Thalash Earvin De Silva-Stargardt Disease-(Australia)

Name: Thalash Earvin De Silva
Sex: Male
Nationality: Australia
Age: 42Y
Diagnosis: Stargardt Disease
Discharge Date: 2019/08/31

Before treatment:
The patient was was diagnosed as having Stargardt disease by a doctor at the age of 24. At the age of 30, there was progressive defect of binocular visual field, annular visual field defect in the left eye and central visual field defect in the right eye. Both his eyes cannot see a full vision field and the right eye had tears in the wind, photophobia and pain. The male family members in the patient's family also have this disease. The eyeballs were not sunken, he felt that starlight-like sensations around with the overlap of the binocular vision were causing visual discomfort. For now he is unable to read which has affected his work and life.

Admission PE:
Bp: 119/80mmHg, breathing rate 19/min, body temperature: 36 degrees, height, 176cm; weight, 84kg. The patient has good nutrition with normal physical development. There were no yellow stains or bleeding spots of the skin or mucosa, he had a symmetrical chest, clear respiratory sounds of both lungs, no dry or moist rales heard, strong heart sounds, regular heart rhythm and no obvious murmur heard in valves. He had a flat and soft abdomen, no masses with a normal liver and spleen.

Nervous System Examination:
Patient was alert, had clear speech, normal memory, calculation and orientation skills with normal intelligence. There was no bulging or denting of the eyeballs which were symmetrical with free movement, sensitive to light; and had normal intraocular pressure. There was pain of the right eye with light stimulation and low color vision of both eyes. Naked eyesight of the right eye at m3: both eyes, 4.8 (0.6); left eye, 4.7 (0.5); right eye 4.0 (0.1). Central visual field deficit at m1: up, 8cm; down, 13cm; left, 14cm; right, 37cm. Circular deficit of central visual field of left eye looking straight ahead, inward circle: up, 3cm; down, 23cm; left, 3cm; right, 2cm, outward circle: up, 13cm; down, 13cm; left, 14cm; right, 16cm. The patient complains of visual discomfort when overlapping bilateral visual field, with star-like sensation of the peripheral visual field. He has difficulty in reading. A dark red area can be seen of the left fundus, with yellow spots or patches and with unclear macular border and brighter optic papilla. The  lower quarter of the macular border was dark red; there were patches between the dark red area and yellow area and the arteriovenous ratio was 2:3. Yellow spots can be seen of the right fundus, with the central equator area dark red, an unclear macular border, irregular macular shaped as a long oval and the arteriovenous ratio was 2:3. He had a symmetrical forehead wrinkle and nasolabial fold, normal swallowing, normal hearing, free neck movement, free limb movement, normal 4 limbs muscle power and muscle tone. There was normal 4 limbs tendon reflexes, normal abdominal reflex, negative sucking reflex, negative palm-jaw reflex bilaterally, negative Hoffmann sign, Rossolimo sign, and Babinski sign bilaterally. Also a normal deep and shallow sensation, normal coordination and a negative meningeal irritation sign.

After the admission he received 3 nerve regeneration treatments (neural stem cells and mesenchymal stem cells) to repair his damaged retina and optic nerves, replace dead nerves and cells, nourish nerves and retina, improve body environment, regulate his immune system and improve blood circulation. This was combined with rehabilitation training.   

After 14 days treatment his vision function was improved. His left eyesight got better with naked eyesight at m3 as: both eyes, 5.0 (1.0), left eye, 5.0 (1.0), right eye, 4.0 (0.6). The central visual field and circular visual field deficit got smaller and he could now see things clearer and was reading better.

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