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Abstract: In this case, the patient presented with decreased vision in both eyes, deformation in seeing, and black shadows in seeing, and should be alerted to whether there is a problem with the macula of the fundus. Since the disease mostly occurs in middle-aged and elderly people over 45 years old, the importance of early medical examination is neglected because it cannot be taken seriously, and the disease cannot be treated in time, which eventually leads to blindness. The patient was able to recover her vision through medication and surgery.
Basic information】Female, 63 years old
Disease Type】Age-related retinal macular degeneration (both eyes), cataract (both eyes)
Hospital】The First Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Intravitreal injection (Abciop) + medication (levofloxacin drops)
[Treatment period] 3 months for preoperative drug injection, discharged after 24 hours of inpatient surgical treatment, and rechecked at 1 and 4 months
【Treatment effect】The vision was effectively improved
I. Initial consultation
The patient reported that her vision had decreased for half a year with distortion and black shadows in front of her eyes, and her state was anxious. Since the patient had not undergone any ophthalmologic examination, we performed a routine ophthalmologic examination for the patient at his request.
Ultrasound results showed vitreous clouding in both eyes; OCT (macula) showed macular anterior membrane and macular edema in both eyes; fundus photography showed visible exudation in both eyes.
The above examinations and the patient’s symptoms confirmed the diagnosis of cataract in both eyes and age-related retinal macular degeneration in both eyes.
II. Treatment history
Since the patient lived alone and suffered from hypertension, coronary heart disease and other underlying diseases, her demand for vision was even more urgent. After explaining her condition to the patient and her family, the patient was in a relatively anxious state, and we explained to the patient the treatment of the disease. We explained to the patient that she needed one injection every month for the first 3 months, and after that, she could choose the time to take the drug according to her condition. We prescribed levofloxacin drops for her before the surgery. The surgery was performed safely and the patient was discharged on the same day, and was asked to come back to the hospital for a review in one month.
III. Treatment results
The surgery was very successful and the patient was discharged on the same day with no other adverse reactions or symptoms, and her physical and mental state was very good after the surgery.
The patient came for a review one month later, the patient himself felt good, communicated with the patient that the drug needed 3 consecutive injections, and after the completion of the 3rd injection the patient came for a review again and said that his visual acuity had improved and the visual acuity test was 0.3 in both eyes, and now his voluntary activities were not restricted anymore, he was very confident. Subsequently, we communicated with the patient that after the consolidation of macular degeneration treatment, cataract surgery could be performed and the vision could be further improved substantially.
IV. Precautions
Since the patient lived alone and was anxious, we reassured him, and he came to the hospital on time for injection and surgery, and actively underwent surgery. However, it is still recommended that the patient should pay attention to the changes in the eyes after discharge, observe whether there are any more black shadows in front of the eyes, visual distortion and other uncomfortable symptoms, pay attention to eye hygiene in life, eat a light and nutritious diet, pay attention to rest, avoid eye fatigue, and avoid looking at things under bright light.
V. Personal insight
Age-related retinal macular degeneration mainly occurs in middle-aged and elderly people, due to the lack of awareness of the disease among the elderly, resulting in the disease getting heavier and heavier, plus many elderly people have chronic diseases of the eye surface, which have seriously affected the normal life when they come to see the doctor, even to the point of blindness. It is recommended that patients can usually wear shading glasses, ensure the quality of sleep, reduce the number of colds and other measures to prevent this disease, if there is a decline in vision, to the hospital for a physical examination of the eye, and a simple annual examination, early detection and early treatment, as in the case of patients through active cooperation with treatment, vision can be effectively improved.