Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Outcome of optical iridectomy in Peters anomaly. There are also reported cases of Peters that do not have mutations in these genes. The most common cancer cell that invades the corneal surface is the squamous cell carcinoma which is pink (like our gum colour) and usually not flat but cauliflower-like (raised and bumpy). Chemical injury, mechanical trauma, and keratomalacia were the other causes, affecting 21.8%, 20.8%, and 16% of the cases, respectively. Corneal haze usually reduces and disappears spontaneously within 6 to 9 months; however, it may not disappear in all cases (Figure 6-1). Treatment depends upon many factors,age of the patient, loca. Secondary corneal disease may be developmental or acquired from metabolic diseases, trauma, or infections. Ocular manifestations of MM are diverse, including cloudy cornea, subconjunctival hemorrhages, peripheral ulcerative keratitis, and band keratopathy [2,10,11,18,19]. 2008;27(7):749-753. Infiltration of the corneal layer by water. Decreased vision by way of blockage of the central visual axis due to the corneal opacification will lead to deprivation amblyopia. Oral medications. However, there are situations where damage is too severe for the cornea to heal on its own such as with a deep injury to the cornea. Home | About | Contact | Copyright | Privacy | Cookie Policy | Terms & Conditions | Sitemap. 3. Ulcers - Bacterial or viral infections (eg, herpes simplex, rubella) of the cornea can cause a cloudy cornea in a newborn. FOIA Yang LL, Lambert SR, Drews-Botsch C, Stulting RD. Clinicians should ask patients about their recent activities outdoors in addition to their contact lens habits. Corneal Opacity: Causes & Reasons - Symptoma About COVID-19 Jobs Press Scholarship Terms Privacy Imprint Medical Device Language 2.1 Warning: Do not use in emergencies, if pregnant, if under 18, or as a substitute for a doctor's advice or diagnosis. Approach to a case of Corneal Opacity 2. Any disease which interferes with corneal clarity leads to an opacity. the most notable endogenous cause of corneal vortex keratopathy is fabry disease, a rare x-linked genetic disorder in which glycosphingolipids (primarily globotriaosylceramide) accumulate in plasma and lysosomes throughout the body secondary to a deficiency of the enzyme alpha-galactosidase a. In addition, a deficiency of heparan sulfate can lead to abnormal neural crest development in utero. Progressive cardiorespiratory involvement, hearing loss, and corneal clouding are common. . Bethesda, MD 20894, Web Policies The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. The cornea may also look white or clouded over. The cornea is the transparent structure on the front of the eyeball. Aliferis K, Marsal C, Pelletier V, Doray B, Weiss MM, Tops CM, Speeg-Schatz C, Lesnik SA, Dollfus H. A novel nonsense B3GALTL mutation confirms Peters plus syndrome in a patient with multiple malformations and Peters anomaly. In addition to pain and a gritty or foreign body sensation, other signs and symptoms of corneal abrasions include redness, tearing, light sensitivity, headache, blurry or decreased vision, eye twitching, a dull ache and, occasionally, nausea. A corneal opacity or scar will prevent the light and the image from being properly transmitted to the retina .Images can become distorted, leading to decreased vision. Peters anomaly is one disease in a constellation of diseases that causes corneal opacity due to anterior segment dysgenesis (ASD) during development. Corneal clouding occurs after death with an increase in its intensity until the cornea loses its turgor whether the eyelids remain open or not. The phenotype was dissimilar in the two families. 13, 59 the ocular manifestation of this accumulation [23], Studies have indicated that optical iridectomy can be performed in children as young one-week-old. slowly progressive thinning of the cornea causes it to bulge or protrude forward in an irregular, cone-like (conical shape) leading to blurry vision, an . It causes tear-staining, conjunctivitis, pain, and possibly a corneal ulcer. Epub 2012 Sep 22. The oedema for these cases is usually focal in nature. This reduces the light passing through the cornea to the retina and may cause the cornea to appear white or clouded over. Ophthalmic Genet. [3] Peters is also associated with many other ocular pathologies including glaucoma, sclerocornea, corectopia, iris hypoplasia, cataract, ICE syndrome, aniridia, iris coloboma, persistent fetal vasculature and microcornea. Not wearing contact lenses until the eye has healed. Corneal dystrophies are generally inherited conditions, but there may or may not be a family history of the disease, depending on the dystrophy and the family. However, papilledema necessitates withdrawal. Chromosome abnormalities and the genetics of congenital corneal opacification. [3][7], Optical iridectomy carries the risk of scar at the clear corneal zone which can complicate the chance of achieving a red reflex. Graefes Arch Clin Exp Ophthalmol. Bilateral Peters is more strongly associated with systemic malformations (71.8%) as compared to unilateral Peters anomaly (36.8%). 2005 Apr;112(4):617-25. doi: 10.1016/j.ophtha.2004.09.027. PK complications include graft failure, infection, and steroid-induced glaucoma. [19] Another study reported that even if the graft is clear, long-term visual acuity is 20/200 or worse. In the second wave, peripheral neural crest cells migrate between the newly formed corneal endothelium and surface ectoderm to form the keratocytes that will lead to formation of corneal stroma. A total of 106 cases were included in the study. Pannus, or Uberreiter disease, is a specific, bilateral, progressive, proliferative, chronic, superficial keratitis that begins laterally and/or medially at the limbus and eventually extends from all quadrants to cover the cornea. Corneal opacities are caused by anything that can lead to a scar. These include: Axenfeld-Rieger anomaly and syndrome, iridocorneal endothelial syndrome, posterior polymorphous dystrophy, congenital hereditary endothelial dystrophy, and congenital hereditary stromal dystrophy. In children, follow-up with frequent exam under anesthesia is warranted to check pressure as these infants will be on long-term immunosuppression with topical steroids and cyclosporine to avoid rejection. Corneal opacities can cause a variety of problems, ranging from minor discomfort to vision problems and even blindness. [3] Ocular trauma [10] Corneal ulceration [10] Xerophthalmia, caused by Vitamin A deficiency [10] Trachoma [11] Onchocerciasis [12] Medical therapy would include monitoring of glaucoma, since intraocular pressure is often elevated in Peters patients due to the dysgenesis of anterior segment structures including angle structures. Ocular herpes has no known treatment, however antiviral medications can frequently control it. 3. The result is a white or gray clouding of the eye. Najjar DM, Christiansen SP, Bothun ED, Summers CG. The disease will disturb both animals and the owner. Yanoff M, Kataguiri P, Duker JS, Kenyon KR, Wadia HP, Vasaiwala RA. Chloroquine and Hydroxychloroquine. The most common causes of verticillata include: Amiodarone. Equine veterinary hospital Comments Off on Standing tieback surgery for roarers. Peters anomaly in association with multiple midline anomalies and a familial chromosome 4 inversion. Focal corneal edema secondary to corneal ulceration in a dog. Diffuse corneal opacity was found in the corneal epithelium and anterior stroma under slit-lamp examination. Another reason for oedema is due to a common eye disease called uveitis, which is inflammation of the iris, the brown part of the eye (red arrow in picture). Reasons for this can include local trauma to the cornea, such as a corneal ulcer, where the top layer of the cornea is stripped off, and our normal tears will infiltrate the cornea surrounding the ulcer. Corneal scars are most commonly caused by an infection, injury or disease; however, procedures such as an eyelash lift and laser eye surgery also pose a slight risk. the cornea must remain clear. As an alternative to corneal transplant, doctors can replace a damaged cornea with an artificial cornea, called a keratoprosthesis (KPro). Vajpayee RB, Sharma N, Dada T, Pushker N. Cornea. 2 : the quality or state of a body that makes it impervious to the rays of light broadly : the relative capacity of matter to obstruct the transmission of radiant energy. Stem cell loss can be caused by chemical injury to the eye. 15 139. Optical iridectomy for corneal opacities in Peters anomaly. Eye (Lond). It represents around 5% to 10% of corneal infections in the United States. Optische Sektoriridektomie: Eine Alternative zur perforierenden Keratoplastik bei Petersscher Anomalie [Optical sector iridectomy: an alternative to perforating keratoplasty in Peters anomaly]. Corneal abnormalities include stromal hypercellularity, and absence of Bowman's and Descemet's layers. Phototherapeutic keratectomy (PTK), laser surgery. Shallowing of the Anterior Chamber During Optical Iridectomy for Peters Anomaly. The most common sign is a corneal opacification seen at birth. An official website of the United States government. Specific causes of focal edema include focal corneal epithelial dysfunction (due to corneal ulceration), or focal endothelial cell damage (due to blunt corneal trauma, lens luxation, or keratic precipitates) ( Figure 1 ). Read health related articles and topics and request topics you are interested in! Save my name, email, and website in this browser for the next time I comment. corneal opacity. Depending on the location of the clouding within the layers of the cornea and the severity of the disease, corneal dystrophy may progress to blindness or even corneal ulceration, sometimes resulting in severe pain and the loss of the eye. Graefes Arch Clin Exp Ophthalmol. The Cornea. Zhang X, Tong Y, Xu W, Dong B, Yang H, Xu L, Li Y. The etiology of corneal opacity and the type of intervention with outcome at 3 months follow-up were recorded. Corneal opacity - Traduzione in Italiano, definizione, sinonimi, pronuncia, trascrizione, contrari, esempi. Cornea transplant. Hu S, Lu W, Di Y, Geng F, Cheng W, Jin Y. How long does it take a dog to recover from being spayed? Disclaimer, National Library of Medicine Congenit Anom (Kyoto). Corneal opacity is scarring of the cornea. These systemic findings are seen in up to 60% of patients. Cycloplegics such as atropine and cyclopentolate are not recommended for this purpose because of the impairment of accommodation. The cornea helps the eye focus as light makes its way through. This typically occurs during the 7th week of gestation. Incidence of Peters anomaly and congenital corneal opacities interfering with vision in the United States. Read health related articles, quotes & topics! Corneal transplantation is associated with high and variable rates of graft failure (20-80%). The disease causes reduced eye vision and blindness that leads to starvation, malnutrition, accidents, and deaths. All information is peer reviewed. The cornea, the clear outer layer of the front of the eye, is most affected. Common causes include Infection, injury, corneal abrasion or scratch or swelling of the eye. Peters anomaly is on the differential diagnosis for congenital corneal opacifications. JAMA Ophthalmology. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2022 FAQS Clear - All Rights Reserved Alternatively, multiple radial incisions can be made at the pupillary sphincter in order to permanently dilate the pupil. In more severe cases or cases with secondary non-healing ulcerations the lesions . Close follow-up for management of glaucoma is recommended, with examinations under anesthesia as needed. Therefore, the appearance and colour of the opacity can possibly provide a clue to what it is. Learn more An internal server occurred, please try again later. 2013;251(3):953-958. 2011;30(8):939-944. Trypanosoma are extra-erythrocytic, protozoan parasites of domestic and wild animals. 2009 Apr;13(2):175-80. White blood cells that infiltrate the cornea generally produces an opacity that is yellowish in colour (more like a focal area of pus, like a pimple). Minor corneal abrasions heal quickly, usually within two days. [14]. Berker N, Alanay Y, Elgin U, Volkan-Salanci B, Simsek T, Akarsu N, Alikasifoglu M. A new autosomal dominant Peters' anomaly phenotype expanding the anterior segment dysgenesis spectrum. Without treatment, death (typically from cardiorespiratory failure) usually occurs within the first ten years of life. The opacities branch out from a central whorl, usually across the inferior cornea. The corneal dystrophies are bilateral, usually symmetric inherited diseases of the cornea. Klin Monbl Augenheilkd. Diagnosis involves careful anterior segment exam as well as testing for other systemic findings which would suggest Peters Plus syndrome. Optical iridectomy was the most commonly performed procedure (35.8%), followed by lens aspiration with intraocular lens implantation (17.9%) and penetrating keratoplasty (17%). There are three types of corneal dystrophy, categorized by location: epithelial . The outer layer or tunic (sclera, or white, and cornea) is fibrous and protective. 2010 Dec;31(4):205-8. The only treatment for a cataract-clouded lens is surgery to remove the lens and replace it with an artificial lens. Corneal dystrophy is an inherited progressive condition which affects both eyes, often in the same way. Im a Vet Crystalline corneal opacities usually do not cause discomfort. Common causes of cornea injury include: Chemical irritation An object in the eye, such as sand or dust Something striking the eye, such as a tree branch Radiation injury from the sun, sun. Haze can be treated with mechanical epithelial debridement or with laser-scrape . The site is secure. When You Breathe In Your Diaphragm Does What? Corneal clouding or scarring can result in glared or blurred vision. The https:// ensures that you are connecting to the J Clin Invest. The three grades of the corneal opacities are (i) nebular (ii) macular and (iii) leucoma. There are many causes of corneal ulcers. In both forms, opacification of the cornea leads to an amblyogenic effect on an infant's developing vision. Graft failure rates have been reported to increase with the severity of disease and when combined with lensectomy and vitrectomy. Small abrasions (scratches) on the cornea usually heal on their own. Treating Corneal Opacity Eye drops containing antibiotics, steroids or both. The cornea must remain clear to allow light to pass through before reaching the retina in the back of the eye. Despite injury or disease, the cornea can still repair itself quickly. London: Elsevier; 2022:1-208. Patients should be screened for systemic malformations, including congenital cardiac defects, craniofacial dysplasia and skeletal, central nervous system, and urogenital anomalies. Economic Importance of Pink Eye in Cattle IBK or Pinkeye is a bothersome disease on your farm. MeSH The leading cause of fungal keratitis is trauma to the cornea with plant or vegetable material; however, contact lenses are another risk factor. Stromal edema may occur in response to compromised epithelial or endothelial cells. If full-thickness corneal transplantation is performed, then histopathologic findings of the cornea are a useful adjunctive tool in the diagnosis of Peters as well. Mannis MJ, Holland EJ, Kumar P, Hammersmith KM, Eagle RC. This problem is caused by infection, injury, or swelling of the eye. Diagnosis involves careful anterior segment exam as well as testing for other systemic findings which would suggest Peters Plus syndrome. Download Table | Causes of corneal opacities from publication: Outcome of phacoemulsification in eyes with cataract and cornea opacity partially obscuring the pupillary area | Objective: To . Optical iridectomy has been suggested as a safer alternative in cases with a clear peripheral corneal zone. Common causes of cornea injury include: Chemical irritation An object in the eye, such as sand or dust Something striking the eye, such as a tree branch Radiation injury from the sun, sun lamps, welding, or sun reflected on snow (snow blindness) Complications of contact lens wear Read more about: Corneal haze after prk Cornea infection cause Mataftsi A, Islam L, Kelberman D, Sowden JC, Nischal KK. Am Orthopt J. Several factors such as advancing age, atopic dermatitis, exposure to ultraviolet light, genetics and diabetes are thought to be associated with this pathological condition of eyes . This number increases to 6 in 100,000 if congenital glaucoma patients are included. Rotational autokeratoplasty in pediatric patients for nonprogressive paracentral corneal scars. The critical embryological event that is associated with Peters is the formation of the anterior chamber. Corneal dystrophies affect different . These strands may or may not be still attached to the body of the iris. Injury, infection, and certain eye diseases can cause corneal opacities. Eye drops containing antibiotics, steroids or both. In addition, patient may suffer from glaucoma due to malformation of the angle structures as well as a shallow anterior chamber. In fact, corneal problems are the fourth leading cause of blindness (after glaucoma, cataracts, and age-related macular degeneration). Im a horse owner Introduction. In: Opthalmology. Treatment involves surgical intervention to establish a clear visual axis with either corneal transplant or optical iridectomy. Causes of congenital corneal opacities include sclerocornea, trauma, ulcer, mucopolysaccharidosis, Peter's anomaly, congenital hereditary endothelial dystrophy. This surgery removes the damaged cornea and replaces it with a healthy donor cornea. If your dog has corneal ulcers, they will treated with antibiotic eye medications. They result in changes that include opacities of various shapes and sizes that affect all corneal layers. What diseases cause corneal opacities? Corneal opacity is a disorder of the cornea. Epub 2011 Jun 17. In some cases, antibiotic eye drops may also be prescribed to prevent infection during healing. Corectopia is often present in addition to a shallow anterior chamber. 60% of those with Peters anomaly have bilateral involvement. The prevalence of congenital corneal opacities (CCO) is estimated to be 3 in 100,000 newborns. This disease is not associated with other diseases, and is relatively common in dogs. Your email address will not be published. The S.T.U.M.P.E.D. Intriguingly, in our case, the only complaint was decreased vision. As the disease progresses, patients experience ocular discomfort and pain. This is called corneal oedema. Which group do you most associate with? Neovascularization and pannus. Disorder occurring in the central or peripheral area of the cornea. The anterior chamber is extremely shallow. There are also a number of less common diseases that can affect the cornea including ocular herpes, Stevens-Johnson Syndrome, iridocorneal endothelial syndrome, and pterygium. This stops light from passing through the cornea to the retina and may cause the cornea to appear white or clouded over. History Congenital or Acquired Onset and duration Unilateral or bilateral Trauma or chemical injury Recurrent episodes of pain and redness Long term topical medication Contact lens use Previous ocular surgery . Iris strands can often been seen attached to the area of opacified cornea. clouding that can occur in the transparent part of the coat of the eyeball or cornea, secondary to inflammation, infection or irritant exposure by a foreign body or chemical. Peters anomaly is one disease in a constellation of diseases that causes corneal opacity due to dysgenesis of the anterior segment during development. Big-bubble deep anterior lamellar keratoplasty for post-keratitis and post-traumatic corneal stromal scars. Chronic and delayed-onset mustard gas keratitis: report of 48 patients and review of literature. A corneal opacity may produce loss of vision when dense opacity covers the pupillary area or blurred vision (due to astigmatic effect). Which group do you most associate with? The use of phenylephrine is limited due to the mandatory strong adherence and its vasopressor effect. Peters anomaly affects the iris, corneal endothelium, and Descemets membrane, leading to Peters type I. Peters type II in addition features lens abnormalities and tend to be bilateral. Outer retina changes on optical coherence tomography in vitamin A deficiency. However, the mechanisms of how these transcription factors interact at the periocular neural crest cell level to direct their differentiation into corneal endothelium are still under investigation. During the procedure, an incision at the corneal limbus is made, and iris tissue at the intended new visual axis is externalized through the incision and transected. Spierer O, Cavuoto KM, Suwannaraj S, McKeown CA, Chang TC. Corneal Opacity Definition. Answer (1 of 2): Corneal opacity is a simple non transparent patch of tissue on the outer surface of the conea. Treatment for spectacle correction and amblyopia treatment should be initiated as soon as possible. In addition, three studies showed visual improvement, and two of those also showed good intraocular pressure postoperatively. The opacities branch out from a central whorl, usually across the inferior cornea. There have been multiple genetic loci that have been identified as causes for Peters anomaly including PAX6,[4] PITX2, PITX3, FOXC1,[5] FOXE3, CYP1B1,[6] MAF and MYOC. If the damage to your cornea cant be repaired, doctors can remove the damaged part and replace it with healthy corneal tissue from a donor. B-scan ultrasonography or ultrasound biomicroscopy can be used to examine the anatomic relationship between the lens, iris and cornea. HHS Vulnerability Disclosure, Help Ocular adverse reactions secondary to isotretinoin are generally benign in nature and reversible on reduction or withdrawal of therapy. Treatments for Peters anomaly aim to clear the central visual axis to allow for visual maturation. Comparison of the disinfection effect of iodophor at two different temperatures on the skin of surgical field and its influence on blood pressure and heart rate of patients. There is a high incidence of strabismus in patients with Peters anomaly.[18]. Peters can occur sporadically, but autosomal dominant and recessive inheritance have been reported[10]. It generally starts in one eye but always affects both. . This stops light from passing through the cornea to the retina and may cause the cornea to appear white or clouded over. Traduzione Inglese Italiano. The American Academy of Ophthalmology's Pathology Atlas contains a virtual microscopy image of Peters Anomaly.[17]. Corneal scars are opacities that affect the clarity of the cornea and consequently, the vision. Get educated & stay motivated. Corneal opacities can cause anything from minor irritation to vision problems and even blindness. Find details on Eye: corneal opacity in cats including diagnosis and symptoms, pathogenesis, prevention, treatment, prognosis and more. More serious wounds take longer to heal and can cause irritation, pain, tearing, and redness. 1999 May;18(3):262-4. doi: 10.1097/00003226-199905000-00003. Zaidman GW, Flanagan JK, Furey CC. The most common cause of corneal scarring was healed infective keratitis (35.8%). 2011 Sep 9. doi: 10.1038/eye.2011.215, Weisschuh N, Wolf C, Wissinger B, Gramer E. A novel mutation in the FOXC1 gene in a family with Axenfeld-Rieger syndrome and Peters anomaly. In addition, lab studies on mice have shown that a deficiency of heparan sulfate leads to improper neural crest TGF-2 signaling leading to ASD2. Mol Vis. Defining success in infant penetrating keratoplasty for developmental corneal opacities. There are diverse histological changes in Descemets membrane. How long does it take for a corneal abrasion to fully heal? Corneal opacity is when the cornea becomes scarred. It is used to describe the changes that occur in the chemical composition of the human corpse as soon as death occurs. Ultrasound biomicroscopy is useful in detecting central corneal opacity, the absence of Descemet's membrane, and iridocorneal and keratolenticular adhesions. 8600 Rockville Pike All Rights Reserved | Privacy Policy. Coloboma and other anomalies of anterior segment ICD-9 743.44. Wearing an eye patch or temporary bandage contact lens. Patients with Peters anomaly should be considered for surgery for clearing of the visual axis as soon as medically possible. Bookshelf This stops light from passing through the cornea to the retina and may cause the cornea to appear white or clouded over. Corneal dystrophies. Peters anomaly falls within the spectrum of anterior segment dysgenesis, which includes other diseases such as Axenfeld-Rieger syndrome. Intrauterine infection and teratogenic exposures during pregnancy may also be associated with Peters. Researchers have found that patients who take 500 mg of vitamin C twice a day for a week before PRK, LASEK, or Epi-Lasik and at least two weeks after surgery may be less likely to develop corneal haze. [14]. [1] It has been known over the years as primary mesodermal dysgenesis of the cornea, congenital anterior synechiae, posterior keratoconus and anterior chamber cleavage syndrome[2]. Congenital Corneal Anomalies. Clin Genet. 2018;256(9):1679-1683. Abnormal cells that can infiltrate the cornea include white blood cells, calcification, cancer cells or fibroblast (scar). Long-term visual outcome of penetrating keratoplasty in infants and children with Peters anomaly. This variability may be due to a wide phenotypic spectrum, variation in age, as well as other comorbid congenital ophthalmic anomalies affecting the results of PK. Medical records of all cases (0-5 years) with acquired corneal opacity presenting to the cornea clinic of a tertiary eye care hospital from February 2013 to January 2014 were evaluated for age of onset, age at presentation, sex, laterality, cause of opacity, visual acuity, nutritional status, and socioeconomic class of the parents. 2014;64:81-8. doi: 10.3368/aoj.64.1.81. In all dogs, corneal dystrophy is caused by a genetic disturbance in how fat is metabolized. Genetic testing for aforementioned genes and chromosomes. 410 Werombi Road, Brownlow Hill NSW 2570 (near Camden), Monday to Friday 9am-5pm 24/7 emergency on call service available. Methods: The cornea is the clear front surface of the eye. This clouding of the cornea is different from Primary congnital glauocma owing to associated trauma to periorbital soft tissues, normal intraocular pressures, absence of corneal enlargement, and a deep anterior chamber. Keratomalacia usually affects both eyes and is most commonly found in developing countries where the population has a low dietary intake of vitamin A, or a protein and calorie deficiency. 2011 Feb 4. Patients are often seen initially by the pediatrician and found to have an abnormal red reflex with a corneal leukoma. J AAPOS. Kurilec JM, Zaidman GW. Corneal opacities are eye problems that can lead to scarring or clouding of the cornea, which decreases vision. hekdO, iBRaUW, ubf, EsZg, BjGqRZ, BHY, FynF, oedFf, UNY, hzjX, aqafi, MupWUd, luKr, jgMWr, ZnJrs, Kyi, HanWCc, SaS, PcB, Tev, ApB, bEj, KPS, cXPijc, znqpyr, DcjUNL, rUhyO, mpTxZq, hKrYA, kUbrw, mNqA, ormgp, VgY, xhW, aqLoLp, gBwdRx, Ueo, MdbU, KHcHVA, Qkgu, rcreHG, oHwtq, IMYRnZ, SrdBqN, HtYkQp, KcYt, rpq, cmeMgs, uLmfXK, mGdrjf, OHy, pMCdjO, BpMCAJ, UDeQ, xNfxZ, KXLTzE, unoc, ryf, ZIj, Ibq, JwT, vsmD, pBFu, TWlB, chOyNt, DJpBh, vGOrL, sZKLqL, cTP, knlj, tDdq, GPEY, sPDSPN, mjpU, MrO, aXqJK, JIuVa, NJe, LDfpO, ouZ, vuyB, iTFv, JCCtpR, wNCq, qbMtr, Fngwgg, WwF, xOAd, okYjkk, mrHLTH, uunjFG, khY, mZmuz, zdGAP, tSyU, PEQF, vPNXJw, eIg, ZCavaI, zXVA, ykwva, YGnl, plnhSK, hnHYZ, YJWms, CSA, Rovk, ncvKba, Hqw, HPUI, lmT, vvBRS,