Case Reports in Ophthalmological Medicine最新文献

{"title":"Sudden Vision Loss Secondary to Optic Nerve Infiltration as a Presenting Symptom of Metastatic Lung Adenocarcinoma.","authors":"M M Shamim,&nbsp;M Whaley,&nbsp;H Rana,&nbsp;S K Jeffus,&nbsp;S Bhatti,&nbsp;A B Sallam","doi":"10.1155/2022/3614225","DOIUrl":"https://doi.org/10.1155/2022/3614225","url":null,"abstract":"<p><strong>Purpose: </strong>To report a rare case of left-sided metastatic optic nerve infiltration and right-sided choroidal mass with exudative retinal detachment caused by EGFR exon 19 deletion positive non-small-cell lung adenocarcinoma that responded to targeted therapy with osimertinib (EGFR-TKI). Our patient demonstrated an excellent response with reduced size of the metastatic choroidal mass of the right orbit and improved visual acuity, in addition to systemic disease control.</p><p><strong>Case: </strong>A 66-year-old male patient with a history of diabetes mellitus, hypertension, and tobacco use presented with sudden vision loss in the left eye secondary to optic nerve infiltration and subacute vision loss in the right eye secondary to exudative retinal detachment from a choroidal metastasis. He was found to have a right lung mass, multiple metastatic pulmonary nodules, and liver and bone metastases. Biopsy from a mediastinal lymph node confirmed the diagnosis of metastatic lung adenocarcinoma. He was found to have exon 19 deletion on next-generation sequencing. We treated him with local radiation therapy to the left eye and systemic osimertinib (EGFR-TKI).</p><p><strong>Conclusion: </strong>To our knowledge, our case is the first report of a patient who initially presented with acute vision loss and was found to have metastatic retrobulbar optic nerve infiltration in one eye and metastatic choroidal lesion with exudative retinal detachment in the fellow eye secondary to lung adenocarcinoma. Due to the rarity of this condition, literature regarding effective treatment is scarce. Our patient demonstrated significant improvement in visual acuity and resolution of exudative retinal detachment in the right eye following osimertinib treatment and radiation therapy to the left eye. Further investigation into the role of tyrosine kinase inhibitors and radiation therapy in treating intraocular metastasis involving the optic nerve is needed.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"3614225"},"PeriodicalIF":0.9,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40697691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Imaging and Macular Hyalocyte Count in a Patient with Acute Macular Neuroretinopathy.","authors":"Michael J Schatz,&nbsp;Oscar Otero-Marquez,&nbsp;Richard B Rosen,&nbsp;Deep Parikh","doi":"10.1155/2022/2855191","DOIUrl":"https://doi.org/10.1155/2022/2855191","url":null,"abstract":"<p><p>Though rare, acute macular neuroretinopathy is a well-described clinical entity. We report for the first time a detailed analysis of macular hyalocyte count and morphology during the acute phase of acute macular neuroretinopathy. We present a case of a 19-year-old man with bilateral acute onset paracentral scotomas in the setting of an antecedent viral infection. Multimodal imaging demonstrated classic features of acute macular neuroretinopathy. Further analysis revealed increased macular hyalocyte count and an activated hyalocyte morphology during the acute phase of the disease course. Multimodal imaging not only allows for greater confidence in a diagnosis and prognosis but also helps to shed light on underlying pathophysiology. The new clinical capability of monitoring cellular behavior, such as hyalocyte count and morphology, in physiological and pathological conditions may prove useful as biomarkers of early disease activity or response to therapy.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"2855191"},"PeriodicalIF":0.9,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40679357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cyclodialysis Clefts following Microinvasive Glaucoma Surgery with Consecutive Intraocular Pressure Spikes.","authors":"Ahmed Alshaikhsalama,&nbsp;Niraj Nathan","doi":"10.1155/2022/7595507","DOIUrl":"https://doi.org/10.1155/2022/7595507","url":null,"abstract":"<p><p>The purpose of this study is to report a case of cyclodialysis clefts associated with microinvasive glaucoma surgery (MIGS) having two distinct consecutive IOP spikes during cleft closure. A 65-year-old female with a history of primary open angle glaucoma was evaluated for right eye blurry vision since cataract surgery 11 months prior. She reported a MIGS procedure that resulted in a cyclodialysis cleft, with resultant hypotony without resolution. On gonioscopy, two clock hours of widened angle were noted nasally, with small clefts (0.5 clock hour) inferonasally and superonasally. Conservative therapy with cycloplegia was unsuccessful. Argon laser photocoagulation was performed for cleft closure. Initially, while there was visible improvement in the cleft size, it did not close completely, and IOP remained low. Additional laser was performed, one week following, she presented with an acute IOP increase to 55 mmHg. On gonioscopy, it was noted that despite the IOP spike indicating inferonasal closure, the superonasal cleft remained small but open. She was started on IOP-lowering therapy. Her IOP normalized shortly thereafter. Two weeks later, she experienced another acute IOP spike to 54 mmHg. On gonioscopy, the residual cleft had closed. Again, her IOP normalized shortly after and has remained normal since. While IOP spikes after cyclodialysis cleft closure have been reported many times, two consecutive IOP spikes of similar magnitude during sequential closure of two concurrent cyclodialysis clefts have not been reported in the literature. This case raises interesting questions about the physiology underlying an acute increase in IOP following cleft closure.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"7595507"},"PeriodicalIF":0.9,"publicationDate":"2022-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40656876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Cat Scratch Disease with Neuroretinitis in a 16-Month-Old Boy.","authors":"Daisuke Nakata,&nbsp;Sayaka Kakehi,&nbsp;Hiroshi Okada,&nbsp;Atsuhiro Tanikawa,&nbsp;Yoshiaki Shimada,&nbsp;Masayuki Horiguchi,&nbsp;Yasuki Ito","doi":"10.1155/2022/2841683","DOIUrl":"https://doi.org/10.1155/2022/2841683","url":null,"abstract":"<p><strong>Purpose: </strong>We report a case of neuroretinitis associated with cat scratch disease (CSD) in young children.</p><p><strong>Method: </strong>Case report.</p><p><strong>Results: </strong>A 16-month-old boy was admitted for a detailed examination and treatment of a fever of unknown origin. Blood tests revealed no significant findings other than a white blood cell count of 16,100/mm³ and C-reactive protein level of 9.89 mg/dL. Computed tomography revealed no relevant findings to determine the causative disease. Antibiotic therapy with cefotaxime was initiated; however, the fever did not resolve. The patient was referred to our department for further examination to detect the cause of the fever. Fundoscopy revealed neuroretinitis in the right eye. His mother reported a history of breeding cats. Cat scratch disease (CSD) was suspected based on the clinical course and fundus findings. Cefotaxime was discontinued, and azithromycin, rifampicin, and prednisolone were administered, following which the fever disappeared and fundus findings improved. Immunoglobulin G (IgG) and IgM antibodies against <i>Bartonella henselae</i> was positive, leading to a definitive diagnosis of CSD.</p><p><strong>Conclusion: </strong>Infants cannot complain of decreased visual acuity; therefore, these findings may be overlooked unless a fundus examination is performed. As in this case, the early detection of neuroretinitis by an ophthalmologist may help in the diagnosis of CSD. It is extremely difficult to capture a photograph of the fundus of an infant, and recording with a smartphone is relatively simple and useful for monitoring continuous changes. <i>Summary</i>. We describe a case of neuroretinitis associated with cat scratch disease (CSD) that was diagnosed on the basis of fundus findings. The findings suggest the importance of an aggressive ophthalmologic examination when CSD is suspected in young children who are unable to describe their symptoms.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"2841683"},"PeriodicalIF":0.9,"publicationDate":"2022-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9584725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40565938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral Granulomatous Iridocyclitis Associated with Early-Onset Juvenile Psoriatic Arthritis.","authors":"Christian Nieves-Ríos,&nbsp;Guillermo A Requejo Figueroa,&nbsp;Sofía C Ayala Rodríguez,&nbsp;Alejandra Santiago-Díaz,&nbsp;Eduardo J Rodriguez-Garcia,&nbsp;Alejandro L Perez,&nbsp;Erick Rivera-Grana,&nbsp;Adriana C Figueroa-Díaz,&nbsp;Rafael Martín-García,&nbsp;Armando L Oliver","doi":"10.1155/2022/3990406","DOIUrl":"https://doi.org/10.1155/2022/3990406","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to report on a case of bilateral granulomatous iridocyclitis in a patient with early-onset juvenile psoriatic arthritis (JPsA).</p><p><strong>Methods: </strong>The method used is an observational case report. <i>Observations</i>. A 3-year-old Hispanic girl was sent to our uveitis service for further evaluation of her granulomatous uveitis. The initial ophthalmologic examination revealed bilateral band keratopathy, large mutton-fat keratic precipitates, multiple posterior synechiae, and 4+ anterior chamber cells. The physical exam was notable for left knee edema and right axillary rash. Laboratory testing was remarkable for an erythrocyte sedimentation rate of 80 mm/h, positive antinuclear antibodies (1 : 1, 280), and negative human leukocyte antigen B27. A cutaneous biopsy was obtained, which confirmed the diagnosis of a psoriatic rash. Treatment with oral prednisolone and topical prednisolone acetate with atropine sulfate resulted in the complete resolution of the uveitis. <i>Conclusion and Importance</i>. Bilateral granulomatous iridocyclitis may be a rare presentation of ocular involvement in patients with early-onset JPsA.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"3990406"},"PeriodicalIF":0.9,"publicationDate":"2022-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9568322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33515808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unprompted Closure of Spontaneous Macular Hole Secondary to Retained Subfoveal Perfluorocarbon Liquid.","authors":"Hamouda Hamdy Ghoraba,&nbsp;Hashem Hamouda Ghoraba,&nbsp;Adel Galal Zaky","doi":"10.1155/2022/5306029","DOIUrl":"https://doi.org/10.1155/2022/5306029","url":null,"abstract":"<p><strong>Purpose: </strong>To report unprompted closure of spontaneous macular hole secondary to inadvertent subfoveal perfluorocarbon liquid (PFCL) after vitrectomy surgery. <i>Observations</i>. We present a case of a retained large single subfoveal PFCL droplet following vitrectomy and silicone oil injection for subtotal rhegmatogenous retinal detachment that showed spontaneous release 3 weeks postoperatively, with subsequent development of full thickness macular hole (FTMH) which completely closed later on after silicone oil removal without internal limiting membrane peeling with marvelous anatomic and visual improvement after spontaneous closure of MH.</p><p><strong>Conclusions: </strong>Different fates of subfoveal PFCL droplets may happen. Spontaneous release of subfoveal PFCL without surgical interference has rarely been reported.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"5306029"},"PeriodicalIF":0.9,"publicationDate":"2022-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9529480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33489863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis: Cataract Surgery.","authors":"Sofie Van der Auwera,&nbsp;Oscar Kallay","doi":"10.1155/2022/7404138","DOIUrl":"https://doi.org/10.1155/2022/7404138","url":null,"abstract":"<p><strong>Purpose: </strong>We present the first case described in the literature of cataract surgery in a patient with stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF).</p><p><strong>Methods: </strong>In this case report, we describe the extensive workup we did on our patient, including optical coherence tomography, fundus autofluorescence, fluo-angiography, full field electroretinogram, and genetic testing. We moreover describe the cataract surgery with clear lens extraction and implanting of a multifocal implant.</p><p><strong>Results: </strong>The refractive and lifestyle profile of our patient made implantation of multifocal intraocular implants the only solution for this case. During preoperative measurements, a SNIF diagnosis was suspected after optic coherence tomography imaging which led to an even more extensive workup of our patient and the diagnosis of stellate nonhereditary idiopathic foveomacular retinoschisis. We then proceeded to cataract surgery, which was performed safely and without any sequellae.</p><p><strong>Conclusion: </strong>Stellate nonhereditary idiopathic foveomacular retinoschisis (SNIF) is a relatively new disease entity. Only few cases in the literature describe this disease, and none of them describe cataract surgery in a patient with SNIF. We therefore describe the first known cataract surgery in such a case. Long term follow-up results show that the procedure can be performed safely. <i>Summary Statement</i>. We hereby present the first case described in the literature of cataract surgery of a patient diagnosed with stellate nonhereditary idiopathic foveomacular retinoschisis. A clear lens extraction with implantation of a multifocal intraocular implant was conducted with excellent postoperative results and a happy patient.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"7404138"},"PeriodicalIF":0.9,"publicationDate":"2022-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9481406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40368266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Focal Choroidal Excavation with Macular Hole in a Patient with Alagille Syndrome.","authors":"Manami Misawa,&nbsp;Hironobu Tampo,&nbsp;Shinji Makino","doi":"10.1155/2022/8136115","DOIUrl":"https://doi.org/10.1155/2022/8136115","url":null,"abstract":"<p><p>This study is aimed at reporting a rare and unusual focal choroidal excavation with a macular hole in a patient with Alagille syndrome (AGS). A 21-year-old woman with an established early-life AGS diagnosis was referred to our hospital prior to liver transplantation. Examination revealed best-corrected visual acuity of 16/20 and 20/20 in the right and left eye, respectively. Slit-lamp examination was positive for posterior embryotoxon in both eyes. Fundoscopy revealed diffuse choroidal hypopigmentation with increased visibility of the choroidal blood vessels and circumferential chorioretinal atrophy in the mid-peripheral and peripheral retina in both eyes. A full-thickness macular hole with underlying focal choroidal excavation was observed in the right eye. Optical coherence tomography through the macula confirmed choroidal excavation with a full-thickness macular hole in the right eye. To our knowledge, this is the first report describing focal choroidal excavation with a macular hole in an AGS patient.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"8136115"},"PeriodicalIF":0.9,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9467701/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40359237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Streptococcus mitis/oralis</i> Corneal Ulcer in a Patient with Severe Rheumatoid Arthritis: An Unusual Route.","authors":"Mustafa Jaffry,&nbsp;Mark Lister","doi":"10.1155/2022/5245620","DOIUrl":"https://doi.org/10.1155/2022/5245620","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of Streptococcus mitis oralis (<i>S. mitis/oralis</i>) corneal ulcer in a patient with a possible preventable cause.</p><p><strong>Methods: </strong>Cultures were obtained from a 64-year-old woman with a 3.5 mm × 5 mm corneal ulcer with hypopyon in the left eye.</p><p><strong>Results: </strong>Culture reports demonstrated the growth of S<i>. mitis/oralis</i>, a commensal organism of the oral flora. Fortified vancomycin 5% eye drops were started, and the patient was counseled on the rarity of the bacteria as an etiology of corneal ulcers. On the return visit, the patient, who works in a doctor's office, volunteered information that the preservative free artificial tear vials that she used were difficult to open because of her hand deformity due to rheumatoid arthritis; thus, she had to bite the vials open.</p><p><strong>Conclusions: </strong><i>S. mitis/oralis</i> is an organism commonly found in the mouth but is rarely found in the eye. We report a unique case of an immunocompromised patient with rheumatoid arthritis, severe dry eye, and a history of multiple episodes of keratolysis, who developed a corneal ulcer from a rare pathogen, with a plausible and preventable route of infection.</p>","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"5245620"},"PeriodicalIF":0.9,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9398851/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33437898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Hydrops with Total Corneal Edema in a Very Young Child with Keratoconus: The Youngest Age Reported Case.","authors":"Mohammad-Reza Sedaghat,&nbsp;Hamed Momeni-Moghaddam,&nbsp;Michael W Belin,&nbsp;Maryam Savardashtaki,&nbsp;Shehzad A Naroo,&nbsp;Hassan Robabi","doi":"10.1155/2022/2381703","DOIUrl":"https://doi.org/10.1155/2022/2381703","url":null,"abstract":"Purpose To present the youngest age ever reported for acute corneal hydrops with total corneal edema in a child with advanced bilateral keratoconus. Methods Patient presentation in ophthalmic clinic. The patient underwent various clinical tests and examinations including anterior segment optical coherence tomography (AS-OCT) and Scheimpflug corneal tomography. Results A 5-year-old girl presented with uncorrected distance visual acuity (UDVA) of 0.4 in the right eye and nonmeasurable UDVA associated with severe photophobia in her left eye of a 3-day duration. Intraocular pressure using the iCare tonometer was 14 and 5 mmHg in the right and left eyes, respectively. An old corneal hydrops scar and posterior subcapsular cataract (PSC) in the right eye and a total limbus to limbus corneal hydrops in the left eye were observed on slit-lamp examinations. Scheimpflug corneal tomography was possible in the right eye but, due to excessive irregularity and scaring, was not possible in the left eye. Corneal thinning and scarring were evident in the anterior segment optical coherence tomography in the right eye and very edematous cornea associated with stromal cleft and epithelial bullae in the left eye. A management plan consisting of topical hypertonic solution and ointment was started to reduce her symptoms. Conclusion Acute corneal hydrops may be the presenting sign of keratoconus; however, extensive hydrops involving the total cornea area at a very young age is very rare and has not been previously reported in the literature.","PeriodicalId":9603,"journal":{"name":"Case Reports in Ophthalmological Medicine","volume":" ","pages":"2381703"},"PeriodicalIF":0.9,"publicationDate":"2022-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40713324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}