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BACKGROUND: Inferior oblique anterior transposition (IOAT) has emerged as an effective surgery in the management of dissociated vertical deviation (DVD) combined with superior oblique palsy (SOP). Traditional IOAT usually provides satisfactory primary position alignment and simultaneously restricts the superior floating phenomenon. However, it also increases the risk of the anti-elevation syndrome and narrowing of the palpebral fissure in straight-ahead gaze, especially after the unilateral operation. CASE SUMMARY: We report the outcomes of the modified unilateral IOAT in two patients with unilateral DVD combined with SOP. The anterior-nasal fibers of the inferior oblique muscle were attached at 9 mm posterior to the corneal limbus along the temporal board of the inferior rectus muscle, the other fibers were attached a further 5 mm temporal to the anterior-nasal fibers. Postoperatively, both hypertropia and floating were improved, and no obvious complications occurred. CONCLUSION: In these cases, the modified unilateral IOAT was an effective and safe surgical method for treating DVD with SOP.
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BACKGROUND: Heavy eye syndrome (HES) is an acquired strabismus typically seen in eyes with high myopia. We report a classic case in which a patient was misdiagnosed with esotropia and underwent disinsertion of the medial rectus muscle and lateral rectus muscle resection procedures. CASE SUMMARY: A 71-year-old woman presented with both eyes fixed in adduction and infraduction for 33 years. She had undergone three complicated strabismus surgeries to amputate the left medial rectus (MR) muscle with lateral rectus muscle recession, but no improvement in the esotropia appeared after each operation. She was diagnosed with HES and underwent a bilateral Yokoyama procedure and recession of the right MR muscle under general anesthesia. After surgery, her eyes were binocularly aligned for 6 mo. This case suggests that pertinacious esotropia combined with high myopia must be considered in HES. Orbital imaging and ultrasonography can demonstrate anatomical abnormality and muscle paths to confirm a definite diagnosis. CONCLUSION: The Yokoyama procedure was effective in correcting HES.
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PURPOSE: To evaluate the relationship between -590C/T polymorphisms of interleukin-4 gene and chronic periodontitis using meta-analysis. METHODS: The selected studies were pooled from eight major electronic databases for case-control study. To gain a more precise estimation of the relationship, a stratified meta-analysis with two subgroups was performed according to the races. Heterogeneity, publication bias and sensitivity analysis were also explored. RESULTS: Totally 8 studies were recruited. Total sample sizes for chronic periodontitis and control groups were 628 and 717, respectively. Meta-analysis showed that both -590C/T polymorphisms and allele frequency were not significantly associated with chronic periodontitis. In subgroup analysis, a significant association of increased chronic periodontitis risk and T allele was found. The results also indicated a significant correlation between -590C/T polymorphisms of IL-4 and Caucasian who suffered from chronic periodontitis(C vs.T: OR=0.71,95% CI=0.56-0.89;CC vs.CT:OR=0.60,95% CI=0.38-0.94;recessive genetic model CC vs.CT+TT:OR=0.61,95% CI=0.42-0.88), further analysis of the results showed the CC genotype was about 39% less likely to have chronic periodontitis than the CT and TT genotype in Caucasian individuals.However, these significant associations was not found in Asian group. CONCLUSIONS: The meta-analysis suggests there may be an important effect of single nucleotide polymorphisms (SNPs) in the promoter region of IL-4 gene on the pathogenesis of chronic periodontitis in Caucasian. This warrants further investigation in larger studies and multi-race epidemiological to evaluate the results.