Clinical Observation On The Improvement Of Retinitis Pigmentosa By Using Prescription No. 3 For Fundus Disease Combined With Acupunctur

OBJECTIVE:To observe the clinical efficacy of combination therapy with acupuncture and Yandibing No.3 Chinese medicine compound formula treating retinitis pigmentosa,and to explore the correlation between genotype and combined therapy effect,and provide reference for clinical treatment.METHODS:Forty-eight patients（96 eyes）with retinitis pigmentosa in our hospital’s ophthalmology clinic were enrolled and informed consent was obtained.After 3 courses of f combined therapy,the visual acuity and visual field changes were compared before and after treatment.The clinical efficacy was observed,and 4 ml of peripheral blood was collected from the patient and sent to Beijing Makino Medical Laboratory for detection of retinal disease-related genes.RESULTS:（1）The best corrected visual acuity improved by 30 eyes（31.25%）,stable by 38 eyes（39.58%）,38 eyes（29.17%）ineffective,and the effective rate was 70.83%.The mean visual acuity before treatment（0.33±0.27）and the average visual acuity after treatment（0.37±0.33）were statistically significant（P<0.05）.（2）The visual field improved by 26 eyes（27.08%）,stable by 41 eyes（42.71%）,ineffective by 29 eyes（30.21%）,and the effective rate was 69.79%.After treatment,the mean sensitivity（MS value）was increased,and the mean defect（MD value）was decreased.The difference was statistically significant（P<0.05）.（3）ERG was extinct in 62 eyes（64.58%）and descending in 34 eyes（35.42%）.The visual acuity efficiency of the descending ERG group was significantly higher than that of the extinct ERG group.After treatment,the b-wave amplitude of the descending ERG group was significant increased,P<0.05 difference was statistically significant.（4）TCM syndrome differentiation is 36 eyes（37.5%）of spleen deficiency and weak syndrome,32 eyes of liver and kidney yin deficiency syndrome（33.33%）,28 eyes of spleen and kidney yang deficiency syndrome（29.17%）.The effective rate of spleen deficiency and weak syndrome,liver and kidney yin deficiency syndrome group was significantly higher than that of spleen and kidney yang deficiency syndrome group,P<0.05 was statistically significant.（5）The pathogenic genes of 14 patients were detected.Four patients（8 eyes）with CYP4V2 mutation c.802-8₈10de117insGC mutation,5 patients with USH2A mutation（10 eyes）,and 3 patients with CRB1 mutation（6 eyes）,2 patients（4 eyes）of RP2 gene mutation patients were c.135₁36insC mutation.The visual field efficacy,fundus characteristics and ERG types of the mutated genome have certain regularity.Conclusion:（1）Combination therapy with acupuncture and Yandibing No.3 Chinese medicine compound formula can improve visual acuity,visual field,and the b-wave amplitude of ERG t.It is a clear and effective treatment method and worthy of clinical use.（2）It has certain curative effect on retinitis pigmentosa with different visual acuity and visual field type.The effective rate of decreased ERG is higher than that of extinction type.The syndrome effect of spleen deficiency and weak syndrome and liver and kidney yin deficiency syndrome is better than that of spleen and kidney yang deficiency syndrome.（3）Retinitis pigmentosa has high clinical heterogeneity and genetic heterogeneity.The clinical manifestations of patients with different genotypes are different,and the efficacy of acupuncture combined with treatment is also different.The relevance of genotype-clinical phenotype,genotype-effects remains to be further researched.