The Observational Study On The Efficiency Of Combined Treatment For The Ischemic Optic Neuropathy

Purpose:Concluding the clinical experience of comprehensive treatment of ischemic optic neuropathy, exploring the more effective treatment of this disease.Method:To incorporate 34 cases (39 eyes) in patients with ischemic optic neuropathy according to the anterior ischemic optic neuropathy diagnostic criteria of "fundus study" Edited by Professor Zhang Chengfen in 1998 and the posteriorischemic optic neuropathy diagnostic criteria of "post-segment ischemic optic neuropathy" edited by Professor Hayreh. To use traditional Chinese medicine (TCM) or TCM and Western medicine therapy treatments according to different times and different conditions of the diseases of the patients. To use traditional Chinese medicine combined therapy in patients with hormone contraindications or a longer course,optic nerve edema without serious non-vascular inflammatory:1. Dialectical therapy:Therapeutic blood circulation qi law, Side addition and subtraction with Xiao yao san to Qi stagnation blood stasis type; Therapeutic Yiqihuoxue Tongluo eyesight, a square with Buyanghuanwu Decoction to qi deficiency blood stasis; 2. To intravenous drip Low molecular weight dextran injection + TMP pin,qd; 3. To subcutaneous inject Compound Zhang Liu the temporal side of ocular alkali injection on point, qd; 4. Ocular iontophoresis with Xiangdan injection; 5. acupuncture. Using TCM and Western medicine treatment in patients without hormone contraindications,short course,severe optic nerve edema or vascular inflammatory:To add glucocorticoids,reduce intraocular pressure,B vitamins, such as hyperbaric oxygen therapy in the early course of the disease on the basis of Chinese medicine treatment group; The treatment of patients with non-vascular inflammation in late course of the disease the same as Chinese medicine treatment group. To treat Vascular inflammation in patients with a gradual reduction in the latter part of hormone. To observe the characteristics,changes and efficacy of the integrated visual acuity,fundus, visual field test results before and after combined therapy for 34 cases (39 eyes) with ischemic optic neuropathy; the different efficacy of the Chinese medicine treatment group and the Chinese medicine and Western Treatment group; the different efficacy in the different therapeutic times。Results:1) 39 eyes of 34 cases with a comprehensive treatment, clinical cure 11 eyes (28.21%), marked effective 10 eyes (25.64%), effective 12 eyes (30.77%), total effective rate of 84.62%, invalid 6 eyes (15.38%).2) The difference of visual acuity was statistically significant before and after treatment:After treatment, the visual acuity increased significantly compared with before treatment, (x2=78, P<0.01).3) After treatment,31 cases had improved vision (79.49%),8 no significant improvement (20.51%). The average field of vision defects (x±s,db):Before treatment 21.71±3.25, after treatment 12.68±1.54, paired t test before and after treatment, there are significant differences in different (t=5.20, P<0.01).4) After treatment, the fundus:16 eyes optic disc appearance of normal,15 eyes edema subsided with varying degrees of optic atrophy..5) The 14 cases (15 eyes) of traditional Chinese medicine combined treatment group:clinical cure 5 eyes (33.33%), marked effective 5 eyes (33.33%), effective 3 eyes (20.0%), total effective rate 86.67%, ineffective 2 eyes (13.33%); TCM and Western medicine treatment group,20 cases (24 eyes):clinical cure 6 eyes (25.0%), marked effective 5 eyes (20.83%), effective 9 eyes (37.50%), total effective rate was 83.33%, invalid 4 eyes (16.67%), no statistically significant difference between the two effects (x2=0.79, P>0.01).6) The 20 cases (22 eyes) within 15 days after onset of treatment:clinical cure 9 eyes (40.91%), marked effective 7 eyes (31.82%), effective in 5 eyes (22.72%), the total effective rate 95.45%, invalid 1 eyes (4.55%); The 14 cases (17 eyes)more than 15 days after onset of treatment:clinical cure 2 eyes (11.76%), marked effective 3 eyes (17.65%), effective 7 eyes (41.18%), the total effective rate 70.59%, ineffective in 5 eyes (29.41%). There was a significant difference between the two (x2=39, P<0.01),Conclusion:1.The comprehensive treatment of ischemic optic neuropathy is effective in improving retinal circulation and improve visual function; 2. The comprehensive treatment of traditional Chinese medicine is a good treatment plan for the patients with ischemic optic neuropathy who can not accept hormone therapy or for who hormone therapy is ineffective; 3. TCM and Western medicine treatment is a better treatment for early treatment of ischemic optic neuropathy or this disease caused by vasculitis; 4. Early diagnosis and treatment of ischemic optic neuropathy are key factor in the prognosis of visual function.