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Risdiani - Retinal pigment degeneration

Author Julia Views Posted at 2014/01/14

Name: Risdiani
Sex: Female
Country: Indonesia
Age: 36
Diagnosis: Retinal pigment degeneration
Admission Date: September 21, 2013
Days Admitted to Hospital: 28 days

Before Treatment:

The patient suffered from constriction of both visual fields. The disease progressed gradually and she went to hospital for treatment, but did not receive a clear diagnosis. She was diagnosed with bilateral retinal degeneration in a local hospital 1 year ago. She received acupuncture, laser treatment and a stem cell implant through her veins, but her vision still had no improvement. From the onset of the disease, her weight had no obvious fluctuation. Her diet and sleep habits were almost normal. Her urine and defecation were normal. Before treatment, both of the patient´s eyes had tubular vision. She had an abnormal sensitivity to a light environment. She needed to wear sunglasses. She could see objects being moved in a dark environment.
Admission PE:
Bp: 127/84mmHg; Hr: 71/min, Br: 18/min. The patient had normal nutrition and development. The skin and mucosa were normal, with no stained yellow spots or petechia. The thorax was symmetrical. The respiration in both lungs was clear, with no moist rales. The heart sounds were strong, the cardiac rhythm was regular, and there was no obvious murmur in the valves. The abdomen was flat and soft with no palpable masses. The liver and spleen were found to be normal through palpation.

Nervous System Examination:
Risdiani was alert and her speech was clear. Her memory, orientation and calculation abilities were almost normal. The diameter of both of her pupils was 3.0mms. Both pupils had sensitive responses to consensual reflex and direct light reflex. She lacked peripheral vision and her central vision was blurred. Her color vision was normal. Perimetry: 1 meter right ahead, the patient had tubular visual field, the radius of tubular visual field was 6cm. Both nasal visual fields were 3 cm larger than normal. Vision examination: with standard visual acuity chart, the patient´s vision in the left eye was 0.8 from 3 meters distance, and in the right eye was 0.4 from 3 meters distance. Under the examination of ophthalmoscope: there was no exudation in fundus. The border of optic papilla was clear. The color of optic papilla was light orange. The color of retina was light yellow. There were bone cell sample black pigmentation in fovea centralis and around the yellow spots. The arteriovenous ratio was 2:3. Both eyeballs could move freely. There was no obvious nystagmus in both eyes. The Intraocular pressure was slightly higher than normal. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical. The tongue was in the center of oral cavity. She could move her neck freely. The muscle tone of four limbs was almost normal. The muscle strength of four limbs was about level 5. The abdominal reflexes was normal. The tendon reflex of four limbs was normal. The sucking reflex, 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. There was a deep sensation and shallow sensation present. The examination of movement coordination was normal.
 

Treatment:
We gave Risdiani a complete examination and she was diagnosed with bilateral retinal degeneration. She received treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves. She was also given treatment to nourish the neurons.

Post-treatment:
Perimetry: 1 meter right ahead, the patient´s top and bottom visual field has enlarged than before, the radius of visual field increased 2-4cm. The left and right visual fields also have been enlarged, the radius of visual field increased 6-8cm. Vision examination: with standard visual acuity chart, the patient´s left eye vision was 1.0 from 3 meters distance, right eye vision was 0.6 from 3 meters distance. Under the examination of ophthalmoscope: The bone cell sample black pigmentation in fovea centralis and around the yellow spots has decreased, as compared to before.

 

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