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Chorioretinopathy

Author Admin Views Posted at 2013/12/29

The patient is a 65 year old male; he was presented with progressively impaired vision and a defect of the visual field of both eyes for more than 25 years. He was diagnosed with chorioretinopathy.

The patient has a history of hypertension for more than 10 years and he took oral medication for treatment. The blood pressure was controlled within normal levels. The patient has no medical history of DM or coronary heart disease (CHD), no history of infectious diseases, such as hepatitis or tuberculosis, no history of blood transfusions. The patient had received a tonsillectomy, surgery on both shoulders, surgery on his nose and the left thumb. The patient has no history of smoking or drinking. The patient is allergic to sulfonamides and vicaden.

Admission PE:
Bp: 120/70mmHg; Hr: 74/min, Br: 18/min. Height: 188cm, weight: 115Kg.
The patient´´s growth and nutrition status was normal. The skin was normal and the mucous membrane intact. The chest was symmetrical. The respiratory sounds were clear, with no dry or moist rales. The heart beat was strong, and the rhythm was regular. There was no obvious murmur in the valve areas. The abdomen was soft, and no masses were touched. The liver and spleen were normal.

Nervous System Examination:
The patient was alert and the speech ability was good. The memory, orientation and calculation ability were almost normal.
The left pupil was oval and the vertical axis was parallel to the body. The diameter of the right pupil was 3.0mms. The bilateral direct and indirect reflex to light was sensitive. There was a large black-brown area in the fundus. The arteriovenous ratio was 1:4. The eyesight of the right eye was poor; he could distinguish fingers from 2 meters away. The vision of the left eye was 0.6; he had problems with night blindness. There was tunnel vision in both eyes, and both eyes had poor ability to distinguish between colors, especially green. Both eyeballs could move freely, with no nystagmus. The forehead wrinkle pattern was symmetrical. The patient could move his neck normally. The muscle tone of all four limbs was normal; the muscle force of all four limbs was level 5. The abdominal reflexes were weak, the tendon reflexes of all four limbs were normal. The sucking reflex and palmomental reflex were negative. The bilateral Hoffmann´s sign was negative; the Rossolimo´s sign of the upper limbs was negative. The pathological reflex of both lower limbs was negative. The deep sensation and coordinated movements were normal.

Main Laboratory Tests, Inspections and Results:
2. Possibility of coronary arterial sclerosis.

Admission Diagnoses:
1. Chorioretinopathy
2. Fatty liver (Moderate -severe)
3. Benign Prostatic Hyperplasia
The blood routine, bowel movements and urine routine are normal. The coagulogram, blood sedimentation, liver functioning, kidney functioning, blood lipid levels and electrolytes were normal. C-reactive protein 1.28mmol/l. Plasma homocysteine 20umol/l, Tumor markers CA1251.18ng/l, FER169.23 ng/l, AFP2.28 ng/l, CEA 0.88 ng/l. The thyroid function: T31.94nmol/l, T4112 nmol/l FT3 5.51 pmol/l , FT417.10 pmol/l ,TSH1.79mIU/l. The HbsAg, syphilis and AIDS examinations were negative.

The ultrasound of the heart: 1. Aortic calcification 2. Left ventricular contractions showed no signs of abnormal functioning.
The ultrasound of the pelvic cavity: Benign prostatic hyperplasia, with calcification.
The ultrasound of the abdomen: 1. Fatty liver (Moderate -severe) 2. There is a low level echo near the gallbladder which strongly indicates a possibility of fatty degeneration.
The CT of the chest: 1. calcification of the superior lobe of the right lung.
Treatment:
The patient received nerve cells transplantation, along with comprehensive treatment to nourish the neurons, improve the blood circulation, and control the blood pressure. During the treatment, the patient´´s mental status was fine and his diet was regular and he got plenty of sleep. He cooperated with the doctor´s treatment plan and the treatment went smoothly. After the completion of the treatment, the patient´´s condition showed good improvement: The black-brown area of the fundus of the eye was reduced gradually with the blood circulation improvement, the bilateral visual field was enlarged also, especially the temporal side: the visual field of the right side was 45º, and the left side was 60º, the visual field of the vertical direction is now nearly normal. The color vision has largely been restored and the patient can now distinguish all colors accurately. The dark adaptation ability has improved and he can adapt to the surrounding environment within several seconds once the lights are turned off. The eyesight of the right eye has had good improvement and has reached 0.1. It is much easier for him to walk up and down stairs. The patient feels a real improvement in his quality of life.

Case discussion:
1) The patient is an elderly male, the onset of his disease was slow, and his condition degenerated gradually;
2) He lost some vision and he had a defect of the visual field as well as color vision problems and night blindness;
3) The examination of the eyeground: there was a large black-brown area in the fundus of the eye and the arteriovenous ratio was abnormal.
The diagnosis of "Chorioretinopathy" can be confirmed.
The exact cause of this disease is not clear. In the past, some doctors thought that the disease was caused by retinal inflammation or choroid retinal inflammation; some thought it was caused by vascular spasms, but there is not sufficient evidence. There is no special medication for the treatment of this disease and the glucocorticoid medication and vasodilator agent are forbidden to be used for these patients. The neural stem cell therapy brought a new treatment method to patients suffering from different kinds of eye conditions such as RP and Chorioretinopathy. We are able to see the obvious positive results from the treatment. The neural stem cell treatment can slow down the development of the course of the disease or even stop further damage to the choroid, increase the patient´´s vision and improve the quality of life.

Case analysis:
Since the eyes are the only visual organ, this ability is the most important for gaining information about the material world. A large part of the brain´s neural system is involved with visual sensitivity and visual control. The optic nerves consist of 1,000,000 neurons. The visual system is composed of epitheliums, vessels, collagens, nerves, pigments, etc. It can be said that the eyes and optic nerve pathway controls are very complicated systems and as a result risk many possible complications leading to disease. In general, the problems affecting the visual ability includes defects of the vision, visual field, color vision, etc, and are caused by retinal disorders, optic nerve disease, and visual agnosia obstacles, etc.

For the optic nerve pathological changes,there was no effective treatment method in the past, the disease includes neural degeneration, hereditary diseases, trauma and related complications including: A. hereditary optic neuropathy B. Chorioretinopathy C. Stargardt disease D. progressive external ophthalmoplegia, etc. For example, with optic atrophy, the patient´´s vision declines quickly, finally resulting in a complete loss of light sensation. In such cases, as is commonly known, there wasn´´t any effective treatment to stop or relieve the symptoms. At present, neural stem cell therapy offers the best option for a new medical treatment for these patients.
Here we will describe the basic mechanisms of the stem cell therapy: 1.The stem cells can differentiate into the optic nerve and related tissue, and repair the damage directly. 2. The stem cells have a secretion function which can promote the growth of nerves and the myelin sheath. 3. According to our research and the case analysis, the stem cells have shown effective treatment capabilities for hereditary optic nerve pathological changes and degeneration. For example, Leber´´s disease can result in optic atrophy. It is a kind of hereditary disease which is caused by abnormal mitochondria DNA which can lead to mitochondria functioning complications. The mitochondria can not provide the normal levels of energy and proteome for surrounding tissue. There are no genetic problems in the stem cells so that they can provide normal energy metabolism and reduce the accumulation of deleterious substances, which can slow down the course of the disease.

The treatment requires a very high level of cell control in vivo which can help the cells express their normal functions after implantation. The patient can expect obvious positive treatment results within the first 3-5 weeks. If a patient does not see good results within 5 weeks, we will have to consider that in this patient´´s case, other options may be more appropriate.

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