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Hull Laurie-Adult Vitelliform Macular Dystrophy-(America)-Posted on Mar.7th, 2018

Author Zhangqi Views Posted at 2018/03/07

Name: Hull Laurie
Sex: Female
Nationality: American
Age: 61Y
Diagnosis: Adult Vitelliform Macular Dystrophy(AFVD)
Date of Admission: Dec. 30th, 2017
Treatment hospital/period: Wu Medical Center/14days

Before treatment:
The patient was diagnosed with AFVD 5 years ago. After that she had changes in her left vision field and she was injected with Avastin in her left eye four times every 6 weeks. The disease progressed fast and four years ago she lost her central vision and  stopped using the Avastin. For now, she is unable to see objects clearly, her dark vision is bad and she has lost the left central vision function completely.
Her spirit and weight are normal. Her sleep is bad and she needs medicines to make her sleep. Her diet, urination and defecation abilities are normal.

Admission PE:
Bp: 125/80mmHg, Hr: 71/min, breathing rate: 18/min, body temperature: 36 degrees. Her height is 155 cm, weight 82Kg. Nutrition status is good with normal physical development. There is no injury or bleeding spots of her skin and mucosa and no blausucht. 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 with no obvious murmur in the valves. The abdomen was bulging and soft but with no masses or tenderness. The liver and spleen were normal by touch examination.

Nervous System Examination:
Patient was alert with clear speech. Her memory, orientation and calculation abilities were normal . Both pupils were equal in size and round, diameter of 3.0 mm, the direct and indirect reaction to light was sensitive. Eyeballs can move freely, no nystagmus.
Her visual acuity exam with 3m standard chart: naked eyesight was 0.4; right eye was 0.4, left eye: none.
Her visual field exam within 50cm distance: left eye visual field loss area were: upward 19cm; downward 37.5cm; left side 29.5cm; right side 33.5cm. The ophthalmofundoscopy: right eye fundus color was orange, there was dot atrophy of the macula area, the A/V was 1:3, there was some osteoid deposit in the equatorial area. Left eye fundus was faint yellow, there was severe macula atrophy, with an irregular border, the A/V was 1:3.
Assist examination (2016-09-30): both eyes adult central macula dystrophin, combined with right eye retina epithelial atrophy. The foveal thickness was 248mm.
The bilateral forehead wrinkle and nasolabial fold were symmetrical, showing the teeth is normal, she could make her tongue extend out as normal. Her neck could move freely, muscle tone of all 4 limbs was normal with muscle power of the 4 limbs basically 5 degrees. The abdominal reflex was normal, bilateral biceps reflex and radial periosteal reflex could not be induced by examination, the triceps jerk of both sides was normal. Bilateral patellar tendon reflex was normal and the ankle reflex could not be induced. Palm-jaw reflex was negative, Hoffmann sign of both sides was negative, Rossilimo sign of the arms was negative. Pathological reflex of both legs was negative. Sensory system and coordinate movement were normal.

After the admission, she received related examinations and received 3 neural stem cell injections and 3 mesenchymal stem cell injections to repair her damaged macular region, nourish macular region and optic nerves, regulate her immune system and improve blood circulation. This was done with rehabilitation training.     

After 14 days treatment her eyesight showed good improvement, the naked eyesight with 3m visual chart was 0.8, right eye sight was 0.8. her left eyes started to get back some eyesight, she could try to distinguish 3-4 “E” correctly in a short distance. The left eye visual field loss was smaller than before within 50cm distance, it was now about 20cm. Funduscopic examination: right eye fundus was orange, bone sample sediment of equatorial had reduced.  3/4 left eye fundus was orange, the macular area was light yellow, arteriovenous ratio was 1:3.

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