Charles-Retinitis Pigmentosa-(United States)-Posted on Junly 2, 2013

Name: Charles
Sex: Male
Country: United States
Age: 40 years
Diagnoses: 1. Retinitis Pigmentosa 2. Cataract 3. Diabetes Type 2 4. Fatty liver (mild)
Admission Date: 2013-05-24
Days Admitted to the Hospital: 30

The patient suffered from poor eyesight from childhood. He wears glassses all the time. He received laser surgery to treat high myopia 15 years ago. After the operation, the eyesight distance didn't extend, but the definition has improved. Then his eyesight still went down progressively. He was diagnosed with retinal pigment degeneration. He didn't received special treatment, was only forbidden to work or drive at night. Then the disease progressed gradually. About 14 months ago, the patient suffered from metamorphopsia of the left eye. He went to a local hospital in May 2012. After corrected vision, it showed the right eye 0.4, left eye 0.1. The diabetic retinopathy was considered. So the patient received Avastin injection with local anesthesia of both eyes. After treatment, the vision had no improvement and the effect was not good. Before the treatment, the patient had poor vision and almost normal colour vision. He had visual field defect in bilateral upward sides.

Nervous System Examination:
Charles was alert and his speech was clear. The memory, orientation and calculation abilities were normal. He wore glasses in daily life. The diameter of both pupils was 3.0mms. Both pupils had sensitive responses to light stimuli. Both eyes were sensitive to direct light reflex and indirect light reflexes. The patient's right eye could distinguish the objects' number from 1.5 meters distance without correction. The right eye had blurred vision from further than 1.5 meters. The patient's left eye could distinguish the objects' number from 30cm distance, but this was accompanied by metamorphopsia and vision fusion. The left eye had blurred vision from more than 30cm distance. The patient's right eye was 0.15 from 1 meter distance of standard visual acuity chart without correction. The right eye was 0.06 from 3 meters distance of standard visual acuity chart without correction. The patient's left eye was 0.12 from 1 meter distance of standard visual acuity chart without correction. Binocular visual field showed no obvious abnormalities. The colour vision of both eyes was normal. He had poorer eyesight in the night than in the daytime. The dark adaption time was extended obviously. Both eyeballs could move freely. There was no obvious nystagmus. Through ophthalmoscope: we found the optic disk had atrophy and presented with a yellowish color. The retinal vessel was not obvious. The blood circulation was poor. The retina presented with dark bluish grey. There was black pigmentation in the retina. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical and the tongue was centered in the oral cavity. There was flexible movement in the neck. The muscle tone of all four limbs was almost normal; the muscle strength of all four limbs was almost level 5. The abdominal reflexes were elicited normally. The tendon reflex of the four limbs was elicited normally. The sucking reflex and palm jaw reflex were negative. Bilateral Hoffmann sign was negative. The Rossolimo sign of both upper limbs was negative. The pathological reflex of both lower limbs was negative. The deep and shallow sensation existed. The coordinated movements were normal. There were no signs of meningeal irritation.

Treatment:
We gave Charles  a complete examination. Then he received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and to nourish the neurons retina. The patient also received treatment for nerve regeneration and activate stem cells. This was accompanied with strengthening nutrition and adjusting immunity.

Post-treatment:
The patient's condition has showed improvement. The right eye can distinguish the object's number from 2 meters distance without correction. The left eye can distinguish the object's number from 1 meter distance. The patient's right eye was 0.25 from 1 meter distance of standard visual acuity chart without correction. The right eye was 0.1 from 3 meters distance of standard visual acuity chart without correction. The patient's left eye was 0.15 from 1 meter distance of standard visual acuity chart without correction. Through a ophthalmoscope: the color of the fundus retina is better than before. The hyperpigmentation in bilateral retinal vessel is alleviated obviously. The diameter of retinal vessel is enlarged. The blood circulation is improved.
 

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