Patient with decreased vi...

A 41-year-old woman with complaints of decreased visual acuity and monocular diplopia visited the hospital. She underwent bariatric biliopancreatic diversion due to morbid obesity and multiple abdominal surgeries because of recurrent hernias. Unfortunately, she developed intestinal malabsorption syndrome. 

Neurological examination revealed mild dysarthria, upper and lower limb hypoesthesia, weak and symmetrical osteo-tendinous reflexes. She had no response to Babinski’s sign. However, she found a positive Romberg sign. The psychological evaluation highlighted a mild cognitive impairment. Ophthalmological examination anterior segment evaluation showed superficial punctate epithelial defects in the left eye. The indirect ophthalmoscopy of both eyes revealed mild temporal pallor of the optic nerve. 

An OCT by TOPCON 3DwideH was performed and showed thinning of the retinal thickness associated with ganglion cell loss in both eyes, as shown in the figure. Laboratory tests showed normocytic normochromic anaemia. Also, Vitamin-E deficiency was observed, and vitamin A level was lower than usual. In contrast, vit-B12 and folate were normal. The patient has been treated with oral supplementation therapy with Retinol 30000 U.I. + Tocopherol acetate 70mg once daily for 2weeks. The patient reported improvement in visual acuity in both eyes associated with the disappearance of monocular diplopia and complete resolution of the scotoma.