Hi everyone. I have what seems to be a traumatic mydriasis from blunt trauma to my right eye that happened back in the middle of December.
Middle of December I took a slapshot to the eye from a rigid PVC hockey ball (wasn't wearing a cage). I immediately lost vision in my right eye. I was rushed to the hospital and determined to have a hyphema. The only thing I could see was light. The next day, the doctors could not get an accurate pressure reading on my eye so they decided to perform an "exploration of the eye" surgery, and found out that I had no tears or ruptures. The day following the surgery, and this is a big part, I was checked out by the doctor and he said when he shined the light into my eyes, my pupil was reacting, so that was a great sign that my nerve was working. I was given Atropine to take 2x daily and Prodnolisone to take 4x daily. I am 25 years old, so you can gauge my healing capacity.
Since then, I was on bedrest for about 2 weeks, staying on the atropine during this time. I was seeing an opthalmologist every few days. The hyphema eventually reabsorbed and I regained vision in my eye. I d/c'd the atropine after 2 weeks of being on it, but stayed on prodnolisone for about another 2 weeks thereafter. About a month after the initial hit, now middle of December, I still had a mydriasis, probably around 8mm when compared to the chart. Bad photophobia, poor visual acuity, everything. I was prescribed Pilocarpine 1% to take 4x daily. Within the first dose of this, my pupil had constricted and I could see much more comfortably. I stayed on this for a week and upon dc'ing the pilocarpine, my pupil had gone back to full size within about 36 hours. I have been off all medication now since that time, seeing my doctor here in a week.
During the course, the doctors all thought I was still under the effects of Atropine, since there did not appear to be any tears in the iris muscle that were noticeable, and that was the best explanation for my very dilated pupil. Now that my entire history has been explained, is it POSSIBLE that since my pupil was reacting to light just 2 days after the surgery, and now doesn't react at all, that the atropine dilated the pupil beyond its normal range of travel and tore a muscle in the iris somewhere? I just don't understand how it was reacting to light initially after the trauma, but now is so unreactive and open. This has been an emotionally taxing ordeal and I'd like to understand where I go from here, or if the atropine may have caused me this permanent state of discomfort with my eye.
Thanks to anyone that can offer assistance, but if not, I hope any searchers with similar issues may be able to benefit from this post.
Wow!! Thank you and thank you. My 6 year old son like all the stories above suffered from traumatic hyphema Aug 24th and now looks like mydriasis.. This thread has given me hope!! Ordered vitamins will start the exercises and of course continue with the DR.. I feel smarter and prepared. So grateful
thanks John we have we were seeing the Dr every other day at first then moved to weekly and now every 2 weeks.... He was being monitored for pressure which has been ok throughout, tearing, we have been keeping him away from any sports for the last 5 weeks...
Exacly 20 days ago I was hit on my right eye and then I did all the required exams in ophto/neuro the result was.. traumatic mydriasis. My eye is answering to light, but not totally. No doctor knows if it will be permanent, all of them told me that is need to wait.. but, probably will be permanent. Even for glasses/lens/drop eyes to reduce the pupil size... is not recommended.
I almost fall in depression.
Reading this forum make me feel better and have some hope!
In 15 days I will check it up again with another ophto... and I hope at least some recommendation to use glass/lens to be able to see to my computer screen without blurred vision. I work with it.
My message is: no panic. In few days you will be able to see to light better, your brain has the power to be used to lots of bad conditions, like this one.
Discuss this with your ophthalmologist. There is a drop you can try without having to worry about the things I mentioned. It's called "Alphagan" its not as strong of constrictor as pilo but fewer side effects. See http://www.eyeworld.org/article.php?sid=1682
If that doesn't work you might discuss trying 0.5% pilocarpine or even 0.25% pilo which often works well in blue or grey eyes with this problem. (brown eyes require more medication to dilate or constrict).
I 've just tried Alphagan P and it really makes my pupil smaller (not so much as Pilo) but it is really better.
But my vision to a computer screen is still blurred. Is there a solution for it ?
I will try my 4th optho tomorrow, I hope he know it better than the other 3..
My last 3 ophot's diagnostic was:
1st - My eye and vision are OK; Not sure why pupil is dilated but he thinks that it may be a Sindrome XPTO caused by the hit
2nd - My eye and vision are OK; Not sure why pupil is dilated, just told me to see a neuro-ophto
3rd - My eye and vision are OK; Think that my pupil is dilated because the iris is demaged. Told me that there is nothing I can do, just used to live with this situation (what I think that is a very hard way to live... because I WORK with computers!)
Share your observations about the effect of Pilocarpine 1% and Alphagan-P with the 4th ophthalmologist. Ask the ophthalmologist if there is any reason you should not use pilocarpine. As I said you can try 0.5% or even 0.25% pilo. You may have trouble finding these and you may need a compounding pharmacist to dilute 1% Pilo down to that concentration. Also ask the ophthalmologist about wearing a bifocal with a reading prescription on the eye with the dilated pupil You can get no line progressive bifocals and no one will know you are wearing them.
I've just arrived from my 4th ophthalmologist and this one, despite told me that I'm his first patient of Traumatic Mydriasis, is very experienced and did lots of exams that the other one didnt. Basically, what he told me is everything that this post describe.
1. Didnt found any injury in sphincter muscle
2. Found a small damage in my iris
3. Allow me to use pilo and teach me how to diluite it
4. Told me that we can try colored lens if Pilo didnt results well
5. He didnt like the idea to use a Bifocal glasses
obs: he doesnt believe that it may recover, even with time. But he is not totally sure about it.
First of all, the use of pilo is good but hurts even for low concentrations. I will talk to my ophto about try tinted lens next week, I hope it can help me better than pilo - once I work with computers I really need something that make me forget my eye condition and keep my mind on my work - if possible, not blurred :-)
a) I have noticed that my pupil is bigger than before use Pilo when I wake up. I'm not sure about it, just looks like. Can it be related ?
b) As everybody here, I'm betting all my hope on the "six months for recovery" (I'm in the middle of my second one) so I have two sub-questions here:
1) Can it recovery - EVEN - when there is a small damage on iris (really small, hard to see, but there is) ?
2) The use of pilo can affect the recovery ?
c) The tinted colored lens Versus lens with pupil - what is the difference here ?
As you know, I'm glad to have you here driving us, despite I have a smart ophto now, his experience with Traumatic Mydriasis is not like yours.
No pilo should not make the pupil bigger after its worn off.
Yes it can get better, sometimes even look normal.
No pilo should not interfere with the recovery
I don't have any experience with pupil contact lens
* 2 months since the trauma
* No improvements was noticed but I think that photophobia decreases - may be because when I´m on sunlight, my pupil is almost the same size as the good eye's pupil / or my brain is used to.
* blurred vision to focus close is worse I guess
* I can work only with pilocarpine drops, 0.2% 3x for day - It hurts but it is the only way to go by now
** about the blurred vision **
* I tried with my ophto tinted contact lens with a pupil, but it does not work - as we are working together we have an idea about this failure attempt.. mydriasis should not be the only reason for the blurred vision: I told him that pilocarpine works while my pupil is a little dot, when it starts increasing it get blurred EVEN when the pupil size is equal as the good eye, so it is working good ONLY while the pupil size is very very small. He told me that pilocarpine has two effects: miosis and eye acommodation.
* Then he thinks that it may be an issue related to eye acommodation and we are going to try glasses
** Question **
what do you think about this situation? "Pupil size isnt the only reason for blurred vision; Eye acommodation is related too".
Hi John, I think that I didnt explain well my question.
The suggestion I´m studing is:
* Assumptions *
Pupil size: 1 (miosis), 2 (medium) and 3 (mydriasis)
* Flow *
1. I drop pilocarpine (0.2%) on my injuried eye
2. It starts to get better from 3 to 2 in 10 minutes
3. It get better for 30 mins in pupil size 2 and then an hour in pupil size 1
4. I noticed that it start get worse/blurred then (1.5 hours later) BUT the pupil size is 1 YET
So, the investigation suggest that it get better NOT only by the miosis effect and this is why Alphagan-P doesnt work for blurred vision despite it become the pupil size to 2 level!
What I mean is.. when I drop pilo in my eye, it work well in the first 1.5 hours and doesnt matter the pupil size!
I told it to my ophtalmo and he told me that it make sense because (according him) pilocarpine has other effect (over miosis) that is increase crystalline lens capacity what suggest that the problem to focus near may not be related only by the pupil size but mainly by the eye accommodation.
So, second him, an eyeglass to fix the eye accomodation could be the alternative to pilo.
Can I get clearead now? What you think about it?
Thank you, Doctor John.
It is getting exciting to know more about this condition and try to found a satisfactory solution to focus near (at least).
I was hit in the eye almost a month ago now (12th) by a hockey ball as well, ended with a Hyphema. I wasn't able to see anything, pupil wasn't moving.
I'm at the point now where I see very well, and I've had days where I've forgotten about the injury. My pupil remains lazy, and about 1mm larger than the other eye most times, but I'm pretty happy that it at least closes and opens. I also use a computer a lot, and it would be really really hard not be to able to focus so I'm thankful.
Outside of the pupil, I still have the odd focus issue? can't really tell what's off now, but I can tell something not there yet. That said, I believe have 20/20 vision (corrected) so that's awesome. On a side note, I've also been fighting dry eyelid weirdness. I've been keeping a small humidifier next to the computer.
Anyways, I go back for a 3rd visit on Tuesday to recheck the pressure. I was 19 a couple days after the injury, then jumped to 31 five days later after being on pred, and then was tested 8 days after that (2 days off pred) and I was down to 27. So hopefully its low now that its been a couple weeks. Fingers crossed for under 20.
I have been following this thread since 4 months. I am a badminton player and was hit on the eye almost 5 months ago. I lost my vision for almost 10 days because of hyphema. Besides high pressure, contaract, I am suffering most from the traumatic mydriasis. My pupil is big, 6-8 mm, it doesn't constrict and shows little or no reaction to lights. The most strange thing for me is, that my good eye on the other side shows a extremely small pupil 1-2 mm (kind of miosis), though I have no problem with vision or light reaction.
Is there any explanation for this?
@robsonvf: I am also living in Germany. Were you able to find a specialist, who is experienced with traumatic mydriasis?
Hi @dapeng, I dont live in germany, I live in Brazil. Unfortunately, I dont think that any MD could do much more than already mentioned in this thread, and see: I did LOTs of researches, I even tried a contact with specialist from USA (CEI - cincinnatti eye institute) and still this thread is the best source of info - he had recommended me the same thing people from this thread already recommended. So, think that you already have the most updated tools to treat it in your hands!
* but, of course, you need to be followed by a MD to check all the other conditions that may be related to the injury.
Did you tried any medicine ?
Alphagan-P has helped-me a lots, because it contricts a little my pupil in a state much more confortable (I think that it came from 7mm to 3 or 4mm with Alphagan-P) and it didnt hurts like the evil pilocarpine, and the time effect is also good: ~ 3 / 4 hours. Without pain.
I did try pilo but it shows no effect. I will ask my MD about Alphagen-P next time. My pressure went high again so I have to deal with the pressure problem at first. I have been off drops already twice. The last time, about 6 weeks without medicine. But somehow, the pressure goes high again. I will definitely give me some more time for a recovery before considering an operation.
Has anyone experience with printed iris lense. Can this kind of lense cause pressure problem?
yes, my injuried pupil reacts to light, but not as much as the good one - on sunny days, it is *almost* the same size with a small difference. If I see to the mirror very close I can notice some abnormality on my pupil, very little and looks like these abnormalities are blocking the full function of the pupil.
About your good pupil I have no idea what is happening, but I have read on this forum that the injuried eye cannot affect the other eye.
A did a quick search on google about this medicine and I found some studies that suggests that Cosopt can cause mydriasis. I think that you should take a look on
What about you, does your injuried pupil react to acommodation and/or light ? is your pupil a perfect circle or can you notice some abnormality ?
thanks for the valuable information you provided. Though my injured pupil is a perfect circle, it shows very little reaction to light and has a size of 6.8mm. The good pupil is only a bit bigger than 1mm under normal condition.
The 5 month since my injury is over and there hasn't been much improvement about the pupil size in this time. Nobody can really tell me whether the root cause is the nerve or the muscle.
I will talk with my doctor about the Cosopt, though I also tried many other types of drops such as Alphagan (not Alphagan P), Xalatan and Arutimol. Somehow I need to keep my pressure under control at first. Though my pressure was normal without drops (once for 3 weeks, second time for 6 weeks). But somehow the pressure went high again. If anyone would share his experience with the pressure problem, I highly appreciate it.
Co-sopt is extremely unlikely to cause any significant mydriasis. The reason dapeng eye pressure is high is not the mydriasis but "traumatic glaucoma" which often is associated with mydriasis but a seperate problem. Traumatic glaucoma is due to damage to the filtration angle of the eye and caused by what is called "angle recession"
if a pupil is not reacting to any medicine like pilo or alphagan-p, and no tears are present; does it suggests that the problem is related to the nerve instead of sphincter muscle?
for readers, an update from me:
* 3 months complete
* no visual/pupil size improvement since then
* last week was the best one since the injury, I could work without pain and walk on the street without sunglasses, photophobia is almost signed off.
I don't know whether this information is relevant. Directly after the injury, my pupil was big, but not as big as now. And I didn't get pilo, but only Cosopt and alphagen to reduce the pressure. Since the pressure still went high, I got an anterior chamber irrigation (hope it is the right name). After this operation, I got Pilo prescribed and my pupil size increased. After that, I kept using pilo for about 3-4 weeks with no effect.
My experience with traumatic mydriasis which is extensive is that whatever the size is at 4-6 months is permanent. The muscle (constrictor) does not have to be torn or visibly damaged. When the pressure in the eye goes high it can block off blood supply to that muscle and it can die (just like the heart muscle with a heart attack) and look normal but functionally be "dead"
This would also account for why your pupil did not respond to pilocarpine
All of the treatments have been discussed in this thread: 1. passage of time 2. alphagan-P 3. dilute concentrations of pilocarpine 4. contact lens with iris and pupil on them 5. "purse string" suture around the iris 6. artificial iris/pupil made by high quality German company Morcher NOT the cheap dangerous iris prosthesis made and implanced in Central/South America 7. accepting condition as is-wearing tinted or photochromic glasses e.g. Photogray.
I'm sure Dr. John has his reasons about the time related to this condition due to his extensive experience; but, 'usually' does not mean 'never'. There is many cases on this thread from people that recover full or partial from no light-reaction to light-reaction later several months (more than 6), even years, like the own thread's creator.
I dont know about you, but to fix my blurred vision I'm using now reading glasses, and it allows me to work just as before. I've had some troubles with headaches but it seems fine now, and see.. I living with mydriasis on the terrible south-america tropical summer. :)
Also, I'm sure that everyone's condition, despite the same diagnosis "traumatic mydriasis" is very individualized, and, for sample, today I'm bit better than you with less time, but you can recover fully while I not.
More, you still can try lots of treatments, and go with lenses with artificial iris or implanted-iris looks good for the future; and, congrats to you that this technology is from Germany, as you told me, you live there.
let us know your updates and experience with whatever you choice to treat it. You can call me in IM also, if you prefer.
I've got both a reading glass and an contact lense. With the reading glass, I have got a better vision for short distance (up to 50 cm), everything above that distance is more blurred. But for book- and screen reading, I thnk the reading glass does improve my vision. My problem is only, that after wearing the reading glass for 1 hour, the photophobia gets worse when I take off the glass.
Furthermore, I tried 2 contact lense, both have a positive diopter of 1.625 (my reading glass has 1.75. I hope we have the same unit system as in US). But somehow my vision is much more blurred when I put the contact lense in. It is much worse than without? Do you have any explanation for that? The plan was to get used to the contact lense at first, then get lense printed with a fixed iris on it. But with such a blurred vision, I am just not able to wear it for long time.
At your age you would expect the contact lens to blur your distance vision just like the reading glasses do. The reading glasses have a focal point that is clear. Anything further away will be blurred.
I don't know why your eye would be more photophobic unless your cornea was drying. When you do your near work (read, computer) every 10-15 minutes take the glasses off, focus far away (down the hall or out a window) and blink forcefully 4-5 times. It does two things: Stretch your focus muscle (ciliary body) and moisten your cornea.
You would have to wear a bifocal contact lens on the eye with the problem. The top of the lens for distance would presumably be zero and their would be a reading add that the fitter would probably be a littler stronger than the reading glasses you find helpful.
Dapeng, are you facing some pain in your neck, kind of stiff neck ? This is the only pain that still persists since Mydriasis... I think that due to my focus issue my head/concentration position is changed what may be the cause.
What are your main problems dealing with that (besides photophobia and near vision) and what you do to combat it ?
Usually its the same problem people have wearing bifocals and doing computer work. It's a chin up position when reading or doing near work. The chin up, eyes down position may aid focus some in the eye with traumatic mydriasis. It might be helped by reading glasses, full from for near or even bifocals of the progressive multifocal type
Hi John, thanks for your comment and all the other guidance on this thread.
I'm already with a reading prescription for the eye with Mydriasis (the other one is just with a clean len).. not using bifocal nor progressive. I still didnt found the root cause for the pains, it is happening even for the weekends (no work/wear glasses).
Hi John, I´m think that make sense it be *also* related to some cervical issue, I'll see a doctor to check this.
For readers, I'm now 4 months and a week since Mydriasis and life is really better than the first months. I think that due to this issue I got some worry about to "never more do things I used to" and then, I'm doing this much more often, lol.
Last days I've noticed an interesting improvement on pupil size (despite MDs told me that I have no tears on my pupil, I can notice an abnormal iris margin, what my own diagnostic suggests one or two tears which blocks the full-function (currently, partial function)) - I´m not sure whether this improvement is due to heavy-sun light (summer here in Brazil) or healing, but I think my pupil is now (under normal conditions) around 5mm (a month ago it was 7mm), while on sunny days it is 3mm.
for those who are using or would like to use Alphagan-P, I've noticed that it works better if you drop it in your injuried eye and go outside for several minutes, last weekend I did it and the effect and duration was really good: pupil down for 5+ hours in a "small size" 3~4mm.
congrats on your progress. I am really glad that you are on a good way of recovery. I hope you all the best.
I am still struggling with the mydriasis everyday, since it just won't get better. My pupil is about 6.6mm and there has been hardly any improvement in last months. The pupil is showing very small reaction to light, but it is very limited. The good eye has now a very small pupil (1.6mm). The pressure is also instable. The most frustrated thing is, that no one can tell me exactly, what is happening within my eyes.
I am trying to get Alphagen-P (must be imported, since it is not available in Germany) and also waiting for my iris print lens. I desperately would like to do things I used to do. But currently I am just not able to.
Hi dapeng, sorry to hear this. Dont understand me bad, I'm also fighting against mydriasis every single day yet, its very, very bad. I just found a way to live with this and I'm sure you will find too.
Honestly, I have no hope of full recovery for me, but once pain is signed-off, I can accept it as-is and life is going on.
Did you tried a neuro-ophtalmologist ? Sometimes I think that only an ophtalmo is not enough due to the limited experience with "not common things" like mydriasis, most of them (at least those I saw) are used to work with prescription glasses and related issues.
As Dr. John told, seems that in your case you are facing a kind of Glaucoma, did you tried some drop to handle this ?
I was not able to read all the recent comments of this thread but I was posting here 3 years ago during the time of my injury.
It's been 3 years since the injury and I believe that the damage of my eye would be forever. I have completed the medication but wasn't in regular visit to the doctor until recently.
I have my eye checked today and the Ophthalmologist said that the injured part had scarred and there is no way to treat it just like the scar we could have anywhere in the body.
My only complain was that when I have to look at the objects particularly words, the images in the part of the injured eye was like there's a glass in it and when I focus to smaller letter, it was covered by somewhat a white spot from my eye. There were also floaters which I am used to since the day of my injury.
According to the doctor, my eyes have no other defects. I even asked if I need glasses because I feel like I need one and he said "not at all" because when I covered one of my eye, the injured one looks nearer compared to the injured one.
This is really a total hassle but I teach myself to get use of it because if it's true that there's no way the scar be removed, then I would have it my lifetime. A fate.
I appreciate your comments in my situation and thank you very much for that.
Hi @badmintonlover, while you are waiting for Dr John response, I can offer my own experience on it once I have the same symptoms as you.
For me, since mydriasis, my issues are: worse near vision and headache. I fixed near vision only with glasses and see, I tried lots of things such as pilocarpine (so much disconfort, despite works), alphagan-p (small improvement) and glasses to fix the focus on the injuried eye: this worked. Today I can work only with glasses (I work with computers), without it, I think that is impossible.
Doctors, usually, dont know how is to live with this problem, for the most part of them (mainly those whom have no experience with traumatic mydriasis) just think that your pupil is greater and there is no other real problem.
I 've fixed my headache using a drug called "Indocid", very, very useful.
so, IMHO, glasses are TOO MUCH important in our situation.
do you have headache due to your mydriasis ? how to handle this?
what is your pupil size, does it respond to light?
In reading your post I am uncertain if the problem is due to your pupil still being dilated. If so some of the recent posts including robsonvf might be helpful. I cannot determine also where the scars are. Usually in traumatic mydriasis there are no visible scars. You symptoms suggest you might have a small scar in the macula.
I might suggest a second opinion, trial of glasses, amsler grid testing and perhaps macular OCT.
Actually, headache is absent and I believe the size of my pupil already gone back to normal size (if it's really) comparing it to the other. So far I can manage with any light situation. Sometimes when I am outside and the sun's at its peak it will cause me to feel uncomfortable. My main problem now is the distorted vision on that part of my eye plus the floaters are disgusting.
I am really thinking I need the glasses but the Oph did not suggest. There were times when I could no longer hold the discomfort, I have to put my hand sideways between my eyes to form a division. I'm in medication no more this time. It's like, the doctor's concluded that i have to live this way and get use to it since no more hope to eliminate the scarring on the injured part.
Thanks for your advice. Am too is thinking a second opinion and another set of check-ups and procedures. I will visit another doctor soon so that I can compare there stand on my situation. I was not able to ask where exactly the scarring is. I was hit by a shuttlecock bull's-eye then.
If there's no way out this could be remedied then I should have to accept the fact, live, and get use to it.
Make the best of your second opinion. Seek out the best Eye MD ophthalmologist you have access to. If possible take your old records. Ask specifically about glasses, traumatic cataract and macular pathology and if a macular OCT might be of benefit.
I need your advice again for following experience of mine. Last wek I was in ski vacation. The weather was good and I stayed outdoor the whole day with sun glasses. In the meantime, I started to drop Alphagan-P. My pupil gets noticeably smaller (at least 1mm) and stayed more or less small the whole week.
After returning from the vacation, where the weather is more rainy or cloudy, my pupil somehow gets bigger again, though I am still using Alphagan-P.
Do you have any idea, what could have made the difference?
The problem is not that your eye iris muscles are not working it's that they are not balanced and the muscle that makes the pupil smaller is considerably weaker than than the one in the other eye and not balanced with the dilator muscle in the injured eye.
I have no idea what "glamisolo" is. Pilo makes the pupil smaller but in younger people blurs the vision at distance. Adhesions of the iris to the lens is unlikely 1. they are usually easy to see 2. They give an irregular pupil that is teardrop shaped.
So its likely the pilo/glamisolo caused the blurred vision
I have recently had a blunt injury to the eye. I went immediately to the ER as I could not see for a couple of hours after the injury. I had mild hyphema. It has now been one month since the injury, and I am still on Predeferin Forte (twice a day). My pupil reacts to light, but very slowly.Could the steroid drop be causing the pupil to react slowly to light/mydriasis?
as i had a ruptured globe due to a metal wire penetrating my eye which left me aphakic, right now i am recovering from my second surgery where the doctors removed the silicone oil. I do not know the exact size of my pupil but i do know that I can not tolerate bright lights. my opthomogist has suggested that if my vision improves with a contact lens that I may not need any more surgeries but my concern is the possibility that i may have Mydriasis. i would prefer a permanent solution like and IOL, how complicated is to suture my iris if my doctor would perform the IOL surgery.
Depending on the status of your eye and your injury it may be very difficult. Plus if the pupil is made smaller with a "purse string" incision it will not dilate and it will be hard for the doctors to see and treat the back of your eye. You need to discuss with your retina surgeon and also get several opinions from cataract surgeons.
Hi John, since I got mydriasis, even using sunglasses, my injuried eye is a little bit red (let´s say it´s a eye: , the "-" chars are constantly red) and I noticed when I traveled during the night, driving for 5 hours, that it becomes too much red.
well, I´m sure it´s a result of mydriasis, but, what you think about it? there is a way to handle it ?
Redness is not a consistent part of dilated pupil syndrome. Since its only a little red I would suggest not doing anything except perhaps using an artificial tear. Whitening eye drops like Visine and Murine are not good for long term repeated use.
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