Application Study Of Traditional Chinese Medicine Combined With Anti-VEGF In The Treatment Of Retinal Vein Occlusion Macular Edema

(1)Clinical observation of YiQI HuoXue TongLuo Decoction combined with anti-VEGF in the treatment of retinal vein occlusion complicated by macular edemaObjective:To observe the effectiveness and safety of YiQI HuoXue TongLuo Decoction(YHTD)combined with Ranibizumab Injections in patients with retinal vein occlusion complicated by macular edema(RVO-ME).Methods:The included subjects were 58 patients(58 eyes),who were admitted to the ophthalmology department of China-Japan Friendship Hospital from October 2018 to December 2020,which were divided into the treatment group(28 cases with 28 eyes)and the control group(30 cases with 30 eyes).Both groups were given one injection of Ranibizumab after enrollment,following the "1+PRN" regimen,and then received Ranibizumab injection again when necessary.On this basis,the treatment group was given YHTD by oral twice a day(100ml for once)for 3 months.The best corrected visual acuity,central macular thickness,injection times of anti-VEGF and adverse reactions were observed before treatment,1,2 and 3 months after treatment.Follow-up period was 3 months after treatment,and the injection times of anti-VEGF during the follow-up period were observedResults:1.BCVA was significantly increased in both groups after 1,2 and 3 months of treatment(P<0.05),and BCVA level in the treatment group was significantly better than that in the control group after 2 and 3 months of treatment(P<0.05);2.CMT in 2 groups was significantly decreased after 1,2 and 3 months of treatment(P<0.01),and CMT in the treatment group was significantly lower than that in the control group after 2 and 3 months of treatment(P<0.05);3.The injection frequency of anti-vascular endothelial growth factor(VEGF)in the treatment group was lower than that in the control group(P<0.05 or P<0.01)after 3 months of treatment and 6 months of observation.4.After 3 months of treatment.the total effective rate of the treatment group(89.29%)was higher than that of the control group(70.00%);5.No definite adverse reactions were found in all patients in the treatment group during the observation period,while 2 patients in the control group had transient intraocular hypertension.Conclusion:1.Both Chinese medicine YHTD and vitreous intravitreal injection of anti-VEGF drugs showed certain efficacy in improving the best corrected visual acuity and central macular thickness in patients with RVO-ME.2.Chinese medicine YHTD combined with anti-VEGF therapy can improve the best corrected visual acuity and central macular thickness in patients with RVO-ME,and the efficacy is better than that of intravitreal injection of anti-VEGF alone.3.From the perspective of safety,that Chinese medicine YHTD combined with anti-VEGF therapy in the treatment of RVO-ME is safe.4.From the perspective of economics,compared with the single anti-VEGF injection,the combination treatment of YHTD can significantly reduce the times of anti-VEGF injections,reduce the economic burden of patients.5.Chinese medicine YHTD with anti-VEGF therapy can be used as a safe and effective treatment for RVO-ME in clinical treatment.(2)Meta-analysis of Traditional Chinese Medicine and Western Medicine in Treating retinal vein occlusion complicated by macular edemaObjective:Meta-analysis was performed to evaluate the clinical efficacy of the combination of traditional Chinese medicine and western medicine in treating patients with retinal vein occlusion(RVO)complicated by macular edema(ME).Methods:We searched The CNKI,Wanfang Data,PubMed and Cochrane Library from database.All of randomized controlled trials(RCTs)of the combination of traditional Chinese medicine and western medicine in treating patients with RVO complicated by ME were searched.The Revman5.3 software were used for meta-analysis.Results:A total of 30 trials involving 1943 patients and 1976 eyes were included.Meta-analysis showed that compared with western medicine,the combination of traditional Chinese medicine and western medicine can significantly improve the best corrected visual acuity[(MD=0.08,95%CI=0.07～0.10,P<0.00001)(MD=-0.16,95%CI=-0.24～-0.08,P=0.0002)(MD=5.78,95%CI=1.30～10.25,P=0.01)].reduce the central macular thickness(MD=-54.6,95%CI=-73.76～-35.43,P<0.00001),and improve the clinical effective rate(RR=1.32,95%CI=1.22～1.43,P<0.00001)Conclusion:The combination of traditional Chinese and western medicine in treating patients with RVO complicated by ME was superior to western medicine in improving the best corrected visual acuity.reducing the thickness of macular fovea and improving the clinical efficacy.(3)Exploration the Mechanism of Salvia Miltiorrhiza in Treating Retinal Vein Occlusion Based on Network PharmacologyObjective:To explore the pharmacological mechanism of Salvia Miltiorrhiza in the treatment of retinal vein occlusion(RVO).Methods:The active components of Salvia Miltiorrhiza were screened through TCMSP,and the corresponding targets were collected;The related targets of RVO were screened through GeneCards database;The ClusterProfiler R software was used to draw the Venn diagram of intersection targets;The STRING database was used for protein-protein interaction(PPI)network;The Cytoscape 3.7.2 was used to construct the network of "drug-component-disease-target".Finally,the GO and KEGG enrichment analysis of key targets were carried out by using the ClusterProfiler R software.Results:1.Forty-one active components of Salvia miltiorrhiza were screened from TCSMP database.2.1705 disease targets of RVO were obtained from GeneCards database,and 70 active component action targets of Salvia miltiorrhiza were obtained,and 46 targets of intersection of the two were obtained.3.PPI network analysis showed that FOS,MYC,CASP3,ESR1,STAT3,APP,CCND1,JUN,PTGS2,RELA might be the key targets of Salvia miltiorrhiza in the treatment of RVO.4.the network of "drug-component-disease-target"showed that the main effective components in salvia miltiorrhiza might be tanshinone Ⅱ A,tanshinone II,salvia miltiorrhiza new quinone,etc.5.The treatment of RVO by Salvia miltiorrhiza mainly involved 81 physiological processes and 76 pathways.KEGG results showed that the mechanism of treatment of RVO by Salvia miltiorrhiza might be related to apoptosis,TNF signaling pathway,interleukin-17 signaling pathway,etc.Conclusions:Salvia Miltiorrhiza might play a role in the treatment of RVO through regulating inflammation response,angiogenesis,coagulation process,apoptosis and so on.