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BMC Ophthalmol 2018 Sep 14;18(Suppl 1):229. Epub 2018 Sep 14.

Princess Alexandra Eye Pavilion, Edinburgh, Scotland.

Background: We present a case of aphakic pupil block caused by vitreous prolapse into the anterior chamber following Nd:YAG capsulotomy.

Case Presentation: This resulted in advanced glaucoma in a young patient, which presented a significant clinical management challenge.

Conclusions: Ultimately, at the time of writing, her intraocular pressure and uveitis were well controlled, however the long-term outcome remains uncertain, given the uncompromising natural history of her complicated ocular condition. Read More

J Cataract Refract Surg 2017 May;43(5):639-642

From the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China.

Purpose: To describe secondary pigment dispersion syndrome (PDS) and pigmentary glaucoma after secondary sulcus transscleral fixation of 1-piece hydrophobic acrylic foldable posterior chamber intraocular lenses (PC IOLs) in aphakic patients in a Chinese population.

Setting: Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao, China.

Design: Retrospective case series. Read More

BMC Ophthalmol 2016 May 17;16(1):58. Epub 2016 May 17.

Department of Ophthalmology, Eye and Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.

Background: Aphakic glaucoma is a common complication after congenital cataract extraction, especially in those who have surgery during infancy. This case report describes a case of bilateral pupillary block glaucoma diagnosed with intraoperative ultrasound biomicroscopy (UBM) after removal of congenital cataract.

Case Presentation: We present a case report of a 9-month-old infant with bilateral corneal enlargement and ocular hypertension after uneventful removal of congenital cataracts. Read More

J AAPOS 2016 06 2;20(3):247-51. Epub 2016 May 2.

Department of Ophthalmology, Children's University Hospital Temple Street, Dublin, Ireland. Electronic address:

Purpose: To describe the long-term incidence of retinal detachment, intra- and postoperative complications, and visual and refractive outcomes of children with Marfan syndrome following lensectomy for ectopia lentis, with or without subsequent correction of aphakia using the Artisan aphakic iris-fixated anterior chamber intraocular lens.

Methods: The medical records of children treated at the Department of Ophthalmology, Children's University Hospital, Dublin, Ireland, from January 1, 1991, to December 31, 2011, were retrospectively reviewed. The primary outcome measure was rate of retinal detachment at final follow-up. Read More

Medicine (Baltimore) 2015 Aug;94(31):e1248

From the Department of Ophthalmology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Uveitic glaucoma (UG) is secondary glaucoma, present as a clinical challenge in both diagnosis and management.We report a case of complex UG, which initially presented as pupillary block and rupture of the anterior lens capsule. We performed cataract extraction with preservation of posterior capsule. Read More

J AAPOS 2015 Jun;19(3):242-6

Ophthalmology Department, Faculty of Medicine, Cairo University & Research Institute of Ophthalmology, Cairo, Egypt.

Purpose: To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support.

Methods: In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth <3 mm, central endothelial cell density (CECD) <2500 cells/mm(²), uncontrolled glaucoma, or uveitis were excluded. Read More

JAMA Ophthalmol 2015 Feb 12;133(2):e141821. Epub 2015 Feb 12.

Br J Ophthalmol 2014 Sep 29;98(9):1291-5. Epub 2014 Apr 29.

Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Purpose: To evaluate clinical outcomes and complications after Descemet membrane endothelial keratoplasty (DMEK) and posterior iris-claw aphakic intraocular lens (IOL) implantation.

Methods: This prospective cohort study comprised seven consecutive eyes (seven patients) without adequate capsular support and bullous keratopathy undergoing posterior iris-claw aphakic IOL implantation and DMEK. Corneal transparency, central corneal thickness, endothelial cell density, visual outcomes and complication rates were measured during the follow-up. Read More

Int Ophthalmol 2015 Apr 12;35(2):233-40. Epub 2014 Apr 12.

Cornea, Cataract and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, 110029, India,

The purpose of this study was to describe a modified technique of sutureless DSAEK with continuous pressurized internal air tamponade. This was a prospective interventional case series, single-center, institutional study. Twenty-seven patients with corneal decompensation without scarring were included. Read More

Br J Ophthalmol 2014 May 31;98(5):658-63. Epub 2014 Jan 31.

Department of Cornea and Refractive Surgery, Instituto Microcirugia Ocular, , Barcelona, Spain.

Background/aims: To evaluate the efficacy, predictability, safety and complications of secondary iris-claw intraocular lens (IOL) implantation in aphakic eyes without capsular support.

Methods: Retrospective, non-comparative, interventional case series of 128 aphakic eyes, which consecutively underwent secondary iris-claw Artisan IOL (Ophtec BV) implantation, were included. Manifest refraction, uncorrected visual acuity, best-spectacle corrected visual acuity, biomicroscopy, tonometry, funduscopy and central endothelial cell count (cECC) were evaluated before surgery, and at yearly intervals up to 5 years. Read More

Int Ophthalmol 2014 Aug 1;34(4):913-7. Epub 2013 Oct 1.

Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin Square, 1336616351, Tehran, Iran,

Closure of the peripheral iridectomy (PI) may lead to forward displacement of silicone oil (SO) in some but not all SO-filled aphakic eyes. In this study, we report three patients with a history of a combined three-port pars plana vitrectomy and cataract surgery, SO injection and inferior PI who underwent laser retinopexy a few months postoperatively. The postoperative courses of these patients were unremarkable except for the closure of the PI without anterior displacement of SO; however, a few hours after laser therapy the SO was displaced to the anterior chamber, leading to acute glaucoma in one of the cases. Read More

Am J Ophthalmol 2013 Aug 27;156(2):382-386.e1. Epub 2013 May 27.

Department of Ophthalmology, Charité, University Medicine Berlin, Berlin, Germany.

Purpose: To evaluate the indications, visual outcomes, and complication rate after posterior implantation of an iris-claw aphakic intraocular lens (IOL) in children.

Design: Noncomparative retrospective cohort study.

Methods: setting: Institutional practice. Read More

Graefes Arch Clin Exp Ophthalmol 2013 Jun 29;251(6):1557-63. Epub 2013 Jan 29.

Department of Ophthalmology, China Medical University Hospital, No. 2, Yuh Der Road, Taichung, Taiwan.

Background: To describe a scleral indentation technique to enhance donor adherence in Descemet's stripping and automated endothelial keratoplasty (DSAEK) in patients with abnormal anterior segment.

Methods: In patients with visual potential, we performed transscleral fixation of a foldable intraocular lens (IOL) and DSAEK. In patients only for pain relief, we performed DSAEK without IOL implantation. Read More

Ophthalmic Surg Lasers Imaging 2010 Mar 9:1-3. Epub 2010 Mar 9.

Pupillary block is seen after pars plana vitrectomy (PPV) with gas or silicone oil endotamponade in aphakic eyes. A case of a pseudophakic patient with pupillary block glaucoma related to the migration of air into the anterior chamber was reported. A 76-year-old woman underwent combined PPV with air endotamponade and uncomplicated cataract extraction for epiretinal membrane and cataract. Read More

Cornea 2009 Jul;28(6):652-6

From the Cornea, Cataract, and External Disease Service, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.

Purpose: To report secondary angle closure caused by air migrating behind the pupil in the context of intraocular pressure (IOP) elevation in the early postoperative period after Descemet stripping endothelial keratoplasty (DSEK).

Methods: A retrospective case series was conducted on 100 consecutive DSEK cases from 90 patients undergoing DSEK because of corneal disease from Fuchs corneal dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, and iridocorneal endothelial syndrome. Preoperative and postoperative slit-lamp examinations and IOP measurements were ascertained for all 100 eyes. Read More

Cornea 2009 Feb;28(2):157-62

From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: To determine the efficacy and postoperative complications of complex deep lamellar endothelial keratoplasty (DLEK) when used for the management of complex bullous keratopathy with severe vision loss.

Methods: Twelve consecutive eyes with severe bullous keratopathy and other associated intraocular abnormalities underwent complex DLEK which was combined with other intraocular surgeries such as vitrectomy, intraocular lens removal, and secondary intraocular lens implantation. An air bubble was used in 9 eyes and an air and C3F8 gas bubble in 3 eyes for tissue support. Read More

Arch Ophthalmol 2008 Oct;126(10):1351-6

Department of Ophthalmology, University Hospital Maastricht, Maastricht, the Netherlands.

Objective: To evaluate the preliminary visual results of femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK).

Methods: We prospectively analyzed results of 20 consecutive patients with Fuchs endothelial dystrophy or aphakic/pseudophakic bullous keratopathy who underwent FS-DSEK. Best spectacle-corrected visual acuity (BSCVA), refraction, corneal topography, and endothelial cell density were measured preoperatively and 3 and 6 months after FS-DSEK. Read More

Int Ophthalmol 2008 Jun;28(3):191-207

Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242-1091, USA.

Glaucoma after penetrating keratoplasty is a frequently observed post-operative complication and is a risk factor for graft failure. Penetrating keratoplasty performed for aphakic and pseudophakic bullous keratopathy and inflammatory conditions are more likely to cause postoperative glaucoma compared with keratoconus and Fuchs' endothelial dystrophy. The intraocular pressure elevation may occur immediately after surgery or in the early to late postoperative period. Read More

Ophthalmology 2008 Sep 18;115(9):1517-24. Epub 2008 Apr 18.

Division of Cornea and External Diseases, Bascom Palmer Eye Institute, University of Miami, Miami, Florida 33418, USA.

Purpose: To compile a survey of complications during and after Descemet's stripping with automated endothelial keratoplasty (DSAEK) in 118 eyes conducted by cornea subspecialists at a single academic center.

Design: Retrospective case series.

Participants: One hundred eighteen eyes undergoing DSAEK in 99 patients. Read More

Ophthalmology 2007 Oct 29;114(10):1839-41. Epub 2007 May 29.

Service Ophtalmologie, Hôpital Purpan, Toulouse, France.

Purpose: To report an unusual cause of decreased vision in an aphakic patient.

Design: Interventional case report.

Participant: One patient. Read More

Eye (Lond) 2006 Dec 11;20(12):1360-5. Epub 2005 Nov 11.

SB Ankara Eye Hospital, Ankara, Turkey.

Purpose: To investigate the causes of glaucoma in children following removal of cataracts.

Methods: In total, 24 patients (37 eyes) with uncomplicated congenital cataracts who developed glaucoma following cataract removal were studied retrospectively. Cataract morphology, surgical technique, postoperative complications, time to glaucoma onset, gonioscopic findings, the presence of microcornea, and the histopathologic characteristics of the filtration angle in one case were the studied parameters. Read More

J Cataract Refract Surg 2004 Dec;30(12):2585-9

Department of Ophthalmology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Purpose: To report the results of pars plana vitrectomy (PPV) for retained lens fragments with implantation of an Artisan intraocular lens (IOL) (Ophtec) to correct aphakia.

Setting: University-based referral center.

Methods: In this retrospective case-controlled study, patients who had had a PPV to remove dislocated lens fragments and implantation of an Artisan IOL for pseudophakic correction during initial cataract surgery or PPV were reviewed. Read More

Am J Ophthalmol 2003 Aug;136(2):364-5

Rotterdam Eye Hospital, Rotterdam, The Netherlands.

Purpose: To demonstrate how an inferior iridectomy prevents a pupillary block in aphakic patients with a silicone oil tamponade.

Design: Observational case series.

Methods: Photographs of two patients who had undergone vitrectomy, lensectomy, membrane peeling, silicone oil tamponade, and inferior iridectomy for a complex retinal detachment were evaluated. Read More

Optometry 2002 Nov;73(11):685-93

Nova Southeastern University, College of Optometry, Ft Lauderdale, Florida 33328, USA.

Background: Angle closure secondary to pupil block is an entity known to occur in aphakic and pseudophakic patients. In aphakic patients, typically the cause of the pupil block is vitreous prolapse (aphakic pupil block). In pseudophakic patients, the typical cause of the pupil block is an anterior chamber lens implant, often in the absence of an iridectomy (pseudophakic pupil block). Read More

Indian J Ophthalmol 2002 Sep;50(3):220-1

Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

We report the case of a 35-year-old aphakic patient who developed an intractable secondary glaucoma due to angle closure after pupillary block following the use of perfluoropropane (C3F8) gas at a nonexpansile concentration of 14%. Read More

Vet Ophthalmol 2002 Mar;5(1):3-7

Animal Eye Specialty Clinic, 2239 S. Kanner Highway, Stuart, FL 34994, USA.

Unilateral uveitis with pupillary occlusion and secondary glaucoma was treated with neodymium:YAG laser iridotomy and iridencleisis in an aphakic 2-year-old male Miniature Schnuauzer. The dog presented 4 months after bilateral phacoemulsification with a complaint of blepharospasm of the left eye. Examination revealed anterior uveitis with pupillary occlusion and iris bombé. Read More

Am J Ophthalmol 2001 Sep;132(3):414-6

Rayne Institute, Academic Department of Ophthalmology, St Thomas' Hospital, Lambeth Palace Rd., London, SE1 7EH United Kingdom.

Purpose: To describe pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection.

Design: Interventional case series.

Methods: Cases were collected from January 1997 to July 2000 from three tertiary referral centers. Read More

Eye (Lond) 1995 ;9 ( Pt 6):757-9

Vitroretinal Unit, Moorfields Eye Hospital, London, UK.

Eighteen patients had a surgical inferior peripheral iridotomy performed to prevent pupil block and silicone oil anterior chamber prolapse. The occlusion of an iridotomy was treated by neodymium: YAG laser therapy and this form of treatment was successful only in 4 cases (22%). The reopening of occluded iridotomies is best performed by surgery as opposed to laser treatment. Read More

Retina 1995 ;15(2):87-90

Retina Department, Duke University Eye Center, Durham, North Carolina 27710, USA.

Background: Silicone oil tamponade is used in treating retinal detachments, but silicone-associated complications remain frequent. Keratopathy and acute pupillary block glaucoma are related to migration of silicone oil into the anterior chamber. Since 1985, many surgeons have created an inferior peripheral iridectomy (PI) at the time of surgery to prevent forward migration of the oil, but the rate of postoperative closure of the PI and the effect on oil position have not been well defined. Read More

Dakar Med 1994 ;39(2):203-6

Clinique Ophtalmologique CHU Le DANTEC, Dakar Etoile, Sénégal.

Intra capsular extraction is the most employed surgical technics for the treatment of senile cataract in developing countries. Nevertheless complications are usual, among them the pupillary block. The authors notified in 365 intra capsular cataract extractions, executed during 8 months, 4 cases of pupillary block occurred after operation without incident. Read More

Klin Monbl Augenheilkd 1992 May;200(5):571-3

Long-term follow-up of secondary implanted anterior chamber intraocular lenses. The long-term results after secondary implantation of an anterior chamber IOL in aphakic patients are illustrated. After a mean period of 7 years after uneventful intracapsular cataract extraction 45 eyes underwent secondary implantation of an anterior chamber IOL of Symflex-Type. Read More

Yan Ke Xue Bao 1990 Jun;6(1-2):11-6

Zhongshan Ophthalmic Center, Sun Yat-sen University of Medical Sciences, Guangzhou, China.

Aphakic pupillary block glaucoma and malignant glaucoma (ciliovitreal block) are severe complications of the intracapsular cataract extraction, presenting clinically as elevated intraocular pressure, persistent shallow anterior chamber and severe vitreal hernia. Six eyes (four women and two men) with aphakic pupillary block glaucoma and aphakic malignant glaucoma were resolved by Neodymium: YAG laser iridotomy and hyaloidotomy. The laser therapy resulted in immediate deepening of the anterior chamber and reducing of intraocular pressure. Read More

Eye (Lond) 1990 ;4 ( Pt 1):226-9

Department of Ophthalmology, Addenbrookes Hospital, Cambridge.

Superior peripheral iridectomy has been performed in 40 patients who have undergone silicone oil surgery for retinal detachment and who are aphakic. Only two developed raised intraocular pressure due to pupil block by liquid silicone and in each case the iridectomies seemed to be closed by proliferative membrane rather than the silicone meniscus. This type of iridectomy is particularly suitable in patients requiring intracapsular cataract extraction after previous vitrectomy and silicone oil surgery. Read More

Am J Ophthalmol 1989 Aug;108(2):170-5

Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.

We injected 25 micrograms of recombinant tissue plasminogen activator into the anterior chamber or the vitreous cavity in seven aphakic patients for pupillary block caused by a complete fibrin pupillary membrane that formed after vitrectomy with fluid-gas exchange. Progressive fibrin deposition resulted in pupillary block by three days after vitrectomy surgery in six patients, and seven days after vitrectomy in one patient. The pupillary block was associated with increased intraocular pressure in six patients. Read More

Yan Ke Xue Bao 1988 Dec;4(4):238-42

Ann Ophthalmol 1988 Oct;20(10):403-5

Dept. of Ophthalmology, Beilinson Medical Center, Petah Tiqva, Israel.

Fifteen eyes of 14 patients who underwent cataract extraction surgery with or without lens implantation developed pupillary block. Six lenses were of the anterior-chamber type, two of the posterior-chamber, and four of the iris-clip Binkhorst type; three were simple aphakic eyes. Ocular hypertension was present in 12 eyes; while in three eyes, the pupillary block was detected by biomicroscopic examination. Read More

Br J Ophthalmol 1987 Dec;71(12):903-6

Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.

Three cases are described of acute glaucoma following vitrectomy and silicone oil injection in proliferative vitreous retinopathy. The first case developed silicone-induced pupillary block in a phakic eye. Cases 2 and 3 developed elevated pressure in aphakic eyes with deep anterior chambers. Read More

Am J Ophthalmol 1987 Nov;104(5):502-7

Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.

We examined five patients who developed pupillary block after extracapsular cataract extraction. One of the patients also had a posterior chamber intraocular lens implanted at the time of cataract operation. In all five patients, pupillary block was promptly relieved by Nd:YAG laser posterior capsulotomy. Read More

Br J Ophthalmol 1987 Mar;71(3):197-200

In the aphakic eye, with intact iris diaphragm, silicone oil has frequently caused a pupillary block. In this situation aqueous humour accumulates behind the iris and forces silicone oil through the pupil into the anterior chamber. An iridectomy at the 6 o'clock position can effectively prevent this pupillary block. Read More

Jpn J Ophthalmol 1987 ;31(1):138-46

Among various substances used for intraocular tamponade in the treatment of vitreous opacity and complicated retinal detachment, silicone oil is superior to hyaluronic acid or sulfur hexafluoride. Its low gravity and hydrophobic nature permit good tamponade effect to be obtained and its high transparency allows us to detect remnant vitreous traction in the far periphery and/or retinal tears. Furthermore, preretinal membrane can be peeled off easily after silicone oil removal. Read More

Int Ophthalmol 1985 Sep;8(3):183-6

Pseudophakia by itself does not cause ocular hypertension. Pseudophakic glaucoma should be defined as glaucoma that would not be present in an eye if it were not pseudophakic. Ocular hypertension was noted in 15 (9%) of 166 pseudophakic eyes. Read More

Arch Ophthalmol 1985 Sep;103(9):1350-4

The number of laser iridotomies in 1982 was more than four times the annual rate of surgical iridectomies performed before the laser was in common use at the Bascom Palmer Eye Institute, Miami. No single reason accounts for the increase. Only a minority of the increase is due to a 32% increase in our outpatient volume, a backlog of individuals with borderline indications who had not undergone surgery, or the number of iridotomies performed prophylactically for asymptomatic narrow angles. Read More

Trans Ophthalmol Soc U K 1985 ;104 ( Pt 2):137-41

Pupilloplasty has given positive results in 40 out of 45 cases of aphakic and pseudoaphakic secondary block glaucoma after one or two laser sessions. Since we first applied this method we have arrived at the following conclusions: Pupilloplasty must be repeated whenever the reformation of the anterior chamber achieved with the first laser session does not persist. [In our instances the anterior chamber was successfully reformed at the first session and maintained its depth in 30 of the 40 cases. Read More

Am J Ophthalmol 1983 Dec;96(6):775-82

We retrospectively evaluated the VITAC (vitreous-tissue aspiration cutter), a portable vitrectomy system with an end-cutting vitrectomy probe with a self-sharpening oscillating blade and a monoblock design, in 110 vitrectomy procedures, 34 performed at the University of California Davis Medical Center and 76 performed at the Eye and ENT Hospital in Shanghai, China. The indications for vitrectomy included penetrating injuries (22 eyes), intraocular foreign bodies (28 eyes), vitreous hemorrhages (18 eyes), cataracts (17 eyes), endophthalmitis (seven eyes), pupillary-block glaucoma (five eyes), bullous keratopathy (five eyes), aphakic penetrating keratoplasty (three eyes), pupillary membranes (two eyes), massive preretinal proliferation (one eye), and cystoid macular edema (one eye). Vitrectomy resulted in visual improvement in 19 of 34 eyes in the California series (56%) and in 60 of the 76 eyes in the Shanghai series (79%). Read More

Klin Monbl Augenheilkd 1982 Nov;181(5):364-6

Within the past three years intraocular Binkhorst lenses have been implanted in 152 consecutive cases. In 36% of the intracapsularly operated cases (123 eyes) and 45% of the extracapsularly (29 eyes), intraocular pressure increased to 40 mm Hg for three to four days postoperatively. Pseudophakic-pupillary block glaucoma was not observed in any of the cases. Read More

Acta Ophthalmol (Copenh) 1982 Jun;60(3):449-54

Pars plana anterior vitrectomy was performed in 9 patients with shallow anterior chamber after cataract extraction. Five patients had choroidal and/or ciliary body effusion (CCBE), and 4 had aphakic pupillary block (APB). Vitrectomy was performed only after medical treatment failed to restore a normal anterior chamber depth. Read More

Am J Ophthalmol 1982 Feb;93(2):172-84

We used closed-eye endosurgery to treat 58 patients with anterior segment problems. These included nonsenile cataract, residual lens material, pupillary membranes, vitreocorneal touch, aphakic pupillary block glaucoma, intraocular lens complications, epithelial ingrowth, and total hyphema. Thirty-five eyes showed an increase in visual acuity of more than two Snellen lines, 13 eyes demonstrated no change, and ten eyes lost more than two lines. Read More

Bull Soc Ophtalmol Fr 1981 Nov;81(11):931-9

Ophthalmic Surg 1981 Jul;12(7):491-5

Pars plana lensectomy by ultrasonic fragmentation appears to be the treatment of choice for extraction of subluxated and dislocated lenses. The closed system technique allowed extraction of 11/11 subluxated lenses without operative or postoperative complications with an average observation period of 4.5 years. Read More

Ophthalmology 1981 Mar;88(3):218-24

Argon laser iridotomy was performed on 140 eyes, with greater than one year postoperative follow-up in 88 eyes. Iris holes were satisfactorily produced in every eye treated, with two-thirds having only one treatment session. Late reclosure of laser iridotomy was rare and easily treated. Read More