| Objectives1.To investigate the medical Constitution of the Patients with central exudative chorioretinoPathy, and preliminarily study the Constitution characteristics of Chinese medicine, hence to provide a theoretical basis and clinical thinking for the treatment of the disease with Chinese medicine.2. To observe the clinical efficacy of treating central exudative chorioretinopathy with Tanglao's empirical decoction of CEC. To compare the efficacy of the three treating methods:the first method, to treat with Tanglao's empirical decoction of CEC, the second method with intravitreal Avastin, the third method with oral intake of Tanglao's empirical decoction of CEC in combination with intravitreal Avastin. To expect that the Chinese medical treatment of the disease have certain characteristics, and Seek out a more clinically effective and the smaller side effects of Integrative Medicine approach.To evaluating indicators by eye sight, area of exudation and hemorrhage, foveal thickness and total macular volume. And to evaluate the untoward reaction.3. To study the inhibition of experimental CNV of BN rats by Tanglao's empirical Decoction of CEC and intravitreal Avastin;evaluate them by pathology and immunohistochemistry of metal loproteinase-9 (MMP-9) expression levels, and probe its mechanism.Methods1.Investigated by questionnaire 160 cases of central exudative chorioretinoPathy patients treated in Beijing Union Medical College Hospital and Eye Hospital of China Academy of Traditional Chinese Medicine from March 2010 to January 2011.Divided them into 9 Constitutions according to Wang Qi type of Constitution law, the Constitution of Yin deficiency, the Constitution of Qi deficiency, the Constitution of Yang deficiency, the Constitution of dampness, the Constitution of heat, the Constitution of peace, the Constitution of stasis, the Constitution of Qi blockade, and the Constitution of Special intrinsic. Graded the symptoms of the patients, analyzed the statistics, and classified the type of the patient's Chinese midicine Constitution. Then investigated 60 cases of the health of the people of Beijing to compare the Constitution type. Summarized the Chinese medical Constitution characteristics of central exudative chorioretinopathy patients.2. Prospectively selected 90 cases of central exudative chorioretinopathy patients;divided at random and in accordance with the chronic order of treatment in three groups:the group of Tanglao's empirical docoction of CEC, the group of Avastin and the group of integration of TCM and WM, with 30 patients in each group. The group of Tanglao's empirical docoction of CEC was treated by oral intake of Tanglao's empirical docoction of CEC, the group of Avastin was treated by intravitreal injection of Avastin;and the group of integration of TCM and WM was treated by both ways. Studied the therapeutic effects of the three groups, analysed the results of eye sight, area of exudation and hemorrhage, area of total affected, foveal thickness and total macular volume and evaluated the untoward reaction.Treating for 3 months, following-up for 3 months.3.40 BN rats were made models by photocoagulating of krypton laser in both eyes, and divided randomly by Charles into four groups:the control group, the Chinese Medicine group, the Avastin group, the-integrated traditional Chinese medicine and Avastin group, with 10 rats in each group. One day after photocoagulation, the 10 rats in the control group received intragastric administration of 1.5ml NS,2 times a day. The 10 rats in the Chinese Medicine groupof received intragastric administration of 1.5ml Tanglao's empirical docoction of CEC,2 times a day. The Avastin group received intravitreal injection of 5μl Avastin. The integrated traditional Chinese medicine and Avastin group received intravitreal injection of 5μl Avastin and intragastric administration of 1.5ml of Tanglao's empirical docoction of CEC, 2 times a day. BN rats were executed 28 days after treatment. Compared by pathology the CNV thickness and observed by immunohistochemistry the regulation of metalloproteinase-9. Results1. In 160 cases of central exudative chorioretinoPathy,22 cases belonged to the Constitution of peace,38 cases of the Constitution of Yin deficiency, 32 cases of the Constitution of Qi deficiency,20 cases of the Constitution of stasis,21 cases of the Constitution of Yang deficiency,2 cases of the Constitution of Special intrinsic,8 cases of the Constitution of dampness, 9 cases of the Constitution of heat, and 9 cases of the Constitution of Qi blockade. And in the 60 cases of normal groups,47 cases belonged to the Constitution of peace,2 cases of the Constitution of Yin deficiency,3 cases of the Constitution of Qi deficiency,1 case of the Constitution of stasis, 2 cases of the Constitution of Yang deficiency,0 case of the Constitution of Special intrinsic,1 case of the Constitution of dampness,2 cases of the Constitution of heat, and 2 cases of the Constitution of Qi blockade,x =86.234,p=0.000,p<0.05,statistically significant.Between the two groups the Constitution of peace P=0.000,the Constitution of Yin deficiency P=0.000, the Constitution of Qi deficiency P=0.007, the Constitution of stasis P=0.015, the Constitution of Yang deficiency P=0.035.2.After 1 month of treating, CEC patients treated by Tanglao's empirical docoction of CEC,had eye sight increased in 15 eyes(50%), stabled in 10 eyes (33.33%) and decreased in 5 eyes (16.67%),comparing with the Avastin groups and the Integrated Medicine groups P<0.05;after 3 months,eye sight increased in 21 eyes(70%), stabled in 7 eyes(23.3%) and decreased in 2 eyes(6.7%),comparing with the Avastin group P>0.05, comparing with the Integrated Medicine group P<0.05.The retinal center thickness of Tanglao's empirical docoction group before threatment was 319.05±61.54um, after 1 month was 265.31±53.87μm,after 3 months was 240.57±42.93μm; the retinal center thickness of the Avastin group before threatment was 313.67±57.89μm,after 1 month was 257.42±52.58μm,after 3 months was 227.89±45.38μm; the retinal center thickness of integrated Medicine group before threatment was 324.61±63.75μm, after 1 month was 245.37±56.46μm, after 3 months was 227.89±45.38μm. Compared before treatment with 1 months after treatment, every group's p<0.05; Compared before treatment with 3 month after treatment, every group's p<0.05. And there is no statistical meaning with the area of hemorrhage and exudation, area of total affected, foveal thickness and total macular volume. FFA had no significant improvement before and after treatment.3. After 4 weeks of treatment, the CNV thickness of the Chinese medical groups was 39.51±8.37μm, the Avastin group was 54.19±9.22μm, the control group was 56.26±10.03μm, the integrated Medicine group was 38.88±8.25μm. the CNV thickness of chinese medical group and the integrated Medicine group was less than the Avastin group and the control group (P<0.05). The MMP-9 IOD of the Chinese medical group was 9.15±7.64, the Avastin group was 25.56±19.38, the control group was 38.05±29.47, the integrated Medicine group was 8.76±6.29. The expression of MMP-9 in the Chinese medical group and integrated Medicine group was less than the other two groups, compared with the Avastin group and the control group (P<0.05)Conclusions1.Compared the patiens of central exudative chorioretinoPathy with normal people,the Chinese medical Constitution has different distribution.The Constitution of Yin deficiency and the Constitution of Qi deficiency are the main Chinese medical Constitution in patiens of central exudative chorioretinoPathy, the expressions of the Constitution of Yang deficiency and the Constitution of stasis were also higher than normal people.2.Tanglao's empirical docoction of CEC can increased or stablize most eye sights of central exudative chorioretinoPathy patients, and has the same efficacy compared with the Avastin group after 3 months of theatment.It can reduce the central macular retinal thickness, reduce the leakage of new blood vessels fluorescence.Integration of Traditional and Western medicineshould be promoted, and it has low incidence of adverse events. Nowadays, since Avastin treatment is not legal in China,the treatment is a Safe and cost-effective method to CEC.3.Tanglao's empirical docoction of CEC can also suppress experimental CNV induced by Krypton laser through the regulation of MMP-9, and reduce CNV thickness. Both Tanglao's empirical docoction of CEC and intravitreal injection of Avastin can lower MMP-9 expression, but the empirical docoction has a stronger effect than Avastin.
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