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Sharma A, Sharma R, Kulshreshta A, Nirankari V. Manual schism and intracameral air injection for impacted Descemet's membrane detachment. BMJ Case Rep 2023; 16:e253252. [PMID: 37586753 PMCID: PMC10432640 DOI: 10.1136/bcr-2022-253252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
A woman in her 60s was referred to us for management of poor vision following cataract surgery in the right eye. She had undergone manual small incision cataract surgery 12 weeks earlier. Slit-lamp biomicroscopy revealed corneal oedema, a horizontal line at the upper border and the adhered inferior border of detached Descemet's membrane (DM). Clinical diagnosis of impacted Descemet's membrane detachment (DMD) was considered.Surgical intervention with manual schisis and intracameral injection of air was planned. Using the 'push technique,' we tried to place the tip of the 27 gauge cannula between the back of the cornea and detached DM. The tip of the 27 gauge cannula was behind the impacted DM, and air injection was unsuccessful. Using the back-up the 'pull technique,' bent tip of the 27 gauge cannula was used to pull the impacted DMD. This manoeuvre, disimpacted the inferior border and the air bubble, was injected using the 27 gauge cannula. The air bubble unfolded and reattached the DM successfully.
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Affiliation(s)
- Ashok Sharma
- Ophthalmology, Dr Ashok Sharma's Cornea Centre, Chandigarh, UT, India
- Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, UT, India
| | - Rajan Sharma
- Cornea Service, Dr Ashok Sharma's Cornea Centre, Chandigarh, UT, India
| | - Ashish Kulshreshta
- Cornea Service, New Chandigarh Eye Hospital, New Chandigarh, Punjab, India
| | - Verinder Nirankari
- Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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A Simple Repair Algorithm for Descemet's Membrane Detachment Performed at the Slit Lamp. J Clin Med 2022; 11:jcm11237001. [PMID: 36498576 PMCID: PMC9741415 DOI: 10.3390/jcm11237001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Our study aims to investigate a simple repair algorithm for Descemet's membrane detachment (DMD) following phacoemulsification with Pentacam and anterior segment optical coherence tomography (AS-OCT). Twelve patients with DMD were included in this retrospective study. All cases had persistent corneal edema after phacoemulsification and no improved response to conservative treatment. The repair algorithm consisted of delineating the DMD with the Pentacam and AS-OCT, paracentesis, and intracameral air bubble performed at the slit lamp, followed by immediate supine position. At one month, the final status of Descemet's membrane (DM), best-corrected visual acuity, and incidence of complications were noted. DMD was involved in the visual axis in all cases. The mean interval between phacoemulsification and repair was 5.3 ± 1.2 days. Complete reattachment of DM and corneal clarity occurred in all 12 eyes. Eleven (91.7%) eyes underwent one repair procedure, while one eye (8.3%) underwent a repeat procedure. No adverse events were found. Minor post-intervention complications included temporary increased intraocular pressure due to pupillary block in one eye (8.3%). In conclusion, our modified and simplified repair algorithm for DMD can be performed safely as an outpatient procedure, with accurate delineation using a Pentacam and AS-OCT. It may provide new insight into the timely diagnosis, evaluation, and management of DMD.
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Three-Dimensional Map of Descemet Membrane Endothelial Keratoplasty Detachment. OPHTHALMOLOGY SCIENCE 2021; 1:100067. [PMID: 36275190 PMCID: PMC9562373 DOI: 10.1016/j.xops.2021.100067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
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Chow JY, Akhtar Ali AN, Bastion MLC. Pneumodescemetopexy With a Lower Concentration of Perfluoropropane (10% C3F8) in Descemet Membrane Detachment. Cureus 2021; 13:e16985. [PMID: 34527463 PMCID: PMC8421232 DOI: 10.7759/cureus.16985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/08/2022] Open
Abstract
A 75-year-old man with underlying left eye idiopathic orbital inflammatory disease and bilateral glaucoma suspect with cup disc ratio 0.7 underwent right eye phacoemulsification. Intraoperatively, Descemet tear and Descemet membrane detachment (DMD) occurred. Pneumodescemetopexy with air bubble was performed. His vision remained counting fingers and the cornea was oedematous three weeks after the operation. Anterior segment optical coherence tomography (ASOCT) showed extensive (80%) rhegmatogenous DMD with planar edge and a maximum of 460 micrometers separation from the stroma. Pneumodescemetopexy with low concentration perfluoropropane (10% C3F8) was performed together with postoperative positioning. On day five post-pneumodescemetopexy, his vision improved to 6/9, the cornea cleared with mild Descemet striae, and the gas bubble reduced to 30% fill. There was no DMD detected on ASOCT. His vision remained 6/9 and the residual gas bubble was 15% in the anterior chamber at two weeks post-pneumodescemetopexy. This case report suggests that pneumodescemetopexy with 10% C3F8 successfully reattached the large nonplanar rhegmatogenous DMD.
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Affiliation(s)
- Jun Yong Chow
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Ophthalmology, Hospital Tengku Ampuan Afzan, Kuantan, MYS
| | | | - Mae-Lynn Catherine Bastion
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Ophthalmology, Hospital Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
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Chung W, Jo YJ, Lee JS. Case Series of Descemet Membrane Detachment Associated with Cataract Surgery. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2021. [DOI: 10.3341/jkos.2021.62.6.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Keye P, Reinhard T, Maier P. [Treatment of Descemet's membrane detachment after cataract surgery : Successful visual recovery by repeated injection of air into the anterior chamber]. Ophthalmologe 2020; 117:700-703. [PMID: 32385551 DOI: 10.1007/s00347-020-01107-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Descemet's membrane detachment (DMD) is a rare complication following cataract surgery. The characteristic clinical sign is a severe persisting corneal edema early after surgery without spontaneous improvement. Descemet's membrane can sometimes be seen partially floating in the anterior chamber. Optical coherence tomography of the anterior segment can help to determine the extent of DMD. The decision to choose a conservative watch and wait approach or a surgical intervention depends on the height, length and extent of the detachment as well as the localization in relation to the optical axis. Detachments of greater extent require surgical treatment and the first line treatment should be descemetopexy by injection of air into the anterior chamber of the eye. Subsequently, regular controls are necessary as DMD may require repeated air injections until reattachment of Descemet's membrane is achieved and the cornea becomes clear again.
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Affiliation(s)
- Philip Keye
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland.
| | - Thomas Reinhard
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland
| | - Philip Maier
- Klinik für Augenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Kilianstr. 5, 79106, Freiburg, Deutschland
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Management of Descemet’s Membrane Detachment after Cataract Surgery—A Case Series. REPORTS 2020. [DOI: 10.3390/reports3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Descemet’s membrane detachment (DMD) is an uncommon, vision-threatening, ocular surface complication of cataract surgery. Among several treatment strategies, sulfur hexafluoride (SF6) descemetopexy is the standard of care. Herein, we report three cases of DMD after cataract surgery managed with SF6 descemetopexy, showing different outcomes. Anatomical success was achieved in cases 1 and 2 while intraocular pressure (IOP) was elevated in case 2. In case 3, despite SF6 descemetopexy, recurrent DMD was observed. Due to persistent corneal edema and possible corneal decompensation in case 3, Descemet’s stripping automated endothelial keratoplasty was performed and a clear graft was found at the final visit. In conclusion, descemetopexy with 20 % SF6 is an effective and safe procedure for repairing DMD in most cases. Pupillary block with elevated IOP is another concern and prophylactic peripheral iridectomy is recommended. For recurrent DMDs, repeat descemetopexy could be considered. However, close monitoring is advocated since secondary management, such as endothelial keratoplasty, may be required.
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Singhal D, Sahay P, Goel S, Asif MI, Maharana PK, Sharma N. Descemet membrane detachment. Surv Ophthalmol 2020; 65:279-293. [PMID: 31923476 DOI: 10.1016/j.survophthal.2019.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/27/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
Descemet membrane detachment (DMD) is a potential vision-threatening complication that occurs most commonly after cataract surgery. DMD has also been reported to occur in various other surgeries such as keratoplasty, iridectomy, vitrectomy, trabeculectomy, holmium laser sclerostomy, alkali burn, and viscocanalostomy. Major risk factors include advanced age, preexisting endothelial diseases like Fuchs dystrophy or abnormality in the Descemet membrane and stromal interface, hard cataract, prolonged surgical time, ragged clear corneal incisions, and inadvertent trauma with blunt instruments or phacoemulsification probe. Most DMDs are peripheral and resolve spontaneously. Large, central DMDs if not managed appropriately may lead to corneal decompensation and opacification. Several authors have classified DMD depending on its configuration, height, extent, length, and position with respect to pupil. Anterior segment optical coherence tomography has been used to confirm and classify DMD and can also aid in deciding the management plan. Spontaneous reattachment of the DM with conservative management may occur in cases with small, peripheral, planar DMD with nonscrolled edges. Cases with nonplanar, central DMD, scrolled edges, and length >2 mm, however, have to be managed surgically. Descemetopexy is the gold standard for the management of DMD. Other management options include mechanical tamponade, suture fixation, descemetotomy, interface drainage, and keratoplasty. Prompt diagnosis and timely management often leads to a good visual outcome.
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Affiliation(s)
- Deepali Singhal
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Siddhi Goel
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Mohamed Ibrahime Asif
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla K Maharana
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
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Sharma N, Singhal D, Nair SP, Sahay P, Sreeshankar SS, Maharana PK. Corneal edema after phacoemulsification. Indian J Ophthalmol 2017; 65:1381-1389. [PMID: 29208818 PMCID: PMC5742966 DOI: 10.4103/ijo.ijo_871_17] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Phacoemulsification is the most commonly performed cataract surgery in this era. With all the recent advances in investigations and management of cataract through phacoemulsification, most of the patients are able to achieve excellent visual outcome. Corneal edema after phacoemulsification in the immediate postoperative period often leads to patient dissatisfaction and worsening of outcome. Delayed onset corneal edema often warrants endothelial keratoplasty. This review highlights the etiopathogenesis, risk factors, and management of corneal edema in the acute phase including descemet's membrane detachment (DMD) and toxic anterior segment syndrome. Various investigative modalities such as pachymetry, specular microscopy, anterior segment optical coherence tomography, and confocal microscopy have been discussed briefly.
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Affiliation(s)
- Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Singhal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sreelakshmi P Nair
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Pranita Sahay
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - S S Sreeshankar
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Prafulla Kumar Maharana
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Weng Y, Ren YP, Zhang L, Huang XD, Shen-Tu XC. An alternative technique for Descemet's membrane detachment following phacoemulsification: case report and review of literature. BMC Ophthalmol 2017; 17:109. [PMID: 28662635 PMCID: PMC5492398 DOI: 10.1186/s12886-017-0506-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background Descemet’s membrane detachment (DMD) is one of the most serious complications of modern cataract surgery. We present an alternative technique for management of DMD with a review of the literature on current strategies for the treatment of DMD. Case presentation A 74-year-old woman developed DMD after phacoemulsification and failed the first descemetopexy with air tamponade. An alternative method was used to drain the pre-descematic fluid and reposition the detached Descemet’s membrane in this rare case. This technique involved completely filling the anterior chamber with an intracameral air injection, followed by using a 23-gauge needle to puncture the peripheral cornea to drain the pre-descematic fluid. The Descemet’s membrane was completely reattached to the stroma during the follow-up. Conclusions Drainage of pre-descematic fluid combined with intracameral air tamponading was used as an alternative surgical option for the management of this severe case of DMD.
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Affiliation(s)
- Yan Weng
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yu-Ping Ren
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.,Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing, 312000, China
| | - Li Zhang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xiao-Dan Huang
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Xing-Chao Shen-Tu
- Eye Center, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Abstract
PURPOSE OF REVIEW The review updates the mechanisms, clinical presentations, diagnoses, and managements of Descemet membrane detachment during cataract surgery. RECENT FINDINGS The advent of new imaging techniques such as anterior segment optical coherence tomography and better comprehension of the clinical and pathological aspects of detachment have improved the diagnosis and treatment of this complication to the extent that the first algorithms and protocols have been proposed. SUMMARY Though infrequent, Descemet membrane detachment is a complication of intraocular surgery, including cataract surgery and phacoemulsification. Since the first systematic description and classification in the literature by Samuels in 1928 and its characterization as a potential sight-threatening condition by Scheie in 1964, plenty of retrospective and anecdotal evidence contribute to uncertainty and debate. The main controversy still lies in the choice between conservative treatment in hopes of spontaneaous reattachment and surgical treatment in a timely manner to maximize visual recovery.
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Singh A, Vanathi M, Sahu S, Devi S. Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment. BMJ Case Rep 2017; 2017:bcr-2016-217268. [PMID: 28062421 DOI: 10.1136/bcr-2016-217268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Descemet's membrane detachment (DMD) though uncommon in the present day scenario of advancing surgical techniques is a significant complication that requires prompt diagnosis and management. A middle-aged man presented to our hospital with poor gain of vision following cataract surgery. There was significant corneal oedema with DMD which was confirmed on anterior segment optical coherence tomography. We describe a modified continuous intraoperative-guided approach for the management of DMD in cases with oedematous hazy corneas. The aim of this technique is to allow early reattachment of Descemet's membrane in chronic cases where fluid pockets prevent reattachment of the posterior layer of cornea. Our technique involves the use of full thickness stromal vent incisions in the paracentral cornea along with intracameral isoexpansile concentration of gas for the successful settlement of the detached Descemet's membrane.
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Affiliation(s)
- Archita Singh
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Murugesan Vanathi
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Suman Sahu
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Saranya Devi
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Datar S, Kelkar A, Jain AK, Kelkar J, Kelkar S, Gandhi P, Shah R, Kedia R. Repeat Descemetopexy after Descemet's Membrane Detachment following Phacoemulsification. Case Rep Ophthalmol 2014; 5:203-6. [PMID: 25126074 PMCID: PMC4130814 DOI: 10.1159/000365279] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of possible etiologies. Probably the commonest cause is a localized detachment occurring after cataract extraction surgery. Descemetopexy gives good anatomic attachment rates and visual outcomes and has become the standard treatment for DMD. However, in cases with failed initial descemetopexy, the next step in the management of such cases remains unclear. Before initiating a complex surgical procedure like keratoplasty, which requires good postoperative care and regular follow-ups, repeat descemetopexy with a long-term tamponade using 14% C3F8 gas for recurrent DMD is definitely a worthwhile attempt.
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Affiliation(s)
- Sameer Datar
- National Institute of Ophthalmology, Pune, India
| | | | | | - Jai Kelkar
- National Institute of Ophthalmology, Pune, India
| | | | | | - Rachna Shah
- National Institute of Ophthalmology, Pune, India
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Fan NW. Outcomes of repeat descemetopexy in post-cataract surgery descemet membrane detachment. Am J Ophthalmol 2014; 157:1330-1. [PMID: 24881848 DOI: 10.1016/j.ajo.2014.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 01/22/2014] [Accepted: 02/03/2014] [Indexed: 11/29/2022]
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