|Year : 1970 | Volume
| Issue : 4 | Page : 180-182
Functional recovery in optic atrophy
BR Shukla, OP Ahuja, NC Gupta
Muslim University, Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh (U.P.), India
B R Shukla
Muslim University, Institute of Ophthalmology, Gandhi Eye Hospital, Aligarh (U.P.)
Source of Support: None, Conflict of Interest: None
|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
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|| |
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|| |
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|| |
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|| |
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|| |
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.
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]