| Objective:To observe the changes of retinal vessel density and retinal thickness before and after treatment by optical coherence tomography angiography,and analysis the relationship between those and best corrected vision.To explore the effectiveness of retinal artery occlusion of Qi stagnation blood stasis type for more than 12 hours,to provide a new treatment plan for the disease.Methods:Thirty-three patients(34 eyes)were involved,including 23 eyes of central retinal artery occlusion and 11 eyes of branch retinal artery occlusion.All the patients were treated by Tongqiaomingmu method,including paracentesis of anterior chamber performed in emergency,Chinese medicine,acupuncture,intravenous injection of Salvia miltiorrhiza polyphenols injection combined with thrombotong injection,intramuscular adenosine cobalamin injection are given to treat for 21 days(3 weeks).OCTA was performed during the time of before treatment,7 day s after treatment,and 21 days after treatment.Result:1.After treatment of 21 days,18 eyes(52.9%)were effective,12 eyes(35.3%)were improved,4 eyes(11.8%)were invalid,the overall efficiency reached 88.2%.2.Best corrected visual acuity(logMAR)of first diagnosis was 0-5,averaging 1.356±1.046;after anterior chamber puncture the best corrected visual acuity was 0-2.9,averaging 1.159±0.888.The non-rank sum test analysis showed that the difference was statistically significant(Z=-2.539,P=0.018).3.There was no correlation between anterior chamber puncture and the effectiveness of vision’s improvement(r=0.079,P>0.05).4.Best corrected visual acuity of first diagnosis was 0-5,averaging 1.356±1.046;at the treatment after 7 and 21 days,it was 1.003±0.824 and 0.771±0.731.The non-rank sum test analysis showed that the difference was statistically significant(Z treatment after 7days-before treatment=-4.651,Ztreatment after 21days-before treatment=-4.867,both P<0.01)and compared to the best corrected visual acuity after anterior chamber puncture,the difference was statistically significant(Z treatment after 7days-after anterior chamber puncture=-4.067,Z treatment after 21 days-after anterior chamber puncture=-4.867,both P<0.01).5.The average of the whole superficial capillary plexus(SCP)within the 3 X 3mm range of the first diagnosis was 40.112 ± 5.695%.After 7 and 21 days of treatment,the average was 40.582±6.925%,41.082±6.729%;The average of macular foveal vessel density of the first diagnosis was 20.021± 7.069%.After 7 and 21 days of treatment,the average was 32.141 ± 11.419%、35.012±15.107%;before treatment retinal capillary density in the temporal,superior,nasal,and inferior regions were 41.741± 7.068%,42.335 ± 7.834%,41.676 ± 5.655%,42.315 ± 6.857%;after 7 days of treatment,they were 42.979 ± 8.108%,43.141 ± 8.808%,43.150 ± 8.102%,42.659± 8.096%;after 21 days of treatment,they were 41.947± 9.415%,44.088 ± 7.331%,42.750 ± 8.970%,and 43.621± 7.906%.After 7 and 21 days of treatment,the whole retina,fovea and regional retinal capillary density of SCP increased.T test showed that the foveal vessel density increased after 7 and 21 days of treatment was statistically significant(t treatment after 7days-before treatment=-2.157,t treatment after 21 days-before treatment=-2.988,both P<0.05).6.The average of whole retinal vessel density in the deep capillary plexus(DCP)within the 3 X 3mm range before treatment was 42.079 ± 6.268%,the average was 42.882± 5.395%and 43.979± 6.109%after 7 and 21 days of treatment.Before treatment,the average foveal macular vessel density was 31.297± 10.882%,the average was 32.141 ± 11.411%,15.419%and 35.012 ± 15.107%after 7 and 21 days of treatment.Retinal capillary density in the temporal,superior,nasal,and inferior regions were 45.656 ± 8.012%,44.174± 8.870%,44.850 ± 7.307%,42.609 ± 8.269%before treatment;after 7 days of treatment,they were 46.188± 7.419%,44.585 ±8.480%,46.262 ± 6.724%,43.321± 7.210%;after 21 days of treatment,they were 46.865 ± 6.497%,46.662 ± 7.285%,47.609 ± 6.469%,and 45.768 ± 7.011%.After 7 and 21 days of treatment,the retinal capillary density of whole retina,fovea and all areas in the DCP increased,and after 21 days of treatment was statistically significant(t treatment after 7days-before treatment=-2.306,t treatment after 21days-before treatment=-2.141,both P<0.05).7.Before treatment retinal thickness was 197-442miu μm,the average of that was 307.35± 58.61 μ m;the thickness of macular fovea was 131-398 μm,the average of that was 267.91± 54.81 μ m.After 7 days of treatment,retinal thickness and macular foveal thickness were 285.74 ± 49.17 μm and 246.82 ± 35.44 μm,and after 21 days of treatment,retinal thickness and macular fovea thickness were 271.12± 43.49 μm and 242.03 ± 32.60 μm.The whole Retinal and macular fovea thickness were decreased after 7 and 21 days of treatment,the difference was statistically significant(retinal thickness of treatment after 7days-before treatment=4.167,t retinal thickness of treatment after 21days-before treatment=4.423,t foveal thickness of treatment after 7days-before treatment=-3.871,t foveal thickness of treatment after 21days-before treatment=3.417;all<0.01).8.foveal vessel density of SCP and BCVA had a significant correlation(r=-0.419,-0.405,-0.433,P<0.05).After 21 days of treatment,foveal vessel density of DCP and BCVA had a significant correlation(r=-0.377,P<0.05).The whole retinal and foveal thickness and BCVA had on correlation(r retinal thickness = 0.024,r foveal thickness=0.018,P>0.05).9.Sex,age,classification,course of disease and effectiveness of vision’s improvement had no correlation(P>0.05).Conclusion:Treatment of Tongqiaomingmu method for more than 12 hours retinal artery obstruction is not affected by gender,age,classification and course of disease.It can improve the best corrected visual acuity,increase the retinal deep and superficial capillary vessel density,reduce retinal edema,which has good clinical effect.Because the sample size is less,it still need a large sample,randomized controlled further research. |
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