The Therapeutic Effect Of Treating The Impaired Optic Nerve By Complex Thrombolysis Caps About POAG After Operation

Objective:To observe the therapeutic effect of treating the impaired eyes' nervers by complex thrombolysis caps about primary open angle glaucoma(POAG) after operation. To provide the objective basis for the protection of the optic nerve after operation.Methods:The study was carried on with patients with POAG from January, 2007 to March 2008 in Guang Dong Hospital of TCM. The 40(61 eyes) cases of the patients were divided randomly into two groups, which were treatment group and control group. There were 11 males (17 eyes) and 9 females(13 eyes) in the treatment group, Meanwhile 10 males(16 eyes) and 10 females(15 eyes) in the control group. All the patients were operated on for trabeculectomy. The intra-ocular tension≤21mmHg, dioptric media were transparent. The diopter: spherical lens≤±6.0D , cylinders≤±2.0D. The corrected vision≥0.1. The treatment group patients were treated by complex thrombolysis caps , the control group patients by VitC. The treatment course was 12 weeks. Then we compared the two treatments by such aspects as blood pressure , arterial pulse , vision, intraocular and visual field. We annlysised whether the complex thrombolysis caps could protect the optic nerve through the study. And to provide the objective basis for the protection of the optic nerve after operation.Results:1. Two kinds of medicine had no obviously effect to the patients' blood pressure and arterial pulse. There was no statistical difference.2. Vision:There was no significant differences between the vision of the treatment group and the control group (P>0.05).3. Intraocular:There was no significant difference between the intraocular of the treatment group and the control group (P>0.05).4. There were both changes of visual field light sensitivity (MS) and visual field damage (MD) . There was significant difference of MS between before and after the treatment in the treatment group (P<0.05). There was no significant difference of MS between before and after the treatment in the control group(P>0.05). The therapeutic effect of the treatment group was better than the control group (P<0.05). There was significant decrease of the indicators of MD in the treatment group (P<0.05) and there was significant difference between the treatment group and the control group(P<0.05).Conclusions:The mechanism of visual function lesion of POAG is quite complex. The multi-factor theory believes that the intraocular pressure is the fundamental factor which cause the visual function lesion of POAG but is not the only factor. There are other risk factors which includes age, race, diabetes, hypertension, vasospasm, ophthalmic artery hypoperfusion, hemorheology abnormality, etc. These factors may cause the visual function lesion alone to harm, may also have an effect together with the intraocular pressure. In the last few years, there were a lot of researaches about patients' hemorheology that with POAG. The results indicated that the POAG patients' blood viscosity elevated. The blood vessel diameter and the automatic control of the irrigation press play the main role in the normal microcycle, the blood viscosity only plays the secondary role. When the vasomotion is limited , the slight increases of the blood viscosity will turn to be the main and only controller of blood stream. When the blood viscosity increases, the blood vessel will expand to maintain the normal blood circulation. If outside pressure (for example the intraocular pressure) elevates at this time, which hinders the vasodilatation or creates the angiostenosis, which will cause the blood stream rate dropping down and the ischemia, aslo will cause the visual function lesion in the papilla optica. Therefore, we should improve the POAG patient's blood viscosity and increase the blood fluid as an auxiliary treatment for the POAG patients after operation to improve the blood supply of the optic nerve and retina. With that method we can protect the visual function and regain the partial vision. The complex thrombolysis caps is one kind of pure Chinese traditional medicine composed by panax pseudo-ginseng, astragalus mongholicus , salvia miltiorrhiza and figwort root. Astragalus mongholicus, panax pseudo-ginseng and salvia miltiorrhiza can diastole blood vessel, promotes the QI-blood circulation. Figwort root can clear heat , nourishing yin , absorb clots and activate the channels. The pharmacology research indicated that the complex thrombolysis caps had the ability of anti-thrombus, expanding the blood vessel, increasing blood stream, improving microcycle. These medicines' function is the base of the complex thrombolysis caps' effect of improving optic nerve's microcycle and the ischemia anoxic condition, enhancing visual cell's excitability and preventing and curing sight droping and contraction of field. This clinical observation demonstrated that the complex thrombolysis caps could protect the impaired eyes' nervers of primary open angle glaucoma (POAG) after operation. The therapeutic effect of the treatment group was better than the control group.