针刺治疗青光眼视神经萎缩:随机对照试验

Acupuncture for glaucoma-induced optic atrophy:a randomized controlled trial

目的:观察针刺治疗青光眼视神经萎缩的临床疗效.方法:将70例(89只患眼)青光眼视神经萎缩患者随机分为观察组和对照组,每组35例.对照组采用西医基础治疗;观察组在对照组基础上联合针刺治疗,主穴取百会、上睛明、承泣、风池、足三里等,配合辨证取穴,间隔2 d针刺1次,每周2次,两组均治疗3个月.分别于治疗前、治疗后和治疗后6个月随访时观察两组患者最佳矫正视力(BCVA)、眼压(IOP)、视野指标[视野指数(VFI)、平均偏差(MD)、图形标准差(PSD)]和平均视网膜神经纤维层(RNFL)厚度.结果:治疗后和随访时,对照组BCVA较治疗前降低(P<0.05);观察组随访时BCVA高于对照组(P<0.05).治疗前后各时间点,两组患者IOP、VFI、MD、PSD组内和组间比较差异均无统计学意义(P>0.05).治疗后和随访时,观察组平均RNFL厚度大于对照组(P<0.05).结论:在西医基础治疗的基础上,针刺治疗可延缓青光眼视神经萎缩患者视力下降及视网膜纤维层变薄.

Objective To observe the clinical effect of acupuncture for glaucoma-induced optic atrophy.Methods A total of 70 patients(89 affected eyes)with glaucoma-induced optic atrophy were randomized into an observation group and a control group,35 cases in each group.The control group was given basic western medicine treatment.In the observation group,on the basis of the treatment in the control group,acupuncture was applied at main acupoints i.e.Baihui(GV 20),Shangjingming(Extra),Chengqi(ST 1),Fengchi(GB 20),Zusanli(ST 36),combined with supplementary acupoints based on syndrome differentiation,once every three days,twice a week.The treatment for 3 months was required in both groups.Before treatment,after treatment and in follow-up of 6 months after treatment,the best corrected visual acuity(BCVA),intraocular pressure(IOP),indexes of visual field(visual field index[VFI],mean deviation[MD],pattern standard deviation[PSD])and mean thickness of retinal nerve fiber layer(RNFL)were observed in the two groups.Results Compared before treatment,BCVA was decreased after treatment and in follow-up in the control group(P<0.05);in the follow-up,BCVA in the observation group was higher than that in the control group(P<0.05).On each time point before and after treatment,there was no significant difference within or between the two groups(P>0.05).After treatment and in the follow-up,the mean thickness of RNFL was larger than the control group(P<0.05).Conclusion On the basis of the basic western medicine treatment,acupuncture can delay the decline of vision and the thinning of retinal nerve fiber layer in patients with glaucoma-induced optic atrophy.