Oculoplastics and Orbit: Aesthetic and Functional Oculofacial Plastic Problem-Solving in the 21st Century

240 Pages·2010·29.96 MB·English

by  Timothy J Sullivan (auth.)

Essentials in Ophthalmology Oculoplastics and Orbit
R. F. Guthoff J. A. Katowitz
Editors
Essentials in Ophthalmology Glaucoma
G. K. Krieglstein R. N. Weinreb Cataract and Refractive Surgery
Series Editors
Uveitis and Immunological Disorders
Vitreo-retinal Surgery
Medical Retina
Oculoplastics and Orbit
Pediatric Ophthalmology,
Neuro-Ophthalmology, Genetics
Cornea and External Eye Disease
Editors Rudolf F. Guthoff
James A. Katowitz
Oculoplastics
and Orbit
Aesthetic and Functional
Oculofacial Plastic
Problem-Solving
in the 21st Century
With 181 Figures, Mostly in Colour
and 18 Tables
Series Editors Volume Editors
Günter K. Krieglstein, MD Rudolf F. Guthoff , MD
Professor and Chairman Professor of Ophthalmology
Department of Ophthalmology University of Rostock
University of Cologne Department of Ophthalmology
Joseph-Stelzmann-Straße 9 Doberaner Straße 140
50931 Köln 18055 Rostock
Germany Germany
James A. Katowitz, MD
Robert N. Weinreb, MD
Professor of Ophthalmology
Professor and Director
Children’s Hospital of Philadelphia
Hamilton Glaucoma Center
R. D. Wood Ambulatory Care Building
Department of Ophthalmology – 0946
Division of Ophthalmology
University of California at San Diego
34th Street Civic Center Blvd.
9500 Gilman Drive
Philadelphia, PA 19104
La Jolla, CA 92093-0946
USA
USA
ISBN: 978-3-540-85541-5 e-ISBN: 978-3-540-85542-2
DOI: 10.1007/978-3-540-85542-2
Library of Congress Control Number: 2009933987
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Foreword
Th e Essentials in Ophthalmology series represents an ership acceptance of the fi rst two series, each of eight
unique updating publication on the progress in all sub- volumes. Th is is a success that was made possible pre-
specialties of ophthalmology. dominantly by the numerous opinion-leading authors
In a quarterly rhythm, eight issues are published cov- and the outstanding section editors, as well as with the
ering clinically relevant achievements in the whole fi eld constructive support of the publisher. Th ere are many
of ophthalmology. Th is timely transfer of advancements good reasons to continue andstill improve the dissemina-
for the best possible care of our eye patients has proven to tion of this didactic and clinically relevant information.
be eff ective. Th e initial working hypothesis of providing
new knowledge immediately following publication in the
peer-reviewed journal and not waiting for the textbook
appears to be highly workable. G.K. Krieglstein
We are now in the third cycle of the Essentials in R.N. Weinreb
Ophthalmology series, having been encouraged by read- Series Editors
Preface
Th is third volume of Oculoplastic and Orbital Surgery Appearance issues are also discussed in relation to
promises to challenge the reader with stimulating new managing ophthalmic anomalies in congenital ano-
concepts at the cutting edge of this subspecialty. A variety phthalmic and microphthalmic patients. Controversies in
of innovative techniques is described in this volume, cov- enucleation techniques, implant selection, and implant
ering both cosmetic and functional aspects of oculoplas- preparation are presented, and the role of pegging an
tic and orbital surgery. implant to ultimately improve prosthesis motility is criti-
Pearls in cosmetic and oculofacialplastic surgery are cally evaluated.
presented in great detail, based on extensive experience. It is our hope, as with the previous two volumes, that
Rather than presenting merely anecdotal solutions, spe- this presentation of the latest concepts and management
cifi c steps are outlined for problem solving in this rapidly techniques for a variety of problem areas in the fi eld of
evolving fi eld. oculoplastic surgery will be of value for both comprehen-
Th e latest therapies in the management of capillary sive ophthalmologists and subspecialists with a particular
hemangiomas, periorbital infections, and orbital and interest in this fi eld.
periorbital malignancies using specifi c targeted therapies
demonstrate the increasingly important interaction
between ophthalmic plastic surgery and the broad fi eld of Rudolf F. Guthoff
modern oncology. James A. Katowitz
Contents
Chapter 1 2.4.4 Upper Blepharoplasty Surgical
Ocular Adnexal Lymphoproliferative Disease Procedure Pearls . . . . . . . . . . . . . . . . . . . . . . . 30
Timothy J. Sullivan 2.5 Lower Blepharoplasty, Fillers,
and Midface Augmentation . . . . . . . . . . . . 33
1.1 Pathogenesis . . . . . . . . . . . . . . . . . . . . . . . . . . 2 2.5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
1.2 Chronic Antigen Stimulation . . . . . . . . . . . 3 2.5.2 Patient Evaluation. . . . . . . . . . . . . . . . . . . . . . 33
1.3 Immunosuppression . . . . . . . . . . . . . . . . . . . 3 2.5.3 Lower Blepharoplasty
1.4 Pathology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Anesthesia Pearls . . . . . . . . . . . . . . . . . . . . . . 37
1.5 Cytogenetics. . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2.5.4 Lower Blepharoplasty Surgical
1.6 Clinical Features. . . . . . . . . . . . . . . . . . . . . . . . 7 Procedure Pearls . . . . . . . . . . . . . . . . . . . . . . . 38
1.7 Imaging Findings . . . . . . . . . . . . . . . . . . . . . . 8 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
1.8 Staging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.9 Positron Emission Tomography . . . . . . . . . 9
Chapter 3
1.10 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Current Concepts in the Management
1.11 Follicular Lymphoma. . . . . . . . . . . . . . . . . . . 11 of Idiopathic Orbital Infl ammation
1.12 Mantle Cell Lymphoma. . . . . . . . . . . . . . . . . 11
Katherine A. Lane and Jurij R. Bilyk
1.13 Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.14 Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . 12 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
1.15 Immunotherapy. . . . . . . . . . . . . . . . . . . . . . . . 12 3.2 What Is the Diagnosis? . . . . . . . . . . . . . . . . . 47
1.16 Radioimmunotherapy. . . . . . . . . . . . . . . . . . 13 3.2.1 Pitfalls of Diagnosis. . . . . . . . . . . . . . . . . . . . . 48
1.17 Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.2.2 A Diagnostic Corticosteroid Trial? . . . . . . . 54
1.18 The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 3.2.3 The Question of Biopsy. . . . . . . . . . . . . . . . . 56
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 3.3 Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
3.3.1 Corticosteroids. . . . . . . . . . . . . . . . . . . . . . . . . 57
Chapter 2 3.3.2 Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Pearls in Cosmetic Oculofacial Plastic Surgery 3.3.3 Other Agents . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Jonathan A. Hoenig 3.4 Special Circumstances. . . . . . . . . . . . . . . . . . 60
3.4.1 Pediatric IOIS. . . . . . . . . . . . . . . . . . . . . . . . . . . 60
2.1 General Introduction. . . . . . . . . . . . . . . . . . . 21
3.4.2 Sclerosing Pseudotumor . . . . . . . . . . . . . . . 60
2.2 The Aging Process and Facial Analysis. . . 22
3.4.3 Tolosa–Hunt Syndrome. . . . . . . . . . . . . . . . . 62
2.3 Endoscopic Brow Lift. . . . . . . . . . . . . . . . . . . 23
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
2.3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.3.2 Endoscopic Browlift Anesthesia Pearls. . . . 26
Chapter 4
2.3.3 Endoscopic Browlift Surgical
Lacrimal Canalicular Infl ammation and Occlusion:
Procedure Pearls . . . . . . . . . . . . . . . . . . . . . . . 26
Diagnosis and Management
2.3.4 Endoscopic Browlift Postoperative
David H. Verity and Geoff rey E. Rose
Care Pearls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.4 Upper Blepharoplasty . . . . . . . . . . . . . . . . . . 29 4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
2.4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.2 Embryology, Anatomy, Physiology,
2.4.2 Patient Evaluation. . . . . . . . . . . . . . . . . . . . . . 29 and Pathophysiology of the Canalicular
2.4.3 Upper Blepharoplasty System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Anesthesia Pearls . . . . . . . . . . . . . . . . . . . . . . 30 4.3 Infective Causes. . . . . . . . . . . . . . . . . . . . . . . . 69
x Contents
4.3.1 Periocular Herpes Simplex Infection . . . . 69 5.7.3.1 The Upper Eyelid. . . . . . . . . . . . . . . . . . . . . . . 85
4.3.2 Bacterial Canaliculitis. . . . . . . . . . . . . . . . . . . 70 5.7.3.2 The Lower Eyelid and Midface . . . . . . . . . . 85
4.4 Systemic Infl ammatory Disease. . . . . . . . . 70 5.7.4 Orbital Involvement. . . . . . . . . . . . . . . . . . . . 86
4.4.1 Lichen Planus . . . . . . . . . . . . . . . . . . . . . . . . . . 70 5.7.4.1 Proptosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
4.4.2 Ocular Cicatricial Pemphigoid . . . . . . . . . . 70 5.7.4.2 Proptosis Due to Orbital
4.4.3 Drug Eruptions (Stevens–Johnson Neurofi bromas. . . . . . . . . . . . . . . . . . . . . . . . . 87
Syndrome). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 5.7.4.3 Proptosis Due to Optic Nerve Glioma . . . 87
4.5 Iatrogenic Causes . . . . . . . . . . . . . . . . . . . . . . 71 5.7.4.4 Orbital Enlargement with Dystopia
4.5.1 Systemic Drugs . . . . . . . . . . . . . . . . . . . . . . . . 71 and Hypoglobus . . . . . . . . . . . . . . . . . . . . . . . 87
4.5.1.1 5-Fluorouracil (5-FU) . . . . . . . . . . . . . . . . . . . 71 5.8 The Natural History of NF1 Tumor
4.5.1.2 Docetaxel (Taxotere) . . . . . . . . . . . . . . . . . . . 72 Growth from Birth to Senescence. . . . . . . 90
4.5.2 Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . 72 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
4.5.3 Topical Ophthalmic Treatments. . . . . . . . . 73
4.5.3.1 Preservative-Related Chronic Chapter 6
Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Clinicopathologic Features of Lesions
Aff ecting the Lacrimal Drainage System
4.5.3.2 Mitomycin C Therapy. . . . . . . . . . . . . . . . . . . 73
in External Dacryocystorhinostomy
4.5.4 Lacrimal Stents and Plugs . . . . . . . . . . . . . . 73
4.6 The Surgical Approach to Managing Ludwig M. Heindl, Anselm G. M. Jünemann,
Canalicular Disease. . . . . . . . . . . . . . . . . . . . . 74 and Leonard M. Holbach
4.6.1 Surgical Technique for
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Dacryocystorhinostomy with
6.2 Surgical Anatomy of the Lacrimal
Retrograde Canaliculostomy. . . . . . . . . . . . 74
Drainage System. . . . . . . . . . . . . . . . . . . . . . . 96
4.6.2 Placement of a Jones Canalicular
6.3 Basic Diagnostics for Disorders
Bypass Tube. . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
of the Lacrimal Drainage System. . . . . . . . 97
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
6.4 Selective Lacrimal Sac Biopsy
in External Dacryocystorhinostomy. . . . . 97
Chapter 5
6.5 Defi nitive Treatment and Prognosis
Orbitofacial Neurofi bromatosis 1:
of Lesions Aff ecting the Lacrimal
Current Medical and Surgical Management
Drainage System. . . . . . . . . . . . . . . . . . . . . . . 99
William R. Katowitz and James A. Katowitz
6.5.1 Case A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.5.2 Case B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
5.2 Nomenclature. . . . . . . . . . . . . . . . . . . . . . . . . . 79 6.5.3 Case C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5.3 Clinical Manifestations of NF1 . . . . . . . . . . 79 6.5.4 Case D. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5.4 Orbitofacial Tumors in NF1 . . . . . . . . . . . . . 80 6.5.5 Case E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.4.1 Neurofi bromas. . . . . . . . . . . . . . . . . . . . . . . . . 80 6.5.6 Case F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
5.4.2 Malignant Peripheral Nerve 6.5.7 Case G . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
Sheath Tumors. . . . . . . . . . . . . . . . . . . . . . . . . 81 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
5.4.3 Optic Pathway Gliomas. . . . . . . . . . . . . . . . . 81
Chapter 7
5.5 Genetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Systemic and Ophthalmic Anomalies
5.5.1 The NF1 Gene. . . . . . . . . . . . . . . . . . . . . . . . . . 83
in Congenital Anophthalmic
5.5.2 Overlapping NF1-Like Phenotype
or Microphthalmic Patients
(SPRED1). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Michael P. Schittkowski and Rudolf F. Guthoff
5.6 Management of Neurofi bromatosis
Type 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
5.6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.2 Patients and Methods . . . . . . . . . . . . . . . . . . 106
5.6.2 Medical Management of 7.2.1 Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Neurofi bromas. . . . . . . . . . . . . . . . . . . . . . . . . 84 7.2.2 Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
5.7 Surgical Management of Orbitofacial 7.3 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Tumors in NF1 . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.3.1 Patient Data. . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
5.7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 7.3.2 Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
5.7.2 Timing of Surgery . . . . . . . . . . . . . . . . . . . . . . 84 7.3.3 Family History. . . . . . . . . . . . . . . . . . . . . . . . . . 106
5.7.3 Periorbital Involvement . . . . . . . . . . . . . . . . 85 7.3.4 Pregnancy History. . . . . . . . . . . . . . . . . . . . . . 107
Contents xi
7.3.5 Birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8.4.1.1 Nonautogenous Materials. . . . . . . . . . . . . . 121
7.3.6 Associated Systemic and 8.4.1.2 Autogenous Fascia Lata . . . . . . . . . . . . . . . . 121
Ocular Diseases . . . . . . . . . . . . . . . . . . . . . . . . 107 8.4.2 Our Technique of Harvesting
7.3.7 Developmental Anomaly and Autogenous Fascia Lata . . . . . . . . . . . . . . . . 121
Potential Visual Capacity of the 8.4.3 Mechanical Principals of Brow
Fellow Eye in Unilateral Disease. . . . . . . . . 110 Suspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
7.3.8 Neuroradiological Findings (Brain MRI). . 111 8.4.4 Upper Lid Approach. . . . . . . . . . . . . . . . . . . . 122
7.3.9 Nasolacrimal System Findings . . . . . . . . . . 111 8.4.5 Fascia Implantation . . . . . . . . . . . . . . . . . . . . 122
7.4 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
7.4.1 Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Chapter 9
7.4.2 Obstetric and Family History. . . . . . . . . . . . 112
Modern Concepts in Orbital Imaging
7.4.3 Associated Pathologies. . . . . . . . . . . . . . . . . 113
7.4.3.1 Ophthalmological Findings Jonathan J. Dutton
in Unilateral Disease. . . . . . . . . . . . . . . . . . . . 113
9.1 Computerized Tomography . . . . . . . . . . . . 125
7.4.3.2 Neuroradiological Findings. . . . . . . . . . . . . 113
9.2 Three-Dimensional Imaging. . . . . . . . . . . . 129
7.4.3.3 Systemic Diseases. . . . . . . . . . . . . . . . . . . . . . 114
9.3 Magnetic Resonance Imaging . . . . . . . . . . 129
7.4.3.4 Nasolacrimal Duct Findings. . . . . . . . . . . . . 114
9.3.1 The T1 Constant. . . . . . . . . . . . . . . . . . . . . . . . 130
7.5 Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
9.3.2 The T2 Constant. . . . . . . . . . . . . . . . . . . . . . . . 131
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
9.3.3 Creating the MR Image. . . . . . . . . . . . . . . . . 131
9.4 Imaging of Common Orbital
Chapter 8
Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Brow Suspension in Complicated Unilateral
9.4.1 Adenoid Cystic Carcinoma. . . . . . . . . . . . . . 134
Ptosis: Frontalis Muscle Stimulation via
9.4.2 Cavernous Hemangioma . . . . . . . . . . . . . . . 134
Contralateral Levator Recession
9.4.3 Dermoid Cyst . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Markus F. Pfeiff er
9.4.4 Fibrous Dysplasia . . . . . . . . . . . . . . . . . . . . . . 135
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 9.4.5 Lymphangioma . . . . . . . . . . . . . . . . . . . . . . . . 136
8.2 Evaluation of Complicated Ptosis . . . . . . . 117 9.4.6 Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
8.2.1 Compensatory Eyebrow Elevation . . . . . . 117 9.4.7 Myositis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
8.2.2 Examples of Complicated Unilateral 9.4.8 Optic Nerve Glioma . . . . . . . . . . . . . . . . . . . . 138
Ptosis with Insuffi cient Compensatory 9.4.9 Pseudotumor . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Brow Elevation. . . . . . . . . . . . . . . . . . . . . . . . . 118 9.4.10 Rhabdomyosarcoma . . . . . . . . . . . . . . . . . . . 139
8.2.3 Innervation Patterns of the Frontalis 9.5 Diff usion MRI (Diff usion-Weighted
Muscle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Imaging). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
8.2.4 Checklist of Preoperative Evaluation 9.6 Positron Emission Tomography . . . . . . . . . 141
of Complicated Ptosis . . . . . . . . . . . . . . . . . . 118 9.7 Orbital Ultrasound . . . . . . . . . . . . . . . . . . . . . 142
8.2.5 Planning Partial or Total Levator 9.7.1 Physics and Instrumentation. . . . . . . . . . . . 142
Muscle Recession Combined with 9.7.1.1 Topographic Echography. . . . . . . . . . . . . . . 143
Unilateral or Bilateral Brow 9.7.1.2 Quantitative Echography. . . . . . . . . . . . . . . 143
Suspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 9.7.1.3 Kinetic Echography. . . . . . . . . . . . . . . . . . . . . 143
8.3 Surgical Technique of Levator Muscle 9.7.2 Extraocular Muscles . . . . . . . . . . . . . . . . . . . . 145
Recession. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.7.3 Optic Nerves. . . . . . . . . . . . . . . . . . . . . . . . . . . 146
8.3.1 Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
8.3.2 Approach to the Levator. . . . . . . . . . . . . . . . 119
Chapter 10
8.3.3 Partial Levator Recession . . . . . . . . . . . . . . . 119
Management of Periorbital Cellulitis
8.3.4 Total Levator Recession. . . . . . . . . . . . . . . . . 119
in the 21st Century
8.3.5 The Lid-Lowering Eff ect and Eyelid
Michael P. Rabinowitz and Scott M. Goldstein
Symmetry: Evolution of the Eyelid
Level After Levator Recession. . . . . . . . . . . 121 10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
8.3.6 Undercorrection and Overcorrection. . . . 121 10.2 The Infection: Stages, Symptoms,
8.4 Surgical Technique of Brow and Eff ects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Suspension . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 10.3 Etiology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
8.4.1 Materials for Brow Suspension. . . . . . . . . . 121 10.4 Microbiology. . . . . . . . . . . . . . . . . . . . . . . . . . . 151