Sushil Sharma-Retinitis Pigmentosa-(Fiji)

Name: Sushil Sharma
Sex: Male
Nationality: Fijian
Age: 43Y
Diagnosis: Retinitis Pigmentosa   
Discharge Date: 2019/1/6

Before treatment:
The patient was found to have night blindness after birth, he could not read in weak night light but it had no effect on his day vision. Five years ago there was no obvious inducement for the decrease of daytime visual acuity and he also had blurred vision under strong sunlight. Three years ago he was unable to use mobile phones, his near and far vision were affected and accompanied with peripheral visual field defects. After a series of examinations in the hospital two years ago he was clearly diagnosed as "retinitis pigmentosa" and there was no treatment. The patient's condition progressed slowly and at present he needs glasses on a daily basis. His vision with both eyes is good under strong light, the vision of the right eye is good, the vision of the left eye is poor, the visual acuity of the normal and weak light drops sharply. He needs assistance with walking.
The patient has been in good spirits, his diet and sleep are basically normal and his urination and defecation functions are normal.

Admission PE:
Bp: 138/87mmHg, Hr: 69/min, breathing rate: 17/min, body temperature: 36 degrees. Height 165cm, weight 61Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht and no throat congestion. Chest development was normal, the respiratory sounds in both lungs were clear and there was no dry or moist rales. The heart beat is powerful with regular cardiac rhythm and no obvious murmur in the valves. The abdomen was flat and soft with no masses or tenderness. The liver and spleen were normal.

Nervous System Examination:
Patient was alert and has clear speech. His memory, comprehension and calculation abilities examinations were normal. The pupil diameter was 2mm, reaction to light was weak, with the  right eye much more severe. He has a poor ability to look upward and there is mild horizontal nystagmus. The eyes converge ability was poor, he could not distinguish colors well, there is peripheral visual field loss and he has tunnel vision. The visual field check of both eyes: upward 13.5cm, downward 4.5cm; left side 11cm, right side 25cm;  right eye visual field check: upward 6.5cm, downward 7.5cm; left side 18cm, right side 21.5cm; left eye visual field check: upward 7.5cm, downward 5.5cm; left side 7cm, right side 10cm. The patient's naked eyesight at 3m chart: both eyes 0.25; right eye 0.25; his left eye sight at 70cm was 0.08. the eyes fundus examination: right eye fundus color was pale orange, A:V 1:4. There were some black deposits at the equator area. Left eye fundus examination: faint yellow, A:V 1:4; there were black deposits covering 2/3 of the equator area. The macula border was unclear. The bilateral forehead wrinkle and nasolabial fold are symmetrical, showing teeth was normal, he could make his tongue extend out normally and his neck can move freely. The 4 limbs muscle tone were normal, muscle power of the 4 limbs was 5 degrees, abdomen reflex was normal, tendon reflex of all 4 limbs was normal, sucking reflex was negative, bilateral palm-jaw reflex was negative. The Hoffmann sign of both sides was negative, the Babinski sign of both sides was negative, patient sensory system was normal, his coordinate movement was normal and the meningeal irritation sign was negative.

Treatment:
After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged retina and optic nerves, nourish retinal cells and optic nerves, improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

Post-treatment:
After 14 days treatment his eyesight improved. Naked vision:3 meters, both eyes is 0.3；right eye is 0.4, 70cm，left eye is 0.1, 70cm. The peripheral visual field of both eyes is enlarged. The visual field check of both eyes: upward 14.5cm, downward 6cm; left side 13cm, right side 25cm; his right eye visual field check: upward 11cm, downward 7.5cm; left side 18cm, right side 21cm; left eye visual field check: upward 9cm, downward 7cm; left side 11cm, right side 14.5cm. His night vision was also improved.