| This thesis consists of two parts:the literature review and the clinical observation.PARTI:Literature review from both Western and Chinese medicine perspectives.Review one summarizes the research progress of Western medicine on tumor compressive or infiltrative optic neuropathy,including the principle of tumor-induced optic nerve damage and current treatment methods.It clarifies that there is still a lack of effective methods to help patients recover their vision after surgery or radiotherapy/chemotherapy for compressive or infiltrative optic neuropathy caused by tumors.Review two summarizes the research progress of traditional Chinese medicine in treating tumor compressive or infiltrative optic neuropathy.It analyzes the historical origins,pathogenesis,syndrome differentiation and treatment,and acupuncture treatment from the perspective of traditional Chinese medicine.It summarizes the understanding of modern Chinese medicine practitioners on tumor compressive or infiltrative optic neuropathy.PART Ⅱ:the clinical study includes both retrospective and prospective studies.Trial 1:Retrospective analysis of acupuncture treatment for Tumor Compressive or Infiltrative Optic Neuropathy.ObjectiveTo clarify the therapeutic effect of acupuncture in the treatment of tumor compressive or infiltrative optic neuropathy,and to identify the influencing factors related to the therapeutic effect,in order to provide a basis for the clinical application and promotion of acupuncture treatment.MethodsA retrospective analysis was conducted on tumor compressive or infiltrative optic neuropathy patients who received acupuncture treatment at the Ophthalmology and Neuro-Ophthalmology Department(Acupuncture Section)of the China Academy of Chinese Medical Sciences from January 1,2018 to December 31,2021.Patient data that met the inclusion criteria were collected,including basic information(gender,age,disease course,and tumor treatment method),visual field examination using the Humphrey Visual Field Analyzer,and optic disc scanning using Cirrus 4000 OCT(Carl Zeiss Meditec AG,Germany).The best corrected visual acuity(BCVA),mean defect(MD),pattern standard deviation(PSD),and retinal nerve fiber layer(RNFL)before and after treatment were recorded.Statistical analysis was performed using SPSS 25.0 software to calculate the effective rate of acupuncture treatment for tumor compressive or infiltrative optic neuropathy.Binary logistic regression analysis was used to identify independent factors that affect the effective rate of acupuncture treatment.Results:1.Visual acuity assessment results:A total of 184 patients(354 eyes)were included in the study.The median logMAR before treatment was 1.85(0.60,2.60),and the median logMAR after treatment was 1.40(0.46,2.60),with a statistically significant difference(z=-11.383,P<0.001).The effective rate of acupuncture treatment for visual improvement was 45.2%(160/354 eyes).Differences in visual improvement were statistically significant among patients with different baseline visual acuity,degree of visual field defects,and duration of illness(P<0.001,P=0.024,P=0.003).However,differences in visual improvement were not statistically significant among patients of different ages or with different tumor types(P>0.05).2.Visual field evaluation results:A total of 99 patients(192 eyes)were included in the study.The mean MD value of the visual field before and after treatment was-18.21±7.12 dB and-16.14±7.48 dB,respectively,and the difference was statistically significant(t=-12.453,P<0.001).The mean PSD value before and after treatment was 11.02±4.11 dB and 10.97±4.28 dB,respectively,and the difference was not statistically significant(t=0.314,P=0.754).The effective rate of visual field improvement after acupuncture was 56.3%(108/192 eyes).There were significant differences in visual field improvement among patients with different degrees of visual field defects,baseline visual acuity,disease course,and age(P<0.001,P=0.003,P<0.001,P=0.044),while there was no significant difference among patients with different tumor treatment methods(P=0.086).3.Peripapillary RNFL thickness results:A total of 89 patients(166 eyes)were included in the study.The average RNFL thickness before treatment was 61.11±11.67μm,and after treatment,it was 59.83±11.05 μm,with a statistically significant difference(t=2.371,P=0.019),indicating that the RNFL thickness decreased after treatment.4.Analysis of related factors:The patients’ baseline visual acuity,degree of visual field defect,and duration of disease are factors that affect the effective rate of visual acuity improvement(P<0.001,P<0.001,P=0.033),and the degree of visual field defect,baseline visual acuity,and duration of disease are factors that affect the effective rate of visual field improvement(P<0.001,P<0.001,P=0.003).ConclusionAcupuncture treatment is effective for tumor-related or infiltrative optic neuropathy,and it can improve patients’ visual acuity and visual field.The patients’baseline visual acuity,degree of visual field defect,and duration of disease are factors that affect the effectiveness of acupuncture treatment.The higher the patients’ baseline visual acuity,the lower the degree of visual field defect,and the shorter the duration of disease,the higher the effective rate of acupuncture treatment.Trial 2:Clinical study on acupuncture treatment for Tumor Compressive or Infiltrative Optic NeuropathyObjectiveTo evaluate the efficacy of acupuncture in the treatment of tumor compressive or infiltrative optic neuropathy by clinical control experiment.To analyze the influence of acupuncture treatment on the quality of life related to TCM syndrome and visual function in patients with tumor compressive or infiltrative optic neuropathy.MethodsPatients with tumor compressive or infiltrative optic neuropathy who visited the neuro-ophthalmology department of the Eye Hospital of the China Academy of Chinese Medical Sciences from January 2022 to December 2022 were collected and divided into two groups according to their wishes.Patients who received combined acupuncture and Western medicine treatment were included in the treatment group,and those who received solely Western medicine treatment were included in the control group.The Humphrey visual field analyzer was used for visual field examination,and the Cirrus 4000 OCT(Carl Zeiss,Germany)was used for optic disc scanning.The patients’ basic information(gender,age,course of disease,tumor treatment method),best corrected visual acuity(BCVA)before and after treatment,visual field mean deviation(MD)before and after treatment,visual field pattern standard deviation(PSD)before and after treatment,traditional Chinese medicine syndrome differentiation score,and National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)were recorded for evaluation of the subjects.Statistical analysis was performed using SPSS 25.0 software.Results1.General Information:A total of 60 cases were included in this study,including 30 cases(60 eyes)in the treatment group and 30 cases(60 eyes)in the control group.In the treatment group,there were 18 males(36 eyes)and 12 females(24 eyes),with 17 non-chemotherapy patients(34 eyes)and 13 chemotherapy patients(26 eyes).The age range was from 3 to 54 years old,with the shortest disease course of 1 month and the longest of 32 months.In the control group,there were 14 males(28 eyes)and 16 females(32 eyes),with 17 nonchemotherapy patients(34 eyes)and 13 chemotherapy patients(26 eyes).The age range was from 3 to 45 years old,with the shortest disease course of 1 month and the longest of 30 months.There were no statistically significant differences between the two groups in terms of gender,age,disease course,etiology,bestcorrected visual acuity(logMAR),visual field MD,visual field PSD,optic disc RNFL,TCM syndrome score,NEI-VFQ-25 questionnaire score,etc.(P>0.05),indicating comparability between the two groups.2.Visual results:The median BCVA of patients in the treatment group was 1.10(0.40,2.30)before treatment and 0.52(0.22,1.85)after treatment,with a statistically significant difference(z=-5.866,P<0.001).The median BCVA of patients in the control group was 1.16(0.52,2.30)before treatment and 1.00(0.52,2.30)after treatment,with a statistically significant difference(z=-3.961,P<0.001).After treatment,there was a statistically significant difference in BCVA between the two groups(z=-2.306,P=0.021).3.Visual field results:The mean MD value of patients in the treatment group was-15.10±4.71 dB before treatment and-11.34±4.10 dB after treatment,with a statistically significant difference(t=-13.078,P<0.001).The mean PSD value before and after treatment was 12.24±3.74 dB and 12.03±3.78 dB,respectively,with no statistically significant difference(t=1.403,P=0.168).The mean MD value of patients in the control group was-15.17±6.04 dB before treatment and-13.92±6.42 dB after treatment,with a statistically significant difference(t=-3.392,P=0.02).The mean PSD value before and after treatment was 12.94±3.89 dB and 12.73±4.11 dB,respectively,with no statistically significant difference(t=1.056,P=0.298).After treatment,there was a statistically significant difference in mean visual field MD values between the two groups(t=-2.111,P=0.039);however,there was no statistically significant difference in mean visual field PSD values between the two groups(t=0.793,P=0.432).4.Peripapillary RNFL thickness results:The average RNFL value of the treatment group before treatment was 59.37±11.46 μm,and after treatment it was 57.60±9.75 μm,with a statistically significant difference(t=3.28,P=0.002).The average RNFL value of the control group before treatment was 57.57±11.33 μm,and after treatment it was 56.35 ± 10.71 μm,and after treatment,there was a statistically significant difference in the mean RNFL values between the two groups(t=2.30,P=0.025).5.Visual function related quality-of-life score results:After treatment,the treatment group had statistically significant differences from the control group in overall health(z=-2.74,P=0.006),distance vision(z=-1.004,P=0.044),social functioning(z=-2.050,P=0.040),dependency(z=-2.505,P=0.012),mental health(z=-2.581,P=0.010),social role(z=-3.173,P=0.002),and total score(z=-2.596,P=0.009).6.TCM syndrome score results:Among the enrolled patients,the distribution of TCM syndromes was mainly Qi and Blood Deficiency,with a total of 21 patients(11 in the treatment group and 10 in the control group),accounting for 35%.There were 15 patients(9 in the treatment group and 6 in the control group)with Liver and Kidney Yin Deficiency,accounting for 25%.There were 13 patients(6 in the treatment group and 7 in the control group)with Qi Stagnation and Blood Stasis,accounting for 22%.There were 11 patients(4 in the treatment group and 7 in the control group)with Liver Qi Stagnation,accounting for 18%.The TCM syndrome score of the treatment group before treatment was 12.1 ±13.94 points,and after treatment it was 4.75±2.84 points,with a statistically significant difference(t=8.640,P<0.001);the TCM syndrome score of the control group before treatment was 13.29±5.30 points,and after treatment it was 6.86±3.87 points,with a statistically significant difference(t=5.879,P<0.001).After treatment,there was a statistically significant difference in the TCM syndrome score between the two groups(t=3.429,P<0.001).7.The score results of each item for Qi and blood deficiency syndrome:After treatment,there was a statistically significant difference in the scores of 5 symptoms,including mental fatigue(t=4.082,P<0.001),shortness of breath(t=3.451,P=0.003),laziness to talk(t=2.095,P=0.049),pale complexion(t=3.182,P=0.005),and spontaneous sweating(t=2.928,P=0.008)for patients with Qi and blood deficiency syndrome in the treatment group compared to before treatment.In the control group,there was a statistically significant difference in the scores of 2 symptoms,including shortness of breath(t=2.278,P=0.035)and pale complexion(t=2.862,P=0.010)compared to before treatment.After treatment,there was a statistically significant difference in the scores of 3 symptoms,including mental fatigue(t=1.548,P=0.031),laziness to talk(t=2.529,P=0.006),and pale complexion(t=1.804,P=0.027)between the two groups.ConclusionAcupuncture treatment can significantly improve the vision of patients with tumor compressive or infiltrative optic neuropathy,improve their visual field,enhance their visual function-related quality of life,reduce their dependency,and improve their self-care ability.It can also reduce the score of traditional Chinese medicine syndrome and improve the systemic symptoms of patients,making it a safe and effective treatment method. |
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