Journal of cataract and refractive surgery最新文献

{"title":"Efficacy of Intracameral Moxifloxacin in Prevention of Post-cataract Surgery Endophthalmitis: A Randomized Control Trial.","authors":"Namrata Sharma, Alok Sen, Mohita Sharma, Aafreen Bari, Chetan Shakkarwal, Prafulla Kumar Maharana, Tushar Agarwal, Tanuj Dada, Sandhya Gaur, Rajesh Joshi, Sandhya A Das, Ashish Dutt Upadhyay, Jeewan Singh Titiyal","doi":"10.1097/j.jcrs.0000000000001788","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001788","url":null,"abstract":"<p><strong>Purpose: </strong>To study the efficacy of intracameral moxifloxacin 0.5% in prevention of post-cataract surgery endophthalmitis.</p><p><strong>Settings: </strong>Three tertiary eye centres of northern India.</p><p><strong>Design: </strong>Multicentric randomized clinical study.</p><p><strong>Methods: </strong>Sixty thousand eyes undergoing phacoemulsification with intraocular lens (IOL) implantation were randomized in two groups in 1:1 format from January 2018 to June 2024. Group 1 received intracameral moxifloxacin (cases) while group 2 did not receive intracameral antibiotics (control). Any case of endophthalmitis in the post-operative period up to six weeks in both groups was documented and managed according to routine protocols.</p><p><strong>Results: </strong>The endothelial cell counts were comparable pre-operatively (p=0.18) and post-operatively (p=0.54). Six eyes (0.02%) in intracameral moxifloxacin group developed endophthalmitis as compared to sixteen eyes in control group (0.05%) (p=0.04). The odds of developing endophthalmitis were 2.5 times lower with the usage of intracameral moxifloxacin. The mean time of presentation of endophthalmitis in group 1 and 2 were 32.26 ± 23.42 and 23.52 ± 13.91days respectively. Eight cases (8/22; 36.36%) were culture positive, of which one was fungus (n=1/8; 12.5%) while rest were bacteria (n=7/8; 87.5%). Coagulase negative Staphylococcus (CoNS) was the most common isolated micro-organism (n=4; 50%). Resistance to fluoroquinolones were higher for ciprofloxacin (5/7) and gatifloxacin (3/7) than moxifloxacin (2/7). At three months, 17/22 eyes (77.27%) responded to treatment and endophthalmitis resolved by three months. However, one eye in group 1 and three eyes in group 2 developed phthisis (4/22; 18.18%).</p><p><strong>Conclusion: </strong>Intracameral moxifloxacin is safe and effective in preventing post-cataract surgery acute bacterial endophthalmitis.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of intraocular lens formula accuracy for eyes with prior scleral buckle surgery.","authors":"Alan W Kong, Michelle J Jeon, Shawn R Lin, John D Bartlett, Colin A McCannel, Kenneth J Hoffer, Giacomo Savini, Mitra Nejad","doi":"10.1097/j.jcrs.0000000000001715","DOIUrl":"10.1097/j.jcrs.0000000000001715","url":null,"abstract":"<p><strong>Purpose: </strong>To compare intraocular lens (IOL) formula prediction accuracy for patients with previous scleral buckling surgery.</p><p><strong>Setting: </strong>Single academic center in Los Angeles, California.</p><p><strong>Design: </strong>Retrospective study.</p><p><strong>Methods: </strong>Patients who had cataract extraction after scleral buckle surgery from 2014 to 2024 were included. The spherical equivalent prediction error (SEQ-PE) from Barrett Universal II (BUII), Hoffer QST, Holladay 1, Kane, Radial Basis Function (RBF) 3.0, and SRK/T was evaluated. The Wang-Koch-adjusted axial lengths were used for eyes >25.0 mm for the Holladay 1 and SRK/T formulas. Analysis was performed with Eyetemis, an online software designed to compare the accuracy, precision, and trueness of the SEQ-PE.</p><p><strong>Results: </strong>79 eyes from 77 patients were included. The 6 formulas showed similar accuracy, with no statistically significant differences for pairwise comparisons of the absolute SEQ-PE, which ranged between 0.33 diopters (D) (±0.52 D) for the Holladay 1 and 0.42 D (±0.56 D) for the RBF 3.0 formulas, and for pairwise comparisons of the precision of SEQ-PE, except for the comparison between BUII and Hoffer QST. There was no significant difference in the absolute SEQ-PE within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D. Comparing the trueness of the SEQ-PE, BUII and Hoffer QST were hyperopic, while Holladay 1 and SRK/T were myopic.</p><p><strong>Conclusions: </strong>The formulas compared had similar accuracy of the absolute and precision SEQ-PE for eyes with scleral buckles. There was variability in the trueness of the 6 formulas, however. Therefore, surgeons should consider these trends for IOL selection in eyes with scleral buckles.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":"845-850"},"PeriodicalIF":3.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Navigation through Keratoconus Landscape: The Crucial Role of Ocular Surface.","authors":"Farideh Doroodgar, Sana Niazi, Maedeh Mazloomi, Farzad Mohammadi, Sepehr Feizi","doi":"10.1097/j.jcrs.0000000000001791","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001791","url":null,"abstract":"<p><strong>Topic: </strong>This comprehensive systematic review addresses how concurrent ocular surface diseases (OSDs) in keratoconus (KC) patients affect KC's development, progression, diagnostic evaluation, and management, as well as KC's effect on ocular surface disturbance. This review integrates findings to bridge the gap between basic KC pathophysiology and its practical clinical management to provide a structured framework for optimizing KC treatment.</p><p><strong>Clinical relevance: </strong>This study represents the first systematic effort to operationally synthesize existing knowledge on the interplay between OSDs and KC, offering actionable insights for clinicians. OSDs are not only recognized contributors to KC onset but are also major factors in treatment failure, making their evaluation critical in KC management.</p><p><strong>Methods: </strong>A systematic search was conducted in Scopus, PubMed, Cochrane, Embase, and Web of Science for studies published up to February 2025. Studies were included regardless of language, provided they met predefined relevance and quality criteria. Exclusion criteria included replies, commentaries, case studies, retracted studies, ex vivo investigations, and studies scoring low on the AMSTAR checklist.</p><p><strong>Results: </strong>Initially, 9,572 records were identified; 5,337 duplicates were removed, leaving 4,235 for screening. After title and abstract review, 576 full texts were assessed, with 372 excluded based on AMSTAR scores or study type, leaving 204 studies. Findings highlight that OSDs significantly impact KC pathogenesis and clinical management. Non-ectatic conditions such as dry eye and tear film instability are increasingly included in the differential diagnosis of KC, emphasizing the need for a multidisciplinary approach. OSDs not only contribute to KC progression but also complicate diagnostic interpretations and influence treatment efficacy.</p><p><strong>Conclusion: </strong>The ocular surface plays a pivotal role not only in KC pathogenesis but also in treatment success or failure. Thus, it is important to address concurrent OSDs in patients with KC as they can complicate its course. This is a vital consideration for treatment strategies. However, more studies on the causal link between KC and OSD are needed to help clinicians diagnose and manage these conditions better.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"VAULT-OCT: Vault Accuracy Using Deep Learning Technology - An AI Model for Predicting Implantable Collamer Lens Postoperative Vault with AS-OCT\".","authors":"Manasi Tripathi, Ashish Markan","doi":"10.1097/j.jcrs.0000000000001794","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001794","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IOL Power Calculation Formula Accuracy in 1178 Eyes With Short Axial Length:Systematic Reviews and Network Meta-analysis.","authors":"Gaoming Zhang, Yiyuan Ma, Zhenzhen Liu, Ling Jin, Danying Zheng, Xinyu Zhang, Guangming Jin","doi":"10.1097/j.jcrs.0000000000001793","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001793","url":null,"abstract":"<p><strong>Topic: </strong>To systematically review the literature and conduct a comprehensive quantitative analysis to compare the accuracy of different intraocular lens (IOL) calculation formulas in eyes with short axial lengths (AL).</p><p><strong>Clinical relevance: </strong>The precision of the IOL formulas decreases when applied in eyes with short AL (AL < 22mm), and many new formulas for calculating IOL power have been proposed in the past few decades. However, the accuracy of these formulas has not been systematically compared when applied in eyes with short AL.</p><p><strong>Methods: </strong>This study systematically searched PubMed, Embase, Web of Science, and Cochrane Library databases to collect relevant research literature published between January 2003 and September 2023. Included were prospective or retrospective clinical studies involving cataract patients with short AL (AL < 22 mm) and reporting the following outcomes: mean absolute error (MAE), median absolute error (MedAE) and percentage of eyes with a prediction error (PE) within ±0.25, ±0.50, and ±1.00 diopters (D). A network meta-analysis was performed using R software (version 4.2.1).</p><p><strong>Results: </strong>A total of 15 prospective or retrospective studies involving 1178 eyes and 12 calculation formulas were included in this study. The network meta-analysis showed that compared with the widely used Haigis formula, the Kane formula had a higher percentage of eyes with PE within the range of ±0.25D, ±0.50D, and ±1.00D (all odds ratio > 1, but P >0.05). In addition, based on the surface under the cumulative ranking area (SUCRA), the Kane formula had the highest probability of predicting the PE of the eyes within the range of ±0.25D, with its SUCRA value of 95.74%, followed by Haigis formula (94.79%) and OlsenStandalone formula (84.04%). The Kane and OlsenStandalone formulas had the lowest MedAE.</p><p><strong>Conclusions: </strong>The Kane, Haigis, and OlsenStandalone formulas may perform better than other formulas in calculating the IOLs power in eyes with short AL. Nonetheless, significant uncertainty remains in this area. The accuracy of these formulas in patients with short AL needs to be verified by large multicenter registry studies.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Intracameral Antibiotics Prophylaxis in Patients with Posterior Capsular Rupture during Cataract Surgery: a Systematic Review and Meta-analysis.","authors":"Maria Antônia Torres Arteche, Sara Hira, Valdez Melo Dos Anjos Filho, Kuan-Yin Wu, Bernardo Bolzani Bach","doi":"10.1097/j.jcrs.0000000000001792","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001792","url":null,"abstract":"<p><strong>Topic: </strong>Posterior capsular rupture (PCR) during cataract surgery predisposes patients to postoperative endophthalmitis (POE). However, little is known about the prophylactic use of intracameral antibiotics (ICA) to prevent POE after PCR. Therefore, we conducted this systematic review and meta-analysis to assess the efficacy of ICA in preventing POE in patients with PCR.</p><p><strong>Clinical relevance: </strong>PCR increases the risk of POE by over 6-fold, emphasizing the need for targeted prophylactic strategies. This study focuses on the clinical importance of ICA in reducing the incidence of POE in this high-risk population.</p><p><strong>Methods: </strong>We searched PubMed, Embase and Cochrane for articles published up to May 21th, 2024, with the following strategy: (cataract OR phaco OR \"Cataract Extraction\" OR \"manual small incision cataract surgery\" OR phacoemulsification OR \"extracapsular cataract extraction\" OR ECCE) AND (intracameral OR \"Intracameral Injection\" OR \"irrigating infusion fluid\" OR \"anterior chamber injection\") AND (antibiotic OR moxifloxacin OR cefuroxime OR vancomycin OR cephalosporin OR prophylaxis). We included studies reporting the incidence of endophthalmitis in patients with PCR during cataract surgery and a comparison of prophylactic intracameral antibiotics with no intracameral antibiotics. Statistical analysis was conducted using R software version 4.3.2. The protocol was registered in PROSPERO (CRD42024558144).</p><p><strong>Results: </strong>The initial search yielded 1,660 results. After removing duplicate records and ineligible studies, 193 remained and were thoroughly reviewed based on the inclusion criteria. Nine studies consisting of two randomized controlled trials and seven observational studies were included in the meta-analysis. There were a total of 153,690 patients, with 50,207 (33,6%) patients in the ICA group and 103,483 (67.3%) in the No ICA group. There was a significantly lower incidence of endophthalmitis in the ICA group (OR 0.41; 95% CI 0.26 to 0.65; p < 0.001; I2 = 9%). Independently, the use of prophylactic intracameral moxifloxacin was also related with a lower risk of endophthalmitis (OR 0.33; 95% CI 0.19 to 0.57; p < 0.001; I2 = 33%).</p><p><strong>Conclusion: </strong>Our findings suggest that the use of intracameral antibiotics is efficient in preventing postoperative endophthalmitis in patients who had PCR during cataract surgery.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: Optical confirmation by a thick-lens formula of the optimized A-constant (as calculated by a thin-lens formula) of a new intraocular lens.","authors":"Michael J Simpson","doi":"10.1097/j.jcrs.0000000000001787","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001787","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperopic Keratorefractive Lenticule Extraction.","authors":"Dan Fu, Ruoyan Wei, Meipan Shi, Xiaoliao Peng, Xingtao Zhou, Tian Han","doi":"10.1097/j.jcrs.0000000000001789","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001789","url":null,"abstract":"<p><p>Keratorefractive Lenticule Extraction (KLEx) is a cutting-edge refractive surgery technique that has garnered considerable attention in recent years due to its minimally invasive nature and the absence of a corneal flap, both of which are notable advantages over traditional Laser-Assisted in Situ Keratomileusis (LASIK) surgery. Currently, the technology for myopia correction using KLEx has been refined and is widely recognized. Consequently, hyperopic KLEx surgery is highly anticipated, having undergone nearly a decade of evolution and development, and it appears to have finally achieved stable and reliable postoperative outcomes. This article reviews the emerging hyperopic KLEx in terms of clinical outcomes, challenges, complications, and outlook.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Photorefractive keratectomy (PRK) in patients with thin corneas: A systematic review and meta-analysis of clinical outcomes and complications.","authors":"Farbod Semnani, Amirmasoud Rayati Damavandi, Mirsaeed Abdollahi, Mohamad Sajadi, Mohammad-Mehdi Sadoughi, Kiana Hassanpour","doi":"10.1097/j.jcrs.0000000000001790","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001790","url":null,"abstract":"<p><strong>Topic: </strong>To systematically investigate the safety and efficacy of photorefractive keratectomy (PRK) or transepithelial photorefractive keratectomy (transPRK) in patients with thin corneas.</p><p><strong>Clinical relevance: </strong>Concerns exist regarding the outcomes of refractive surgeries including PRK/trnasPRK in patients with thin corneas.</p><p><strong>Methods: </strong>This study was registered prospectively in PROSPERO with an ID of CRD42023457156. It was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Consensus Statement. We searched six databases and three registries from January 1, 1985, until November 30, 2024: PubMed, Web of Science, Scopus, Google Scholar, Embase, ProQuest, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and International Clinical Trials Registry Platform (ICTRP). Our primary outcomes include the safety index (SI), efficacy index (EI), and best-corrected visual acuity (BCVA) changes, while our secondary outcomes include predictability and the rate of complications (including corneal ectasia and haze). We included any observational or interventional study reporting data on the primary or secondary outcomes of PRK or transPRK in patients with a mean central corneal thickness (CCT) <500 μm, with no history of previous ocular pathology or surgery. The outcome estimates and 95% confidence intervals (CI) were derived from a random-effects model meta-analysis to account for possible heterogeneity.</p><p><strong>Results: </strong>A total of 946 eyes from 10 studies were included. All included studies were case series, either retrospective (n=4) or prospective (n=6). Four studies (n=4) reported the SI and EI, with pooled estimates of 1.01 (95% CI: 0.73 to 1.29) and 1.01 (95% CI: 0.98 to 1.04) after sensitivity analysis, respectively. The mean post-operative change in BCVA was -0.01 (95% CI: -0.07 to 0.05). Compared to baseline values, a mild yet non-significant improvement in BCVA was observed (Standardized mean difference: -0.20 95% CI: -0.89 to 0.49). The pooled predictability within ±0.5 D of emmetropia, based on data from six studies, was 0.83 (95% CI: 0.98 to 1.04). No study reported any cases of corneal ectasia after surgery.</p><p><strong>Conclusion: </strong>PRK/transPRK appears to be a safe and effective refractive surgery for thin corneas with simple or astigmatic myopia and without any other ocular pathologies/topographic abnormalities. However, the power analysis and insufficient follow-up call for future studies to draw definitive conclusions about safety and efficacy.</p>","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracorneal deposits after keratorefractive lenticule extraction (KLEx): the importance of instrument quality.","authors":"Klemens Paul Kaiser, Thomas Kohnen, Navid Ardjomand","doi":"10.1097/j.jcrs.0000000000001781","DOIUrl":"https://doi.org/10.1097/j.jcrs.0000000000001781","url":null,"abstract":"","PeriodicalId":15214,"journal":{"name":"Journal of cataract and refractive surgery","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}