| Objective:To observe the neuroprotection effect of bujingyishipian (essence-supplementing and vision-promoting tablet) on the glaucoma whose intraocular pressure were controlled and SD rats of chronic EIOP model,and preliminarily explore the mechanism of bujingyishipian for protecting the visual function of glaucoma.Methods:1.Clinical study60patients were recruited from outpatient with same inclusion and exclusion criteria. They were divided into2groups as1:1proportion randomly. The test group was treated with bujingyishipian and mecobalamin Tablet, while the control group treated with mecobalamin Tablet. Both groups were underwent6months of continuous medication. Observating symptoms and signs of Chinese medicine, eyesight visual field before and after treatment respectively.2.Experiment study The rat model of chronic EIOP was established by unilaterally cauterizing3episcleral vessels, then randomly divided into3groups:control group, model group and treatment group. After given bujingyishipian and normal saline for8weeks, killed the rats and taken out the right eye. The effect of bujingyishipian on the EIOP rat model’s intraocular pressure(IOP), the pathological changes of retina and the affection of the expression on p-Akt in PI3K/Akt signaling pathway was observed.Results:1.Clinical study Before the treatment, there was no significant difference between the groups in age, course, various indicators of visual field and symptoms and signs (P>0.05). The total effective rate of test group is88.23%. and that of control group is59.57%. the effect of test group was better than control group(P<0.01):The total effective rate of TCM symptoms scores of test group is86.21%. and that of control group is57.14%. the effect of test group was better than control group (P<0.05). After treatment, the index including MS. MD. LV and visual field defect score were improved significantly in treatment group (P<0.05). There were not significantly changed in control group (P>0.05):Comparing every data before and after treatment. TCM symptoms scores were improved obviously in treatment group (P<0.01). While blurred vision and narrowed visual field was not statistically significant(P>0.05). 2.Experiment study (1) Immediately modeling and8weeks after-modeling. the IOP of model were highly significant different compared with before modeling.(P<0.01):there was obviously reduce in treatment group between8weeks after-modeling and immediately modeling (P<0.01). While model group was not statistically significant.(2) The number of RGCs in treatment and model groups were lower than control group(P<0.05). The thickness of the retina had statistically significant difference between control group and model group (P<0.01). While was not statistically significant between control group and treatment group (P>0.05). The number of RGCs and retinal thickness in treatment group were better than model group (P<0.01). Ultrastructure of RGCs showed that treatment group was improved than model group.(3)The immunohistochemical analysis of p-Akt was as follows: total area in the treatment group was (74631.81±12841.30) μm, mean optical density was (939.26±175.17), integrated optical density was (37814.96±5822.71). while total area in modle group was (37947.26±8050.5l)μm2, mean optical density wa (481.45±161.02). integrated optical density was (18907.64±4367.29). There were statistical differences(P<0.01). Though the mean black degree was little higher the treatment group than model group, there was no significant difference in statistics(P>0.05).Conclusion:Bujingyishipian had protect the visual function on glaucoma patients whose intraocular pressure were controlled. It can improve vision, visual sensitivity and control the visual field defect. Unilaterally cauterizing episcleral vessels increased IOP of the rat modle obviously and keep lasted8weeks. Bujingyishipian can protect the visual function on the rat model of chronic EIOP. The effects mainly as follows: reduced IOP. enha(?)ed the number of RGCs and retinal thickness, up-regulate the expression of p-Akt and improved the ultrastructure. |
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