Clinical Study On The Protection Of Visual Function Of Primary Open-Angle Glaucoma With Traditional Chinese Medicine Of Tonifying Kidney And Activating Blood Circulation Based On Retinal Vascular And Oxygen Technology

Objective:This study used OCTA and Oxymap T1 to observe the clinical characteristics of the optic disc vascular density and retinal oxygen saturation in POAG patients.And based on this feature,the clinical study on the protection of POAG visual function by traditional Chinese medicine of tonifying kidney and activating blood circulation was conducted.Methods:1.A total of 60 patients with POAG and 40 normal people were included.All subjects were examined for routine ophthalmological examination(Including visual acuity,IOP,IOL Master),glaucoma related examination(Including visual field,optic disc OCT),optic disc OCTA(Including intra optical disc,near optic disc,around optic disc,intact optic disc Vd and Pd),Oxymap T1(Including SAO₂,SVO₂,A-V).To analyze the differences between the two groups and the correlation between the indicators,as well as the diagnostic efficacy of the indicators.2.60 POAG patients were randomly divided into a control group and a treatment group.The control group was given basic treatment for local intraocular pressure reducing,and the treatment group was given traditional Chinese medicine for tonifying kidney and activating blood circulation at the same time as the basic treatment.After three months of treatment,review the routine ophthalmological examination(Including visual acuity,IOP),glaucoma related examination(Including visual field,optic disc OCT),optic disc OCTA(Including intra optical disc,near optic disc,around optic disc,intact optic disc Vd and Pd),Oxymap T1(Including SAO₂,SVO₂,A-V),ect.To analyze the difference of the two groups of indicators,observe the effect of traditional Chinese medicine for tonifying kidney and activating blood circulation on vascular and oxygen in POAG patients,and explore the clinical efficacy of Chinese medicine for tonifying kidney and activating blood circulation in the treatment of POAG.Result:1.Routine ophthalmological examinations in the two groupsThere was no statistically significant difference in IOP,diopter,corneal thickness and anterior chamber depth between POAG patients and normal people(P>0.05).2.Glaucoma related examination in the two groupsThere is a significant differences in visual field,average RNFL thickness,disc edge area,vertical C/D rate and the optic cup between POAG patients and normal people(P<0.05).3.Examination of optic disc vascular density and perfusion density in the two groupsThe optic disc vascular density of POAG patients are 0.76±1.71mm^-1,12.13±4.37mm^-1,13.39±4.09mm^-1,12.72±3.84mm^-1(intra optical disc,near optic disc,around optic disc,intact optic disc),and optic disc vascular density of normal people are 4.20±5.06mm^-1,17.87±1.36mm^-1,18.09±1.63mm^-1,17.66±1.33mm^-1.The optic disc perfusion density of POAG patients are 0.020±0.044%,0.308±0.114%,0.332±0.107%,0.317±0.099%(intra optic disc,near optic disc,around optic disc,intact optic disc),and optic disc perfusion density of normal people are 0.126±0.149%,0.458±0.039%,0.447±0.047%,0.441±0.038%.There are significant differences in optic disc vascular density and perfusion density between the two groups(P<0.05).4.Examination of arterial oxygen saturation in the two groupsThere is no significant difference in retinal SAO₂between POAG patients and normal people(P>0.05).The average SVO₂of POAG patients is 62.84±6.73%,the temporal SVO₂is 64.19±7.26%,the nasal SVO₂is 66.32±6.14%,the upper SVO₂is 62.06±8.68%,and the lower SVO₂is 58.29±8.62%.The average SVO₂of normal people is 58.03±4.69%,temporal SVO₂is 59.53±4.21%,nasal SVO₂is 61.15±6.52%,upper SVO₂is 56.68±5.82%,lower SVO₂is 54.68±6.06%,there is a significant difference between the two groups(P<0.05).The average A-V of POAG patients is 33.61±6.38%,the temporal A-V is34.23±10.99%,the nasal A-V is 31.97±6.15%,the upper A-V is 33.39±8.60%,and the lower A-V is 34.65±8.94%.The average A-V of normal people is 37.98±5.19%,temporal A-V is 38.75±5.26%,nasal A-V is 37.55±7.84%,upper A-V is 36.75±7.54%,lower A-V is 38.95±8.29%,there is a significant difference between the two groups(P<0.05).5.Correlation analysis between examination indexes of POAG patientsThe visual field MD is positively correlated with the optic disc vascular density and perfusion density(R are 0.353,0.461,0.308,0.415),visual field MD is positively correlated with the average A-V,average RNFL thickness,and disc edge area(R are 0.333,0.802,0.754),the disc edge area is positively correlated with intact optic disc vascular density and intact optic disc perfusion density(R are 0.324,0.281),and the average RNFL thickness is positively correlated with optic disc vascular density and perfusion density(R are 0.370,0.469,0.329,0.432),the visual field PSD is positively correlated with the average SVO₂,the vertical C/D ratio,and the optic cup volume(R are 0.429,0.564,0.267),and the average A-V is positively correlated with the intact optic disc vascular density(R=0.309).The vertical C/D ratio is negatively correlated with the around optic disc vascular density,intact disc vascular density,intact disc perfusion density,and visual field MD(R are-0.274,-0.409,-0.350,-0.785).Visual field MD is negatively correlated with average SVO₂,optic cup volume(R are-0.353,-0.447).Visual field PSD is negatively correlated with intact optic disc vascular density,average A-V,average RNFL thickness,disc edge area(R are-0.269,-0.295,-0.625,-0.501).The average RNFL thickness is negatively correlated with SVO₂(R=-0.357).6.The diagnostic efficacy of each examination index for POAGVisual field MD,PSD,RNFL thickness,disc edge area,vertical C/D,optic cup volume,around optic disc vascular density,intact disc vascular density,around optic disc perfusion density,intact disc perfusion density,average A-V to the diagnosis of primary open-angle glaucoma efficiency was statistically significant.The area under the area from large to small was disc edge area(1.000),intact disc vascular density(0.942),RNFL thickness(0.931),intact disc perfusion density(0.927),around optic disc vascular density(0.879),around optic disc perfusion density(0.846),visual field MD(0.845),average A-V(0.348)?PSD(0.173),optic cup volume(0.059),vertical C/D(0.037).7.Clinical curative effect of traditional Chinese medicine tonifying kidney and activating blood circulation and its effect on retinal vascular and oxygenThere was no significant difference in BCVA,IOP,average RNFL thickness,disc edge area,vertical C/D ratio,optic cup volume,SAO₂,SVO₂,and A-V between the two groups before and after treatment(P>0.05).The MD of the visual field before treatment in the control group was-8.91±10.13d B and the PSD was 4.93±4.53d B.After treatment,the MD of the visual field was-9.55±9.95d B and the PSD was 5.56±4.73d B.The visual field difference before and after treatment is statistically significant.The MD of the visual field before treatment in the treatment group was-12.26±11.79d B and the PSD was 5.77±4.36d B.After treatment,the MD of the visual field was-11.01±11.67d B,and the PSD was 5.33±4.19d B.The visual field difference before and after treatment is statistically significant(P<0.05).There was no significant difference in optic disc vascular density and optic disc perfusion density in the control group before and after treatment,but the optic disc vascular density and optic disc perfusion density in the treatment group increased after treatment,and the difference was significant(P<0.05).There was no statistically significant difference in baseline data between the two groups before treatment(P>0.05).After treatment,there was no significant difference in BCVA,IOP,average RNFL thickness,disc edge area,vertical C/D ratio,optic cup volume,optic disc vascular density,optic disc perfusion density,SAO₂,SVO₂,and A-V difference between the two groups(P>0.05).After treatment,the difference of visual field in treatment group were better than that in the control group,and the difference is significant(P<0.05).Conclusion:1.The vascular characteristic of POAG patients is that compared with normal people,the vascular density and perfusion density of the optic disc are reduced.2.The retinal oxygen saturation characteristic of POAG patients is that compared with normal people,SVO₂is increased and A-V is decreased3.There is a correlation between optic disc vascular density,optic disc perfusion density,retinal oxygen saturation,visual field,and optic disc structure,and there is a stronger correlation between visual field and optic disc structure.4.Vascular density around optic disc,vascular density of intact optic disc,perfusion density around optic disc,perfusion density of intact optic disc,visual field MD,RNFL thickness,disc edge area are more effective in diagnosing POAG(AUC>0.8).5.On the basis of local intraocular pressure reducing treatment,adding traditional Chinese medicine of tonifying kidney and activating blood circulation can improve the visual field,optic disc vascular density,and optic disc perfusion density in patients with POAG,protect the visual function of POAG patients.Adding traditional Chinese medicine of tonifying kidney and activating blood circulation treatment can improve the visual field of POAG patients better than local intraocular pressure reducing treatment.