Johanna - Retinitis Pigmentosa (Costa Rica) Posted on July 3, 2014

Name: Johanna Alvarado Salas           
Sex: Female
Country: Costa Rica
Age:33 years
Diagnosis: Retinitis Pigmentosa
Date:May 01, 2014
Days Admitted to Hospital: 29 days

Before treatment:
The patient suffered from eyes disorders from childhood. Her family members found out that the patient's eyes was unusually following light when she was few months old. She was diagnosed with Retinitis Pigmentosa when she was 2 years old. She received operation for the eyes when she was 12 years old, but the vision had not improved. The vision decline progressively. She could read a book and write when she was in a primary school. Her vision declined obviously in middle school and university and she couldn’t read a book or write. With the assistance of her mother, she completed college.

Before the treatment, the patient could see light or shadow from 1 meter distance in bright environment. She couldn't distinguish object's shape, size or colors. With assistance of others, she could walk or do exercises. She could see stairs or barrier.

Admission PE:
BP: 115/76mmHg, HB: 75/min, BTM: 19/min. She was in a normal figure, her diet was normal. Her skin was normal, with no petechial or yellow stains. The thorax was symmetrical. The respiratory sounds in both lungs were clear with no signs of dry or moist rales. The rhythm of heartbeats was regular without obvious murmur in the valves. The abdomen was soft without any abnormal masses during palpation. The liver and spleen were normal to palpate.

Nervous System Examination:
The patient was alert. Her calculation, memory, orientation were normal. Her pupils were 3.0mm wide. The pupils had slower response to light stimulus. The visual field examination could not be conducted. In one meter away under a good light condition, she could perceive big moving object, but she could not distinguish the shape, size or color of the object. In a 50cm's away, she could tell the dark or shallow color of the object, while she could not tell what exactly the color was. She could not distinguish the shape and size of objects, and she could not perceive the moving finger. Under ophthalmoscope: (Right eye) retina showed a pale yellow color, quite a lot of black pigments could be observed. The head of the optic nerve could be seen while the border was not clear. The macula lutea could not been observed. The ratio of artery to vein was 1:3. (Left eye) retina showed a pale yellow color. A lot of black pigments could be seen but less than that of right eye. The head of the optic nerve was not swollen and its border was clear. The macula lutea was blurred. The ratio of artery to vein was 1:3. The eyeball moved flexibly and there was no nystagmus. The forehead wrinkle pattern was symmetrical. Bilateral nasolabial sulcus was equal in depth. The tongue and the teeth were in the center of the oral cavity. The muscle tone of her four limbs was at level 5. The muscle strength of her four limbs was at level 5. The tendon reflex of her four limbs was normal. The pathological reflex of lower limbs was negative. The sensory system was normal, and the coordination ability was normal.

Treatment:
After admission, we conducted a complete examination on Johana and confirmed the diagnosis of Retinitis Pigmentosa. The patient received treatment for retina and optic nerve regeneration and to activate stem cells in vivo. She was given vasodilatory treatment to improve the blood circulation in order to increase the blood supply to the damaged nerves and we also used medicine to nourish the neurons. This was combined with daily physical rehabilitation therapy.

Post-treatment:
After the treatment, Johana's vision has improved. She can distinguish the shape of people when they move in front of window, but she cannot distinguish further like the face, or the limbs. Her eyes can see the light from pupil pen from 1.5 meters. Her left eye can perceive the movement of the pupil-exam torch in 25cm away. Right eye can perceive the movement of the pupil-exam torch in 15cm away. Under ophthalmoscope: the color of optic discs is better than before, it presents orange. The black deposition in fundus has reduced slightly.