The Clinical And Experimental Research About Treatment Based On Syndrome Differentiation Combined With Bypass Surgery Of Superior Rectus Muscle In The Treatment Of Retinitis Pigmentosa

Retinitis pigmentosa is a group of inherited degenerative retinal disorders characterized by loss of functions of photoreceptor and pigmentary epithelium.RP's main manifestation is nyctalopia,progressive decrease of peripheral vision,vision impairment,hindrance of chromatic vision,deaf, sluggish genital development,fatness,polydactylism,mental subnormality, ichthyosis and so on.Autosomal recessive inheritance is about 60%.Autosomal dominant inheritance is about 10-25%.And X-linkage inheritance is about 5-18%. In addition,there is some isolated RP sufferers.Because it is a kind of hereditary disease.The pathogenesis is complicated,and pathological mechanism is unknown.There are no safe and effective treatments in western medicine.In TCM,we named RP"Gaofengneizhang"or"Gaofengquemu".By diagnosis and treatment,it has effective treatment,but it has not improved enough.This research was based on relevant reference from both home and abroad and mastering the current research situation of pigmentary degeneration of retina.Moreover,we have explored the new thought about treatment of pigmentary degeneration of retina by clinical observation,information collection of hospital patients with RP in the first affiliated hospital of Guangzhou University of TCM.The patients accepted bypass surgery of superior rectus muscle and treatment based on syndrome differentiation,and the research objectively evaluated healing effect about bypass surgery of superior rectus muscle and treatment based on syndrome differentiation in treating RP and provided a new idea to treatment of RP.Part one Literature ResearchThis paper summarized the name,pathogenesis,treatment of RP in TCM,and summarized the domestic and foreign scholars' research progress on the pathogenesis,pathology,histopathological changes,diagnosis and treatment. It also discoursed the domestic.and foreign scholars' research results in bypass surgery of rectus muscle,clinical observation and animal experiments.Part two Clinical Research1.ObjectiveBy treatment based on syndrome differentiation combined with bypass surgery of superior rectus muscle and observation of the difference on vision and field of view between before therapy and after therapy.And assess is valid.2.MethodUsing retrospective survey method choosing in-patients of Ophthalmology of First Affiliated Hospital of Guangzhou University of TCM in January,1994 to December,2006,who are in line with the diagnostic code.All patients accepted bypass surgery of superior rectus muscle and treatment based on syndrome differentiation.Observe the differences on vision and field of view, and handle statistics with the statistical processing software SPSS 11.5.3.Result①Among the RP patients and the ratio of syndrome of deficiency of kidney yang was highest,about 33.3%.The ratio of syndrome of stagnation of QI and blood stasis was lower,about 14.4%.②Among the RP patients,the average age of syndrome of deficiency of kidney yang is the smallest.The average age of syndrome of qi stagnation and blood stasis is the biggest.Comparison in the age of RP with different TCM syndromes,the difference between all groups was not significant ((P=0.3＞0.05).Among the RP patients,the course of syndrome of deficiency of kidney yang is the shortest.The course of syndrome of qi stagnation and blood stasis is the longest.Comparing the course of RP with different TCM syndromes,the difference between all groups was not significant(P=0.2＞0.05).③Comparing the different TCM syndromes of RP patients,the vision of syndrome of deficiency of kidney yang is almost≥0.1,and its ratio is 85.0%. The ratio of syndrome of deficiency of kidney yang is 78.6%.The ratio of syndrome of deficiency of spleen QI is 66.7%.The ratio of syndrome of qi stagnation and blood stasis is 50%.But the difference between all groups was not significant(P=0.15＞0.05).④Comparing the different TCM syndromes of RP patients,12 eyes were remarkably effective(21.4%),17 eyes effective(30.4%)and the total effectiveness rate was 51.8%.Comparing the different TCM syndromes of RP patients,the ratio sequence of different TCM syndromes is syndrome of qi stagnation and blood stasis(57.2%)＞syndrome of deficiency of kidney yang(55.0%)＞syndrome of yin deficiency of liver and kidney(50.0%)＞syndrome of deficiency of kidney yang(40.1%).But the difference between all groups was not significant (P=0.11＞0.05).Part three Experimental study1.ObjectiveTo prove the bypass surgery of rectus muscle is effectual from the standpoint of pathology.There are new blood vessels,and the blood vessel of rectus muscle can be in touch with the blood vessel of choroid so as to improve blood supply2.MethodTo do bypass surgery of rectus muscle on one eye of the Zealand rabbits after three months,enucleate the eyeballs,do pathological section,observe the growth of blood vessel in the surgical area,and compare with another eye.3.ResultThe result from pathological section shows that there are three rabbits in five.We can see blood vessel and granulation tissue.The blood vessel of surgery eye are more obvious than not-surgery eye in the area of sclera,closer to the operation area and vessels compact district and new blood vessels distribute in the partial area.Therefore,bypass surgery of superior rectus muscle can make new blood vessels.ConclusionClinical research indicates that the treatment of pigmentary degeneration of retina combined with bypass surgery of superior rectus muscle is effective, and pathological section from animal experiments approves the operation is valid and successful.