| (1)Clinical observation of Huangban One Decoction combined with anti-VEGF in the treatment of wet age-related macular degenerationOBJECTIVE:To observe the difference in the therapeutic effect of HBOD,based on the principle of YiQi TiaoXue HuaTan,combined with Ranibizumab Injections in treating wet AMD and Ranibizumab alone or simply taking HBOD for AMD.METHOD:A total of 84 patients(108 eyes)with wet AMD who met the inclusion criteria were divided into three groups,namely the treatment group(34 cases with 45 eyes),the western medicine control group(30 cases with 36 eyes)and the Chinese medicine control group(20 cases with 27 eyes).The treatment group get a Ranibizumab injection after admission,and take HBOD in the morning and evening every day,100 ml each time.The patients’ condition was continuously observed,and ranibizumab injection therapy was performed when necessary.Western medicine control group was only treated with "1+PRN"regimen,which Ranibizumab was injected once after admission then be given if necessary,while traditional Chinese medicine control group was only treated with HBOD,and ranibizumab injection therapy was performed when necessary.After 3 and 6 months of treatment,the best corrected visual acuity(ETDRS visual acuity chart),central macular thickness,the area of retinal hemorrhage and exudation,quality of life scale score and the number of anti-vascular therapy were recorded.RESULTS:1.The best corrected visual acuity of the three groups was significantly improved after the treatment of 12w and 24w(P<0.05).After 24w’s treatment,the average increase of the number of letters in the treatment group was 15.11±8.73,which was significantly better than the western medicine control group and the Chinese medicine control group;2.After 12w of treatment,CMT of the three groups fell significantly.Between 12w and 24w,CMT of the treatment group and the traditional Chinese medicine control group fell continuously while that of the western medicine control group fell not significantly(P>0.05);3.After 24w of treatment,the area of fundus hemorrhage in the three groups was significantly reduced,and the therapeutic effect in the treatment group was better than that in the western medicine control group and the Chinese medicine control group(P>0.05);4.After 24w of treatment,the QOL scores of the three groups were all improved,and there were significant differences between the treatment group and the western medicine control group,but no significant differences between the Chinese medicine control group and the treatment group;5.During the 24w’s observation period,the average number of anti-VEGF treatments per eye in the treatment group was 1.60,which was significantly different from the western medicine control group(2.94 times)and the Chinese medicine control group(0.56 times)..CONCLUSIONS:1.Chinese medicine HBOD combined with anti-vegf therapy,anti-vegf therapy alone and Chinese medicine therapy have certain effects on improving vision,reducing CMT,reducing fundus bleeding and improving quality of life of patients with wet AMD;2.Chinese medicine HBOD combined with anti-vegf therapy has better efficacy than anti-vegf treatment and Chinese medicine therapy in improving vision and promoting fundus bleeding absorption;3.The treatment of wet AMD with traditional Chinese medicine HBOD combined with anti-vegf therapy can effectively lead to fewer injections,reduce the financial burden of patients,which meet the requirements of health economics;4.HBOD combined with anti-vegf therapy can significantly improve the quality of life of patients with wet AMD.(2)Methodological quality evaluation of randomized controlled trials of Chinese patent medicine in the treatment of age-related macular degeneration and meta-analysis of it’s efficacy and safetyOBJECTIVE:To evaluate and analyze the literature quality of published randomized controlled clinical trials(RCT)of Chinese patent medicines in the treatment of age-related macular degeneration(AMD),and to meta-analyze the efficacy and safety of Chinese patent medicines in the treatment of AMD.METHOD:We retrieved the RCT studies on the treatment of AMD with Chinese patent medicines from both Chinese and English databases until October 2018,the modified Jadad scale and ROB scale were used to evaluate the quality and offset risk of AMD,and then the meta-analysis was carried out using Review Manager 5.0 software.RESULTS:A total of 27 studies were included,and only 2 articles(7.41%)were found to be of high quality by the modified Jadad scale.The results of ROB scale evaluation showed that 22 articles(81.48%)adopted the randomized control method,but the quality and reliability of randomization were poor,blind methods were rarely used;no article had ever calculated sample content.In addition,there is a lack of intention to treat analysis of the shedding cases,and lack of safety evaluation.There were 8 studies that met the inclusion criteria of meta-analysis.The treatment group was treated with Chinese patent medicine/Chinese patent medicine combined with basic treatment,while the control group was treated with western medicine.The meta-analysis results showed that the total effective rate of AMD treated by integrated traditional Chinese and Western medicine was higher than that of the control group,and the difference was statistically significant[OR=5.33,95%CI(3.56,7.98),P<0.00001].However,there was no statistically significant difference in efficacy between visual acuity and drusen area reduction.CONCLUSIONS:The quality of RCT studies on the treatment of AMD with Chinese patent medicine is generally of low quality,the standardization of experimental design needs to be improved.The overall efficacy of integrated Chinese and Western medicine in the treatment of AMD was superior to that of western medicine alone,and no serious adverse reactions were reported.However,due to the insufficiency and low quality of this meta-analysis,it still needs scientific and rigorous multi-center large sample study to verify its efficacy. |
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