Effect of Wei’s triple nine needling therapy on flash visual evoked potentials in rats with traumatic optic neuropathy

Objective:To investigate the effect of Wei’s triple nine needling therapy on the N2-P2 wave of the flash visual evoked potential(FVEP)in rats of the of the transverse directional pulling model.Methods:Thirty-six Wistar rats were randomly grouped,nine were in normal control group without any treatment,and the remaining 27 were surgically modelled in the right eyes.Eighteen of these rats were randomly divided into a Wei’s triple nine needling therapy group and a model group of nine rats each after the TON model was made using the transverse quantitative retraction method.The other 9 rats were sham-operated,and only the optic nerve was exposed without retraction.On the next day of modelling,the Wei’s triple nine needling therapy group was treated with Wei’s triple nine needling therapy for 20 minutes/1 time/1 day for 14 days.The model group,sham-operated group and normal control group were not intervened.Wei's triple nine acupoints were represented as follows:1st link:"Jingming"(BL1)and"Chengqi"(ST1);2nd link:"Sizhukong"(SJ23)penetrating"Taiyang"(EX-HN5);and the third:"Fengchi"(GB 20)and"Taichong"(LV3).The FVEP of each group was observed on 1d,7d and 14d.The FVEP of each group was observed on 1d,7d and 14d.Results:Compared with the model group,the N2 wave latency and P2 wave latency were shortened in the Wei’s triple nine needling therapy on 1d(P<0.05,P<0.01);on 7d,their N2 wave latency was shortened(P<0.01)and the N2-P2 wave amplitude was increased compared with the model group(P<0.05);on 14d,their P2 wave latency was shortened(P<0.05)and the N2-P2 wave amplitude was increased.There was no statistical difference in N2 wave latency,P2 wave latency and N2-P2 wave amplitude in the sham-operated group on 1d,7d and 14d(P>0.05).The delayed N2 and P2 wave latencies in the model group did not improve from 1d to 14d(P>0.05)and the amplitude decreased throughout,showing a significant difference on 14d compared to 1d(P<0.05).In contrast,the N2 wave latency in Wei’s triple nine needling therapy group was not significantly different until 7d to 14d(P<0.05);its P2 wave latency,although significantly delayed from 1d to 7d(P<0.05),recovered on 14d and reached a level that was not statistically different from 1d and 7d(P>0.05).There was also no significant decrease in N2-P2 wave amplitude between 1d and 14d in Wei’s triple nine needling therapy group(P>0.05).Conclusion:In this experiment,the TON rat model was successfully established by the transverse quantitative retraction method,and the treatment of TON rats with Wei’s triple nine needling therapy reduced the P2 wave delay of the FVEP electrophysiological signal and increased the N2-P2 amplitude,which had a certain positive effect on the repair of optic nerve injury,probably related to its effect of improving the conduction function of the optic nerve and protecting the retinal ganglion cells that had not been degenerated and necrosed.

中西医结合治疗外伤性视神经病变疗效评价的Meta分析

目的:系统评价中西医结合治疗外伤性视神经病变(TON)的临床疗效及安全性。方法:通过计算机检索PubMed、Embase、Cochrane Library、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、万方数据库、维普数据库自建库至2020-05的关于中西医结合与单纯西医治疗TON的随机对照研究,使用Cochrane评价手册对纳入文献进行质量评价,使用RevMan5.3统计软件进行资料提取与Meta分析。结果:共筛选出12篇符合纳入、排除标准的文献;Meta分析结果显示,与单纯西药治疗TON比较,中西医结合治疗有效率更高[RR=1.33,95%CI(1.23~1.45),P<0.001];在改善视力[MD=0.18,95%CI(0.14~0.23),P<0.001]、视野平均缺损[MD=-3.08,95%CI(-5.20~0.96),P=0.004]、视觉诱发电位P100波峰潜时[MD=-9.47,95%CI(-16.37~2.57),P=0.007]以及视觉诱发电位P100波峰振幅[MD=1.44,95%CI(0.22~2.66),P=0.02]上作用更显著。纳入文献有2篇提及不良反应的发生和处理,余10篇均未描述。结论:与单纯西医治疗相比,中西医结合治疗TON的疗效更佳。

视网膜神经纤维层厚度与11778位点Leber视神经病变患者视功能预后的关系

目的:研究视网膜神经纤维层(RNFL)厚度变化与11778位点突变的Leber遗传性视神经病变(LHON)患者远期视功能的相关性,以及早期RNFL厚度对远期视功能的预测价值。方法:回顾性分析经mtDNA检查确诊为11778 G>A/ND4位点突变的LHON患者23例44眼,以病程30mo远视力0.5(LogMAR)为标准将患者分为两组,先得到两组患者各预定时间点(病程)的RNFL厚度均值并对比获得备选的RNFL预测界值,再以备选界值为标准,将不同RNFL厚度的患眼分为两组进行统计分析,判断该界值能否用于预测远期视力和视野,最终选定能同时评估远期视力和视野的最早界值为目标界值。结果:根据RNFL厚度均值的分布获得备选界值为:病程2mo 130μm,病程4mo 100μm,病程8mo 80μm,病程12mo 65μm,分析发现病程8mo时RNFL厚度是否超过80μm对远期视力的区分更佳,且对远期视野平均缺损(MD)及平均敏感度(MS)值均有很好的区分(P<0.05)。病程8mo时RNFL≤80μm的患眼远期(病程30mo)视力均低于LogMAR 0.5(WHO低视力标准),100%患眼远期为低视力;而病程8mo时RNFL>80μm的患眼中,31%患眼远期视力优于LogMAR 0.1(相当于小数视力0.8),仅34%患眼为远期低视力,且RNFL>80μm的患眼视力和视野均显著优于RNFL≤80μm。结论:病程8mo时RNFL厚度是否超过80μm可作为判断远期视力和视野的最佳预测界值,该界值对11778位点突变的LHON患者的远期视力、视野均有良好的预判性。

青盲一号方治疗中毒性视神经萎缩的疗效分析

目的:评价青盲一号方治疗中毒性视神经萎缩的临床疗效。方法:分析2013-01/2018-02于北京中医药大学东方医院眼科采用青盲一号方治疗的肝郁血虚型中毒性视神经萎缩患者7例13眼,随访6~24mo,观察治疗前后视力、视野、电生理及视网膜神经纤维层(RNFL)厚度等指标的变化,综合评估青盲一号方的临床疗效。结果:本研究纳入患者中乙胺丁醇中毒者5例10眼,酒精中毒者1例1眼,狂犬疫苗中毒者1例2眼。治疗前4例8眼患者行OCT检查示鼻侧与颞侧RNFL厚度已发生明显薄变,末次随访时各象限厚度仍呈下降趋势。至末次随访时,视力提高≥0.1者4眼(31%),提高0.06~<0.1者2眼(15%),提高0.04~<0.06者1眼(8%),提高0.01~<0.04者4眼(31%),视力无提高者2眼(15%);青盲一号方治疗显效3眼(27%),有效4眼(36%),无效4眼(36%),总有效率为64%。结论:青盲一号方能够延缓视神经萎缩的进展,可在一定程度上改善视功能,发挥视神经保护的作用。

糖尿病视网膜病变激光治疗的并发症及其防治

糖尿病视网膜病变是慢性高血糖造成的慢性缺血性视网膜病变,是糖尿病微血管并发症之一,可严重影响患者视力甚至致盲。DR致盲的主要原因包括黄斑水肿、玻璃体积血以及新生血管性青光眼等,视网膜激光光凝是目前临床上治疗DR的最主要方法之一。其原理是利用激光的热效应,使蛋白质变性,组织凝固、破坏并结痂。使耗氧低的瘢痕组织代替耗氧高的视锥、视杆细胞,减少组织耗氧,改善中周部视网膜缺血缺氧状态。但激光治疗的过程中可能会出现黄斑水肿、玻璃体积血、视野缺损等并发症,为了更全面地评估激光治疗的益处和风险,本文就近几年来有关DR激光治疗的并发症及其防治方法的文献进行综述。