| Objective1.Treatment of secondary retinal vein occlusion(Bravo Retinal Vein Occlusion,BRVO)through the combination of Chinese and Western medicine,namely acupuncture,Chinese medicine "Quji Tongluo Decoction" and western medicine"Anti-VEGF(Vascular Endothelial Growth Factor,VEGF)drugs" Macular edema(Macular Edema,ME)clinical efficacy analysis,found the advantages of traditional Chinese and Western medicine treatment of the disease,and explored its possible mechanism of action.2.Combining the clinical efficacy of eye disease,and paying attention to the changes in systemic symptoms and emotions of patients before and after treatment,in order to explain the overall concept of TCM treatment and the connection and influence of eye disease and emotion,as well as the effect and advantage of integrated TCM and Western medicine treatment.MethodsIt is planned to include 60 patients with secondary macular edema secondary to branch retinal vein occlusion diagnosed in the Eye Hospital of China Academy of Chinese Medical Sciences from January 2019 to January 2020.The course of disease is within 28 days and all meet the diagnostic criteria for ME secondary to BRVO.The type of syndrome is phlegm and stasis combined with water-dampness internal stopping syndrome(the "collateral loss and accumulation resistance syndrome"proposed in this subject).After the patient's consent was obtained and the informed consent was signed,the patients were randomly divided into two groups:the control group was a simple western medicine group(that is,the anti-VEGF drug group);the experimental group was a traditional Chinese and western medicine treatment group(acupuncture+traditional Chinese medicine "Quji Tongluo Decoction "+anti-VEGF drug group).Acupuncture is based on acupoints around the eyes(often selected points such as:savvy,upper savvy,behind the ball,the sun,bamboo,silk bamboo,etc.),and acupuncture points are selected in conjunction with the whole body(selected points such as Baihui and Sishencong,Fengchi,Hegu,Guangming,Zusanli,Sanyinjiao,Taichong,etc.),routine disinfection,choose needle acupuncture,once a day,5 consecutive times as a course of treatment,1-2 courses per month;The head of this research group,Xie Like,the chief physician's clinical experience in treating retinal vein occlusion-"Quji Tongluo Decoction "is the main prescription.Its composition is:peach kernel,safflower,habitat,angelica,chicken internal gold,Faxia,Chenpi,Poria,Panax notoginseng,windproof,etc,which can be added or subtracted according to the condition of the whole body.Taking method:decoction,1 dose daily,warm morning and evening,one course in February;anti-VEGF drugs are based on the principle of"1+prn",CMT>300?m and reinjection Time interval?1 month.The main observational indicators of this trial are:the efficacy indicators are recorded by the International Standard Vision Chart(Best Corrected Visual Acuity,BCVA);optical coherence tomography angiography(OCTA)is used to record the central macular thickness(CMT);according to the observation period of 2 months,the efficacy index is before treatment as the baseline,and 1 month after treatment and 2 months after treatment are the observation nodes.Each node needs to check BCVA,routine ophthalmological examination,fundus examination and OCTA examination,so as to compare the efficacy of two groups of patients in different observation nodes and comparison between groups.In addition,the TCM syndrome grading and quantification scale score and anxiety self-assessment scale were used for comparison before and after treatment,and were filled in and retrieved on-site at the time of patient enrollment and 2m after treatment.Results Statistical analysis was performed using SPSS24.0 statistical software.P<0.05 was considered statistically significant.Results1.Due to the difficulty of individual patients receiving acupuncture or long-term adherence to Chinese medicine,some patients cannot complete follow-up visits due to the impact of the new coronavirus pneumonia epidemic.At the end of the study,a total of 15 cases were lost,of which 9 cases were lost in the control group,6 cases were lost in the test group,and 45 cases were actually included.2.There were no statistically significant differences between the two groups of subjects in terms of number,gender,age,course of disease,eye type,intraocular pressure,and pre-treatment indexes(P>0.05).3.BCVA(LogMAR)The BCVA(LogMAR)of the control group and the test group were 0.65±0.11 and 0.69±0.19 before the treatment,respectively,and the difference was not statistically significant(P>0.05);1 m after the treatment,the control group and the test group were 0.41±0.06 and 0.35±0.13 respectively.The difference was statistically significant(P<0.05);2m after treatment,the control group and the test group were 0.26±0.05,0.20±0.08 respectively,the difference was statistically significant(P<0.05);the control group was lm after treatment Before treatment,2m after treatment to before treatment,2m after treatment to 1m after treatment were 0.25±0.11,0.37±0.10,0.12±0.04 respectively,in the test group,1m to before treatment,2m to before treatment,From 2m to 1m after treatment,they were 0.34±0.15,0.48±0.16,and 0.14±0.07,respectively,and the differences were statistically significant(P<0.05).4.Macular foveal thickness(CMT)After treatment,the CMT results showed that 6 cases(28.6%)were effective in the control group,15 cases(71.4%)were effective,15 cases(62.5%)were effective in the test group,and 9 cases(37.5%)were effective,with differences between the two groups.Statistical significance(P<0.05).The CMT of the control group and the experimental group before treatment were 559.53±134.44?m and 568.63±140.95?m,respectively,and the difference was not statistically significant(P>0.05).1 m after treatment,the control group and the test group were 366.62±48.55?m and 330.75±47.14?m,respectively,the difference was statistically significant(P<0.05);2 m after treatment,the control group and the test group were 303.76±44.55?m,259.67±30.21 ?m,the difference was statistically significant(P<0.05),The control group was 192.90±104.43?m,255.76±113.12?m,62.86±33.57?m from 1m to before treatment,2m to before treatment,2m to 1m after treatment,and test group from 1m to pretreatment,treatment.The last 2m to before treatment,and 2m to 1m after treatment were 237.88±109.7?m,308.96±125.27?m,and 71.08±32.93?m,and the differences were statistically significant(P<0.05).5.Traditional Chinese Medicine Syndrome GradesAccording to the TCM syndrome grading and quantification scale scoring standard,there were no significant cases in the control group,15 cases(71.4%)were effective,and 6 cases(28.6%)were not effective;8 cases(33.3%)were significantly effective in the test group,and 15 cases(62.5%)Was effective,1 case(4.2%)was ineffective;there was a statistically significant difference between the two groups(P<0.05).The control group scored 14.09±3.05 before treatment and the test group scored 15.38±3.68 before treatment.There was no significant difference between the two groups(P>0.05).The control group scored 6.00±2.77 after treatment and the test group scored 8.33±2.61.The difference between the two groups was statistically significant(P<0.05);the difference between the control group and the experimental group before and after treatment was 5.76±2.07,9.38±3.32 respectively,and the difference was statistically significant(P<0.05);The decrease rate was 64.42±17.11%,and the decrease rate before and after treatment in the experimental group was 52.24±17.76%,and the difference was statistically significant(P<0.05).6.SAS scale scoreThe standard score before treatment in the control group was 55.33±5.59,and the standard score before treatment in the test group was 53.21±7.51.There was no significant difference between the groups(P>0.05);the standard score after treatment in the control group was 46.10±5.13,and the standard score after treatment in the test group was 40.29±8.89,the difference between the groups was statistically significant(P<0.05).The difference between the standard score before and after treatment in the control group was 9.24±4.44,and the difference between the standard score before and after treatment in the test group was 12.92±6.06,and the difference was statistically significant(P<0.05).Conclusion1.Intravitreal injection of anti-VEGF drugs can effectively reduce macular edema,to a certain extent,can delay the development of the disease and save some visual function.2.Combination of traditional Chinese and western medicine(acupuncture+traditional Chinese medicine+anti-VEGF drugs)in the treatment of ME secondary to BRVO,the effect is better than that of anti-VEGF drugs alone.The combination of traditional Chinese medicine and western medicine has given full play to its advantages in the changes of patients' systemic symptoms and emotional changes. |
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