| Purpose: 1.To analyze the characteristics of syndrome differentiation of traditional Chinese medicine in primary glaucoma,and explore characteristics of optic nerve damage in primary glaucoma patients with different syndrome of Chinese medicine.2.Basing on “tonifying the liver and kidney,promoting blood circulation and Qi,nourishing yin for improving eyesight” theory,to investigate the effects and mechanism of “Ziyin Mingmu Decoction” on primary glaucoma patients with “YIN-deficiency of liver and kidney”;3.To observe the effects of “Ziyin Mingmu Decoction” on RGCs apoptosis and ERG in SD rats with chronic intraocular pressure,to study the mechanism of retinal atrophy and thinning induced by glaucoma optic neuropathy.Material and method: 1.Clinic Research: 103 patients,103 eyes with primary glaucoma were divided into “excess heat in liver meridian”,“abundance of damp due to spleen-deficiency”,and “Yin-deficiency of liver and kidney” three groups,according to syndrome differentiation of Chinese medicine,there were analyzed including different course of diseases with different syndromn of Chinese medicine,regularities of distribution of intraocular pressure,and regular changes of visual field mean deviation,p RNFL,thickness of GCC layer,optic disc vascular density,macular vascular density.2.Clinic research: to treat the optic neuropathy in primary glaucoma with “Yin-defficiency in liver and kidney” by “Ziyin Mingmu Decoction”;compare with control group(Cobamanide treat),to evaluate the therapeutic effect of “Ziyin Mingmu Decoction” by testing syndrome differentiation of Chinese medicine evaluated level,visual field,the thickness of p RNFL and GCLP,the blood vessel density of optic disk and macular region.3.Experimental researches: Chronic EIOP model in rats was established by injecting of magnetic bead into anterior chamber,then the model rats were divided into 6 groups: blank control,EIOP control,high-dose “Ziyin Mingmu Decoction”,middle-dose “Ziyin Mingmu Decoction”,low-dose “Ziyin Mingmu Decoction”,positive control.High-,middle-,low-dose “Ziyin Mingmu Decoction” were continuously intragastric administrated in rats for 4 weeks,and the intraocular pressure(IOP)in all rats was monitored;all rats were sacrificed after ERG test,and to observe the effects of “Ziyin Mingmu Decoction” on IOP,ERG,retinal structural and histological changes,RGCs count and neuroglia cells count and RGCs apoptosis.Results: 1.To compare three types of syndrome differentiation of Chinese medicine with early-,medium-,late-stage of primary glaucoma,late-stage of glaucoma account for 60.00% of 21 eyes in “Yin-difeciency in liver and kidney”group;Compare with other two syndrome differentiation,less GCC,RNFL,visual field MD,optic disc blood flow density,macular blood flow density in “Ziyin Mingmu Decoction”,there existed significantly different(p<0.01).2.Intraocular pressure,visual field MD value,GCIPL,macular vascular density,optic disk vascular density,and syndrome differentiation evaluation in “Ziyin Mingmu Decoction” treatment group are superior to c control(p<0.05);But there are no significant differences in visual acuity and p RNFL thickness compared with pre-treatment between “Ziyin Mingmu Decoction” treatment group and control.3.IOP in rats increased significantly induced by chronic EIOP model and higher than basic intraocular pressure significantly(p<0.05).The effects of “Ziyin Mingmu Decoction” on visual function damage induced by chronic EIOP in rats included: slightly decline the IOP,effectively improve ERG a-wave,b-wave and Ph NR wave amplitude;HE staining of retina,RGCs count,neuroglia cells count,and RGCs apoptosiss were all recovered significantly,especially in high-dose group.Conclusion: 1.Most of “Yin-defficiency in liver and kidney” patients stayed in late-stage of primary glaucoma,with severe optic nerves damage,lowest vascular density;different course of optic nerve damage closely correlated to the liver meridian syndrome,there appeared tendency that syndrome differentiation changed from ““excess heat in liver meridian” to “abundance of damp due to spleen-deficiency”,then to “Yin-deficiency of liver and kidney”.2.Total effective rate is about 82.14% in optic neuropathy induced by primary glaucoma with “Yin-deficiency of liver and kidney” treated by “Ziyin Mingmu Decoction”,which improve retinal superficial layer microcirculation,enhance visual function clearly.3.The chronic EIOP model in rats is successful established by injecting magnic bead into anterior chamber;RGCs apoptosis was significantly attenuated by “Ziyin Mingmu Decoction”,which protect normal structure and function of optic nerve in rats. |
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