42:
350:. The average perioperative PION patient loses 4 liters of blood during surgery, and the majority receive blood transfusions. Massive blood loss is just one cause of low blood pressure. Medications used for general anesthesia can also lower blood pressure. The average surgery duration in PION cases is 7 to 9 hours, which increases the risk of prolonged low blood pressure.
515:
PION most commonly affects the elderly. The mean patient age was 62 years in one series (range 18 to 90 years).The mean age varies by etiology category; patients with giant cell arteritis (GCA) are older (mean 78 years, range 50 to 82 years), while those with PION in the setting of spine surgery are
426:
The anterior optic nerve receives blood primarily from the posterior ciliary arteries. The anterior optic nerve, a.k.a. the optic nerve head, is surrounded by the scleral canal, and is vulnerable to crowding of nerve fibers. The portion of the optic nerve head that is visible by looking into the eye
371:
The diagnosis of PION is often difficult since the optic nerves initially appear normal. The injury occurs posterior to that portion of the nerve visible during ophthalmoscopic examination. There may be an abnormal relative pupillary response (APD) if the injury is confined to one optic nerve, but
271:
Evidence suggests that the multifactorial origin of perioperative PION involves the risks discussed above and perhaps other unknown factors. Current review articles of PION propose that vascular autoregulatory dysfunction and anatomic variation are under-investigated subjects that may contribute to
267:
Low blood pressure and anemia are cited as perioperative complications in nearly all reports of PION, which suggests a causal relationship. However, while low blood pressure and anemia are relatively common in the perioperative setting, PION is exceedingly rare. Spine and cardiac bypass surgeries
506:
One retrospective report proposes that incidence of PION could be reduced in high-risk cases by altering surgical management. For example, for patients undergoing spine surgery, measures could be taken to minimize intraoperative hypotension, to accelerate the process of blood replacement, and to
493:
should begin immediately. A sample (biopsy) of the temporal artery should be obtained to confirm the diagnosis and guide future management, but should not delay initiation of treatment. Treatment does not recover lost vision, but prevents further progression and second eye involvement. High dose
519:
There is a higher than expected prevalence of atherosclerotic risk factors and comorbid vascular disease, especially in patients with nonarteritic (idiopathic) PION, with 87 percent of patients having at least one risk factor for, or one other manifestation of, atherosclerotic vascular disease.
362:
Surgeries with the highest estimated incidence of PION are surgeries with a higher risk of the aforementioned conditions. In spine surgery, patients are susceptible to significant blood loss, and they are positioned face down for long periods of time, which increases venous pressure, decreases
502:
Rapid blood transfusions, to correct anemia and raise blood pressure, may improve PION outcomes. In one report of a related disease, hypotension-induced AION, 3 out of 3 patients who received rapid transfusions reported partial recovery of vision. While rapid transfusions offer some hope, the
472:
are most susceptible to PION as they have a compromised system of blood vessel autoregulation. Hence, extra efforts may need to be taken for them in the form of careful or staged surgery or the controlling the anemia from blood loss (by administration of blood transfusions), and the careful
138:
A-PION most commonly affects
Caucasian women, with an average age of 73. At onset vision loss is unilateral, but without treatment it rapidly progresses to involve both eyes. Vision loss is usually severe, ranging from counting fingers to no light perception. Associated symptoms are jaw pain
439:
At the onset of symptoms, ophthalmoscope examination can differentiate AION from PION. If optic nerve head involvement is observed, it is AION. PION does not produce optic atrophy that is observable via ophthalmoscope until four to eight weeks after onset. In addition, AION often shows a
255:. Men are also noted to be at higher risk, which is in accordance with the trend, as men are at higher risk of cardiovascular disease. These cardiovascular risks all interfere with adequate blood flow, and also may suggest a contributory role of defective vascular autoregulation.
363:
arterial perfusion pressure, and often causes facial swelling (increased tissue pressure). Spine surgery is estimated to have the highest incidence of PION, 0.028%. Long duration of feet-above-head position in prostate surgery has also been suggested to increase risk of PION.
210:
The combination of anemia and low blood pressure means that the blood is carrying less oxygen to the tissues. The optic nerve can be at very high risk for damage from insufficient blood supply due to swelling (from lack of oxygen) in a confined bony space resulting in a
345:
Many causes of decreased blood flow during surgery are systemic, i.e. they decrease blood flow throughout the body. Studies have shown that nearly all perioperative PION patients had prolonged periods of low blood pressure during the operation and postoperative
333:
to optic nerve cells. Alone, none of these risk factors is enough to cause PION. However, in susceptible individuals, a combination of these risk factors produces devastating blindness. This evidence suggests that PION is a disease of multifactorial origin.
358:
in feet-above-head position, have all been reported to be associated with perioperative PION. All of these factors are believed to increase tissue pressure and venous pressure around the optic nerve, thereby decreasing local blood flow and oxygen delivery.
1724:
1709:
263:
As illustrated by the risk factors above, perioperative hypoxia is a multifactorial problem. Amidst these risk factors it may be difficult to pinpoint the optic nerve's threshold for cell death, and the exact contribution of each factor.
268:
have the highest estimated incidences of PION, 0.028% and 0.018% respectively, and this is still extremely low. This evidence suggests that optic nerve injury in PION patients is caused by more than just anemia and low blood pressure.
353:
Other intraoperative ischemic pressures are local, i.e. they decrease blood flow to the affected area, the optic nerve. Facial swelling, periorbital swelling, direct orbital compression, facedown position during surgery, and a tilted
383:
There is no confirmatory test for PION. PION is a diagnosis of exclusion. To prevent impending blindness, it is urgent to rule out giant cell arteritis when a patient over 50 presents with sudden vision loss.
110:
originating from the damaged posterior optic nerve progresses to involve the anterior optic nerve head. Four to eight weeks after onset, atrophy of the optic nerve head is observable upon ophthalmoscope exam.
293:, a bony tunnel leading to the brain, swelling in this rigid space causes compression of the optic nerve. This compression worsens ischemia and perpetuates the cycle of injury, and swelling, and compression.
74:
also includes cases where the cause of inadequate blood flow to the nerve is anterior, as the condition describes a particular mechanism of visual loss as much as the location of damage in the
481:
Once visual loss has occurred, it becomes more problematic, but there are reports of recovered vision if blood transfusions and agents that raise blood pressure are administered within hours.
215:. Restricted blood flow can lead to permanent damage to the optic nerve and result in blindness (often in both eyes). For technical reasons this occurs more frequently with spinal surgeries.
392:
In the postoperative setting, without gross eye injury, visual loss requires an assessment of the whole visual system for ischemic damage. The optic nerve is not the only tissue of the
155:. Signs observable to a bystander include long surgery duration and facial swelling. Vision loss is usually bilateral and severe, ranging from counting fingers to no light perception.
888:
Chang SH, Miller NR (June 2005). "The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns
Hopkins Hospital Experience".
1441:
Salvarani C, Macchioni PL, Tartoni PL, et al. (1987). "Polymyalgia rheumatica and giant cell arteritis: a 5-year epidemiologic and clinical study in Reggio Emilia, Italy".
82:(AION) is distinguished from PION by the fact that AION occurs spontaneously and on one side in affected individuals with predisposing anatomic or cardiovascular risk factors.
123:
may look symmetrical. However, if the eyes are asymmetrically affected, i.e. one eye's optic nerve is more damaged than the other, it will produce an important sign called an
991:
2769:
1470:"Polymyalgia rheumatica and temporal arteritis: a retrospective analysis of prognostic features and different corticosteroid regimens (11 year survey of 210 patients)"
523:
While anterior ischemic optic neuropathy (AION) appears to be more common than PION after cardiac surgery, PION is relatively more common in cases of spine surgery.
2166:
1517:
Lundberg I, Hedfors E (October 1990). "Restricted dose and duration of corticosteroid treatment in patients with polymyalgia rheumatica and temporal arteritis".
1368:
Hunder GG, Bloch DA, Michel BA, et al. (August 1990). "The
American College of Rheumatology 1990 criteria for the classification of giant cell arteritis".
2838:
2764:
90:
PION is characterized by moderate to severe painless vision loss of abrupt onset. One or both eyes may be affected and color vision is typically impaired.
412:(AION). Blood supply and surrounding anatomy make the anterior and posterior portions of the optic nerve susceptible to different ischemic pressures.
1778:
834:"The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss"
227:
of cardiovascular risk factors than in the general population. Documented cardiovascular risks in people affected by perioperative PION include
2786:
2781:
2606:
1544:
Foroozan R, Deramo VA, Buono LM, et al. (March 2003). "Recovery of visual function in patients with biopsy-proven giant cell arteritis".
1163:
Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA (June 1997). "Visual loss as a complication of spine surgery. A review of 37 cases".
376:
may not be helpful. It is not uncommon for the erroneous diagnoses of malingering or cortical blindness to be made. If possible, an urgent
2646:
1249:
Sweeney PJ, Breuer AC, Selhorst JB, et al. (May 1982). "Ischemic optic neuropathy: a complication of cardiopulmonary bypass surgery".
649:
Sadda SR, Nee M, Miller NR, Biousse V, Newman NJ, Kouzis A (November 2001). "Clinical spectrum of posterior ischemic optic neuropathy".
130:
Defective light perception in one eye causes an asymmetrical pupillary constriction reflex called the afferent pupillary defect (APD).
2754:
2641:
2208:
409:
79:
2369:
1658:
Buono LM, Foroozan R, Savino PJ, Danesh-Meyer HV, Stanescu D (June 2003). "Posterior ischemic optic neuropathy after hemodialysis".
337:
Risks of perioperative PION can be divided into two categories, intraoperative ischemic pressures, and cardiovascular risk factors.
2509:
2474:
449:
3049:
2567:
2479:
285:
In both types of PION, decreased blood flow leads to the death of optic nerve cells. Ischemic injury to the optic nerve causes
2469:
2198:
1406:
Connolly SE, Gordon KB, Horton JC (February 1994). "Salvage of vision after hypotension-induced ischemic optic neuropathy".
1578:
Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond) 2004; 18:1188.
175:
People who have undergone non-ocular surgery that is particularly prolonged or is associated with a significant blood loss.
2562:
2453:
2319:
2960:
2651:
2636:
1206:
Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS (June 1997). "Ophthalmic complications after spinal surgery".
1123:
Pazos GA, Leonard DW, Blice J, Thompson DH (1999). "Blindness after bilateral neck dissection: case report and review".
557:
Dunker S, Hsu HY, Sebag J, Sadun AA (June 2002). "Perioperative risk factors for posterior ischemic optic neuropathy".
1848:
1806:
1771:
329:
The exact cause of perioperative PION is unknown. Many risk factors have been identified, all of which contribute to
2776:
2572:
2546:
2504:
2499:
2364:
2237:
2225:
2181:
2843:
2242:
2955:
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2188:
124:
71:
2494:
2465:
2089:
2054:
1739:
2965:
2719:
2519:
2039:
2032:
792:
Buono LM, Foroozan R (2005). "Perioperative posterior ischemic optic neuropathy: review of the literature".
1034:
Alexandrakis G, Lam BL (March 1999). "Bilateral posterior ischemic optic neuropathy after spinal surgery".
3234:
3204:
3139:
3134:
2861:
2139:
2004:
1764:
452:
has defined a combination of physical symptoms and inflammatory changes to diagnose giant cell arteritis.
3319:
3177:
2853:
423:, a boney tunnel leading to the brain, surrounds the most posterior part of this optic nerve segment.
2950:
2536:
2531:
2489:
2304:
2220:
321:
forms and stops blood flow. When blood flow stops, oxygen delivery stops and optic nerve fibers die.
302:
236:
212:
744:
Hayreh SS, Podhajsky PA, Zimmerman B (April 1998). "Ocular manifestations of giant cell arteritis".
41:
3255:
3129:
2929:
2812:
2804:
2592:
2556:
2541:
2396:
2176:
1956:
1728:
377:
2866:
2616:
2524:
2448:
2401:
2213:
2149:
2134:
1994:
1943:
1617:
1274:
1231:
1188:
913:
863:
726:
152:
503:
prognosis for perioperative PION remains poor. Prevention remains the best way to reduce PION.
3209:
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2871:
2731:
2514:
2171:
2077:
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330:
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30:
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1999:
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959:
951:
897:
845:
801:
753:
710:
658:
612:
566:
244:
164:
103:
372:
often it is bilateral and the symmetry of pupillary responses is maintained. Furthermore,
3064:
3028:
2992:
2611:
2436:
2423:
2357:
2314:
2232:
2044:
1976:
1896:
1881:
469:
355:
3294:
3146:
3091:
2934:
2702:
2631:
2413:
2383:
2329:
2283:
2154:
2027:
1961:
1951:
1733:
1494:
1469:
1100:
1075:
1008:
964:
939:
901:
601:"Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management"
490:
393:
191:
99:
1671:
1642:
1557:
1419:
1136:
1047:
805:
757:
662:
570:
3313:
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3009:
2726:
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2347:
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1966:
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1219:
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850:
833:
714:
35:
1278:
1235:
917:
867:
730:
3079:
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2203:
2111:
1989:
1984:
1929:
1924:
1621:
1192:
461:
286:
228:
183:
58:) is a medical condition characterized by damage to the retrobulbar portion of the
1744:
1605:
1345:
1328:
415:
The posterior optic nerve receives blood primarily from the pial branches of the
3278:
3229:
3172:
3167:
3124:
3102:
3013:
3004:
2924:
2902:
2714:
2686:
2484:
2352:
2193:
2014:
1891:
1843:
1790:
420:
305:(GCA). GCA is an inflammatory disease of blood vessels. It is believed to be an
290:
195:
75:
59:
1592:
Luneau K, Newman NJ, Biousse V (November 2008). "Ischemic optic neuropathies".
3199:
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3086:
3074:
3018:
2979:
2885:
2821:
2800:
2690:
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1914:
1718:
1091:
955:
494:
corticosteroids may be tapered down to low doses over approximately one year.
428:
306:
224:
179:
167:
of the optic nerve that may cause either unilateral or, more often, bilateral
3250:
3224:
3098:
3044:
3032:
2917:
2912:
2897:
2893:
2431:
2129:
2106:
1919:
1866:
1861:
1838:
1756:
1329:"Posterior ischemic optic neuropathy after minimally invasive prostatectomy"
168:
1679:
1650:
1613:
1565:
1381:
1354:
1313:
1144:
1109:
1055:
1017:
973:
909:
859:
813:
722:
670:
626:
617:
600:
578:
1530:
1503:
1468:
Delecoeuillerie G, Joly P, Cohen de Lara A, Paolaggi JB (September 1988).
1454:
1427:
1389:
1292:
Weyand CM, Goronzy JJ (July 2003). "Medium- and large-vessel vasculitis".
1270:
1227:
1184:
765:
3289:
3054:
2588:
2391:
2022:
1629:
Remigio D, Wertenbaker C (2000). "Post-operative bilateral vision loss".
1485:
1305:
1262:
373:
318:
314:
140:
63:
1701:
3116:
3059:
2601:
2408:
2339:
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2299:
1906:
252:
240:
107:
3219:
2121:
2098:
1818:
1713:
397:
347:
310:
248:
187:
120:
440:
characteristic altitudinal defect on a
Humphrey Visual Field test.
289:
and swelling. Because the posterior optic nerve passes through the
3191:
396:
susceptible to decreased blood flow. Decreased oxygenation of the
2271:
1833:
1327:
Weber ED, Colyer MH, Lesser RL, Subramanian PS (December 2007).
3276:
2672:
2075:
1804:
1760:
16:
Damage to the optic nerve's back part due to lack of blood flow
990:
Ho VT, Newman NJ, Song S, Ksiazek S, Roth S (January 2005).
1076:"Postoperative visual loss associated with spine surgery"
380:
consult is most likely to lead to the correct diagnosis.
832:
Lee LA, Roth S, Posner KL, et al. (October 2006).
701:
Hayreh SS (January 2009). "Ischemic optic neuropathy".
139:
exacerbated by chewing, scalp tenderness, shoulder and
98:
Looking inside the person's eyes at the time of onset,
72:
damage to the eye's optic nerve due to poor blood flow
940:"Perioperative visual loss after nonocular surgeries"
171:. PION typically occurs in two categories of people:
1691:
3243:
3190:
3155:
3115:
3027:
2978:
2943:
2884:
2852:
2820:
2799:
2740:
2685:
2581:
2422:
2382:
2338:
2279:
2270:
2120:
2097:
2088:
2013:
1975:
1942:
1905:
1826:
1817:
1695:
992:"Ischemic optic neuropathy following spine surgery"
489:If a diagnosis of GCA is suspected, treatment with
301:A-PION is caused by an inflammatory disease called
29:
24:
2765:arteritic anterior (AAION or arteritic AION)
151:Vision loss is usually apparent upon waking from
66:(ischemia) to the optic nerve. Despite the term
1069:
1067:
1065:
1029:
1027:
985:
983:
1401:
1399:
1158:
1156:
1154:
933:
931:
929:
927:
883:
881:
879:
877:
827:
825:
823:
787:
785:
783:
781:
779:
777:
775:
696:
694:
692:
690:
688:
686:
684:
682:
680:
644:
642:
640:
638:
636:
594:
592:
590:
588:
552:
550:
548:
546:
544:
542:
540:
538:
536:
1772:
8:
2839:Chronic progressive external ophthalmoplegia
2167:Thygeson's superficial punctate keratopathy
559:Journal of the American College of Surgeons
3273:
3037:
2826:
2817:
2695:
2682:
2669:
2276:
2094:
2085:
2072:
1823:
1814:
1801:
1779:
1765:
1757:
1692:
223:Perioperative PION patients have a higher
186:. In these cases, the person may develop
40:
21:
1493:
1344:
1099:
1007:
963:
849:
616:
178:People who have experienced significant
996:Journal of Neurosurgical Anesthesiology
532:
237:high levels of cholesterol in the blood
119:If both eyes are affected by PION, the
102:exam reveals no visible changes to the
1443:Clinical and Experimental Rheumatology
198:as well. This combination can produce
473:maintenance of their blood pressure.
427:with an ophthalmoscope is called the
202:, and PION has sometimes been called
106:. Weeks after ischemic insult, nerve
7:
2647:Familial exudative vitreoretinopathy
703:Progress in Retinal and Eye Research
507:aggressively treat facial swelling.
2770:non-arteritic anterior (NAION)
2607:Leber's hereditary optic neuropathy
1294:The New England Journal of Medicine
400:or brain could also impair vision.
194:in the bloodstream) and often have
52:Posterior ischemic optic neuropathy
2642:Persistent tunica vasculosa lentis
1125:American Journal of Otolaryngology
902:10.1097/01.brs.0000163884.11476.25
410:Anterior Ischemic Optic Neuropathy
404:Anterior ischemic optic neuropathy
80:anterior ischemic optic neuropathy
25:Posterior ischemic optic neuropath
14:
2370:Polypoidal choroidal vasculopathy
1408:American Journal of Ophthalmology
1074:Gill B, Heavner JE (April 2006).
1036:American Journal of Ophthalmology
944:American Journal of Ophthalmology
806:10.1016/j.survophthal.2004.10.005
746:American Journal of Ophthalmology
651:American Journal of Ophthalmology
341:Intraoperative ischemic pressures
272:patient-specific susceptibility.
2475:Central retinal artery occlusion
1474:Annals of the Rheumatic Diseases
1220:10.1097/00007632-199706150-00008
1177:10.1097/00007632-199706150-00009
851:10.1097/00000542-200610000-00007
715:10.1016/j.preteyeres.2008.11.002
450:American College of Rheumatology
309:disease caused by inappropriate
2480:Branch retinal artery occlusion
2209:Terrien's marginal degeneration
2510:Bietti's crystalline dystrophy
2470:Central retinal vein occlusion
2199:Pellucid marginal degeneration
1333:Journal of Neuro-Ophthalmology
460:Individuals with a history of
313:activity. When T-cells damage
204:shock-induced optic neuropathy
1:
2563:Vitelliform macular dystrophy
2454:Posterior vitreous detachment
2320:Persistent pupillary membrane
1672:10.1016/S0161-6420(03)00257-4
1643:10.1016/S0039-6257(00)00107-7
1558:10.1016/S0161-6420(02)01775-X
1420:10.1016/s0002-9394(14)73082-x
1137:10.1016/S0196-0709(99)90039-X
1048:10.1016/S0002-9394(98)00343-2
758:10.1016/s0002-9394(99)80192-5
663:10.1016/S0002-9394(01)01199-0
571:10.1016/S1072-7515(02)01210-3
331:inadequate delivery of oxygen
317:supplying the optic nerve, a
182:from an accident or ruptured
3050:Leber's congenital amaurosis
2961:Internuclear ophthalmoplegia
2652:Vogt-Koyanagi-Harada disease
2637:Persistent fetal vasculature
2568:Leber's congenital amaurosis
1606:10.1097/NRL.0b013e318177394b
1346:10.1097/WNO.0b013e31815b9f67
1849:Meibomian gland dysfunction
1519:The Journal of Rheumatology
599:Hayreh SS (November 2004).
219:Cardiovascular risk factors
190:(too few oxygen-delivering
3336:
2573:Birdshot chorioretinopathy
2547:Central serous retinopathy
2365:Focal choroidal excavation
2238:Corneal neovascularization
2055:Subconjunctival hemorrhage
3285:
3272:
3040:
2956:Convergence insufficiency
2829:
2698:
2681:
2668:
2597:Primary juvenile glaucoma
2442:Cytomegalovirus retinitis
2084:
2071:
1857:
1813:
1800:
1791:Diseases of the human eye
1092:10.1007/s00586-005-0914-6
956:10.1016/j.ajo.2007.09.016
408:PION is less common than
125:afferent pupillary defect
2466:Ocular ischemic syndrome
1370:Arthritis and Rheumatism
938:Newman NJ (April 2008).
844:(4): 652–9, quiz 867–8.
143:, headache and fatigue.
2966:One and a half syndrome
2720:Foster Kennedy syndrome
1631:Survey of Ophthalmology
794:Survey of Ophthalmology
3205:Argyll Robertson pupil
2005:Periorbital cellulitis
1382:10.1002/art.1780330810
1080:European Spine Journal
618:10.1038/sj.eye.6701562
388:Differential diagnosis
245:abnormal heart rhythms
3178:Scintillating scotoma
2844:Kearns–Sayre syndrome
2787:Toxic and nutritional
2760:posterior (PION)
2243:Kayser–Fleischer ring
64:inadequate blood flow
2951:Conjugate gaze palsy
2822:Paralytic strabismus
2755:anterior (AION)
2537:Retinitis pigmentosa
2532:Macular degeneration
2305:Intermediate uveitis
2221:Keratoconjunctivitis
1486:10.1136/ard.47.9.733
1306:10.1056/NEJMra022694
1263:10.1212/wnl.32.5.560
516:younger on average.
303:giant cell arteritis
213:compartment syndrome
165:watershed infarction
94:Ophthalmoscopic exam
3256:Childhood blindness
3235:Parinaud's syndrome
2805:Extraocular muscles
2593:Ocular hypertension
2557:Epiretinal membrane
2542:Retinal haemorrhage
2397:Congenital cataract
462:high blood pressure
378:neuro-ophthalmology
229:high blood pressure
2782:Leber's hereditary
2449:Retinal detachment
2402:Childhood cataract
2214:Post-LASIK ectasia
1995:Orbital cellulitis
1944:Lacrimal apparatus
325:Perioperative PION
259:Perioperative PION
196:low blood pressure
153:general anesthesia
147:Perioperative PION
86:Signs and symptoms
3307:
3306:
3303:
3302:
3268:
3267:
3264:
3263:
3210:Marcus Gunn pupil
3186:
3185:
3107:Visual impairment
2974:
2973:
2880:
2879:
2867:Fourth-nerve (IV)
2795:
2794:
2732:Optic disc drusen
2664:
2663:
2660:
2659:
2378:
2377:
2266:
2265:
2172:Corneal dystrophy
2067:
2066:
2063:
2062:
1938:
1937:
1754:
1753:
417:ophthalmic artery
233:diabetes mellitus
200:circulatory shock
49:
48:
19:Medical condition
3327:
3274:
3038:
3029:Vision disorders
2988:Refractive error
2930:Brown's syndrome
2886:Other strabismus
2872:Sixth-nerve (VI)
2862:Oculomotor (III)
2834:Ophthalmoparesis
2827:
2818:
2809:Binocular vision
2742:Optic neuropathy
2708:optic papillitis
2696:
2683:
2670:
2559:(Macular pucker)
2277:
2258:Band keratopathy
2095:
2086:
2073:
2000:Orbital lymphoma
1887:Blepharophimosis
1877:Blepharochalasis
1824:
1815:
1802:
1781:
1774:
1767:
1758:
1693:
1683:
1654:
1625:
1579:
1576:
1570:
1569:
1541:
1535:
1534:
1514:
1508:
1507:
1497:
1465:
1459:
1458:
1438:
1432:
1431:
1403:
1394:
1393:
1365:
1359:
1358:
1348:
1324:
1318:
1317:
1289:
1283:
1282:
1246:
1240:
1239:
1203:
1197:
1196:
1160:
1149:
1148:
1120:
1114:
1113:
1103:
1071:
1060:
1059:
1031:
1022:
1021:
1011:
987:
978:
977:
967:
935:
922:
921:
896:(11): 1299–302.
885:
872:
871:
853:
829:
818:
817:
789:
770:
769:
741:
735:
734:
698:
675:
674:
646:
631:
630:
620:
611:(11): 1188–206.
596:
583:
582:
554:
435:PION versus AION
104:optic nerve head
45:
44:
22:
3335:
3334:
3330:
3329:
3328:
3326:
3325:
3324:
3310:
3309:
3308:
3299:
3281:
3260:
3239:
3182:
3151:
3111:
3065:Color blindness
3031:
3023:
2970:
2944:Other binocular
2939:
2876:
2848:
2811:
2807:
2803:
2791:
2736:
2689:
2677:
2656:
2612:Ocular hypotony
2577:
2437:Chorioretinitis
2418:
2374:
2358:Chorioretinitis
2334:
2315:Rubeosis iridis
2293:
2262:
2233:Corneal opacity
2189:Corneal ectasia
2116:
2080:
2059:
2045:Pseudopterygium
2009:
1971:
1934:
1901:
1897:Ankyloblepharon
1853:
1809:
1796:
1795:
1785:
1755:
1750:
1749:
1704:
1690:
1657:
1628:
1594:The Neurologist
1591:
1588:
1586:Further reading
1583:
1582:
1577:
1573:
1543:
1542:
1538:
1516:
1515:
1511:
1467:
1466:
1462:
1440:
1439:
1435:
1405:
1404:
1397:
1367:
1366:
1362:
1326:
1325:
1321:
1291:
1290:
1286:
1248:
1247:
1243:
1214:(12): 1319–24.
1205:
1204:
1200:
1162:
1161:
1152:
1122:
1121:
1117:
1073:
1072:
1063:
1033:
1032:
1025:
989:
988:
981:
937:
936:
925:
887:
886:
875:
831:
830:
821:
791:
790:
773:
743:
742:
738:
700:
699:
678:
648:
647:
634:
598:
597:
586:
556:
555:
534:
529:
513:
500:
487:
479:
458:
446:
437:
406:
390:
369:
356:operating table
343:
327:
299:
283:
278:
261:
221:
192:red blood cells
161:
149:
136:
117:
96:
88:
78:. In contrast,
70:, this form of
39:
20:
17:
12:
11:
5:
3333:
3331:
3323:
3322:
3312:
3311:
3305:
3304:
3301:
3300:
3298:
3297:
3295:Onchocerciasis
3292:
3286:
3283:
3282:
3277:
3270:
3269:
3266:
3265:
3262:
3261:
3259:
3258:
3253:
3247:
3245:
3241:
3240:
3238:
3237:
3232:
3227:
3222:
3217:
3212:
3207:
3202:
3196:
3194:
3188:
3187:
3184:
3183:
3181:
3180:
3175:
3170:
3165:
3159:
3157:
3153:
3152:
3150:
3149:
3147:Quadrantanopia
3144:
3143:
3142:
3137:
3132:
3121:
3119:
3113:
3112:
3110:
3109:
3096:
3095:
3094:
3092:Oguchi disease
3084:
3083:
3082:
3077:
3072:
3062:
3057:
3052:
3047:
3041:
3035:
3025:
3024:
3022:
3021:
3016:
3007:
3002:
3001:
3000:
2995:
2984:
2982:
2976:
2975:
2972:
2971:
2969:
2968:
2963:
2958:
2953:
2947:
2945:
2941:
2940:
2938:
2937:
2935:Duane syndrome
2932:
2927:
2922:
2921:
2920:
2915:
2905:
2900:
2890:
2888:
2882:
2881:
2878:
2877:
2875:
2874:
2869:
2864:
2858:
2856:
2850:
2849:
2847:
2846:
2841:
2836:
2830:
2824:
2815:
2797:
2796:
2793:
2792:
2790:
2789:
2784:
2779:
2774:
2773:
2772:
2767:
2762:
2757:
2746:
2744:
2738:
2737:
2735:
2734:
2729:
2724:
2723:
2722:
2712:
2711:
2710:
2703:Optic neuritis
2699:
2693:
2679:
2678:
2673:
2666:
2665:
2662:
2661:
2658:
2657:
2655:
2654:
2649:
2644:
2639:
2634:
2632:Phthisis bulbi
2629:
2624:
2619:
2614:
2609:
2604:
2599:
2585:
2583:
2579:
2578:
2576:
2575:
2570:
2565:
2560:
2554:
2549:
2544:
2539:
2534:
2529:
2528:
2527:
2522:
2517:
2515:Coats' disease
2512:
2507:
2505:of prematurity
2502:
2497:
2492:
2482:
2477:
2472:
2463:
2458:
2457:
2456:
2446:
2445:
2444:
2439:
2428:
2426:
2420:
2419:
2417:
2416:
2414:Ectopia lentis
2411:
2406:
2405:
2404:
2399:
2388:
2386:
2380:
2379:
2376:
2375:
2373:
2372:
2367:
2362:
2361:
2360:
2350:
2344:
2342:
2336:
2335:
2333:
2332:
2327:
2322:
2317:
2312:
2307:
2302:
2296:
2294:
2292:
2291:
2286:
2280:
2274:
2272:Vascular tunic
2268:
2267:
2264:
2263:
2261:
2260:
2255:
2250:
2245:
2240:
2235:
2230:
2229:
2228:
2218:
2217:
2216:
2211:
2206:
2201:
2196:
2186:
2185:
2184:
2179:
2169:
2164:
2159:
2158:
2157:
2155:Photokeratitis
2152:
2147:
2142:
2137:
2126:
2124:
2118:
2117:
2115:
2114:
2109:
2103:
2101:
2092:
2082:
2081:
2076:
2069:
2068:
2065:
2064:
2061:
2060:
2058:
2057:
2052:
2047:
2042:
2037:
2036:
2035:
2028:Conjunctivitis
2025:
2019:
2017:
2011:
2010:
2008:
2007:
2002:
1997:
1992:
1987:
1981:
1979:
1973:
1972:
1970:
1969:
1964:
1962:Dacryocystitis
1959:
1954:
1952:Dacryoadenitis
1948:
1946:
1940:
1939:
1936:
1935:
1933:
1932:
1927:
1922:
1917:
1911:
1909:
1903:
1902:
1900:
1899:
1894:
1889:
1884:
1879:
1874:
1869:
1864:
1858:
1855:
1854:
1852:
1851:
1846:
1841:
1836:
1830:
1828:
1821:
1811:
1810:
1805:
1798:
1797:
1794:
1793:
1787:
1786:
1784:
1783:
1776:
1769:
1761:
1752:
1751:
1748:
1747:
1736:
1721:
1705:
1700:
1699:
1697:
1696:Classification
1689:
1688:External links
1686:
1685:
1684:
1655:
1626:
1587:
1584:
1581:
1580:
1571:
1536:
1525:(10): 1340–5.
1509:
1460:
1433:
1395:
1360:
1319:
1284:
1241:
1198:
1171:(12): 1325–9.
1150:
1115:
1061:
1023:
979:
950:(4): 604–610.
923:
873:
838:Anesthesiology
819:
771:
736:
676:
632:
584:
531:
530:
528:
525:
512:
509:
499:
496:
486:
483:
478:
475:
457:
454:
445:
442:
436:
433:
405:
402:
394:visual pathway
389:
386:
368:
365:
342:
339:
326:
323:
298:
295:
282:
279:
277:
274:
260:
257:
220:
217:
208:
207:
176:
160:
157:
148:
145:
135:
134:Arteritic PION
132:
116:
113:
100:ophthalmoscope
95:
92:
87:
84:
47:
46:
33:
27:
26:
18:
15:
13:
10:
9:
6:
4:
3:
2:
3332:
3321:
3318:
3317:
3315:
3296:
3293:
3291:
3288:
3287:
3284:
3280:
3275:
3271:
3257:
3254:
3252:
3249:
3248:
3246:
3242:
3236:
3233:
3231:
3228:
3226:
3223:
3221:
3218:
3216:
3215:Adie syndrome
3213:
3211:
3208:
3206:
3203:
3201:
3198:
3197:
3195:
3193:
3189:
3179:
3176:
3174:
3171:
3169:
3166:
3164:
3161:
3160:
3158:
3154:
3148:
3145:
3141:
3138:
3136:
3133:
3131:
3128:
3127:
3126:
3123:
3122:
3120:
3118:
3114:
3108:
3104:
3100:
3097:
3093:
3090:
3089:
3088:
3085:
3081:
3078:
3076:
3073:
3071:
3070:Achromatopsia
3068:
3067:
3066:
3063:
3061:
3058:
3056:
3053:
3051:
3048:
3046:
3043:
3042:
3039:
3036:
3034:
3030:
3026:
3020:
3017:
3015:
3011:
3010:Anisometropia
3008:
3006:
3003:
2999:
2996:
2994:
2991:
2990:
2989:
2986:
2985:
2983:
2981:
2977:
2967:
2964:
2962:
2959:
2957:
2954:
2952:
2949:
2948:
2946:
2942:
2936:
2933:
2931:
2928:
2926:
2923:
2919:
2916:
2914:
2911:
2910:
2909:
2906:
2904:
2901:
2899:
2895:
2892:
2891:
2889:
2887:
2883:
2873:
2870:
2868:
2865:
2863:
2860:
2859:
2857:
2855:
2851:
2845:
2842:
2840:
2837:
2835:
2832:
2831:
2828:
2825:
2823:
2819:
2816:
2814:
2813:Accommodation
2810:
2806:
2802:
2798:
2788:
2785:
2783:
2780:
2778:
2775:
2771:
2768:
2766:
2763:
2761:
2758:
2756:
2753:
2752:
2751:
2748:
2747:
2745:
2743:
2739:
2733:
2730:
2728:
2727:Optic atrophy
2725:
2721:
2718:
2717:
2716:
2713:
2709:
2706:
2705:
2704:
2701:
2700:
2697:
2694:
2692:
2688:
2684:
2680:
2676:
2671:
2667:
2653:
2650:
2648:
2645:
2643:
2640:
2638:
2635:
2633:
2630:
2628:
2627:Keratomycosis
2625:
2623:
2622:Globe rupture
2620:
2618:
2615:
2613:
2610:
2608:
2605:
2603:
2600:
2598:
2594:
2590:
2587:
2586:
2584:
2580:
2574:
2571:
2569:
2566:
2564:
2561:
2558:
2555:
2553:
2552:Macular edema
2550:
2548:
2545:
2543:
2540:
2538:
2535:
2533:
2530:
2526:
2523:
2521:
2518:
2516:
2513:
2511:
2508:
2506:
2503:
2501:
2498:
2496:
2493:
2491:
2488:
2487:
2486:
2483:
2481:
2478:
2476:
2473:
2471:
2467:
2464:
2462:
2461:Retinoschisis
2459:
2455:
2452:
2451:
2450:
2447:
2443:
2440:
2438:
2435:
2434:
2433:
2430:
2429:
2427:
2425:
2421:
2415:
2412:
2410:
2407:
2403:
2400:
2398:
2395:
2394:
2393:
2390:
2389:
2387:
2385:
2381:
2371:
2368:
2366:
2363:
2359:
2356:
2355:
2354:
2351:
2349:
2348:Choroideremia
2346:
2345:
2343:
2341:
2337:
2331:
2328:
2326:
2325:Iridodialysis
2323:
2321:
2318:
2316:
2313:
2311:
2308:
2306:
2303:
2301:
2298:
2297:
2295:
2290:
2287:
2285:
2282:
2281:
2278:
2275:
2273:
2269:
2259:
2256:
2254:
2253:Arcus senilis
2251:
2249:
2248:Haab's striae
2246:
2244:
2241:
2239:
2236:
2234:
2231:
2227:
2224:
2223:
2222:
2219:
2215:
2212:
2210:
2207:
2205:
2202:
2200:
2197:
2195:
2192:
2191:
2190:
2187:
2183:
2180:
2178:
2175:
2174:
2173:
2170:
2168:
2165:
2163:
2162:Corneal ulcer
2160:
2156:
2153:
2151:
2148:
2146:
2143:
2141:
2140:acanthamoebic
2138:
2136:
2133:
2132:
2131:
2128:
2127:
2125:
2123:
2119:
2113:
2110:
2108:
2105:
2104:
2102:
2100:
2096:
2093:
2091:
2090:Fibrous tunic
2087:
2083:
2079:
2074:
2070:
2056:
2053:
2051:
2048:
2046:
2043:
2041:
2038:
2034:
2031:
2030:
2029:
2026:
2024:
2021:
2020:
2018:
2016:
2012:
2006:
2003:
2001:
1998:
1996:
1993:
1991:
1988:
1986:
1983:
1982:
1980:
1978:
1974:
1968:
1967:Xerophthalmia
1965:
1963:
1960:
1958:
1955:
1953:
1950:
1949:
1947:
1945:
1941:
1931:
1928:
1926:
1923:
1921:
1918:
1916:
1913:
1912:
1910:
1908:
1904:
1898:
1895:
1893:
1890:
1888:
1885:
1883:
1880:
1878:
1875:
1873:
1872:Lagophthalmos
1870:
1868:
1865:
1863:
1860:
1859:
1856:
1850:
1847:
1845:
1842:
1840:
1837:
1835:
1832:
1831:
1829:
1825:
1822:
1820:
1816:
1812:
1808:
1803:
1799:
1792:
1789:
1788:
1782:
1777:
1775:
1770:
1768:
1763:
1762:
1759:
1746:
1742:
1741:
1737:
1735:
1731:
1730:
1726:
1722:
1720:
1716:
1715:
1711:
1707:
1706:
1703:
1698:
1694:
1687:
1681:
1677:
1673:
1669:
1666:(6): 1216–8.
1665:
1661:
1660:Ophthalmology
1656:
1652:
1648:
1644:
1640:
1637:(5): 426–32.
1636:
1632:
1627:
1623:
1619:
1615:
1611:
1607:
1603:
1600:(6): 341–54.
1599:
1595:
1590:
1589:
1585:
1575:
1572:
1567:
1563:
1559:
1555:
1552:(3): 539–42.
1551:
1547:
1546:Ophthalmology
1540:
1537:
1532:
1528:
1524:
1520:
1513:
1510:
1505:
1501:
1496:
1491:
1487:
1483:
1479:
1475:
1471:
1464:
1461:
1456:
1452:
1449:(3): 205–15.
1448:
1444:
1437:
1434:
1429:
1425:
1421:
1417:
1414:(2): 235–42.
1413:
1409:
1402:
1400:
1396:
1391:
1387:
1383:
1379:
1376:(8): 1122–8.
1375:
1371:
1364:
1361:
1356:
1352:
1347:
1342:
1338:
1334:
1330:
1323:
1320:
1315:
1311:
1307:
1303:
1299:
1295:
1288:
1285:
1280:
1276:
1272:
1268:
1264:
1260:
1256:
1252:
1245:
1242:
1237:
1233:
1229:
1225:
1221:
1217:
1213:
1209:
1202:
1199:
1194:
1190:
1186:
1182:
1178:
1174:
1170:
1166:
1159:
1157:
1155:
1151:
1146:
1142:
1138:
1134:
1130:
1126:
1119:
1116:
1111:
1107:
1102:
1097:
1093:
1089:
1086:(4): 479–84.
1085:
1081:
1077:
1070:
1068:
1066:
1062:
1057:
1053:
1049:
1045:
1041:
1037:
1030:
1028:
1024:
1019:
1015:
1010:
1005:
1001:
997:
993:
986:
984:
980:
975:
971:
966:
961:
957:
953:
949:
945:
941:
934:
932:
930:
928:
924:
919:
915:
911:
907:
903:
899:
895:
891:
884:
882:
880:
878:
874:
869:
865:
861:
857:
852:
847:
843:
839:
835:
828:
826:
824:
820:
815:
811:
807:
803:
799:
795:
788:
786:
784:
782:
780:
778:
776:
772:
767:
763:
759:
755:
752:(4): 509–20.
751:
747:
740:
737:
732:
728:
724:
720:
716:
712:
708:
704:
697:
695:
693:
691:
689:
687:
685:
683:
681:
677:
672:
668:
664:
660:
657:(5): 743–50.
656:
652:
645:
643:
641:
639:
637:
633:
628:
624:
619:
614:
610:
606:
602:
595:
593:
591:
589:
585:
580:
576:
572:
568:
565:(6): 705–10.
564:
560:
553:
551:
549:
547:
545:
543:
541:
539:
537:
533:
526:
524:
521:
517:
510:
508:
504:
498:Perioperative
497:
495:
492:
484:
482:
476:
474:
471:
467:
463:
455:
453:
451:
443:
441:
434:
432:
430:
424:
422:
418:
413:
411:
403:
401:
399:
395:
387:
385:
381:
379:
375:
366:
364:
360:
357:
351:
349:
340:
338:
335:
332:
324:
322:
320:
316:
312:
308:
304:
296:
294:
292:
288:
280:
275:
273:
269:
265:
258:
256:
254:
250:
246:
242:
238:
234:
230:
226:
218:
216:
214:
205:
201:
197:
193:
189:
185:
184:blood vessels
181:
177:
174:
173:
172:
170:
166:
158:
156:
154:
146:
144:
142:
133:
131:
128:
126:
122:
114:
112:
109:
105:
101:
93:
91:
85:
83:
81:
77:
73:
69:
65:
61:
57:
53:
43:
37:
36:Ophthalmology
34:
32:
28:
23:
3320:Eye diseases
3105: /
3101: /
3080:Monochromacy
3012: /
2908:Heterophoria
2896: /
2759:
2595: /
2591: /
2495:hypertensive
2468: /
2289:Ciliary body
2204:Keratoglobus
2112:Episcleritis
1990:Enophthalmos
1985:Exophthalmos
1930:Trichomegaly
1925:Distichiasis
1827:Inflammation
1738:
1723:
1708:
1663:
1659:
1634:
1630:
1597:
1593:
1574:
1549:
1545:
1539:
1522:
1518:
1512:
1480:(9): 733–9.
1477:
1473:
1463:
1446:
1442:
1436:
1411:
1407:
1373:
1369:
1363:
1339:(4): 285–7.
1336:
1332:
1322:
1300:(2): 160–9.
1297:
1293:
1287:
1257:(5): 560–2.
1254:
1250:
1244:
1211:
1207:
1201:
1168:
1164:
1131:(5): 340–5.
1128:
1124:
1118:
1083:
1079:
1042:(3): 354–5.
1039:
1035:
1002:(1): 38–44.
999:
995:
947:
943:
893:
889:
841:
837:
800:(1): 15–26.
797:
793:
749:
745:
739:
709:(1): 34–62.
706:
702:
654:
650:
608:
604:
562:
558:
522:
518:
514:
511:Epidemiology
505:
501:
488:
480:
459:
447:
438:
425:
414:
407:
391:
382:
374:MRI scanning
370:
361:
352:
344:
336:
328:
300:
287:inflammation
284:
276:Pathogenesis
270:
266:
262:
222:
209:
203:
162:
150:
137:
129:
118:
97:
89:
67:
55:
51:
50:
3230:Cycloplegia
3173:Photophobia
3168:Hemeralopia
3125:Hemianopsia
3103:Vision loss
3014:Aniseikonia
3005:Astigmatism
2925:Cyclotropia
2903:Hypertropia
2715:Papilledema
2687:Optic nerve
2520:Sickle cell
2500:Purtscher's
2485:Retinopathy
2353:Choroiditis
2194:Keratoconus
2015:Conjunctiva
1892:Xanthelasma
1844:Blepharitis
421:optic canal
291:optic canal
76:optic nerve
60:optic nerve
3279:Infections
3200:Anisocoria
3163:Asthenopia
3156:subjective
3140:homonymous
3135:bitemporal
3087:Nyctalopia
3075:Dichromacy
3019:Presbyopia
2980:Refraction
2801:Strabismus
2691:Optic disc
2050:Pinguecula
1915:Trichiasis
527:References
456:Prevention
429:optic disc
319:blood clot
307:autoimmune
225:prevalence
163:PION is a
3251:Nystagmus
3225:Mydriasis
3099:Blindness
3045:Amblyopia
3033:Blindness
2993:Hyperopia
2918:Exophoria
2913:Esophoria
2898:Exotropia
2894:Esotropia
2432:Retinitis
2130:Keratitis
2107:Scleritis
2040:Pterygium
1920:Madarosis
1867:Ectropion
1862:Entropion
1839:Chalazion
1251:Neurology
477:Treatment
367:Diagnosis
169:blindness
68:posterior
31:Specialty
3314:Category
3290:Trachoma
3055:Diplopia
2750:Ischemic
2675:Pathways
2589:Glaucoma
2490:diabetic
2392:Cataract
2330:Synechia
2182:Meesmann
2150:Exposure
2135:herpetic
2033:allergic
2023:Chemosis
1957:Epiphora
1680:12799249
1651:10734242
1614:19008740
1566:12623817
1355:18090562
1314:12853590
1279:28381520
1236:23877951
1145:10512147
1110:15926057
1056:10088754
1018:15632541
974:18358851
918:25631710
910:15928556
868:13138366
860:17006060
814:15621075
731:41796396
723:19063989
671:11704036
627:15534605
579:12081060
491:steroids
466:diabetes
315:arteries
180:bleeding
141:hip pain
3130:binasal
3117:Anopsia
3060:Scotoma
2854:palsies
2617:Red eye
2602:Floater
2409:Aphakia
2340:Choroid
2310:Hyphema
2300:Uveitis
1907:Eyelash
1745:D018917
1622:8445417
1531:2254893
1504:3178314
1495:1003589
1455:3501353
1428:8116753
1390:2202311
1271:7200214
1228:9201834
1193:7611986
1185:9201835
1101:3489312
1009:2699455
965:2989384
766:9559737
470:smoking
253:obesity
241:tobacco
108:atrophy
62:due to
3220:Miosis
2998:Myopia
2777:Kjer's
2525:photic
2424:Retina
2177:Fuchs'
2145:fungal
2122:Cornea
2099:Sclera
1882:Ptosis
1819:Eyelid
1807:Adnexa
1734:377.41
1678:
1649:
1620:
1612:
1564:
1529:
1502:
1492:
1453:
1426:
1388:
1353:
1312:
1277:
1269:
1234:
1226:
1191:
1183:
1143:
1108:
1098:
1054:
1016:
1006:
972:
962:
916:
908:
866:
858:
812:
764:
729:
721:
669:
625:
577:
485:A-PION
468:, and
419:. The
398:retina
348:anemia
311:T-cell
297:A-PION
251:, and
249:stroke
188:anemia
121:pupils
115:Pupils
38:
3244:Other
3192:Pupil
2582:Other
2226:sicca
2078:Globe
1977:Orbit
1719:H47.0
1618:S2CID
1275:S2CID
1232:S2CID
1208:Spine
1189:S2CID
1165:Spine
914:S2CID
890:Spine
864:S2CID
727:S2CID
243:use,
159:Cause
2384:Lens
2284:Iris
1834:Stye
1740:MeSH
1729:9-CM
1676:PMID
1647:PMID
1610:PMID
1562:PMID
1527:PMID
1500:PMID
1451:PMID
1424:PMID
1386:PMID
1351:PMID
1310:PMID
1267:PMID
1224:PMID
1181:PMID
1141:PMID
1106:PMID
1052:PMID
1014:PMID
970:PMID
906:PMID
856:PMID
810:PMID
762:PMID
719:PMID
667:PMID
623:PMID
575:PMID
448:The
281:PION
56:PION
1725:ICD
1710:ICD
1668:doi
1664:110
1639:doi
1602:doi
1554:doi
1550:110
1490:PMC
1482:doi
1416:doi
1412:117
1378:doi
1341:doi
1302:doi
1298:349
1259:doi
1216:doi
1173:doi
1133:doi
1096:PMC
1088:doi
1044:doi
1040:127
1004:PMC
960:PMC
952:doi
948:145
898:doi
846:doi
842:105
802:doi
754:doi
750:125
711:doi
659:doi
655:132
613:doi
605:Eye
567:doi
563:194
444:GCA
3316::
1743::
1732::
1717::
1714:10
1674:.
1662:.
1645:.
1635:44
1633:.
1616:.
1608:.
1598:14
1596:.
1560:.
1548:.
1523:17
1521:.
1498:.
1488:.
1478:47
1476:.
1472:.
1445:.
1422:.
1410:.
1398:^
1384:.
1374:33
1372:.
1349:.
1337:27
1335:.
1331:.
1308:.
1296:.
1273:.
1265:.
1255:32
1253:.
1230:.
1222:.
1212:22
1210:.
1187:.
1179:.
1169:22
1167:.
1153:^
1139:.
1129:20
1127:.
1104:.
1094:.
1084:15
1082:.
1078:.
1064:^
1050:.
1038:.
1026:^
1012:.
1000:17
998:.
994:.
982:^
968:.
958:.
946:.
942:.
926:^
912:.
904:.
894:30
892:.
876:^
862:.
854:.
840:.
836:.
822:^
808:.
798:50
796:.
774:^
760:.
748:.
725:.
717:.
707:28
705:.
679:^
665:.
653:.
635:^
621:.
609:18
607:.
603:.
587:^
573:.
561:.
535:^
464:,
431:.
247:,
239:,
235:,
231:,
127:.
1780:e
1773:t
1766:v
1727:-
1712:-
1702:D
1682:.
1670::
1653:.
1641::
1624:.
1604::
1568:.
1556::
1533:.
1506:.
1484::
1457:.
1447:5
1430:.
1418::
1392:.
1380::
1357:.
1343::
1316:.
1304::
1281:.
1261::
1238:.
1218::
1195:.
1175::
1147:.
1135::
1112:.
1090::
1058:.
1046::
1020:.
976:.
954::
920:.
900::
870:.
848::
816:.
804::
768:.
756::
733:.
713::
673:.
661::
629:.
615::
581:.
569::
206:.
54:(
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