1. Pathogenesis: Many experts are controversial about the pathogenesis of wet AMD, and there is no unified understanding. However, most scholars believe that wet AMD is related to bruch's membrane thickening, retinal pigment epithelium consumption and retinal pigment epithelium deposition. Pathogenesis and drug treatment of age-related macular degeneration [J]. China Journal of Experimental Prescriptions, 20 13, (19): 370-375. It is also related to oxidative stress, inflammatory immunity and the formation of new blood vessels. 6 Yang Xuan, Wei Wenbin. Research progress on the pathogenesis of age-related macular degeneration [J]. China Medical Frontier Journal, 20 14, (6): 5-9.
2. Diagnostic criteria: Refer to paragraph 7 of Ophthalmology of Integrated Traditional Chinese and Western Medicine in Guo Jun [M]. The ninth edition. Beijing: China Traditional Chinese Medicine Press, 20 13, 278-28 1. The vision of one eye suddenly drops, and the other eye may be affected after several years. Vitreous warts and neovascularization or neuroepithelial detachment will appear in the retina at the posterior pole of macular region. Fundus fluorescein angiography showed subretinal neovascularization, the fluorescence of bleeding area was blocked and the fluorescence area leaked.
3 treatment
3. 1 TCM treatment: TCM, as a method of TCM treatment, has a series of characteristics such as low price, relatively safe administration and extensive materials. 8 weeks Shang Kun et al. Research progress of Mingjing Granule in treating wet age-related macular degeneration [J]. New progress in ophthalmology, 20 14, (34): 155- 157. Gao Zhiqiang 10 Gao Zhiqiang. Observation on therapeutic effect of cooling blood and removing blood stasis on wet age-related macular degeneration [J]. Health standard management in China. (4):58-59.50 cases of wet AMD were treated by removing blood stasis and cooling blood. The medicine consists of Radix Rehmanniae, Radix Paeoniae, Cortex Moutan, Herba et Gemma Agrimoniae, Herba Cirsii, Radix Rubiae, Herba Cirsii Cirsii, Pollen Typhae, Fructus Gardeniae preparata, and Fructus Aurantii, and the dosage is increased or decreased according to the symptoms of patients. On the basis of the original prescription, Pinellia ternata, Thallus Laminariae, Fritillaria thunbergii and seaweed are added as appropriate, so as to soften and disperse hard mass and accelerate scar absorption; Adding cogongrass rhizome, Cirsium japonicum, Platycladus orientalis leaves, Cirsium japonicum, lotus root charcoal, etc. can stop bleeding. Plantaginis Semen, Alismatis Rhizoma and Poria can be added to reduce exudation. Daily 1 dose, decocted in water, morning and evening 1 time, for 3 months. After taking 1 and 3 months, the number of cases of vision improvement increased significantly. Zhang et al. used the principles of invigorating spleen and improving eyesight, eliminating dampness and resolving phlegm to treat 52 cases of wet AMD. The prescription is Erchen decoction, which is added and subtracted according to the symptoms of patients. Cirsium japonicum, Cirsium japonicum, madder, Pollen Typhae, etc. Was added to the bleeding patient. If exudation is serious, add kelp, etc. And add and subtract according to the patient's eye symptoms. On this basis, combined with acupuncture treatment, the main acupoints are Taiyang, Chengqi, Fengchi and Zhuan Xu. Matching points: Ganshu, Houqiu, Shenshu and Sanyinjiao. At the same time, Xueshuantong powder injection was injected, each time 100 mg, and 3 ml of water for injection was added for direct current treatment, once a day 1 time. 20 days is a course of treatment, and all patients can be treated for 60 days at the longest and 20 days at the shortest. After 20 days of treatment, the visual acuity of 40 eyes was improved 1-3 lines or more, and the total effective rate was 76.92%. Zhang et al. Clinical observation on 34 cases of senile wet macular degeneration treated with integrated traditional Chinese and western medicine [J]. Liaoning Medical Journal, 20 13, (27): 126- 127.
3.2 Western medicine treatment: Vascular endothelial growth factor (VEGF) plays a key role in the formation of wet AMD CNV, and anti-VEGF therapy has become an effective means of CNV treatment. 1 1 Clinical Guidelines for Age-related Macular Degeneration in China, Ophthalmology Group of Chinese Medical Association. Clinical diagnosis and treatment of age-related macular degeneration in China-Chinese Journal of Ophthalmology.2013,29 (4): 343-355. Laser photocoagulation, photodynamic therapy, radiotherapy, macular transposition surgery and retinal pigment epithelial cell transplantation surgery, and intravitreal injection of anti-vascular endothelial growth factor drugs bring hope to wet AMD. 12 X, Ren B C. Recent research progress in the treatment of age-related macular degeneration. International Journal of Ophthalmology, 2007,7 (6): L674 ~1676.13, Chen. Changes of visual function after intravitreal injection of monoclonal antibody bevac-izumab. Chinese Journal of Ophthalmology, 20 1 1, 27 (1): 97 ~ 99. Ding Xiao et al. injected 0.05ml of Kangpeixin into the vitreous cavity of 22 eyes of 20 patients, 65,438 0 times a month. After three consecutive treatments, they decided whether to continue the injection according to the observation of their condition. After 65, 438+0, 3 and 6 months of treatment, the central retinal thickness of the affected eyes decreased compared with that before treatment. It can be seen that Compaxip can improve the vision of the affected eyes and inhibit the leakage of new blood vessels when treating wet AMD, and there is no adverse reaction related to treatment. Ju, Shan Wuqiang, Xie, et al. Intravitreal injection of Kangsaipu for wet age-related macular degeneration [J]. International Journal of Ophthalmology, 20 16, (1 1): 2088-2090. Yang Mochi and others treated 46 cases of wet AMD. Every month 1 time, continuous injection for 3 times, with a total treatment time of 3 months. After treatment, the average best corrected visual acuity of patients gradually improved, and the retinal thickness in macular area gradually decreased. Yang Mochi, et al. Clinical efficacy of anti-Lei Zhu monoclonal antibody in the treatment of age-related macular degeneration [J]. Journal of Ningxia Medical University, 20 15, (37),1215-18.
3.3 Traditional Chinese Medicine combined with intravitreal drug injection: 60 cases (60 eyes) with wet AMD in Xue Juan and Shandong, among which 30 cases (30 eyes) in the control group were injected with triamcinolone acetonide (specification: 40mg: 1ml)0. 1ml (containing 4 mg of triamcinolone acetonide), and 30 cases (30 eyes) in the treatment group. Prescription drug composition: Pollen Typhae 15g, Astragalus membranaceus 30g, Eclipta prostrata 20g, which can be modified according to syndromes. For patients with symptoms of yin deficiency and fundus hemorrhage, Radix Rehmanniae 15g and Folium Platycladi 10g should be added. For patients with old fundus hemorrhage, accompanied by macular edema, heart discomfort, red and dark tongue, and poor pulse condition, Kochia scoparia 10g, Ligusticum chuanxiong 15g, daily 1 dosage, and take 150ml twice in the morning and evening. After 3 months of treatment, 83.3% of the patients' fundus bleeding and exudation decreased by 75%, and exceeded 25%-75% after treatment, while the control group was 43.3%. The visual acuity improved by more than 2 lines or 1 line or remained unchanged was 86.7%, while the control group was 60%. 14 Xue Juan, Lu. Therapeutic effect of Mingjing Granule combined with intravitreal injection of triamcinolone acetonide on exudative age-related macular degeneration. Introduction to traditional Chinese medicine, 20 16, (22): 86-88. Wu Quanlong et al. randomly divided 77 cases (77 eyes) of wet AMD patients into combined treatment group (39 cases, 39 eyes): Sanxue Mingmu Tablet Leimonoclonal antibody injection; Rezumab group (38 cases, 38 eyes): Rezumab injection. In the combined treatment group, 0.05ml(0.2ml) of rezumab injection was injected, and 10 tablet was taken orally, three times a day, and Sanxue Mingmu tablet was a hospital preparation (0.3g/ tablet). Take it continuously for 3 months. Racuzumab group was injected with Racuzumab injection 0.05ml(0.2ml) once a month 1 time for 3 months. After 3 months of treatment, the visual acuity of the combined treatment group was improved by 2 or more lines, which was 76.9%, while that of Racuzumab group was 50%. Before and after treatment, the retinal thickness of macular center decreased significantly in both groups, especially in the combined treatment group. 10. 0000000000605 Peng Qinghua et al. Clinical observation on the treatment of wet age-related macular degeneration with Sanxue Mingmu Tablet combined with Leizumab intraocular injection [J]. Zhongnan Pharmacy, 20 16, (14):329-332. Fang Yiwei and others randomly divided 1 10 wet AMD patients into control group (55 cases) and integrated traditional Chinese and western medicine group (55 cases): Zhu Lei monoclonal antibody injection and traditional Chinese medicine decoction. The control group was injected with 0.05 ml of Rezumab injection, while the combination of traditional Chinese and western medicine group was treated with traditional Chinese medicine decoction on the basis of Rezumab injection. The formula of traditional Chinese medicine decoction is: 20 g of concha Haliotidis, 20 g of Radix Pseudostellariae, 0/0 g of Poria/kloc, 0/0 g of kelp/kloc, 0/0 g of Pollen Typhae, 0/0 g of Coicis Semen and 0/0 g of Radix Curcumae. Every time 150ml, three times a day, around each group. The best corrected visual acuity was 465,438 0.82% in the control group and 63.64% in the integrated traditional Chinese and western medicine group. The best corrected vision of the integrated traditional Chinese and western medicine group is obviously better than that of the control group. The disappearance rate of choroidal neovascularization was 60% in the control group and 94.55% in the integrated traditional Chinese and western medicine group. The disappearance rate of choroidal neovascularization in the integrated traditional Chinese and western medicine group was significantly higher than that in the control group. 17 Fang Yiwei et al. Clinical observation on the treatment of wet age-related macular degeneration with integrated traditional Chinese and western medicine [J]. China Journal of Ophthalmology. china medical engineering, 20 16, (24):17-118.
4. Summary: To sum up, TCM has a long history and unique advantages in treating AMD. Although it is still difficult to understand choroidal neovascularization in traditional Chinese medicine treatment, it can play a positive role in regulating the key factors of neovascularization, especially in preventing recurrent macular hemorrhage and improving visual quality. An Lina, Wei Wei's research progress in traditional Chinese medicine on age-related macular degeneration. Chinese Journal of Ophthalmology, 2009, 19 (6): 365-367. Liu Hongyu. General situation of research on treatment of age-related macular degeneration with traditional Chinese medicine. Asia-Pacific Traditional Medicine, 20 1 1, 7 (2): 162- 163. Lu Hui. Progress in treatment of age-related macular degeneration with traditional Chinese medicine. Zhejiang Journal of Integrative Medicine, 20 1 1, (4): 29 1-293 1. Anti-angiogenic drugs appear for a short time, and there are some problems such as high price, high recurrence rate, repeated injection and adverse reactions. , beam,. Research progress of treating fundus neovascularization with traditional Chinese and western medicine [J]. Journal of Tianjin University of Traditional Chinese Medicine, 20 16, (35):279-283. As for the recovery of visual function in age-related macular degeneration, most western doctors believe that it is irreversible, but the improvement of vision by Chinese medicine does exist in clinic. Wang Li, Liang, etc. Clinical study on treatment of age-related macular degeneration by tonifying kidney and promoting blood circulation [J]. journal of changchun university of traditional chinese medicine, 2009, (25): 337-338. Traditional Chinese medicine combined with intravitreal injection can effectively improve the best corrected vision, reduce retinal thickness and reduce the leakage of choroidal neovascularization, which has clinical significance.