Shaikh - Optic atrophy (Pakistan) Posted on April 2, 2013
Name: Shaikh Nadeem Abdul Saleem 
Sex: Male
Country: Pakistan
Age: 47
Diagnoses: 1. Optic atrophy 2. Retinosis 3. Glaucoma 4. Post-cataract surgery
5. Hepatitis C, Dysfunction of liver
Admission Date: 2013-02-17
Days Admitted to Hospital: 26 days
Before treatment:
The patient suffered from muscae volitantes before his eyes 5 years ago without obvious reason. The patient didn't pay attention to it. About 1 year ago, the patient started with constriction of the visual field of the left eye and blurred vision of the right eye. The disease was obvious under hard light. The disease progressed gradually. The patient had varying degrees of constriction of visual field in the left eye's nasal side, bitemporal lower quadrant. He went to local hospital and received vision and fundus examination, head MRI. He was diagnosed with Optic atrophy, Retinosis, glaucoma, post-cataract surgery and tobacco amblyopic. The patient received medication for treatment, but the effect was not good. The disease worsened gradually. Before the treatment, the patient's vision declined gradually. Both visual field defected and presented tubular vision. The dark adaptation was extended. He had burning sensation and scintillation around the eyes when he entered from indoor to outdoors. He had weaker visions in outdoor than indoors. The colour vision had no abnormality.
Admission PE:
Bp: 138/90mmHg. Sharwy Abdula was alert and his speech was clear. His orientation, calculation ability and comprehension were normal. The diameter of both pupils was 2.0mms, and both pupils were sensitive to light stimuli. Optic examination in daytime: bilateral direct light reflex and indirect light reflexes were sensitive. Under daylight in the room: From 3 meters distance, visual acuity of the left eye was 0.6, the right eye was 0.8. The patient had poor eyesight under hard light. The patient had poor adaptability to hard light. The adaptation time was obviously extended than normal. Both eyes presented tubular visual field. From 1 meter distance, as the dead ahead centre: the visual field of the left eye nasal side, bitemporal, upward side and downward were 4cm, 19cm, 7cm and 8cm. the visual field of the right eye nasal side, bitemporal, upward side and downward were 12.5cm, 21.5cm, 9cm and 16.5cm. The colour vision was normal. Both eyes could move freely, range of activity was full. There was no obvious nystagmus. Under ophthalmoscope: the optic disc was presented yellow and atrophied. The retinal vessel was thin and the retina was presented with gray blue color. The retinal vessel in the ambitus had hyperpigmentation. The forehead wrinkle pattern was 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 level 5. The abdominal reflexes were elicited normally. The tendon reflexes of the four limbs were normal. The sucking reflex and the palmomental reflex were negative. The pathological reflex of four limbs was negative. The deep sensation and superficial sensation were normal. The coordinated movements were normal. The meningeal irritation sign was negative.Laboratory tests showed the liver function was abnormal, the transaminase was increased obviously.
Treatment:
We gave Shaikh Nadeem Abdul Saleem a complete examination. He received treatment which included improving nerve repair, nerve regeneration. He also received treatment to enlarge the blood circulation in order to increase the blood supply, immunity enhancement, reduce blood pressure, improve liver function and nourish the neurons.
Post-treatment:
During the hospital, the patient's blood pressure was higher than normal. The numerical value fluctuated between 130-138/80-90mmHg. The patient received treatment to adjust the blood pressure. At present, the patient's blood pressure is better than before and the blood pressure is stable between 110-120/70-80 mmHg. Shaikh Nadeem Abdul Saleem's condition has improved. From 1 meter distance, as the dead ahead centre: the visual field of the left eye nasal side, bitemporal, upward side and downward were 4cm, 20cm, 7cm and 8cm. The visual field of the right eye nasal side, bitemporal, upward side and downward were 12.5cm, 21.5cm, 19cm and 21cm. Under ophthalmoscope: the retinal vessel was enlarged than before. The color was better than before. The hyperpigmentation of the retinal vessel in the ambitus was reduced. The blood pressure was stable between 110-120/70-80mmHg. The liver function index was normal.