British Journal of Ophthalmology最新文献

{"title":"New grading classification for paediatric atopic keratoconjunctivitis.","authors":"Christopher Ashton,Daniel F P Larkin","doi":"10.1136/bjo-2024-326976","DOIUrl":"https://doi.org/10.1136/bjo-2024-326976","url":null,"abstract":"","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"60 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropathic corneal pain following refractive surgery: risk factors, clinical manifestations, imaging and proteomic characteristics.","authors":"Calesta Hui Yi Teo,Chang Liu,Isabelle Xin Yu Lee,Molly Tzu-Yu Lin,Fengyi Liu,Charmaine Jan Li Toh,Siew Kwan Koh,Da Qian Lu,Thomas Chuen Lam,Lei Zhou,Louis Tong,Jodhbir Mehta,Yu-Chi Liu","doi":"10.1136/bjo-2024-325996","DOIUrl":"https://doi.org/10.1136/bjo-2024-325996","url":null,"abstract":"BACKGROUND/AIMSTo identify the risk factors for neuropathic corneal pain (NCP) following corneal refractive surgery and to report its clinical manifestations, imaging and proteomic characteristics.METHODSThis 1 year prospective cohort study included 100 eyes that underwent small incision lenticule extraction (SMILE) or laser-assisted in situ keratomileusis (LASIK). Ocular surface assessments, in-vivo confocal microscopy scans, tear neuromediators and proteomics analyses were performed. NCP was assessed using the ocular pain assessment survey. Univariate and multivariate analyses were conducted to identify the risk factors associated with postoperative NCP.RESULTSThe incidence of NCP was 13.3% and 10.5% after SMILE and LASIK, respectively (p=0.70). In SMILE, preoperative manifest refractive spherical equivalent (MRSE) and spherical power (both p=0.02) were significantly higher in the NCP compared with the non-NCP group. In LASIK, NCP eyes had a significantly lower corneal nerve fibre length (CNFL) (p=0.02), lower nerve fractal dimension (p=0.003), higher nerve fibre width (p=0.04) and larger neuroma area (p=0.04) than non-NCP eyes. In SMILE, higher preoperative MRSE was a significant risk factor for postoperative NCP (95% CI: 0.48-1.96, p=0.04). An MRSE greater than -8.0 diopter was 9.57 times more likely to develop postoperative NCP (OR=9.57, p=0.002). In LASIK, lower preoperative corneal nerve fibre density (95% CI:0.13-1.11, p=0.05) and CNFL (95% CI:0.09-1.25, p=0.05) were significant risk factors for postoperative NCP. Significant increases in tear nerve growth factor, calcitonin gene-related peptide, Frizzled class receptor 7 and nucleoside-diphosphate kinase three were observed in postoperative NCP.CONCLUSIONSThe reported characteristics and risk factors would identify patients susceptible to NCP after corneal refractive surgery.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"121 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Change in subjective well-being and the associated costs of a woman-targeted presbyopia correction programme among older craftswomen in Zanzibar: a cost-outcome and scenario analysis.","authors":"Ving Fai Chan,Omar Juma Othman,Ai Chee Yong,Christine Graham,Carlos Price-Sanchez,Bhagyalaxmi Shivalingam Pillai,Eleanor Holland,Emma McConnell,Jamison Jones,Adrianna Farmer,Michelle Fernandes Martins,Kajal Shah,Damaris Mulewa,Ronnie Graham,Eden Mashayo,Fatma Omar","doi":"10.1136/bjo-2024-325887","DOIUrl":"https://doi.org/10.1136/bjo-2024-325887","url":null,"abstract":"BACKGROUNDA pilot eyecare programme aimed to address the urgent eye health needs of older Zanzibari craftswomen. We investigated the impact of correcting presbyopia on their subjective well-being (SWB) 6 months post-correction and assessed the cost-effectiveness of a women-targeted presbyopia correction programme.METHODSThis study involved Zanzibari craftswomen aged 40 and older with presenting and corrected distance visual acuity better than 6/12 in both eyes and were presbyopic. Using a before-after method, we assessed SWB on a 10-point scale before and after providing free spectacles. Mean SWB scores and differences pre-correction and post-correction were calculated. Programme costs were analysed to determine the cost per SWB score gained and the monthly cost for each SWB score improvement. Additionally, scenario analysis estimated costs for 12 approaches.RESULTSOf 282 craftswomen, 209 met the eligibility criteria. SWB scores significantly increased from 3.34 to 8.14 post correction (p<0.001). Screening costs totalled US$12 885.84, with an average cost of US$45.69 per craftswoman screened and US$61.66 per presbyopia identification. The total programme cost was US$14,574.69. One hundred fifty-four craftswomen experienced increased SWB, with a total of 747 score gains. Achieving one SWB score improvement cost an average of US$19.50, with a monthly average cost of US$3.40 per improvement. Utilising woman screeners, organised transport and ready-made spectacles appeared to be the most cost-effective approach.CONCLUSIONCorrecting presbyopia through a targeted eyecare programme significantly enhanced SWB among craftswomen. While the programme seems cost-effective, further research is warranted to explore long-term economic benefits and definitively assess cost-effectiveness in larger studies.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"13 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights from 1096 clinical cases: pioneering a universal grading system for vernal keratoconjunctivitis management.","authors":"Ambika Chandrasekar,Shweta Agarwal,Gaurav Chauhan,Bhaskar Srinivasan,Varsha Bhambani Chavda,Geetha Iyer","doi":"10.1136/bjo-2024-325762","DOIUrl":"https://doi.org/10.1136/bjo-2024-325762","url":null,"abstract":"AIMTo analyse the clinical and demographic profiles of patients with vernal keratoconjunctivitis (VKC) and propose a grading for VKC based on corneal status and symptom periodicity rather than disease activity.METHODSRetrospective observational study from January 2015 to January 2020 in India. VKC grading was based on past/present clinical signs and frequency of symptoms rather than disease activity. The electronic medical records were screened and details of VKC patients diagnosed by cornea specialists were recorded and analysed.RESULTS1096 VKC patients with a mean age of onset of 7.05±5.3 with 8.39% having adult onset were analysed. Symptoms included; itching (50.55%) and decreased vision (15.44%). Mixed VKC (52.04%) was the most common presentation with 49.1% having active disease. Complications included; keratoconus (18.43%), steroid-induced cataract (11.41%), glaucoma (10.95%) and limbal stem cell deficiency (5.29%). Dual-acting antiallergics (69.39%) were most commonly used, followed by topical immunomodulators.The patients were graded as, grade I: mild-presence of mild and seasonal symptoms and/or signs. Grade II: moderate-presence of persistent symptoms/and/or signs without corneal involvement. Grade III: severe-chronic persistent symptoms/and/or intermittent signs with corneal involvement or asymptomatic to mild symptoms with corneal pathognomonic signs. Grade IV: very severe-chronic persistent symptoms and/or corneal pathognomonic signs or active involvement/complication or asymptomatic with complications.CONCLUSIONVKC is a chronic disease that often causes visual complications. The new grading system based on the cornea status and symptom periodicity rather than disease activity might help plan the management better.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"53 1","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert CONsensus on Visual Evaluation in Retinal disease manaGEment: the CONVERGE study.","authors":"Roger S Anderson, Mark Roark, Rose Gilbert, Dayyanah Sumodhee","doi":"10.1136/bjo-2024-325310","DOIUrl":"10.1136/bjo-2024-325310","url":null,"abstract":"<p><strong>Background/aims: </strong>Recent decades have seen significant advances in both structural and functional testing of retinal disease. However, the current clinical value of specific testing modalities, as well as future trends, need to be clearly identified in order to highlight areas for further development in routine care and clinical trials.</p><p><strong>Methods: </strong>We designed a modified two-round Delphi study to obtain the opinion of a multidisciplinary group of 33 international experts involved in the field of retinal disease management/research to determine the level of agreement and consensus regarding the value and performance of specific structural and functional testing methods for retinal disease. On a Likert scale, a median of 1-2 indicated disagreement with the statement, and 5-6 indicated agreement with the statement. An IQR of ≤2 indicated consensus in the responses. Several questions also allowed comments on responses.</p><p><strong>Results: </strong>There was overall agreement that structural testing currently predominates for detection and monitoring. There was moderate agreement that functional testing remains important and will continue to do so in the future because it provides complementary information. Certain respondents considered that properly designed and applied psychophysical tests are as reliable and repeatable as structural observations and that functional changes are the most important in the long run. Respondents considered future care and research to require a combination of structural and functional testing with strong consensus that the relative importance will depend on disease type and stage.</p><p><strong>Conclusion: </strong>The study obtained important insights from a group of international experts regarding current and future needs in the management of retinal disease using a mix of quantitative and qualitative approaches. Responses provide a rich range of opinions that will be of interest to researchers seeking to design tests for future patient care and clinical trials.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"228-236"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11866297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation of delayed severity flares in patients with HLA-B27-associated anterior uveitis.","authors":"Andrew M Philip, Fatima Babiker, Carla C Fernandez-Santos, Max N Chikovsky, Andrew H Dolinko, Koosha Ramezani, Sydney Look-Why, Ambika Manhapra, Maria L Ruggeri, Peter Y Chang, Stephen Foster, Stephen D Anesi","doi":"10.1136/bjo-2024-325364","DOIUrl":"10.1136/bjo-2024-325364","url":null,"abstract":"<p><strong>Background/aims: </strong>To explore and characterise the clinical phenotype of acute anterior uveitis flares with delayed severity in patients with human leucocyte antigen B27 (HLA-B27)-associated anterior uveitis.</p><p><strong>Methods: </strong>Retrospective chart review of patients with HLA-B27-associated anterior uveitis. Demographic and clinical data were recorded, as well as the clinical characteristics of acute anterior uveitis flares. A flare was considered to have delayed severity if any of the following criteria were met within 3-21 days of symptomatic onset: a two-step increase in anterior chamber inflammation on consecutive exams; a new development of hypopyon or fibrinoid aqueous reaction on consecutive examinations or a significant worsening of symptoms.</p><p><strong>Results: </strong>A total of 371 patient charts were identified, of which 137 were included. 321 acute anterior uveitis flares were documented, with 36 (11.2%) meeting the criteria for a delayed severity flare. The average time from symptomatic onset was 10.2 days, and patients presented with an average anterior chamber cell grade of 3.5 in delayed severity flares compared with 1.6 in non-delayed severity flares. No significant difference in frequency of delayed severity presentation was noted based on the presence or absence of systemically associated rheumatological disease, papillitis on initial presentation and retinal vasculitis on initial presentation. The frequency of topical steroid therapy after symptomatic onset was not significantly different between the two flare phenotypes.</p><p><strong>Conclusions: </strong>Our study presents the novel characterisation of a delayed severity phenotype of HLA-B27-associated acute anterior uveitis flares.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"199-202"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sympathetic ophthalmia: epidemiology and cohort-based assessment of clinical outcomes.","authors":"Tim J Patterson, Weidong Gu, David Eliason, William Rojas-Carabali, Bernett Lee, Padmamalini Mahendradas, Jyotrimay Biswas, Parthopratim Dutta Majumder, Manisha Agarwal, Carlos Pavesio, Vishali Gupta, Rupesh Agrawal, Richard James Blanch","doi":"10.1136/bjo-2024-325267","DOIUrl":"10.1136/bjo-2024-325267","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to report the incidence, time after inciting event, aetiology and risk after specific intraocular procedures and the visual outcomes associated with sympathetic ophthalmia (SO) occurrence.</p><p><strong>Methods: </strong>This study reports data from multiple retrospective cohorts: retrospective population-based data were extracted from the TRICARE service network (between 2017 and 2021) and retrospective case-based data from the Ocular Autoimmune Systemic Inflammatory Infectious Study (OASIS) database (cohorts from the UK, South India and North India).</p><p><strong>Results: </strong>There were 159 patients with SO identified. The length of time from sensitising event to SO occurrence was a median of 151 days (range: 6-9100 days).In the TRICARE database, 2 patients developed SO after open globe trauma and primary repair (of 615 eyes, rate 0.33%; 95% CI 1.26% to 1.30%). None developed SO after vitrectomy (total of 23 903 events; 95% CI 0% to 0.012%). The combined North Indian and UK cohorts reported 78.6% (81 patients) after trauma, 18.45% (19 patients) after elective surgery.Visual outcomes were reported in the OASIS database for 98.01% of patients (155 of 157 patients). The median presenting and final best corrected visual acuity (BCVA) for the inciting eye were no perception of light, the median presenting and final BCVA for the sympathising eye were 0.65 and 0.3 logMAR, respectively.</p><p><strong>Conclusion: </strong>This study identified 159 cases of SO. With poor visual outcomes in the inciting eye, early diagnosis and management are crucial for optimising visual outcomes in the sympathising eye.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"223-227"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142364494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choroidal involvement in acute retinal necrosis: case series and review of the literature.","authors":"Anamika Patel, Avinash Pathengay, Carlos Pavesio, Ilaria Testi","doi":"10.1136/bjo-2024-325724","DOIUrl":"10.1136/bjo-2024-325724","url":null,"abstract":"<p><strong>Purpose: </strong>To show the role of multimodal imaging in identifying choroidal involvement in acute retinal necrosis (ARN).</p><p><strong>Methods: </strong>Retrospective case series of ARN patients. Clinical data, including medical history, clinical features and multimodal imaging findings, were collected.</p><p><strong>Results: </strong>Three patients were included. Imaging modalities, such as indocyanine green angiography and optical coherence tomography, were critical in showing choroidal involvement in ARN.</p><p><strong>Conclusion: </strong>Choroidal involvement may occur in ARN along with the well-known retinal features.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"203-208"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting visual outcomes in keratoprosthesis surgery with critical flicker fusion frequency, B-scan, visual electrophysiology and endoscopy.","authors":"Guangcan Xu, Haolan Qi, Qianwei He, Mingxiong Chen, Junxia Fu, Qun Wang, Biyue Chen, Qing Hua Yang, Yifei Huang, Shihui Wei, Liqiang Wang","doi":"10.1136/bjo-2024-325719","DOIUrl":"10.1136/bjo-2024-325719","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the predictive power of the critical flicker fusion frequency (CFF) test for visual outcomes in keratoprosthesis (KPro) candidates, comparing its accuracy with B-scan ultrasound, flash visual evoked potentials (fVEP) and endoscopy.</p><p><strong>Methods: </strong>The study included 42 patients (42 eyes) scheduled for KPro surgery with a median follow-up period of 6 months. The receiver operating characteristic curve identified the cut-off threshold for CFF in the model development study (17 eyes). All patients in the comparison study (25 eyes) underwent preoperative assessments including trichromatic CFF (red, green and yellow), B-scan ultrasound, fVEP and perioperative endoscopy. Results were classified as either favourable or unfavourable predictors of visual outcomes based on predefined criteria. Sensitivity and specificity of each assessment were calculated based on postoperative best-corrected visual acuity (BCVA)≥20/200. The Bland-Altman test assessed the consistency between CFF-predicted BCVA and actual BCVA.</p><p><strong>Results: </strong>Among the trichromatic CFF tests, the yellow-CFF (yCFF) exhibited the highest area under the curve value of 0.97 and a cut-off threshold at 10 Hz for predicting postoperative BCVA≥20/200 (p<0.05). yCFF achieved 90% sensitivity and 80% specificity in predicting satisfactory postoperative outcomes. Endoscopy had 80% sensitivity and 80% specificity, B-scan showed 70% sensitivity and 60% specificity, and fVEP had 75% sensitivity and 40% specificity. yCFF showed a mean bias of 0.091 logarithm of the minimum angle of resolution (logMAR) in postoperative prediction.</p><p><strong>Conclusions: </strong>The CFF test provides robust visual function evaluation in KPro candidates. It demonstrates superior predictive accuracy for visual prognosis compared with routine ophthalmologic examinations, such as B-scan ultrasonography, fVEP and endoscopy.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"177-184"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between long-term statin use and cataract surgery: a nationwide study on 505 105 cataract surgery patients.","authors":"Andrim Halili, Saranda Haxha, Bochra Zareini, Casper Lund-Andersen, Kathrine Kold Sørensen, Christian Torp-Pedersen, Talip E Eroglu, Casper Niels Bang","doi":"10.1136/bjo-2022-322409","DOIUrl":"10.1136/bjo-2022-322409","url":null,"abstract":"<p><strong>Aims: </strong>To assess the association between statin use and cataract surgery according to different statin treatment durations in patients with different cardiovascular risk profiles.</p><p><strong>Methods and results: </strong>We performed a nested case-control study using Danish registries, covering the period from 1 January 1996 to 31 December 2020. We defined cases as surgically treated cataract patients, matched in a 1:1 ratio by sex and age with controls not undergoing cataract surgery. The exposure of interest was statin use in different durations (1, 5 and 10 years) compared with never use of statins. Conditional logistic regression provided adjusted HRs and corresponding 95% CIs in subgroups defined by established atherosclerotic cardiovascular disease, diabetes, hypertension and individuals without these comorbidities. We identified 505 150 cataract surgery cases and found no increased HR of cataract surgery with statin treatment at any duration in any of the subgroups with established atherosclerotic cardiovascular disease, diabetes or hypertension.</p><p><strong>Conclusion: </strong>Our findings do not support a possible association between long-term statin use and cataract in patients with established atherosclerotic cardiovascular disease, diabetes or hypertension. Although we found an association between statin use and cataract in individuals without these comorbidities, increasing durations of statin use did not yield higher cataract surgery rates.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"192-198"},"PeriodicalIF":3.7,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141757236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}