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ARTICLE
Year : 1970  |  Volume : 18  |  Issue : 4  |  Page : 180-182

Functional recovery in optic atrophy


Muslim University, Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh (U.P.), India

Correspondence Address:
B R Shukla
Muslim University, Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh (U.P.)
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Shukla B R, Ahuja O P, Gupta N C. Functional recovery in optic atrophy. Indian J Ophthalmol 1970;18:180-2

How to cite this URL:
Shukla B R, Ahuja O P, Gupta N C. Functional recovery in optic atrophy. Indian J Ophthalmol [serial online] 1970 [cited 2019 Oct 18];18:180-2. Available from: http://www.ijo.in/text.asp?1970/18/4/180/35638

Causes of optic atrophy are varied and many. Frequently, the underlying process responsible for the lesion is transitory and self-limiting which does not lead to a progressive complete optic atrophy. In these cases also, it is gene­rally believed that once, some function has been lost and unmistakable ophthalmoscopic signs of atrophy have appeared at the optic nerve head, treatment to restore the visual function is of little help. Consequently, a clinician does not feel very much hopeful and enthusiastic in treating established cases of optic atrophy. The purpose of this communication is to report an un­expected improvement in a case of bilateral optic atrophy, following a pro­longed treatment for over two years. This particular case shows a ray of hope in cases of optic atrophy provided the patient and the physician are prepared for a long-term treatment.


  Case Report Top


The patient. G.V.S., 24 years old Hindu male, reported on May 10, 1965 to the outpatient department of this hospital, with the complaint of a marked and rapid reduction of vision in hot heyes with occasional headache, for the last three months. A diagnosis of bilateral optic neuritis had been made at Gwalior for which he was given antibiotics and steroids without any significant improvement. The exa­mination of the patient at this hospital revealed the following findings:

Pupil (both eyes) - semidilated with ill-sustained reaction to direct light.

Fundus (both eyes) - media were clear. Disc margins were slightly fuzzy and there was a well established tem­poral pallor of the disc. Veins were slightly engorged and tortuous. Macular area showed stippling with absent foveal reflex.

Visual acuity (both eyes) - finger counting at two meters; no improve­ment with glasses. Colour vision was absent.

Fields - Peripheral fields with 7 mm, white object showed an all round con­striction. greater in the left eye [Figure - 1],[Figure - 2]. Scotometry was not possible due to poor visual acuity.

Family history - A maternal cousin of the patient (son of his mother's sister) aged 24 years, had similar com­plaint an year earlier and was treated in this hospital. His records showed a diagnosis of bilateral optic neuritis with good visual recovery after treatment.

Neuro physician's report did not sug­gest any lesion to explain optic atrophy.

The investigations carried out con­sisted of total and differential leucocyte count, E.S.R., urine and stool examina­tion. sputum examination, V.D.R.L. and Mantoux tests, X-ray chest and X-ray of the skull. All these tests were non-contributory.

Based on the above clinical and labo­ratory findings a provisional diagnosis of Hereditary Optic Atrophy was made.


  Treatment Top


The main treatment given to the patient consisted of vasodilators and vitamins of the B group (B 1 , B 6 and B 12 *) interruptedly for a period of about 2½ years. He was hospitalised four times for a course of retrobulbar injections of vasodilators (Arlidine or Pelonin).

A total of 40 injections were given dur­ing this period. In the intervening period he was kept on these vasodila­tors by oral route.


  Course Top


For about two years there was no significant objective or subjective im­provement. However, in March, 1967, the visual acuity started improving rather rapidly and after about a month his corrected distant vision was 6/6 in both eyes. Colour vision was normal and the visual fields had markedly im­proved [Figure - 3],[Figure - 4]. There was however, no significant change in the fundus picture.


  Comments Top


The improvement in visual functions of this case was remarkable. This brings home the argument that seemingly hopeless cases of optic atrophy may not be left alone but a long term protracted treatment could be rewarding in atleast some cases. The improvement even if obtained in a very small percentage of such cases may be worth the efforts.

We do not suggest that ultimate de­generation in optic nerve can be re­versed on intensive vasodilator therapy.

The apparently total atrophic optic nerve (ophthalmoscopically) may not be fully degenerated pathologically in each and every case. A prolonged per­sistent vasodilator therapy as in this case may restore physiological function in some of the cases of optic neuro­pathies.


  Summary Top


A case of bilateral optic atrophy is reported where a prolonged treatment with vasodilators achieved almost full visual recovery.

It is suggested that a case of optic atrophy may not be left alone and should be treated on lon- term basis which may be rewarding at least in some cases where the optic nerve though under-nourished may not have undergone a pathological degeneration.


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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