only on anti-tubercular drugs with the presumptive diagnosis of cerebral tubercular abscess. Therapeutic response confirmed the diagnosis. Atypical ophthalmic manifestations may be the initial presenting feature in patients with HIV infection. This highlights the need for increased index of suspicion for HIV infection in young patients with atypical ophthalmic manifestations.
  3,577 165 -
Spontaneous globe luxation associated with chronic obstructive pulmonary disease
M Ashok Kumar, K Srikanth, R Pandurangan
July-August 2012, 60(4):324-325
Spontaneous globe luxation is a rarely reported condition which can lead to complications like optic neuropathy. Common causes are thyroid eye disease, shallow orbit and floppy eyelid syndrome. We report a case of spontaneous globe luxation with the onset and severity associated with chronic obstructive pulmonary disease (COPD). To our knowledge, this is the first case of spontaneous globe luxation associated with COPD.
  3,531 175 -
Candida albicans interface infection after deep anterior lamellar keratoplasty
Mohammad Reza Sedaghat, Setareh Sagheb Hosseinpoor
July-August 2012, 60(4):328-330
The clinical features of interface Candida keratitis after deep anterior lamellar keratoplasty (DALK), may imitate rejection or crystalline keratopathy. We report here an 18-year-old woman presented with red eye, 4 months after undergoing DALK. Slit lamp examination revealed keratic precipitates (KPs) and cojunctival injection. She was prescribed corticosteroid treatment for endothelial rejection by another ophthalmologist because of misdiagnosis, but suffered a recurrence of symptoms after reduction of the corticosteroid treatment. At that time, she was referred to our office. The recurrence persisted despite antibiotic and antifungal therapies. Ten days after treatment with interface irrigation with amphotericin, the infiltration and hypopyon were resolved. Topical steroid was added after 3 months of antifungal monotherapy. Irrigant cultures confirmed the presence of Candida albicans. The corneal graft appeared semi-clear with no signs of infection at 17-month follow-up. We recommend a close follow-up and a timely intervention to prevent the need for more invasive treatment such as penetrating keratoplasty.
  3,442 234 2
Electrophysiological abnormalities associated with extensive myelinated retinal nerve fibers
Su Ann Tay, Srinivasan Sanjay
July-August 2012, 60(4):330-332
An observational case report of electrophysiological abnormalities in a patient with anisomyopic amblyopia as a result of unilateral extensive myelinated retinal nerve fibers (MNFs) is illustrated. The electrophysiological readings revealed an abnormal pattern electroretinogram (PERG) but normal full-field electroretinogram readings in the affected eye. The visual-evoked potential was also undetectable in that eye. Our findings suggest that extensive MNFs can be associated with electrophysiological abnormalities, in particular the PERG, which can aid in diagnosing the cause of impaired vision when associated with amblyopia.
  3,276 180 -
Analysis of photoastigmatic keratectomy with the cross-cylinder ablation
Nicola Rosa, Maddalena De Bernardo, Mario R Romano, Gianluca Scarfato, Francesco Verdoliva, Rodolfo Mastropasqua, Michele Lanza
July-August 2012, 60(4):283-287
Aim: The aim was to evaluate the safety and efficacy of the "cross-cylinder" technique in the correction of astigmatism. Setting and Design: A prospective interventional study from a university eye department was conducted. Material and Methods: The photoastigmatic refractive keratectomy (PARK) using the "cross-cylinder" technique was performed in 102 eyes of 84 patients with at least 0.75 D of astigmatism. The study population was divided into two groups: in the first group the preoperative astigmatic power ranged from −0.75 D to −3.00 D (group 1), in the second group it ranged from −3.25 D to −6.00 D (group 2). Group 1 included 82 eyes of 67 patients (29 males and 38 females) with a mean cylinder power of −1.90 ± 0.63 D, group 2 included 20 eyes of 17 patients (13 males and 4 females) with a mean cylinder power of -4.28 ± 0.76 D. All eyes were targeted for emmetropia. The results were evaluated using Calossi's vector analysis method. Six-month postoperative outcomes are presented. Results: Six months after PARK the mean sphere for the entire cohort was +0.28 ± 0.75 D (range +2.5 to −2 D), the mean cylindrical power was +0.33 ± 0.51 D (range +2.5 to −1.25 D) and the mean spherical equivalent refraction was +0.73 ± 0.81 D (range +1.75 to −2 D). Conclusions: The cross-cylinder technique may be safely used with predictable results for the correction of astigmatism.
  3,030 260 -
Traumatic endophthalmitis presenting as isolated retinal vasculitis and white-centered hemorrhages: Case report and review of literature
Nidhi Relhan, Subhadra Jalali, Suma Nalamada, Vivek Dave, Annie Mathai
July-August 2012, 60(4):317-319
The article reports a case and review of the literature of endophthalmitis presenting as isolated retinal vasculitis. A 26-year-old male was observed to have white-centered retinal hemorrhages and retinal vasculitis following an occult scleral perforation. At presentation, the visual acuity was 20/60. With clinical suspicion of early endophthalmitis, he underwent wound exploration, scleral tear repair, vitreous biopsy and administration of intravitreal antibiotics. Microbiology evaluation revealed significant presence of methicillin-resistant coagulase-negative Staphylococcus epidermidis. Final visual acuity improved to 20/20 at 6 weeks postoperatively. Literature search revealed eight similar cases, all of them due to Staphylococcus species. Retinal vasculitis and white-centered retinal hemorrhages can be a presenting sign of early endophthalmitis, especially with non-fulminant pathogens like S. epidermidis.
  3,023 182 -
Fractured Ozurdex TM implant in the vitreous cavity
Pukhraj Rishi, Gaurav Mathur, Ekta Rishi
July-August 2012, 60(4):337-338
  2,955 195 8
Managing bevacizumab-induced intraocular inflammation
Subijay Sinha, Nagender Vashisht, Pradeep Venkatesh, Sat Pal Garg
July-August 2012, 60(4):311-313
The outcome of four cases of sterile endophthalmitis that developed after intravitreal injections of bevacizumab has been reported here. All four eyes received 1.25 mg/0.05 ml intravitreal bevacizumab from 0.2-ml aliquots for different etiologies. The inflammation predominantly involved the anterior chamber with mild vitreous reaction. All patients were culture negative and regained preinjection visual acuity and were culture negative following intravitreal antibiotic administration. This report highlights that intravitreal bevacizumab can cause sterile endophthalmitis and this has to be kept in mind, and clinical judgment should be used to differentiate it from infective endophthalmitis.
  2,638 212 -
Nanophthalmos and situs inversus totalis
Alparslan Sahin, Refik Oltulu, Ali S Kivrak, Ahmet Özkagnici
July-August 2012, 60(4):319-321
Nanophthalmos is characterized by short axial length, high hypermetropia, thick sclera and a normal-sized crystalline lens. Situs inversus totalis is the mirror image of the normal morphology of the thoracic and abdominal viscera. To the best of our knowledge this is the first report of a nanophthalmic patient with situs inversus totalis. Therefore, we would like to invite the attention of our colleagues to our case and underline the importance of the systemic examination of the nanophthalmic patients to detect systemic malformations and visceral transpositions.
  2,608 194 -
Can conventional long case examination be improved?
Suneetha Nithyanandam, Mary Joseph, Usha Vasu
July-August 2012, 60(4):333-333
  2,391 157 -
Grapevine from the optic nerve head
Dhananjay Shukla, Abhishek Sharan
July-August 2012, 60(4):338-339
  2,198 250 -
A comparative study between intravitreal triamcinolone and bevacizumab for macular edema due to central retinal vein occlusion with poor vision
Fatih C Gundogan, Ahmet Tas, Gungor Sobaci
July-August 2012, 60(4):339-340
  2,040 298 1
Flare up of choroiditis and choroidal neovasculazation associated with punctate inner choroidopathy during early pregnancy
Vandana Dwivedi, Neeraj Pandey
July-August 2012, 60(4):340-340
  2,045 258 -
Role of potassium hydroxide preparation in the management of mycotic corneal ulcers
Amit Agarwal, Rachna Agarwal
July-August 2012, 60(4):336-336
  2,098 179 -
Outcome of in-the-bag implanted square-edge polymethyl methacrylate intraocular lenses with and without posterior capsulotomy in pediatric traumatic cataract
Suresh Ramchandani, Sushama Ramchandani
July-August 2012, 60(4):334-335
  2,116 153 -
Authors' reply
Neelam Verma, Jagat Ram, Jaspreet Sukhija, Surinder S Pandav, Amit Gupta
July-August 2012, 60(4):335-336
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Authors' reply
Vinita G Rao, Girish S Rao, Nilesh S Narkhede
July-August 2012, 60(4):341-341
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Author's reply
Kavita R Bhatnagar
July-August 2012, 60(4):334-334
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July-August 2012, 60(4):332-332
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Authors' reply
Reema Nath, Syamanta Baruah, Lahari Saikia, Bhanu Devi, Achinta K Borthakur, Jagadish Mahanta
July-August 2012, 60(4):336-337
DOI:10.4103/0301-4738.98733  PMID:22824615
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