|
Background: choroidal neovascularization (choroidal neovascularization, CNV) due to macular degeneration is a common refractory eye disease. CNV caused by bleeding, oozing, retinal pigment epithelium (retinal pigment epithelium, RPE) detachment and retinal nerve sensory layer detachment, resulting in the final scar formation is the cause wet age-related macular degeneration (age-related macular degeneration, AMD), Center exudative chorioretinopathy (central exduative chorioretinopathy, CEC), the main pathologic myopia (pathological myopia, PM) and other common CNV blindness. Against the of CNV pathogenesis and treatment of the research is the hot spot of the current domestic and international ophthalmology. Photodynamic therapy (photodynamic therapy, PDT) is a more effective treatment of the disease, has gradually be applied. The main mechanism of PDT for CNV: injected into the body of the photosensitizer specificity combined with neovascular endothelial cells more stranded in CNV lumen photochemical reaction occurs by the specific wavelength laser irradiation, the destruction the CNV of endothelial cells caused CNV closed, to prevent or reduce the leakage of blood components, thereby controlling the CNV further damage photoreceptor cells. PDT has greatly expanded the therapeutic areas of CNV, safe and effective treatment of subfoveal CNV become possible, many domestic and international studies have shown to have certain advantages in the short term, to maintain or slow vision loss. PDT can not fundamentally eliminate the occurrence of CNV, and therefore there is inadequate treatment of CNV can not make it completely disappear for long periods of time, easy recurrence shortcomings. Chinese traditional medicine that macular degeneration and the the spleen closely related macular disease dialectical from the spleen to start. Temper weak spleen lost health movement is the basis of the incidence of macular degeneration is centered; wet endogenous, phlegm and basic pathological changes, as the standard, therefore, clinical diagnosis and treatment of macular degeneration, spleen, beneficial Qi is the root of the law, diuresis Shenshi, phlegm XiaoyuJiangzhi Endometriosis commonly stopgap measures. The constitution is an objective existence of the phenomenon of life, individual life process showed morphology, physiological function and psychological state, in congenital and acquired on the basis of comprehensive, relatively stable characteristics. This trait determines the tendency of the human body's susceptibility to certain pathogenic factor and their lesion type. On physical factors differentiating style of governance has a significant correlation between the diagnosis and treatment of the disease is important. Instructors use the PDT, and spleen Huazhuo side CNV, for many years, has accumulated some experience, but previous studies mainly focused observation and treatment after three months of short-term efficacy, lack of long-term efficacy observed. Objective: to observe PDT and PDT Joint-spleen Huazhuo square treatment of choroidal neovascular macular degeneration of the long-term efficacy. Observed choroidal neovascular disease TCM constitution type distribution characteristics, preliminary observations of physical type, disease and prognosis, identifying certain laws, to provide for the prevention and treatment of CNV disease experience. Method: 1. Return visit from May 2005 to February 2009, in our hospital to accept PDT and PDT Joint-the spleen Huazhuo the Treatment of CNV in patients with macular degeneration, collected a total of 88 cases, 80 cases, the longest follow-up time 56 months, a minimum of 12 months. 27 cases of wet age-related macular degeneration 33, 36 cases of 17 patients with 18 pathologic myopia, central exudative chorioretinopathy 37. According to and whether joint spleen Huazhuo. Patients were divided into two groups: joint the spleen Huazhuo side of the PDT group and PDT group (referred to as the Chinese intervention group). Detailed records of patients since the onset of the disease development and treatment, measuring the best corrected visual acuity, dilated check eyes, combined with previous imaging studies (FFA and OCT), visual acuity, fundus the situation evaluate its long-term efficacy. According to the 2009 Association of Chinese Medicine the standard - TCM constitution classification criteria \transformed points, judged by the standard physical type. Application SPSS16.0 statistical software, and the data were statistically analyzed the results. Results: After the first treatment PDT group 38, 13 of recurrence, the recurrence rate was 34.21%, the recurrence interval for a minimum of 3 months and a maximum of 26 months, with an average of 9.9 months. Chinese intervention group 44, six recurred, the recurrence rate was 13.64%, the recurrence interval for a minimum of six months and a maximum of 15 months, with an average of 10.8 months. Visual improvement and stability PDT group and Chinese medicine intervention group was no significant difference; compared to the three diseases: best CEC prognosis, followed by patients with PM, again is AMD patients. The 3. TCM constitution investigation, 80 cases of CNV patients with physical distribution significant difference was statistically significant. The physical type proportion high to low: the peaceful quality (27.5%), Qi deficiency (23.75%), the yang quality (18.75%), phlegm (8.75%), hot and humid quality (7.5%), blood stasis quality (6.25%), yin deficiency and qi quality (both 6.25%). Prognosis, relative to the biased constitution, a lower relapse rate in patients with gentleness type. Conclusion: The view from the follow-up to some patients, the relapse rate of traditional Chinese medicine in the intervention group relatively lower than those in the PDT group. Visual improvement and stability CEC patients best prognosis, followed by patients with PM, again is AMD patients. Peaceful quality stable rate of patients after treatment, biased constitution recurrence rate is high quality at peace.
|