| Objective:To investigate the clinical effect and mechanism of in collaterals on patients with nonarteritic anterior ischemic optic neuropathy (NAION) and to investigate the method of Yiqihuoxuetongluo on protective effect for rNAION.Methods:This study included two parts:clinical study and experimental study. In clinical study,39 patients with NAION (49 eyes) were randomly divided into observation group and control group. The patients in observation group were treated by intravenous Huangqi injection (20 ml), ligustrazine injection (160 mg), Xingnaojing injection (20 ml) and dexamethasone (10 mg), which were added into 0.9% normal saline (250 ml). The patients in control group were treated by intravenous dexamethasone (10 mg).The drugs were administrated by intravenous drip, once a day, and a course of treatment was 2 weeks. The patients were treated by 1-2 courses of treatment. The dose of dexamethasone was decreased grdually after 3-5 d. In addition, the patients in observation group were treated byYiqihuoxuetongluo decoction, modified with the symptoms, with a dose per day. The vision, field of vision and retinal nerve fiber layer (RNFL) were observation before and after treatment.In experiment study,40 Sprague-Dawley rats were randomly divided into 4 groups: normal group, model group, observation group and control group, with 10 rats in each group. After rose bengal (2.5 mmol/mL.kg) was injected by tail vein,2/3 of the area above the optic disk was irradiated with green laser (514-535 nm) with 500μm of the laser diameter for 20 s. After the rAION model was made successfully, Huangqi injection (1.8 ml/kg), ligustrazine injection (15 mg/kg), Xingnaojing injection (1.8 ml/kg) were injected intraperitoneally, once a day. The rats in control group were treated by dexamethasone (1.8 ml/kg) intraperitoneally, once a day. The changes of RNFL and retinal ultra microstructure were observated. Results:1. Among 20 patients (26 eyes) in observation group,5 eyes were cured with cure rate of 19.23%,11 eyes had marked effect,8 eyes had effect,2 eyes had no effect. The total effective rate was 92.31%. Among 19 patients (23 eyes) in control group,2 eyes were cured with cure rate of 8.7%,8 eyes had marked effect,8 eyes had effect,5 eyes had no effect. The total effective rate was 78.26%. Compared with the control group, the therapeutic effect in observation group was significantly superior to the control.2. After 2 weeks treatment, the visual field defect were improved in two groups, but there was no statistical significance in the two groups (P>0.05). Compared with the control, the visual field defect of patients in observation group was improved significanly after 4 weeks treatment (P<0.05).3.15 patients were examed by OCT before treatment and 2 weeks post-treatment,9 patients in observation group and 7 patients in control group. Compared with the control, the edema of retinal nerve fibre were significantly alleviated (P<0.05). The retinal nerve fibre began to shrink and tenuate in patients of control group.4. The nasal lateral RNFL in model rats of 1d was significantly thicker than that of normal rats (96.70±5.60μm vs 79.80±6.94μm, P<0.05), so was in model rats of 7d (88.75v7.03μm vs 79.80■6.94μm, P<0.05). After 14d, the RNFL was significantly thinner than that of Id (67.17±5.49μm vs 96.70±5.60μm, P＜0.05). The RNFL of rats after 7 d treantment in observation group was close to normal (74.75＜4.03μm vs 79.80＜6.94μm, P>0.05), so was the RNFL of rats after14 d treatment. In control group, the RNFL of rats after 7 d treatment was significantly thicker than that of normal rats (97.50±9.06μm vs 79.80±6.94μm, P<0.05), after 14 d treatment, the RNFL alleviated compared with that of 7 d treatment and that of normal (P＜0.05).The RNFL of rats after 7 d treatment in observation group was significantly thiner than that of rats 7 d treatment in control group (P<0.05), and The RNFL of rats after 14 d treatment in observation group was significantly thicker than that of rats 14 d treatment in control group (P＜0.05).5. The retina was observed by light microscope, indicating that the configuration of retinal photosensitive cells outer segments was turbulent and broken, the optic nerve were dropsical and necrotic, the retina was shifted, the blood vessles were occluded in rNAON after 1 week. In rats of observation group, the edema of retinal outer segments was regressive, and they were organized. A portion of occluded vessesls was reperfused. In rats of control group, the retinal outer segments was dropsical, loose, turbulent and vacuolized, the blood vessles were occluded. Two weeks later, RNFL of rats in model group was attenuated, the vessels were occlusive. In rats of observation group, the edema of retinal outer segments was regressive, the retinal structure was clear, the outer segments were loose and swoln, inner segments were dense, the surface of every layer was some swoln, the layer of nerve fibre was well organized, there is no changes in pigment epithelium, the occluded vessesls was reperfused. In rats of control group, the outer segments were mildly loose and swoln, the nerve cells were mildly swollen and vacuolized, the RNFL was thinner, and the vessels were still occluded.6. The retina of rats in observation group was observed by electron microscope, indicating congestive and dilated capillary, thin vascular wall, few vacuolized mitochondria, no dissolved nucleolus, intact cell membrane, dense nucleoli and decreased microfilaments in the synapses. In rats of control group, it showed congestive capillary, vacuolized mitochondria, dissolved nucleoli, dilated endoplasmic reticulum, intact nucleus membrane and decreased microfilaments in the synapses. After 2 weeks treatment in observation group, it showed intact nuclear membrane, normal cytoplasma, few vacuolized mitochondria, unchanged nucleoli, and clear microfilaments, capillary and nerve fibrocytes in the synapses. In rats of control group, it showed asymmetric, concentrated and apototic nucleoli, vacuolized mitochondria and decreased microfilaments in the synapses.Conclusion:1. The method of Yiqihuoxuetongluo in collaterals could control the condition of acute NAION rapidly with marked effect.2. The method of Yiqihuoxuetongluo in collaterals could improve the vision, visual field and RNFL, suggesting it could protect the function of optic nerve. The therapy is worth popularizing in clinic.3. The method of Yiqihuoxuetongluo in collaterals could protect the RNFL and the ischemic injury in rAION.4. The method of Yiqihuoxuetongluo in collaterals could improve the occular circulation, increase the blood supply of optic nerve, alleviate the edema of nerve and restore the function of optic nerve. It also has protective role on retina synapses complex, mitochondria in inner segment nerve cells and capillary.
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