| Objective1.To compare the clinical efficacy of Danhuang Mingmu Decoction combined with laser in the treatment of diabetic retinopathy(DR)and the clinical efficacy of laser alone in the treatment of diabetic retinopathy2.To explore the effect of Danhuang Mingmu Decoction on blood rheology and retinal tissue structure of DR rats after laser surgeryMethodsPart 1:First,collected patients of the Department of Ophthalmology,the First Affiliated Hospital of Hunan University of Traditional Chinese Medicine,from December 2016 to October 2018,diagnosed with diabetic retinopathy(stage III-V)and differentiated pathological fire due to yin deficiency and blood stasis.52 patients were divided into control group totally 26 cases(44 eyes)and treatment group totally 26 cases(41 eyes)by randomized,controlled,double-blind design method.The control group received laser treatment alone for 4 weeks,once a week totally 4 times.The treatment group took Danhuang Mingmu Decoction while using the first laser surgery treatment,one doseper day for 4 weeks.Before the treatment,the general data of the two groups,optimal correction of vision and fundus condition were statistically analyzed After 4 weeks of treatment,we observed the best corrected visual acuity,OCT,FFA and other related indicators in the two groups then analyzed statistic allyPart 2:After 1 week of adaptive feeding,28 BN rats were randomly divided into 4 groups:group A is normal control group,group B is model control group,group C is Chinese medicine group(Danhuang Mingmu decoction group),group D is positive control group(Andomin group),with 7 rats in each group.The group A was fed with ordinary diet,Group B,group C and group D were fed with high fat diet.After Two weeks of feeding,modeling was started.In Group B,group C and group D,BN rats were injected intraperiton eally with 40 mg·Kg-1 STZ to induce DR rat model,and then 532 argon retinal laser photocoagulation was used to establish DR rat postoperative model,the time of model establishment is 8 weeks,after 1 week of observation,FFA was performed.At the ninth week,the intragastric administration was started.The distilled water of group A and B was 10ml/kg(equals to the equivalent dose of adult)and the group C was given the Danhuang Mingmu Decoction granules 7.92g/kgd(equals to the equivalent dose of adults),and group D was given the Danhuang Mingmu Decoction granules 0.135g/kgd,once a day,continuing for 4 weeks.After 4 weeks of intragastric administration,the rats were sacrificed and blood from aorta abdominalis was collected for hemorhe ological examination.Retinal tissue was taken for HE staining to observe the changes of retinal structure.Resultspart 1:1.Comparison of general data between the two groups before treatment:There was no significant statistical difference in age,gender,best corrected visual acuity,number of macular edema eyes and lesion stage between the treat ment group and the control group(P>0.05),which was comparable.2.Comparison of the best corrected visual acuity between the two groups after treatment:the best corrected visual acuity in the treatment group and the control group were improved.The total effective rate of treatment group is 93.1% and total effective rate of control group is 78.0%.The difference between the two groups was statistically significant(P<0.05),and the treatment group was superior to the control group.3.Comparison of the reduction of macular edema in the two groups after treatment:the total effective rate of the treatment group and the control group was 97.3% and 66.6%,the difference between the two groups was statistic ally significant(P<0.05),and the treatment group was superior to the control group4.Comparison of FFA changes between the two groups after treatment:According to FFA,the total effective rate of retinal hemorrhage,exudative abs orption,microangioma reduction,and neovascular atrophy regression in the tre atment group and the control group was 90.9% and 68.2%.The difference bet ween the two groups was statistically significant(P<0.05),and the treatment group was superior to the control group5.Comparison of the overall efficacy of the two groups after treatment:The effective rate of stage III-V in the treatment group was higher than that of the control group;the total effective rate of the treatment group and the control group were 86.3%and 68.2%,respectively.The difference between the two groups was statistically significant(P<0.05),and the treatment group was superior to the control grouppart 2:1.FFA observation:In 9 weeks of DM,the FFA image in blank group showed no obvious abnormal changes in the fundus;the FFA image of the Chi nese medicine group,the model control group and positive control group showed obvious changes of microangioma,and laser spot formation was formed2.Hemorheology results:The whole blood viscosity,plasma viscosity,ESR and red blood cell agglomeration index were the lowest in the blank group,followed by the positive control group,the Chinese medicine group.The mod el control group was the highest.Compared with the blank group,the blood rheology indexes of all indicators in the model control group were significantly increased and the difference was statistically significant(P<0.05).Compared with the model control group,the blood rheology of all indicators in Chines e medicine group and the positive control group were significantly lower and the difference was statistically significant(P<0.05)3.HE staining results:the retinal structure of the blank group was dense and neatly arranged without obvious edema and vacuolization.The retinal tissue structure of the model group was unclear,the structure was loose,the arra ngement was very disordered,and the obvious edema and vacuoles were formed.The retinal structure of the Chinese medicine group was tighter than that of the model group,and edema and vacuoles were formed.The positive control group had clear retinal structure,and edema and vacuoles were formedConclusion1.Compared with retinal photocoagulation therapy,Danhuang Mingmu Decoction combined with laser treatment is more effective for patients with path ological fire due to yin deficiency and blood stasis type DR(III-V stage),which can improve the best corrected visual acuity better and reduce the macular edema,promote the absorption of retinal hemorrhage and exudation,while reducing fundus microangioma,neovascularization,non-perfusion area,is one of the effective methods for clinical treatment of DR.2.Danhuang Mingmu Decoction can effectively improve the abnormal state of blood rheology in rats after DR laser surgery3.Danhuang Mingmu Decoction can improve the structure of rat retina after DR laser. |
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