Carlos Kong-Leber Hereditary Optic Neurology-(Argentina)

Name: Carlos Kong
Sex: Male
Nationality: Argentinean
Age: 26Y
Diagnosis: Leber Hereditary Optic Neurology  
Discharge Date: 2018/11/28

Before treatment:  
Four and a half years ago (Feb. 2014) the patient suddenly developed binocular visual impairment without inducement and the visual acuity decreased gradually. Five months after the onset of the disease he went to the ophthalmology hospital for a related examination. Gene examination showed mitochondrial DNA 11778G-A gene mutation. It was diagnosed as "Leber hereditary optic neuropathy" and there was no treatment. The patient came to our hospital in October 2014 for optic nerve repair treatment. After treatment his visual acuity  was improved and color discrimination was improved. Although the visual acuity of the patient fluctuated in the past four years it was not significantly aggravated. At present, letters within 40cm of the right eye can be distinguished and the number of fingers can be distinguished at 10cm with the left eye but the visual acuity and night vision of the left eye are still poor.
His spirit is OK, his body weight is basically normal, diet and sleep are basically normal, defecation and urination functions are normal.

Admission PE:
Bp: 119/70mmHg, Hr: 66/min, breathing rate: 18/min. Height 174.5cm, weight 76Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of his skin and mucosa, no blausucht, no throat congestion and his tonsils do not have swelling. 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 and there was no edema of the legs

Nervous System Examination:
Patient was alert, had clear speech, his calculation,  memory and orientation abilities were normal. Bilateral pupils were equal and round with a diameter of 2.5mm. Right side direct and indirect light reflex were sensitive, left side was clumsy and the color vision was normal. The eyesight of both sides were poor, he could distinguish words around 40cm distance with his right eye, with the left side he can only can read at around 10cm, the eyeballs can move freely and there is no nystagmus. There was left eye central vision loss, the eyes fundus examination: right eyes fundus was light orange color, A/V was 2:3; clear border of optic nerve head, there was no deposit; right side fundus was dark red, A/V was 2:3; there was vascular proliferation, with pathological vascular wart, the optic nerve head color was pale, with osteoid sediment, the optic nerve head border was slightly enlarged, with mild edema. The bilateral forehead wrinkle and nasolabial fold are symmetrical, he could make his tongue extend out normally and his neck can move freely. The 4 limbs muscle tone were normal and the 4 limbs muscle power was 5 degrees. The abdomen reflex was normal, the tendon reflex of the 4 limbs was normal, sucking reflex and palm-jaw reflex was negative. The Hoffmann sign and Rossilimo sign were negative, sensory system examination was normal, coordinate movement was normal and the meningeal irritation sign was negative.

Treatment:
After the admission he received 3 optic nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged nerves, replace dead nerves, nourish 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 so he can now distinguish fingers and colours at 40cm distance with his left eye and he could distinguish the similar colours much easier than before. He can distinguish letters at 60cm distance with right eye, the dark vision of both eyes was better, both sides eyes fundus blood circulation improved and the optic nerve head was now light yellow.

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