Outward Deviation Research Articles

Transient eye closure and ocular preference in patients with intermittent exotropia

PurposeTo assess the relationship of sensory and motor ocular dominance to transient eye closure (TEC) under bright light conditions in patients with intermittent exotropia. MethodsForty patients (age range, 7-40 years) with intermittent exotropia were included in this prospective study. Motor and sensory ocular dominance were evaluated using the hole-in-the-card and Worth 4-Dot tests. Presence of any outward eye deviation or TEC was assessed and recorded in all participants under bright light conditions. Based on the fusion control grade of exodeviation, patients were assigned to good, fair, and poor control groups, and the results were compared. ResultsA total of 23 patients (58%) showed TEC under bright light: 18 (45%) in the good control group, 14 (35%) in the fair control group, and 8 (20%) in the poor control group. Eighteen patients (56%) with good and fair control showed TEC in the dominant eye. Five (63%) with poor control closed their nondominant eyes, and in all of them, outward eye deviation was observed before TEC. The angle of deviation at far and near and the degree of near stereopsis were not related to presence of TEC (P = 0.70, P = 0.06, and P = 0.34, resp.). ConclusionsIn patients with intermittent exotropia who exhibit TEC under bright light, those with good control tend to close the dominant eye, whereas in the majority of patients with poor control, spontaneous deviation occurs and is then followed by TEC of the nondominant eye.

A challenging case of scleral buckle-related restricted strabismus with unexpected good postoperative outcomes: A case report

Abstract Strabismus surgery in a scleral buckle patient is a challenging task that requires precise planning and meticulous surgical skills to accomplish a successful outcome. We report a case of a 32-year-old male who presented with complaints of diminution of vision in the right eye (RE) for 23 years and outward deviation of RE for 5 years after blunt trauma with a ball. The patient was diagnosed with RE total retinal detachment (RD) with traumatic retinal dialysis. He underwent scleral buckling as RD surgery in 2004 followed by silicon oil removal 6 months later elsewhere. On ocular examination of the RE, the best corrected visual acuity was perception of light with accurate projection of rays in all four quadrants, there was grade III relative afferent pupillary defect with an exotropia of 20° on Hirschberg test. The prism bar reflex test revealed an exotropia of 50 prism diopters (PD) [Figure 1]. An anterior segment examination revealed posterior subcapsular and cortical cataracts. After taking a retina clinic opinion, the patient underwent uneventful RE cataract surgery with in-bag implantation of a foldable implant cataract surgery first, followed by strabismus surgery under a guarded visual prognosis. Clinically significant adhesion and the presence of the scleral buckle posed a magnificent challenge during the strabismus surgery. The plan was improvised to 8 mm lateral rectus recession with 4 mm hang loose recession irrespective of a large deviation under local anesthesia. To our surprise, a satisfactory primary position alignment within 10 PD (orthophoria) was achieved, which was maintained on subsequent follow-up visits. We report an interesting and challenging case of restrictive strabismus due to scleral buckle which emphasizes that surgical procedures and their outcomes may not always align with expectations. Therefore, it is necessary to adopt a flexible and customized approach to effectively manage such instances.

Conjunctival Epithelial inclusion Cyst after Strabismus Surgery: A Case Report

Abstract We present a case of a 26-year-old man with outward deviation of left eye since birth, diagnosed with exotropia underwent squint correction surgery, and later developed a conjunctival cyst. The histopathological findings from the biopsy indicated an epithelial inclusion cyst with retention.

Abnormal occipital and frontal activity during voluntary convergence in intermittent exotropia: A task-fMRI study

Intermittent exotropia (IXT) is characterized by intermittently outward deviation of the eye and involved with vergence dysfunction. This study aimed to investigate the brain areas related to voluntary convergence and cortical activation changes between IXT patients and normal subjects. A total of 21 subjects, including 11 IXT patients and 10 age- and sex-matched normal subjects, were recruited for this study. A voluntary convergence task was employed, with changes in brain function measured by functional magnetic resonance imaging (fMRI). Correlations between cortical activation and clinical measurements were conducted by Pearson's correlation analysis. fMRI results showed that during voluntary convergence, the medial frontal gyrus (MFG) and bilateral occipital cortex were activated in the normal group, whereas only activation of the occipital cortex in IXT patients. Compared with the normal, IXT patients showed hypo-activation of both the MFG and cuneus during the task. The activation of MFG was negatively correlated to the duration of IXT. This study demonstrates that both MFG and occipital cortex may participate in voluntary convergence in normal subjects, while IXT patients have an aberrant cortical function of the MFG and cuneus, and the duration of IXT likely influences the severity of MFG. These findings may provide valuable insights for understanding the relationship between convergence and IXT.

Gender differences in horizontal strabismus: Systematic review and meta-analysis shows no difference in prevalence, but gender bias towards females in the clinic.

Strabismus is a misalignment of the visual axis that affects 2-3% of the population and can lead to loss of binocular vision. It is currently controversial whether there is a gender difference in the most common form of visual misalignment: horizontal strabismus. Some studies claimed that more females than males have an outward deviation (exotropia), while others concluded that there is no significant gender difference. No previous work has systematically explored gender differences in horizontal strabismus or has compared the results of population-based studies with those of clinic-based studies. We conducted a systematic review and meta-analysis of studies reporting the prevalence of horizontal strabismus. We included 73 population-based studies and compared their disclosed gender population with that in 141 comparable clinical-based studies. We analysed the data according to gender, strabismus type (esotropia, exotropia), and geographic region/ethnicity. Summary statistics showed a nearly identical prevalence of horizontal strabismus (2.558% for males, 2.582% for females), esotropia (1.386% males vs. 1.377% females), and of exotropia (1.035% males vs. 1.043% females). Meta-analysis results showed that these differences between males and females were not statistically significant (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.97-1.10), but that females were significantly more frequent (by 7.50%) in clinic-based studies than males, with 5.00% more females for esotropia, and 12.20% more females for exotropia when adjusted for the population's sex ratio. The extent of the female gender bias differed between geographic regions/societies, with Asians having the lowest bias towards females and Latin American countries having the strongest bias. Males and females have the same prevalence of horizontal strabismus, including exotropia. Females with strabismus seek health care or are brought to clinics significantly more often than males. This is an example of gender bias in health care in favour of females rather than males, apparently because parents - erroneously fearing only cosmetic consequences - are more concerned about strabismus in their daughters than their sons. Societal attitudes towards females, as well as economic factors (insurance status), appear to be relevant factors that determine the magnitude of the gender bias in horizontal strabismus.

Structural and spontaneous functional brain changes in visual and oculomotor areas identified by functional localization task in intermittent exotropia children

Intermittent exotropia (IXT) is characterizedby an intermittent outward deviation of the eyes. Yet, the neural substrates associated with IXT are not fully understood. This study investigated brain structure and spontaneous functional activity changes in children with IXT. All participants underwent detailed ophthalmological examinations and multimodal magnetic resonance imaging (MRI) scanning. During functional scanning, binocular visual stimuli were presented to subjects to determine brain areas involved in visual and oculomotor processing. Regions of interest(ROI) were subsequently selected based on functional activation to investigate brain structural and spontaneous functional differences between IXT children and healthy controls (HCs) using small volume correction (SVC). Reduced gray matter density (GMD) was found in the right frontal eye field (FEF) and bilateral inferior parietal lobe (IPL) in IXT children compared with HCs. Besides, reduced fractional amplitude of low-frequency fluctuations (fALFF) values were observed in the left lingual gyrus, right inferior occipital gyrus (IOG), bilateral IPL, and bilateral cerebellum in the IXT children compared to the HCs. IXT children with worse eye position control ability exhibited lower GMD and fALFF values in these areas. Finally, resting state functional connectivity (RSFC) was reduced in frontoparietal oculomotor processing areas in IXT children compared to HCs. In addition, increased cortical thickness was found in the right visual areas and bilateral IPL. These results showed that IXT-related structural and functional brain abnormalities occurred in childhood and may be related to underlying neuropathological mechanisms.

Case report: Pupil sparing third nerve palsy in an immunocompetent host – A rare sequelae of congenital ocular toxoplasmosis

We share a case of a 20 yr old female who presented with drooping of left upper eyelid with down and outward deviation of left eye since birth and diminution of vision in left eye noticed since 2 yrs with retinal abnormalities suggestive of congenital ocular toxoplasmosis. The clinical and complementary examinations of the case are discussed. Ocular toxoplasmosis remains to be the most common cause of infectious posterior uveitis in immunocompetent and immunocompromised individuals with highly variable prognosis. A precise diagnosis of the disease is necessary to opt effective and rapid treatment. Hence, It is essential that clinicians be aware of antenatal and postnatal presenting signs and symptoms, as early diagnosis and treatment will minimise the possibility of sequelae as majority of affected infants may develop chorioretinitis, deafness and/or neurological symptoms if left untreated.

Integration Analysis of circRNA-miRNA-mRNA and Identification of Critical Networks in Valgus-Varus Deformity (Gallus gallus).

Valgus-valgus deformity (VVD) is a common leg deformity in broilers with inward or outward deviation of the tibiotarsus and tarsometatarsus. The competing endogenous RNA (ceRNA) network plays an essential role in the study of leg disease. However, its role in the etiology and pathogenesis of VVD remains unclear. Here, based on case (VVD) and control (normal) group design, we performed analyses of differentially expressed circRNAs (DEcircRNAs), differentially expressed miRNAs (DEmiRNAs) and differentially expressed mRNAs (DEmRNAs). Transcriptome data derived 86 DEcircRNAs, 13 DEmiRNAs and 410 DEmRNAs. Functional analysis showed that DEmRNAs were significantly enriched in cell cycle, apoptosis, ECM-receptor interaction, FoxO signaling pathway and protein processing synthesis. DEcirc/miRNA-associated DEmRNAs were associated with skeletal and muscle growth and development pathways, including mTOR, Wnt, and VEGF signaling pathways. Subsequently, a circRNA-miRNA-mRNA regulatory network was constructed based on the ceRNA hypothesis, including 8 circRNAs, 6 miRNAs, and 31 mRNAs, which were significantly enriched in the skeletal developmental pathway. Finally, two key mRNAs (CDC20 and CTNNB1) and their regulatory axes were screened by the PPI network and cytohubba. The expression levels of CDC20 and CTNNB1 in cartilage and seven other tissues were also quantified by qPCR. In conclusion, we analyzed the functions of DEmRNA, DEcircRNA and DEmiRNA and constructed the hub ceRNA regulatory axis, and obtained two hub genes, CDC20 and CTNNB1. The study more deeply explored the etiology and pathogenesis of VVD and lays the foundation for further study of the role of the ceRNA network on skeletal development.

Orbital Metastases of Breast Cancer in Males

We report a case of orbital metastasis of infiltrative breast carcinoma in a 65-year-old man. The patient was diagnosed with stage four breast cancer one year before, for which a mastectomy was performed. He refused postoperative radiotherapy and chemotherapy at that time. He had a history of lung, liver, and mediastinal metastases. At admission, he presented with blurred vision, diplopia, ocular pain, and mild swelling of the upper lid of the left eye (LE). Computed tomography (CT) of the brain and orbit revealed a front-ethmoidal tissue mass with left orbital and frontal intracranial extension. Ophthalmologic examination revealed exophthalmos on the LE with a downward and outward deviation of the eyeball, proptosis, and intraocular pressure (IOP) of 40 mmHg. The patient's treatment started with topical maximal anti-glaucomatous drops and radiotherapy sessions. After three weeks of follow-up, there was a gradual improvement of local symptoms and signs and a normal IOP.

Anomalous head posture

Intermittent exotropia (IXT) usually presents with occasional outward deviation of the eye, asthenopia, headache, diplopia, or photophobia. We report here an unusual presentation of IXT in a 21-year-old man, with an anomalous head posture (AHP) of face rotation towards left as the primary symptom. On examination, there was lateral gaze incomitance, and improved fusion range in dextroversion explained his AHP.

Bardet Biedl Syndrome-Report of three Cases and Review of Recent Articles

Purpose: To report three cases of a rare inherited familial disorder of Bardet-Biedl Syndrome (BBS). Study Design: Observational case report. Method: Two out of eight siblings presented in their second decade of life with dimness of vision in both eyes since birth. The third one is the only person of the family presented also in second decade of life with gradual blurring of vision in both eyes and outward deviation of left eye. Detail clinical history was taken. Physical, anthropometric, ophthalmic, psychological examination was done and appropriate clinical investigations were performed to exclude other systemic disorder. Review of recent literatures was done. Result: First two cases were brothers, who were mentally retarded child with delayed developmental mile stone. They were short, obese and had polydactyly, gynecomastia, hypogonadism. Their vision was poor and had retinitis pigmentosa with optic atrophy. The third one was also mentally retarded and had polydactyly, trunkal obesity, atypical retinitis pigmantosa with optic atrophy. They did not had deafness or any systemic abnormalities. Depending on clinical findings they were diagnosed as a case of BBS.

Interocular suppression in primary visual cortex in strabismus: impact of staggering the presentation of stimuli to the eyes.

Diplopia (double vision) in strabismus is prevented by suppression of the image emanating from one eye. In a recent study conducted in two macaques raised with exotropia (an outward ocular deviation) but having normal acuity in each eye, simultaneous display of stimuli to each eye did not induce suppression in V1 neurons. Puzzled by this negative result, we have modified our protocol to display stimuli in a staggered sequence, rather than simultaneously. Additional recordings were made in the same two macaques, following two paradigms. In trial type 1, the receptive field in one eye was stimulated with a sine-wave grating while the other eye was occluded. After 5 s, the occluder was removed and the neuron was stimulated for another 5 s. The effect of uncovering the eye, which potentially exposed the animal to diplopia, was quantified by the peripheral retinal interaction index (PRII). In trial type 2, the receptive field in the fixating eye was stimulated with a grating during binocular viewing. After 5 s, a second grating appeared in the receptive field of the nonfixating eye. The impact of the second grating, which had the potential to generate visual confusion, was quantified by the receptive field interaction index (RFII). For 82 units, the mean PRII was 0.48 ± 0.05 (0.50 = no suppression) and the mean RFII was 0.46 ± 0.08 (0.50 = no suppression). These values suggest mild suppression, but the modest decline in spike rate registered during the second epoch of visual stimulation might have been due to neuronal adaptation, rather than interocular suppression. In a few instances neurons showed unequivocal suppression, but overall, these recordings did not support the contention that staggered stimulus presentation is more effective than simultaneous stimulus presentation at evoking interocular suppression in V1 neurons.NEW & NOTEWORTHY In strabismus, double vision is prevented by interocular suppression. It has been reported that inhibition of neuronal firing in the primary visual cortex occurs only when stimuli are presented sequentially, rather than simultaneously. However, these recordings in alert macaques raised with exotropia showed, with rare exceptions, little evidence to support the concept that staggered stimulus presentation is more effective at inducing interocular suppression of V1 neurons.

CASE REPORT OF AN ATYPICAL PRESENTATION OF CONGENITAL FIBROSIS OF THE EXTRAOCULAR MUSCLES (CFEOM)

INTRODUCTION: CFEOM is a disorder that includes multiple extra ocular muscle restrictions. It is a rare, non –progressive, congenital condition and refers to at least eight genetically dened strabismus syndromes. Commonly presented clinical signs and symptoms in CFEOM includes- congenital nonprogressive ophthalmoplegia (inability to move the eyes) with or without ptosis (droopy eyelids) affecting part or all of the oculomotor nucleus and nerve (cranial nerve III) and its innervated muscles. Refractive errors are also common. CASE REPORT: The patient was the rst child of non-consanguineous parents. There was no similar history or any history of ocular motility disorders in family in both paternal and maternal side. There is no prior history of use of glasses, occlusion therapy, surgery or trauma. Typically, binocular vision is absent. The child had difculty looking at objects in downgaze, up gaze and laterally. They also observed outward deviation of both eyes which was more for distance. Child had normal weight for age (30 kgs) Head circumference was within normal range (57 cm) There was absence of lid crease in both eyes and chin up head posture was seen for distance. No facial asymmetry was seen. Patient was able to spontaneously alternate xate in the primary position. Patient had hypertropia of 6 prism diopters in left eye when xing with right eye and hypertropia was same in upgaze and downgaze. No evidence of globe retraction on ocular movements. Patient had history of ocular deviation since birth which had not changed over the years. Mutations in the KIF21A gene are the primary cause of CFEOM1. Patients typically have convergent-type nystagmus movements with attempted up gaze (synergistic convergence) and an A pattern with divergence of the eyes in downgaze. There was no associated neurologic abnormalities and systemic disorders. The patient was found to have bilateral lagophthalmos, limitation of elevation and depression (vertical gazes). The patient underwent two surgeries. In the rst surgery, B/L LR RC (14mm from limbus) and B/L SR RC(11mm)was done. DISCUSSION: Congenital brosis of extraocular muscles is a common condition encountered by pediatric ophthalmologists. If not properly diagnosed, it is often confused with other ocular motility disorders. The treatment of CFEOM must focus on specic pattern of decit and include management of head position, ocular alignment in primary position and maximizing outcome by preventing ambylopia. Currently no treatment has been developed to restore full functionality and range of motion of the extraocular muscles. Patients presenting with CFEOM1 usually require large bilateral inferior rectus recessions, often enhanced with bilateral superior oblique tenotomies to allow the eyes to come to vertical midline. Patient might also need multiple strabismus surgeries like with our patient. CFEOM is often associated with potential complications like strabismus, decreased binocular vision, ambylopia and facial palsy.

Congenital ocular counter-roll: a review of cases treated exclusively by ophthalmologists.

To review the demographics, clinical manifestations, and surgical experiences of patients with congenital ocular counter-roll, whose treatments were performed exclusively by ophthalmologists. A retrospective review was conducted consisting of patients who received strabismus surgery between 2017 to 2019. Patients with obvious ocular counter-roll were included. A total of 7008 patients who received strabismus surgery, 28 (12 males, 16 females) were diagnosed as congenital ocular counter-roll, accounting for 0.40%. All patients were initially misdiagnosed: 21 patients were misdiagnosed as superior oblique palsy (SOP), 3 as inferior oblique overaction, 2 as dissociated vertical deviation (DVD), 1 as superior oblique overaction with A-pattern exotropia, and 1 as medial rectus palsy. The mean±SD age was 12.4±9.4y (range 2.5-36y). The most common clinical findings included ocular counter-roll, vertical deviation or vertical deviation combined with outward deviation and head tilt. At follow-up, an excellent surgical result was achieved in 20 patients. Preoperative horizontal deviation of 26±24 prism diopter (PD) and vertical deviation of 18±12 PD were reduced to 0±12 PD (P=0.0001) and 3±4 PD (P=0.001), respectively. Congenital ocular counter-roll is a rare supranuclear vertical strabismus caused by congenital abnormalities involving vestibule-ocular reflex pathways. In addition to ocular counter-roll, the most salient clinical features included, but are not limited to, hyperdeviation, outward deviation, overelevation in adduction and head tilt.

Single stage Large LR recession with or without MR resection and its motor outcomes in Concomitant Exotropia

Exotropia is a manifest outward deviation of the visual axes, which is either constantly or intermittently present. Untreated, poorly controlled intermittent exotropia later progresses to constant exotropia. Sensory exotropia is unilateral divergent misalignment of the eyes, resulting from loss of vision or long-standing poor vision in an eye. In sensory exotropia the angles are characteristically large, ranging from 30 to 100 prism dioptres (PD) and increases gradually over time as long as the cause of visual deficit remains active. Treatment is directed to re-establish the normal ocular alignment and binocular vision[1]. The preferred treatment for manifest exotropia is surgery[2]. Large angle constant exotropia negatively impacts the way the patients see themselves and are perceived by others. The benefits of surgical treatment of exotropia in adults is well proven, both psychologically and visually. The surgical treatment for largeangle exotropia has been a subject of sufficient debate. A variety of surgical plans have been described including two, three or four horizontal rectus muscles recession and resections with or without adjustable suture technique.[3] In more recent studies, the management of large-angle exotropia falls into two surgical approaches. Large bilateral lateral rectus recession is done when the acuity is good in each eye and indicated for true divergent excess type. For basic exodeviation R-R procedure is done popularly. Before embarking on surgical plan we do post occlusion test and identify the clinical type. If one eye is amblyopic, a maximal or supramaximal unilateral recess- resect procedure is performed. Records of previous studies have shown that monocular surgery had shown good results for exotropia of < 60 PD. But for exotropia of > 60 PD, monocular surgery was not so effective (4). In previous studies mild to moderate LR recessions were described but our study involves maximum recession on LR. In previous studies large LR recessions were reported to have complications like Lid changes and palpebral aperture widening. This study was done to evaluate the outcome of single stage, unilateral large LR recession with or without MR resection for constant exotropia

Recovery of Stereopsis After Squint Surgery: A Case Report

Exophoria (X) may be defined as an outward deviation of the eyes. This may deteriorate to constant exotropia (XT), resulting in partial or complete loss of stereo-acuity and other sensory parameters. Studies have shown a good outcome of stereo-acuity in intermittent exotropia patients with surgical correction. This present 19-year-old female subject with 70 PD strabismus in LE was treated with surgical and therapeutic intervention resulting in stable binocular coordination, a remarkable improvement of stereo-acuity (from < 480 sec of arc to 30 sec of arc). The therapy plan was designed to perform in three stages including 1 hr office-based therapy once a week along with hometherapy for 30 min everyday for 5 months. Anti- suppression therapy was planned in the first stage to restore bi-ocular vision whereas second and final stage therapy was designed for recovery of fusion, accommodation, and stereo-acuity. To understand and conclude regarding improvement, pre and post vision therapy data were compared.

Aetiology, clinical features and surgical outcomes of isolated medial rectus palsy.

Isolated medial rectus palsy is extremely rare in clinical practice. To report demographics, aetiology, clinical findings, imaging features and surgical outcomes in patients with isolated medial rectus palsy. Retrospective study. All patients treated for isolated medial rectus palsy at Zhongshan Ophthalmic Center, Sun Yat-sen University, between September 2003 and March 2019. Review of patient records. Aetiology, clinical findings, imaging features and surgical outcomes. A total of 32 patients (22 males, 10 females) were included. Mean age was 33.19 ± 19.78 years. The right eye was involved in 17 patients, the left eye was involved in 14 patients, and both eyes were involved in one patient. The most common causes were iatrogenic injury (43.75%), followed by trauma (37.50%) and congenital (18.75%). The most common clinical findings included outward deviation, diplopia and limited adduction. Six patients showed combined small-angle vertical strabismus, and 10 patients experienced a scale of -1 motility defect in other directions. After individualized strabismus surgery, preoperative exotropia of 60 ± 25 prism diopters (PD) was significantly reduced to 12 ± 13 PD (t = 10.938, P < .0001). Ocular motility improved in 21 patients, and five patients achieved normal ocular motility. Successful correction was obtained in 20/32 (62.50%) patients, with under-correction in 12/32 (37.50%) patients. Twenty-eight patients had only one surgery, three patients had two surgeries and one patient had three surgeries. The most common cause of isolated medial rectus palsy was local injury. Satisfactory results were obtained after individualized surgical interventions based on personalized preoperative evaluations.

Integrative analysis of long non-coding RNA and mRNA in broilers with valgus-varus deformity.

Bone abnormality and leg disease in commercial broiler flocks are increasingly prominent, causing serious economic losses to the broiler breeding industry. Valgus-varus deformity (VVD) is a common deformity of the long bone in broilers that manifests as an outward or inward deviation of the tibiotarsus or tarsometatarsus. There is a paucity of studies on the molecular mechanisms of VVD. In this study, 6 cDNA libraries were constructed from spleen samples from VVD birds and normal birds. A total of 1951 annotated lncRNAs, 7943 novel lncRNAs and 30252 mRNAs were identified by RNA-sequencing. In addition, 420 differentially expressed (DE) mRNAs and 124 differentially expressed lncRNAs (adjusted P-value < 0.05) were obtained. A total of 16 dysregulated genes were confirmed by qPCR to be consistent with the results of the RNA-Seq. The functional lncRNA-mRNA co-expression network was constructed using differentially expressed mRNAs and target genes of the differentially expressed lncRNAs. 11 DE genes were obtained from the analysis. In order to gain insight into the interactions of genes, lncRNAs and pathways associated with VVD, we focused on the following pathways, which are involved in immunity and bone development: the Jak-stat signaling pathway, Toll-like receptor signaling pathway, Wnt-signaling pathway, mTOR signaling pathway, VEGF signaling pathway, Notch signaling pathway, TGF-beta signaling pathway and Fanconi anemia pathway. All together, 30 candidate DE genes were obtained from these pathways. We then analyzed the interaction between the DE genes and their corresponding lncRNAs. From these interaction network analyses we found that GARS, NFIC, PIK3R1, BMP6, NOTCH1, ACTB and CREBBP were the key core nodes of these networks. This study showed that differentially expressed genes and signaling pathways were related to immunity or bone development. These results increase the understanding of the molecular mechanisms of VVD and provide some reference for the etiology and pathogenesis of VVD.

Two level osteotomies in bilateral genu valgum: A case report

Genu valgum is Latin derived term, commonly known as knock-knees, in which there is outward deviation of legs so that there is medial angulation at the knee. They are spontaneously corrected by 7 years of age. It is deemed that valgus (femorotibial alignment) of more than 15° (taking into consideration the measuring error) above 8 years of age is pathological. There are wide array of treatment options for deformity prevention & correction. We report an 18-year-old male who noticed progressive deformity in his bilateral knees for 7 years with bilateral knee pain & problems while walking. After necessary investigations and pre-operative planning, patient underwent two level osteotomies – distal lateral femur open wedge osteotomy with bone grafting and proximal medial tibial closed wedge osteotomy augmented with fibula osteotomy. At final follow-up, the patient has a good functional result.

High-throughput transcriptome analysis reveals potentially important relationships between lncRNAs and genes in broilers affected by Valgus-varus Deformity (Gallus gallus).

Valgus-varus Deformity (VVD) is an outward or inward deviation of the tibiotarsus or tarsometatarsus, which results in physical distress of chickens and economic loss in poultry industry. While the etiology and pathogenesis of VVD at the molecular level are still not fully understood so far. Here, based on a case/control design with VVD birds and normal birds, we identified genes and lncRNAs which associated with VVD using RNA sequencing. Transcriptome analysis revealed 231 differentially expressed mRNAs and 23 differentially expressed lncRNAs between case and control of leg cartilage. We identified the cis- and trans-regulatory targets of the differentially expressed lncRNAs, and we constructed a functional lncRNA-mRNA co-expression network. Analysis of the network showed that the differentially expressed mRNAs and the target genes of the differentially expressed lncRNAs were enriched in the signaling pathways associated with bone development, including p53, MAPK, Toll-like receptor, Jak-STAT, Hedgehog, and PPAR. The expression levels of DENND4A, FGF10, FGF12 and BMP3 were also determined in cartilage and other six tissues. Overall, our study predicted the mRNAs and lncRNAs related with leg diseases by transcriptome analyses, which might contribute to understand the etiology and pathogenesis of VVD. It established the foundation for the further research on the function of -mRNAs and lncRNAs in skeleton development.