Pub Date : 2025-03-01Epub Date: 2024-08-14DOI: 10.4103/IJO.IJO_950_24
Indira Pegu, Rengaraj Venkatesh, Swati Upadhyaya
Surgical skill training in ophthalmology is pivotal for ensuring optimal and safe patient outcomes. Access to traditional training resources such as cadaveric or animal eyes, as well as modern alternatives such as silicone eyeballs and simulators, remains limited, especially in resource-constrained settings. We present a series of innovative and low-cost do-it-yourself (DIY) models for glaucoma training using readily available hospital waste materials. These models allow ophthalmic assistants, fellows, and junior consultants to practice various procedures before transitioning to live patients, thereby enhancing surgical proficiency and minimizing the financial burden on both trainees and training institutions. We were able to practice procedures such as tonometry, central corneal thickness measurement, laser suture lysis, laser iridotomy, anterior chamber decompression, bleb needling, trabeculectomy flap construction, and suturing. By providing a practical and easy training solution, these models have the potential to boost confidence among glaucoma trainees and thus address the growing demand for skilled glaucoma surgeons.
{"title":"Low-cost do-it-yourself (DIY) kit for glaucoma procedures.","authors":"Indira Pegu, Rengaraj Venkatesh, Swati Upadhyaya","doi":"10.4103/IJO.IJO_950_24","DOIUrl":"10.4103/IJO.IJO_950_24","url":null,"abstract":"<p><p>Surgical skill training in ophthalmology is pivotal for ensuring optimal and safe patient outcomes. Access to traditional training resources such as cadaveric or animal eyes, as well as modern alternatives such as silicone eyeballs and simulators, remains limited, especially in resource-constrained settings. We present a series of innovative and low-cost do-it-yourself (DIY) models for glaucoma training using readily available hospital waste materials. These models allow ophthalmic assistants, fellows, and junior consultants to practice various procedures before transitioning to live patients, thereby enhancing surgical proficiency and minimizing the financial burden on both trainees and training institutions. We were able to practice procedures such as tonometry, central corneal thickness measurement, laser suture lysis, laser iridotomy, anterior chamber decompression, bleb needling, trabeculectomy flap construction, and suturing. By providing a practical and easy training solution, these models have the potential to boost confidence among glaucoma trainees and thus address the growing demand for skilled glaucoma surgeons.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"S324-S326"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072644","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}
Purpose: To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG).
Methods: Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma.
Results: Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects ( r = 0.47, P < 0.01) and early POAG patients ( r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects ( P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls.
Conclusion: OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.
{"title":"Comparative evaluation of OCT with OCTA changes at the optic disc and macula in glaucoma suspect and early glaucoma.","authors":"Dewang Angmo, Anirudh Kapoor, Gazella B Warjri, Shorya Vardhan Azad, Rohan Chawla, Viney Gupta, Tanuj Dada","doi":"10.4103/IJO.IJO_2575_23","DOIUrl":"10.4103/IJO.IJO_2575_23","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the diagnostic ability of macular ganglion cell inner plexiform layer (mGCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness on optical coherence tomography (OCT) and macular and peripapillary perfusion changes using OCT angiography (OCTA) in glaucoma suspect and early primary open angle glaucoma (POAG).</p><p><strong>Methods: </strong>Ninety patients (30 normal, 30 glaucoma suspects, and 30 early POAG) were recruited in this cross-sectional, prospective study. The average thickness of mGCIPL and pRNFL on spectral domain-OCT and macular vessel density (VD), optic nerve head (ONH) perfusion, and ONH flux index (FI) on OCTA were evaluated for early diagnosis of glaucoma.</p><p><strong>Results: </strong>Macular VD, ONH perfusion, and ONH FI were significantly reduced in early POAG eyes compared to normal. The best correlation was observed between ONH FI and the average RNFL in both glaucoma suspects ( r = 0.47, P < 0.01) and early POAG patients ( r = 0.53, P < 0.01). Out of all the measured OCTA parameters, only ONH perfusion was significantly lower in glaucomatous eyes compared to glaucoma suspects ( P < 0.001). Average GCIPL (0.82) and macular VD (0.76) had the highest area under the receiver operating characteristic (AUROC) curve value among all the OCT and OCTA parameters, respectively, for differentiating glaucoma suspects from controls. Rim area (0.92) and ONH FI (0.81) had the highest AUROC value among all the OCT and OCTA parameters for differentiating early POAG patients from controls.</p><p><strong>Conclusion: </strong>OCTA vascular parameters had a good correlation with structural damage both at the disc and the macula. OCT parameters were superior to OCTA parameters for diagnosis of glaucoma, although OCTA parameters are deranged very early in the disease.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"S260-S266"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499470","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":"Early outcomes of bent ab interno needle goniectomy and Espaillat goniotomy with phacoemulsification in open-angle glaucoma.","authors":"Devendra Maheshwari, Madhavi Ramanatha Pillai, Shweta Ranjiv Dev, Nimrita Gyanchand Nagdev, Rengappa Ramakrishnan","doi":"10.4103/IJO.IJO_2078_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2078_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S352-S353"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467897","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}
Pub Date : 2025-03-01Epub Date: 2025-02-21DOI: 10.4103/IJO.IJO_1233_24
Arshi Singh, Kirti Singh, Aastha Singh
The success of trabeculectomy surgery depends on the longevity of the filtering bleb. Bleb failure can be categorized into two types: the scarred bleb with high intraocular pressure or the over-filtering and leaking bleb with low intraocular pressure. Bleb scarring is an insidious process over time as a consequence of excessive subconjunctival fibrosis. Timely recognition and early intervention utilizing a stepped-up approach are important for resuscitating the bleb and salvaging the trabeculectomy. Over-filtration and leaky bleb on the other end of the spectrum lead to failure of optimal bleb function and require a different management approach. This review discusses in detail various surgical techniques to revive dysfunctional blebs with a special focus on bleb needling. Timely identification and multifaceted management of bleb-related complications is the key to ultimately improving long-term success rates and patient outcomes.
{"title":"Bleb resuscitation of failing, leaking and dysfunctional blebs: A review.","authors":"Arshi Singh, Kirti Singh, Aastha Singh","doi":"10.4103/IJO.IJO_1233_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1233_24","url":null,"abstract":"<p><p>The success of trabeculectomy surgery depends on the longevity of the filtering bleb. Bleb failure can be categorized into two types: the scarred bleb with high intraocular pressure or the over-filtering and leaking bleb with low intraocular pressure. Bleb scarring is an insidious process over time as a consequence of excessive subconjunctival fibrosis. Timely recognition and early intervention utilizing a stepped-up approach are important for resuscitating the bleb and salvaging the trabeculectomy. Over-filtration and leaky bleb on the other end of the spectrum lead to failure of optimal bleb function and require a different management approach. This review discusses in detail various surgical techniques to revive dysfunctional blebs with a special focus on bleb needling. Timely identification and multifaceted management of bleb-related complications is the key to ultimately improving long-term success rates and patient outcomes.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S197-S206"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467887","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}
Pub Date : 2025-03-01Epub Date: 2025-02-26DOI: 10.4103/IJO.IJO_1315_24
Ayushi Choudhary, Gaurang Sehgal, Chaitra Jayadev, Nagesha C Krishnappa
Sutured scleral fixation of intraocular lenses (SSFIOL) is a stable technique with a low risk of dislocation either from suture dehiscence (suture breakage or loosening) or suture erosion (suture degradation or wear), making it a reliable and durable option for intraocular lenses (IOL) fixation. Dislocation of rigid IOLs is managed conventionally by removing the IOL through a large sclerocorneal section and refixing the same lens or tucking another IOL into the sclera. The procedure described here is a modified ab-externo 4-exit 2-knot technique, wherein the dislocated SSFIOL can be refixated with a closed globe maneuver without removing the entire IOL. The eyelet of the haptic is exteriorized through a small limbal incision, and sutures are replaced at both ends. The IOLs refixated using this technique showed good centration postoperatively. Closed globe refixation of rigid IOLs can be easily performed with minimal or no complications. Minimal tissue handling and early postoperative recovery are advantages over conventional IOL removal and re-surgery.
{"title":"Modified ab-externo scleral fixation method for dislocated scleral fixated intraocular lenses.","authors":"Ayushi Choudhary, Gaurang Sehgal, Chaitra Jayadev, Nagesha C Krishnappa","doi":"10.4103/IJO.IJO_1315_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1315_24","url":null,"abstract":"<p><p>Sutured scleral fixation of intraocular lenses (SSFIOL) is a stable technique with a low risk of dislocation either from suture dehiscence (suture breakage or loosening) or suture erosion (suture degradation or wear), making it a reliable and durable option for intraocular lenses (IOL) fixation. Dislocation of rigid IOLs is managed conventionally by removing the IOL through a large sclerocorneal section and refixing the same lens or tucking another IOL into the sclera. The procedure described here is a modified ab-externo 4-exit 2-knot technique, wherein the dislocated SSFIOL can be refixated with a closed globe maneuver without removing the entire IOL. The eyelet of the haptic is exteriorized through a small limbal incision, and sutures are replaced at both ends. The IOLs refixated using this technique showed good centration postoperatively. Closed globe refixation of rigid IOLs can be easily performed with minimal or no complications. Minimal tissue handling and early postoperative recovery are advantages over conventional IOL removal and re-surgery.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 3","pages":"450-454"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143500625","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}
Pub Date : 2025-03-01Epub Date: 2025-02-21DOI: 10.4103/IJO.IJO_2258_24
Zeba Khanam, Bhawesh Chandra Saha, Aditya Rajan
{"title":"Comment on \"Outcomes of bent ab interno needle goniectomy with phacoemulsification in moderate to severe primary open angle glaucoma\".","authors":"Zeba Khanam, Bhawesh Chandra Saha, Aditya Rajan","doi":"10.4103/IJO.IJO_2258_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2258_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S347"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467889","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}
Pub Date : 2025-03-01Epub Date: 2025-02-21DOI: 10.4103/IJO.IJO_2943_24
Arnav Panigrahi, Viney Gupta, Shikha Gupta
The role of glaucoma drainage devices (GDDs) for refractory glaucoma is well established because of certain advantages offered over conventional filtering surgeries. However, the correct plane of placement of the GDD tube inside an eye with an opaque cornea can be challenging, due to poor intra-operative visualization. These cases are also challenging if they undergo subsequent corneal grafting. In cases with presence of totally opaque cornea precluding tube visualization within the anterior chamber, we describe a novel technique for ensuring the correct positioning of a GDD tube.
{"title":"Intraoperative tube placement in opaque corneas: The illuminated tube.","authors":"Arnav Panigrahi, Viney Gupta, Shikha Gupta","doi":"10.4103/IJO.IJO_2943_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2943_24","url":null,"abstract":"<p><p>The role of glaucoma drainage devices (GDDs) for refractory glaucoma is well established because of certain advantages offered over conventional filtering surgeries. However, the correct plane of placement of the GDD tube inside an eye with an opaque cornea can be challenging, due to poor intra-operative visualization. These cases are also challenging if they undergo subsequent corneal grafting. In cases with presence of totally opaque cornea precluding tube visualization within the anterior chamber, we describe a novel technique for ensuring the correct positioning of a GDD tube.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S339-S340"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467902","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}
Purpose: To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients.
Design: Retrospective observational study.
Methods: Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions.
Results: Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction ( P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively ( P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout.
Conclusion: NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.
{"title":"Outcomes of non-penetrating deep sclerectomy combined with mitomycin C in advanced open-angle glaucoma in Indian eyes.","authors":"Devendra Maheshwari, Rinkal Goyal, Madhavi Ramanatha Pillai, Shivam Gupta, Drishti Chautani, Rengappa Ramakrishnan","doi":"10.4103/IJO.IJO_1257_24","DOIUrl":"10.4103/IJO.IJO_1257_24","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the safety and efficacy of non-penetrating deep sclerectomy (NPDS) in advanced open-angle glaucoma patients.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>Forty-two eyes of 38 patients with advanced glaucoma who underwent NPDS surgery combined with mitomycin-C with or without phacoemulsification were evaluated for up to 12 months at a tertiary eye care center in South India. Patients with intraoperative perforation of the trabeculo-Descemet membrane who did not meet the follow-up criteria were excluded. The primary outcome measured was intraocular pressure (IOP) reduction postoperatively on day 1, week 2, and months 1, 3, 6, and 12. The secondary outcomes measured were the need for antiglaucoma medications (AGMs), postoperative complications, and interventions.</p><p><strong>Results: </strong>Patients enrolled had a mean age of 61.08 ± 10.2 years. There was a statistically significant reduction ( P < 0.001) of IOP from 29.48 ± 10.89 mmHg (baseline) to 11.58 ± 6.29, 11.90 ± 5.99, 13.60 ± 7.06, 14.03 ± 8.00, 13.94 ± 4.65, and 13.19 ± 3.29 mmHg at day 1, week 2, and months 1, 3, 6, and 12, respectively. The number of AGMs reduced from 3.14 ± 1.03 preoperatively to 1.85 ± 0.83 at 12 months postoperatively ( P < 0.001). Nd: YAG laser goniopuncture was done in 21.4%, bleb needling in 11.9%, and one patient underwent 260° trabeculotomy after NPDS. There were no cases of choroidal detachment or wipeout.</p><p><strong>Conclusion: </strong>NPDS with or without phacoemulsification has good safety for managing advanced open-angle glaucoma.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"S214-S219"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894113","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":"Commentary on: Role of selective laser trabeculoplasty in India.","authors":"Geeta Behera, Karthikeyan Mahalingam, Subashini Kaliaperumal","doi":"10.4103/IJO.IJO_2575_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2575_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S225-S226"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467891","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}
Pub Date : 2025-03-01Epub Date: 2025-02-21DOI: 10.4103/IJO.IJO_2538_24
Viney Gupta
{"title":"Goniodysgenesis and glaucoma: A perspective worth revisiting.","authors":"Viney Gupta","doi":"10.4103/IJO.IJO_2538_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2538_24","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 Suppl 2","pages":"S187-S188"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467898","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}