Correlation Study Of Syndrome Differentiation Of Age-related Macular Degeneration By Chinese Medicine

Purpose:To study the syndrome of age-related macular degeneration(AMD) in different phases by traditional Chinese medicine(TCM). Next, to explore the regularities in differentiation of AMD by TCM from the data of optical coherence tomography(OCT), automatic perimetry and survival qualities, the relationship between improving condition and impacting survival qualities, the instruction of treatment based on differentiation.Method:From clinical study, records of 115 AMD patients were devided into four groups based on fundus fluorecein angiography (FFA) and criteria of AMD diagnosis and filled in CRF and form of survival quality. Only 81 patients were scaned by OCT and 69 patients were measured by perimetry. Using OCT-3000 to do OCT image and measure 9 regions of retinal neuroepithelial layer (RNL) thickness including the fovea of the macular region and 4 regions in inner ring and outer ring respectively and the 5 spots of the retinal pigment epithelium/choriocapillaris (RPE/CC) including fovea and nosal, temporal, superior, inferior 750μm away from the fovea; Utilizing Octopus 101 automatic perimetry to examine visual field and recording the index of visual field including mean sensitivity(MS), mean defect(MD), loss variance(LV) and Bebie curvess. Finally, all data were analyzed statistically.Results:1.The development of various syndrome of AMD follows defined regularity. The early stage of dry AMD belongs to stagnation of Phlegm-Dampness syndrome type. The early stage and intermediate of wet AMD belongs to Spleen-Qi deficiency combined with Phlegm accumulation plus stagnant Blood syndrome type. Both GA and the disiform scar stage are grouped in the impairment of Liver and Kidney syndrome type. The total clinical scores of symptom, deficiency and blood stasis by TCM of the early stage and intermediate of wet AMD and the geography atrophy(GA) stage are statistically increased than that of the early stage of dry AMD (P<0.01).The total clinical scores of symptom, deficiency and blood stasis by TCM of disiform scar stage of AMD are significantly increased than that of the early stage and intermediate of wet AMD (P<0.01), while the total clinical scores of symptom, deficiency and blood stasis by TCM of GA stage and the disiform scar stage has no difference. The TCM symdrome is aggravating while AMD is developing. 2.Statistically, the total clinical scores of symptom, deficiency and blood stasis by TCM all correlated to the mean thickness of RNL and RPE/CC (P<0.05). The mean thickness of RNL is declining from the early stage of AMD to GA stage (P<0.01); The mean thickness of RNL is increasing from the early stage and intermediate of AMD to the disiform scar stage (P<0.05); The mean thickness of RPE/CC is increasing while the TCM symptom is aggravating.3.The total clinical scores of symptom, deficiency and blood stasis by TCM all correlated to the index of visual field (P<0.01). Mean sensitivity(MS) decreases gradually and mean defect(MD) increases gradually while the TCM syndrome of AMD is aggravating. Data from late stages show more mix type Bebie curves.4.The physical functioning(PF), vitality(VT) and social functioning(SF) of survival qualities has relation with the total clinical scores of symptom, and the general health(GH) of survival qualities has correlation with scores of deficiency.Conclusion:1. The TCM syndrome type of the early stage of dry AMD is stagnation of Phlegm-Dampness syndrome type, the early stage and intermediate of wet AMD is Phlegm accumulation plus stagnant Blood syndrome type, both the GA stage of dry AMD and the disiform scar stage of wet AMD are grouped in impairment of Liver and Kidney syndrome type.2.From the early stage to the GA stage of dry AMD, the TCM syndrome is aggravating while the mean thickness of RNL is significantly declining; from the early and intermediate stage to the disiform scar stage of wet AMD the mean thickness of RNL is statistically increasing while the clinical manifestations is aggravating and the average thickness of RPE/CC is increasing.3. The scores of the TCM syndrome significantly correlated to the index of visual field arid Bebie curves.4. PF, VT and SF among the survival qualities of the AMD patients is declining while the TCM syndrome is aggravating.