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Apichat Pepathum-Retinitis pigmentosa-(Thailand)-Posted on Dec.22,2014

Author Tracy Views Posted at 2014/12/22

Sex: Male
Country: Thailand
Age: 53 years
Diagnosis: 1.Retinitis pigmentosa, 2. Hypertension 2 level high risk
Date: Nov. 24, 2014
Days Admitted to Hospital: 21 days

Before treatment:
     The patient had blurred vision for the past 10 years (about 40 years ago), it was serious at night, and his condition gradually aggravated. At the age of 16, his nasal and temporal sides of both eyes, and lower quadrant vision reduced, the right eye was more serious, but he could drive. 8 years ago, he had significant reduction in vision, dark adaptation time became longer, and the condition of vision reduced was more serious, he couldn’t drive any more. 4 years ago, he could hardly see near objects, and was bad at color discrimination. He was diagnosed as immedicable retinitis pigmentosa. He came to our hospital 3 years ago, after treatment, all of his sight, vision and color discrimination were better, but six months later, his sight was bad again, and he went to many other hospitals ,but his physical condition worsened, he couldn’t even see his fingers, so he came to our hospital again to have further therapy.
      He also has hypertension for about 10 years, highest Bp: 160/120mmHg, he didn’t take his pills regular.

Admission PE: 
      Bp: 105/78mmHg; Hr: 83/min, Br: 18/min. Temperature: 36.6 deg. Apichat’s growth and nutrition were normal; his skin mucosa was without hemorrhaging spots or yellow stains. There was no edema of both lower limbs. His thorax was symmetrical. The respiration of both lungs was clear, without dry or moist rales. The heart sound was strong, and the cardiac rhythm was regular, and there was no obvious murmur in the valves. Abdominal bulge, and the abdomen was soft, with no masses. The liver and spleen were normal.

Nervous System Examination: 
      Apichat was alert and his speech was clear. His memory, orientation and calculation ability were normal. The diameter of both pupils was 2.0mms, pupils color were beige, and both pupils were insensitive to light stimuli. The movement of eyeballs to each side was good. The range of activity was sufficient, and there was no obvious nystagmus. The examination of vision: He saw framed Silhouette from a distance of 3 meters left eye, and could saw palms shaking from 10 meters, but couldn’t distinguish the number of fingers. The visual field of both eyes were poor, only has central field of vision, he couldn’t distinguish any color except the shades. Through use of an ophthalmoscope, 1/3 part of right fundus presented light yellow, other was dark red, left fundus presented light yellow. AV ratio of both eyes were 1:4, The retinas of both eyes were found to be thin, and there was pigmentation near the ambitus of the retina, the right eye was more severe, optic papilla and macular of both eyes were obscure boundary. The forehead wrinkle pattern was symmetrical. The nasolabial sulcus was equal in depth. The teeth were symmetrical and the tongue was centered. There was free movement in the neck. The muscle tone and strength of all four limbs were normal. The tendon reflexes in four limbs were normal; the pathologic features were negative. The deep and shallow sensation was normal. The coordinated movements were normal. Meningeal irritation sign was negative.

      We gave Apichat a treatment to stimulate the retinas at the same time repaired and regenerated his optic nerves , activated his stem cells, nourished the neurons, enhanced immunity and stabilize his blood pressure, this was accompanied with physical rehabilitation treatment.

      After 3 weeks treatment, the patient’s vision was better. Right eye can distinguish fingers from 2 meter, left eye can see palms shaking from 0.8 meter, but can’t distinguish fingers. The definition of black and white was batter, his definition of yellow, red and green, and he was more sensitive to moving objects than before.  Through use of an ophthalmoscope, 1/6 part of the fundus of right is light yellow, other parts are dark red, the fundus of left is light yellow, AV ratio of both eyes are 1:3, The retinas of both eyes are thinner, and the pigmented near the ambitus of the retina is less than before, the border of optic papilla and macular of both eyes were sharp.


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