Surgical management of unilateral restrictive strabismus in an 8-month-old dog.

CASE HISTORY: An 8-month-old male, entire, mixed-breed dog was presented with a 1-month history of left exophthalmos and green mucopurulent ocular discharge. Subsequently, exophthalmos resolved but esotropia (medial strabismus) developed in the left eye, prompting referral to an ophthalmologist. CLINICAL FINDINGS: At the initial referral consultation, enophthalmos and esotropia of the left eye were identified. The patient showed mild improvement after a 3-week tapering course of oral prednisolone and doxycycline. MRI was performed and showed left medial rectus muscle atrophy with increased contrast enhancement which was consistent with chronic extraocular muscle myositis (EOM). A forced duction test was performed to confirm the diagnosis of fibrosing esotropia, which is likely a sequela of chronic EOM. DIAGNOSIS: Fibrosing esotropia presumably caused by untreated EOM. TREATMENT AND OUTCOME: One month later, esotropia progressed to a marked ventro-medial strabismus resulting in visual deprivation. Surgical release of the ventral oblique, medial and ventral recti muscles was performed, resulting in immediate resolution of the enophthalmos. Despite a tapering post-operative course of oral prednisolone, mild esotropia was present 4 weeks later. In an effort to stabilise the globe position, the low dose of prednisolone was increased to a higher anti-inflammatory dose before slowly tapering over 2 months. The vision in the left eye was improved after surgery and has been maintained since without further treatment. CLINICAL RELEVANCE: This is the first documented case of fibrosing esotropia in a young dog with prior signs of acute exophthalmos. Fibrosing esotropia has been documented in certain breeds or as a sequela to chronic EOM. In this patient, it was presumably caused by EOM, which was strongly supported by the case history, progression and MRI findings. Most historical reports of EOM described it as a bilateral condition that resolves with systemic corticosteroids at an anti-inflammatory dose. EOM has been shown to also present unilaterally and it can progress to strabismus if not promptly recognised and treated with systemic steroids. Surgical management can restore vision when severe strabismus results in visual deprivation.

Discovery of a novel HLA-DRB1*09 variant, HLA-DRB1*09:28, in a Taiwanese individual.

One nucleotide substitution at residue 332 of HLA-DRB1*09:01:02 results in a novel allele, HLA-DRB1*09:28.

HLA-DRB1*16:39, a novel HLA-DRB1*16 variant, discovered in a Taiwanese bone marrow hematopoietic stem cell donor.

One nucleotide substitution at residue 112 of the HLA-DRB1*16:02:01:01 results in a novel allele, HLA-DRB1*16:39.

Discovery of HLA-B*58:80, a novel HLA-B*58 variant, in a Taiwanese bone marrow donor.

One nucleotide substitution at residue 133 of HLA-B*58:01:01:01 results in a novel allele, HLA-B*58:80.

A novel HLA-B*38 variant, B*38:15, detected in a Taiwanese individual.

One nucleotide substitution at residue 346 of HLA-B*38:02:01 results in a novel allele, HLA-B*38:15.

Recognition of a novel HLA-A*11 variant, HLA-A*11:196, in a Taiwanese unrelated bone marrow stem cell donor.

One nucleotide substitution at residue 484 of HLA-A*11:01:01:01 results in a novel allele, HLA-A*11:196.

HLA-A*11:235Q, a novel HLA-A*11 variant, detected in a Taiwanese individual.

Nucleotide deletions from residue 120 to 125 of HLA-A*11:01:01:01 result in a novel allele, HLA-A*11:235Q.

HLA-A*33:03:31, a novel variant of HLA-A*33:03, discovered in a Taiwanese individual.

One nucleotide substitution of HLA-A*33:03:01 results in a novel allele, HLA-A*33:03:31.

Detection of a novel HLA-C*07:341 variant, HLA-C*07:341:02, in a Taiwanese hematopoietic stem cell donor.

Two nucleotide replacements in codon 138 of the HLA-C*07:341:01 result in a novel allele, HLA-C*07:341:02.

HLA-B*46:65, a novel HLA-B*46 variant, detected in a Taiwanese unrelated bone marrow stem cell donor.

One nucleotide exchange at residue 550 of the HLA-B*46:65 results in a novel allele, HLA-B*46:65.

HLA-C*07:486, a novel HLA-C*07 variant, detected in a Taiwanese individual.

One nucleotide exchange at residue 812 of the HLA-C*07:02:01:01 results in a novel allele, HLA-C*07:486.

HLA-A*24:333, a novel HLA-A*24 variant, discovered in a Taiwanese individual.

Four nucleotide replacements of HLA-A*24:02:01:01 result in a novel allele, HLA-A*24:333.

Detection of HLA-DRB1*04:207, a novel HLA-DRB1*04 variant, in a Taiwanese hematopoietic stem cell donor.

Recombination may result in the formation of HLA-DRB1*04:207.

Identification of a novel HLA-A*02 variant, HLA-A*02:610, in a Taiwanese individual.

One nucleotide substitution at residue 204 of the HLA-A*02:01:01:01 results in a new allele, HLA-A*02:610.

Discovery of HLA-B*58:77, a novel HLA-B*58 variant, in a Taiwanese blood donor.

One nucleotide substitution at residue 506 of HLA-B*58:01:01:01 results in a novel allele, HLA-B*58:77.

HLA-A*24:334, a novel variant of HLA-A*24, discovered in a Taiwanese individual.

One nucleotide replacement at residue 587 of HLA-A*24:02:01:01 results in a novel allele, HLA-A*24:334.

Discovery of HLA-B*35:307, a novel HLA-B*35 variant, in a Taiwanese hematopoietic stem cell donor.

One nucleotide substitution at residue 421 of HLA-B*35:01:01:01 results in a novel allele, HLA-B*35:307.

Discovery of HLA-B*55:02:10, a novel HLA-B*55:02 variant, in a Taiwanese hematopoietic stem cell donor.

One nucleotide substitution at residue 448 of HLA-B*55:02:01:01 results in a novel allele, HLA-B*55:02:10.

HLA-B*40:01:44, a novel variant of HLA-B*40:01, discovered in a Taiwanese hematopoietic stem cell donor.

One nucleotide replacement at residue 147 of HLA-B*40:01:01 results in a new allele, HLA-B*40:01:44.

HLA-B*40:327, a novel HLA-B*40 variant, discovered in a Taiwanese blood donor.

One nucleotide substitution at residue 220 of HLA-B*40:01:01 results in a new allele, HLA-B*40:327.