Klinische Monatsblatter fur Augenheilkunde最新文献

{"title":"Inflammatory Choroidal Neovascularization in Pediatric Uveitis: A Case Series.","authors":"Amandine Gauderon, Chiara Eandi, Aikaterini Koryllou, Florence Hoogewoud, Katerina Theodoropoulou, Yan Guex-Crosier","doi":"10.1055/a-2467-1804","DOIUrl":"https://doi.org/10.1055/a-2467-1804","url":null,"abstract":"<p><strong>Background: </strong>The aim of our study is to describe clinical features, therapy, and outcome of children with inflammatory choroidal neovascularization (CNV).</p><p><strong>Methods: </strong>Retrospective case series of children seen at the Jules-Gonin Eye Hospital between 2000 and 2024 with macular choroidal neovascularisation secondary to ocular inflammation.</p><p><strong>Results: </strong>Four children (one male, three females) developed a retro-foveolar neovascular membrane after a median time of 2.5 months (range 1 - 16 months) following uveitis onset. The median age at presentation was 12 years (range 5 - 12 years). The CNV presentation was unilateral in all four cases, with three patients having posterior uveitis and one panuveitis. Two patients had idiopathic bilateral granulomatous uveitis while the other two had suspected toxoplasmosis chorioretinitis. Idiopathic cases were treated with oral steroids, with one patient being additionally treated with adalimumab. Toxoplasmosis cases were managed with antibiotics and oral steroids. CNV treatment involved a single anti-VEGF injection in two cases, six injections in one case, and no injection in one case due to CNV inactivity. Median follow-up period was 4.25 years (range 0.75 to 11 years) and the median final best-corrected visual acuity was 0.9 (range 0.6 - 1.25). No recurrence of CNV was observed, despite uveitis reactivation in two cases.</p><p><strong>Conclusion: </strong>Anti-VEGF therapy is safe even in young children with minimal injections required to control the disease. Treating the underlying cause of uveitis with appropriate therapy is also crucial.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Axial Length Influence the Dose Effect of Horizontal Strabismus Surgery?","authors":"Hatice Uecelehan, Anja Palmowski-Wolfe","doi":"10.1055/a-2511-3537","DOIUrl":"https://doi.org/10.1055/a-2511-3537","url":null,"abstract":"<p><strong>Background: </strong>Dose effect (DE) of strabismus surgery is thought to decrease with increasing axial length (AL), and it has been suggested that this effect may be more important in hyperopes over + 2 D. Here, we analyse the influence of AL on the DE of horizontal strabismus surgery in regard to its clinical relevance.</p><p><strong>Methods: </strong>Retrospective chart analysis of patients who had undergone horizontal strabismus surgery between 2020 and 2023.</p><p><strong>Statistical analysis: </strong>descriptive analysis and ANOVA (R 4.1.2).</p><p><strong>Results: </strong>There were 65 patients (34 male and 31 female) included; mean age: 18.0 years (range 5 - 74). Mean AL was 23.50 mm (range: 20.80 - 28.50 mm). At the 3-month follow-up, 83.1% of patients demonstrated binocularity. Mean DE was 2.36 PD/mm at distance and 2.60 in near vision. There was no significant influence of AL on the DE of surgery (p = 0.30). However, DE was significantly higher in esotropia (n = 32) than exotropia (n = 33) in distant and near vision (p = 0.0 000 403) and in both groups, patients with positive binocularity had a significantly greater DE than patients without binocularity (p = 0.0032).</p><p><strong>Conclusion: </strong>Our data showed no significant correlation between AL and the DE of surgery, while the type of strabismus and binocularity had a significant influence on the DE of surgery. However, AL is still important for surgical planning, in particular, to assess the risk of a deviating muscle path or thin sclera in high myopia.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Foveal Herniation on Surgical Outcomes of Idiopathic Epiretinal Membrane Peeling: A Challenging Presentation.","authors":"Giacomo Edoardo Bravetti, Matteo Mandrioli, Luca Cappuccini, Giorgio Enrico Bravetti","doi":"10.1055/a-2511-6405","DOIUrl":"https://doi.org/10.1055/a-2511-6405","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this report is to describe the visual symptoms and spectral-domain optical coherence tomography (SD-OCT) findings associated with foveal herniation with epiretinal membrane and to evaluate the postoperative visual, anatomical, and surgical outcomes.</p><p><strong>Background: </strong>Foveal herniation occurs when neuroretinal tissue protrudes through and above the level of an epiretinal membrane. The pathogenesis of foveal herniation is still unknown, though it is likely attributable to the centripetal contraction of the epiretinal membrane (ERM). Moreover, thinning of the prefoveolar internal limiting membrane (ILM) may further exacerbate this process by reducing the structural support for the retina in that area. In the literature, foveal herniation with ERM is rare and usually described as unilateral. Most cases present a good visual outcome after surgical intervention.</p><p><strong>Case description: </strong>We describe the case of a 37-year-old Caucasian male patient, without any previous ocular history, who presented with metamorphopsia and a sustained reduction visual acuity to his left eye that had persisted for several months. The baseline best-corrected visual acuity (BCVA) was recorded as 0.05 decimals. Anterior segment examination was unremarkable, while dilated fundoscopy revealed an ERM with a concentric ring of foveal tissue prolapse. SD-OCT showed the foveal tissue protruding through and above the ERM, demonstrating the severe foveal herniation. A diagnosis of idiopathic ERM with foveal herniation was established based on these findings. Subsequently, the patient was scheduled for surgical intervention to undergo pars-plana vitrectomy with ERM peeling. After the surgery, the patient experienced progressive restoration of the foveal anatomy and an improvement of vision to 0.6 decimals from baseline at 3 months.</p><p><strong>Conclusion: </strong>This case report shows a rare finding of foveal herniation with ERM. This atypical presentation is of important clinical relevance in drawing clinicians' attention to the possibility of these findings, with the goal to prevent erroneous diagnosis and unnecessary treatments. We demonstrate the visual improvement and gradual resolution of foveal herniation with SD-OCT images after ERM removal, and the images show that it may take a few months for the foveal bulge to decrease in height. When the outer retinal layers are normal, visual recovery, though delayed, is appreciable.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Therapy Results of Topical Dorzolamide Treatment in Enhanced S-Cone Syndrome.","authors":"Dmitri Artemiev, Margarita G Todorova","doi":"10.1055/a-2495-8656","DOIUrl":"https://doi.org/10.1055/a-2495-8656","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphology of Retinal Hemangioblastoma in von Hippel-Lindau Disease Revealed by Optical Coherence Tomography Angiography.","authors":"Yannik Laich, Stefan J Lang, Andreas Glatz, Navid Farassat, Felicitas Bucher, Simone Nuessle, Daniel Böhringer, Wolf Alexander Lagrèze, Spyridon Sideris, Peter Maloca, Clemens Lange, Thomas Reinhard, Hansjürgen Agostini, Michael Reich","doi":"10.1055/a-2501-8628","DOIUrl":"https://doi.org/10.1055/a-2501-8628","url":null,"abstract":"<p><strong>Background: </strong>To characterize different growth patterns of retinal hemangioblastomas (RHs) in patients with von Hippel-Lindau disease (VHLD) using swept-source optical coherence tomography angiography (SS-OCTA).</p><p><strong>Methods: </strong>Single-center observational cross-sectional study. SS-OCTA B-scans were centered over primary treatment-naïve RHs to display the perfusion in the inner, middle, and outer areas (IA, MA, OA). Distinctive growth patterns were characterized using K-means cluster analysis of the flow signal.</p><p><strong>Results: </strong>Annual screening of 201 patients with VHLD revealed 49 patients with 85 RHs (41 recurrent, 44 primary treatment-naïve RHs). High-quality SS-OCTA images were available for 24 primary RHs and were pooled with scans of the treatment-naïve form of 6 recurrent RHs, which were taken at a prior visit, for further analysis. Out of 30 primary RHs, 18 were located juxtapapillary (jRH) and 12 peripherally (pRH). K-means cluster analysis distinguished seven exophytic (23.3%, 2 jRH, 5 pRH), nine endophytic (30%, 6 jRH, 3 pRH), and fourteen sessile (46.7%, 10 jRH, 4 pRH) growth patterns. Fractions of the flow signal in the IA, MA, and OA were 7.3 ± 3.3%, 89.3 ± 5.0%, and 3.4 ± 3.5% for exophytic RHs, 22.2 ± 7.4%, 65.6 ± 7.3%, and 12.1 ± 8.2% for sessile RHs, and 65.4 ± 5.7%, 26.6 ± 4.9%, and 8.0 ± 6.1% for endophytic RH.</p><p><strong>Conclusion: </strong>OCTA contributes to further elucidating the morphology of RHs as a useful complementary diagnostic tool that can help to provide customized therapeutic approaches in the future and thus improve the effectiveness of RH treatment.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Conventional Horizontal Strabismus Surgery Still a Valid Option in High Myopia?","authors":"Lene Maurer, Anja Palmowski-Wolfe","doi":"10.1055/a-2498-0202","DOIUrl":"https://doi.org/10.1055/a-2498-0202","url":null,"abstract":"<p><strong>Background: </strong>Surgical methods to join extraocular muscles are now often used to reduce the risk of scleral perforation in strabismus surgery, but published results indicate that the outcome is highly variable. We therefore wanted to assess whether conventional horizontal strabismus surgery is still a valid option in high myopia.</p><p><strong>Patients and methods: </strong>A retrospective chart review of patients with high myopia, defined as a spherical equivalent of ≥ - 6.0 D in at least one eye, and who had undergone conventional horizontal strabismus surgery was performed. Exotropic angles were converted to positive angles to summarize the results.</p><p><strong>Results: </strong>22 patients were analyzed (15 corrected for esotropia, 7 for exotropia). Prior to surgery, the mean angle of deviation, measured with the alternate prism cover test, was 33.9 prism diopters (PD; range 13 - 75 PD) at distance and 35.3 PD (range 8 - 75 PD) at near. Three months post-surgery, the overall mean dose effect (DE in PD/mm surgery) was 2.8 (standard deviation [SD] 0.5) at distance and 2.9 (SD 0.6) at near. In esotropia, the mean DE was 3.0 at both distance and near; in exotropia, the mean DE was 2.3 at distance and 2.5 at near. There were no major complications such as scleral perforations or retinal detachment.</p><p><strong>Conclusion: </strong>Our data show that conventional horizontal strabismus surgery in high myopia is feasible, is not linked to an increased risk of scleral perforation, and offers predictable results.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Postoperative Subconjunctival Corticosteroid Injections in a Multimodal Approach for the Treatment of Severe Symblepharon.","authors":"Dmitri Artemiev","doi":"10.1055/a-2511-3586","DOIUrl":"https://doi.org/10.1055/a-2511-3586","url":null,"abstract":"","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exit Strategy for Treatment of Neovascular Age-Related Macular Degeneration in a Real-World Setting: Wishful Thinking?","authors":"Michael Eastline, Sadiq Said, Martina Monika Bosch, Pascal Knecht-Bosch","doi":"10.1055/a-2511-5899","DOIUrl":"https://doi.org/10.1055/a-2511-5899","url":null,"abstract":"<p><strong>Introduction: </strong>To analyze our outcome for patients with neovascular age-related macular degeneration (nAMD) treated with aflibercept in a treat-and-extend regimen pursuing an exit strategy (with best possible adherence to the \"Bern\" exit criteria) over 6 years in a real-world setting. The primary objective of the study was to investigate the proportion of patients who were able to achieve and maintain treatment exit.</p><p><strong>Methods: </strong>This is a retrospective chart review study of treatment-naïve patients diagnosed with nAMD receiving intravitreal aflibercept injections performed at our department with at least 2 years of follow-up visits. The primary outcome was the percentage of patients able to achieve and maintain the treatment exit regarding intravitreal anti-VEGF injections. Further outcome measures were best-corrected visual acuity (BCVA), incidence of recurrence after treatment cessation, duration of therapy, and number and intervals of injections.</p><p><strong>Results: </strong>There were 31 eyes of 25 patients included in this retrospective study. The observation period was from September 1, 2017 to August 31, 2023. Of all included patient eyes, 22.6% (n = 7) reached exit criteria. Of all the \"exit\" patients, 28.6% (n = 2) suffered from disease relapse and therapy was restarted at a mean (± SD) of 41.5 ± 12.5 weeks (range: 29 to 54 weeks). Regarding the eyes that met treatment exit, 5 of 31 (16.1%) had no disease recurrence in the observed study period. The median BCVA (Snellen decimal; ± interquartile range: IQR) changed from 0.63 (0.27) at baseline to 0.63 (0.4) in the first year, 0.63 (0.3) in the second year, 0.63 (0.46) in the third year, 0.63 (0.3) in the fourth year, 0.63 (0.4) in the fifth year, and 0.4 (0.04) in the sixth year. The median number of injections (± IQR) per eye in the first year of treatment was 8 (2), in the second year 5 (2), in the third year 5 (2.5), in the fourth year 5 (1), in the fifth year 3 (0.8), and in the sixth year 3 (0). Extension of the treatment interval after the loading phase in weeks was achieved up to a median (± IQR) of 5.8 (4) in the first year, 8.4 (6) in the second year, 8 (5.7) in the third year, 9.4 (5.6) in the fourth year, 7 (6.9) in the fifth year, and 8.4 (3.1) in the sixth year of observation.</p><p><strong>Discussion: </strong>Our study indicates a lower rate of patients reaching exit criteria with a treat-and-extend regimen compared to clinical study settings, and a similar recurrence rate of nAMD after treatment cessation. Nonadherence to a strict treat-and-extend protocol might influence the result.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Oregis Dashboard: Web-based Ophthalmic Research Benchmarking in Germany.","authors":"Julian Alexander Zimmermann, Christopher Dicke, Maren Arndt, Noel-Adrian Hollosi, Jens Julian Storp, Nicole Eter","doi":"10.1055/a-2481-2044","DOIUrl":"https://doi.org/10.1055/a-2481-2044","url":null,"abstract":"<p><strong>Introduction: </strong>The oregis registry operated by the German Ophthalmological Society (DOG) serves as a central digital platform for collecting and analysing ophthalmological healthcare data in Germany. The aim of oregis is to provide a comprehensive picture of the current healthcare situation and promote healthcare research using real-world-data from inpatient and outpatient facilities. Since its launch in 2020, oregis has continuously expanded its database to enable scientific analyses on a wide range of topics. This paper presents the new dashboard feature allowing participating centres to compare their own patient data with aggregated data in real time while also covering privacy aspects of the system.</p><p><strong>Materials and methods: </strong>The oregis steering committee opted to implement the oregis dashboard based on existing medical registries. First, forty-nine national and international registries were analysed to identify common features such as benchmarking functionality. This was followed by technical realisation and implementation.</p><p><strong>Results: </strong>Each centre connected to oregis has secure access to the oregis dashboard, which displays key indicators for patients, diagnoses, and treatments. Dynamic filtering options allow targeted data analysis, comparing each centre's results anonymously with aggregated data from other centres. The dashboard uses Apache Superset data visualisation software [! etwas informativer]. Data is synchronised using an integrated oregis Konnektor module to anonymise patient data according to defined standards. Extensive security and privacy measures ensure data security, including server-side encryption, transport encryption, and two-factor authentication. The dashboard is part of a comprehensive privacy policy developed and validated for oregis by privacy experts.</p><p><strong>Conclusion: </strong>The number of centres connected to oregis is still growing. The new web-based dashboard allows flexible analysis of data and comparison with other centres without allowing conclusions to be drawn about any individual care centre; this ensures data privacy and independence in each centre. More features can be added to provide a more thorough overview of eye care in Germany as oregis grows.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Glaucoma drainage devices: Indications, intraoperative management and postoperative follow-up].","authors":"Karl Mercieca, Constance Weber","doi":"10.1055/a-2423-9133","DOIUrl":"10.1055/a-2423-9133","url":null,"abstract":"<p><p>Glaucoma drainage devices (GDD) are used for patients with secondary glaucoma, such as uveitic or neovascular glaucoma, which is uncontrolled under local therapy. They are also used in patients with conjunctival scarring, for example after a previous vitrectomy or after unsuccessful previous glaucoma surgery, such as trabeculectomy. They are also a treatment option for congenital glaucoma, aphakic glaucoma or for the treatment of iridocorneoendothelial syndromes. The conventional GDD were the Baerveldt, Molteno or Ahmed glaucoma implant, whereby the first two were valveless and the latter had a valve. Newer GDD include the PAUL glaucoma implant, the Ahmed Clear Path and the EyeWatch system. Hypotony is a feared complication after GDD surgery, and there are various options for avoiding it: external ligation of the tube or intraluminal suture obstruction. However, low IOP may still occur postoperatively. If early postoperative hypotension occurs in combination with a shallow anterior chamber, the injection of a viscoelastic can be helpful. Late hypotension is usually treated with permanent occlusion or removal of the tube. Furthermore, GDD erosion and migration can occur postoperatively, in such cases a surgical revision is required. Corneal decompensation can also occur after GDD; Descemet's membrane endothelial keratoplasty (DMEK) is the treatment of choice in many centers and is performed more frequently than a penetrating keratoplasty. Finally, double vision is a possible complication after GDI. Most patients have short-term, self-limited diplopia or can be adequately treated with prism glasses; a few require strabologic surgery.</p>","PeriodicalId":17904,"journal":{"name":"Klinische Monatsblatter fur Augenheilkunde","volume":" ","pages":"161-173"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}