abstract
Optic atrophy is not the name of a disease, but refers to the pathological changes of retinal ganglion cells and their axons caused by any disease, which makes the optic nerve all thinner. It is a common term in pathology and generally occurs in axonal degeneration of ganglion cells between retina and lateral geniculate body.
Optic atrophy is the final result of optic neuropathy. It is characterized by the disappearance of optic nerve fiber degeneration, conduction dysfunction, visual field change, vision loss and loss. Generally divided into primary and secondary categories, acupuncture mainly treats primary and secondary optic atrophy caused by inflammation. In addition to the above symptoms, fundus examination still shows that the color of optic papilla is yellowish or pale, the boundary is blurred, the physiological depression disappears and the blood vessels become thinner. Modern western medicine still lacks specific treatment for this disease.
Acupuncture treatment of optic atrophy received great attention in the late 1950s, and there were reports of acupuncture treatment of early optic atrophy in children [1]. There are hundreds of large samples of clinical observation [2]. In the 1960s, based on the data measured by the meridian tester, someone selected the acupoint formula and used the reinforcing and reducing method to treat this disease [3]. Since the late 1970s, we have mainly sought ways to improve the curative effect from different aspects. For example, in acupoint selection, in addition to traditional acupoint selection, some effective new acupoints have been found; In terms of manipulation, emphasis is placed on inducing to reach the eye area on the basis of supplementary method; Acupoint stimulation is mainly acupuncture, but also scalp acupuncture, acupoint injection, electroacupuncture and ear acupuncture. Due to different evaluation criteria and different acupuncture methods, the curative effect of acupuncture on this disease is also different, and the effective rate is between 55% and 90%.
treat cordially
Scalp acupuncture
(1) acupoint selection
Key points: visual area.
(2) treatment
Use a 28-gauge 2-inch needle to quickly pierce and advance to the required depth. Puncture on both sides, and then turn on the electro-acupuncture instrument, continuous wave, frequency of 240 times/minute, intensity subject to tolerance, and electrify for 20 ~ 30 minutes. Every day 1 time,1time is a course of treatment. The interval is 3 ~ 4 days, and then the next course of treatment is carried out.
(3) Evaluation of curative effect
87 cases (136 eyes) of primary, secondary and traumatic optic atrophy were treated with the above methods. 20 were markedly effective (14.4%), 56 were effective (40.6%) and 62 were ineffective (45.0%), with a total effective rate of 55.0%. Traumatic optic atrophy is the most serious. The first and second courses are effective, and the third and fourth courses are the best. This method has a certain long-term effect [9].
Human acupuncture (1)
(1) acupoint selection
Main acupoints: Xin Ming Ⅰ, retrobulbar and fengchi.
Matching points: Xin Ming Ⅱ, Neijing Ming, Tongzi Chuan, Yi Ming, Yizhu, Guangming, Baihui and Ganshu.
Location of inner eye: on the lacrimal mound of inner canthus.
(2) treatment
As the main points, only 1 points are selected at a time. You can always use 1 point, or use it alternately. Point matching needs 1 ~ 2 points at a time, in which Xin Ming Ⅱ generally matches Xin Ming Ⅰ.
The operation method is as follows: when Xin Ming I takes the needle, the earlobe is pushed forward, and the needle tip is at a 45-degree angle forward and upward. The needle is quickly inserted and slowly sent to the back of mandibular condyle, with a depth of about 1 ~ 1.5 inch, so as to patiently find a satisfactory needle feeling. When the needle sensation appears, the hot compress technique is used to induce the needle sensation around the eyes by combining tight insertion with slow lifting and twisting. It is best to let the eyeball feel the heat expansion and lightning. The manipulation should be applied for 1 ~ 2 minutes, and the needle should be taken out and not left. After the ball, choose a 30 # 2-2.5 inch long filiform needle and quickly penetrate into the subcutaneous tissue, with the needle tip slightly to the right, to the back and to the upper along the lower edge of the orbit, about 1.5-2 inch. When the patient feels sore eyes or exophthalmos, do not twist the needle or insert the needle, and keep it for 65,438+00 minutes. Fengchi point, press the point with your left hand, and acupuncture or twisting the needle with your right hand into the point. The needle tip should be in the direct vision direction of the ipsilateral pupil, and the needle should be inserted about 1 ~ 1.5 inch. By lifting, inserting and twisting, the needle sensation is gradually radiated to the eye area or forehead, then the needle is inserted downward to a depth of 1 ~ 2 minutes, and the thumb is twisted forward for 3 ~ 9 times, so that the heat sensation can be generated. Leave the needle 15 minutes. The vertical penetration depth of Xin Ming Ⅱ needle tip to forehead is about 5 ~ 8 minutes. After feeling sour, hemp and swelling, use tight insertion and slow lifting combined with twisting to transport the needle for 65,438+0 minutes, then use even lifting and inserting combined with twisting to transport the needle for half a minute, and finally use tight lifting and slow insertion combined with twisting to transport the needle for half a minute, and then take out the needle. Acupoint Neijing Ming uses a 30 # millineedle to stab straight along the inner side wall of the orbit, gently press and slowly insert the needle until the needle feels like a needle. The rest of the eye points are treated in a similar way. After needling limbs to get qi, the method of flat reinforcing and purging should be applied. The above-mentioned acupoints, except those marked, are kept 15 ~ 30 minutes. Every day or every other day 1 time, 15 times as a course of treatment, stop acupuncture for 5 days, and then continue the next course of treatment.
(3) Evaluation of curative effect
Criterion of curative effect: basic cure: visual acuity recovered 1.0 or above, or improved by more than 5 lines on the basis of the original visual acuity, or improved to more than 0.0 1 below 0.2, and the visual field expanded by more than 25 degrees; The effect is remarkable: the visual acuity is improved by more than 3 lines, or by more than 10 times than the original visual acuity, and the visual field is expanded by more than 15 degrees; Effective: the vision is slightly improved, but it is not so effective; Ineffective: there was no change before and after treatment.
936 cases were ruled according to law, *** 1 680 eyes. The total effective rate is between 64.0 and 88.8% [4,5,6,7]. According to the above criteria, 698 cases of *** 1 252 eyes were basically cured, 103 eyes (8.2%), 1 12 eyes (9.0%), 586 eyes (46.98%) and 456543. It is found that the effect of heat-tonifying method on activating qi in the affected area is satisfactory.
Acupoint laser irradiation
(1) acupoint selection
Key points: after the ball, it is clear.
Matching points: bright eyes, dilated pupils, bright feet and Sanyinjiao.
(2) treatment
Take 1 main points and 1 ~ 2 auxiliary points at a time. Use He-Ne laser acupuncture instrument for penetrating irradiation, adjust the light needle and needle tip with output power of 2 MW to the point where red light is concentrated, put them in 75% alcohol for disinfection 10 minute, then penetrate the selected acupoints, and irradiate them for 10 minute after ignition. Every day 1 time,1time is a course of treatment, and the interval of treatment is 3 days.
(3) Evaluation of curative effect
25 cases (39 eyes) were treated by the above method. Results: The effective rate was 1 1 eye, the effective rate was 19 eyes, and the ineffective rate was 9 eyes. The total effective rate was 76.9% [10].
Body Acupuncture Therapy (Ⅱ)
(1) acupoint selection
Main points: supraorbital point, relay point and frontal middle point.
Matching points: Sun, Rate Valley, Wind Pool and Waiguan.
The position of supraorbital point: the intersection of supraorbital inner 1/3 and outer 2/3.
Location of relay point: the midpoint of the connecting line between occipital tuberosity and ear tip.
(2) treatment
Select all the main points and match them according to the symptoms. Use a 2-inch needle at the supraorbital point. The needle bends about 30 degrees, and penetrates 65438 0.5 inch or 65438 0.7 inch along the supraorbital wall toward the optic foramen, without manual manipulation. The relay point is penetrated into the wind pool with a 2.5 ~ 3 inch millineedle, and the needle is about 2.5 inches. Twist after 20 minutes 1 time. Use a 2-inch needle to pierce the Tang Yin at the midpoint of the forehead. The length of the needle is about 65,438 0.5 inches. The operation is the same as that of the relay point. The routine acupuncture method of matching points, keeping the needle for 30 minutes, 1 time every day,1time as a course of treatment.
(3) Evaluation of curative effect
* * * 1 10 A total of 164 eyes were treated. Results 12 eyes were cured, 7/kloc-0 eyes were markedly effective, 39 eyes were effective and 42 eyes were ineffective. The total effective rate was 74.4%. It is found that young patients with short course of disease have better curative effect [1 1].
Acupoint injection
(1) acupoint selection
Key points: gas bearing and back mound.
Matching points: Fengchi, Dazhui and Dummy Gate.
(2) treatment:
Liquid medicine: vitamin B 12( 100 mg/ml) and acetylglutamine (100 mg/ml).
Select 1 point as the main point and matching point at a time. Acupoints can be applied in turn. Vitamin b 12 0.5 0.5ml was injected into the main points, and acetyl glutamine 1 ~ 2ml was injected into the matching points. Injection method: All patients were treated with No.5 dental needle for exudation or retrobulbar spot. First, push and fix the eyeball with the index finger of the left hand, and then slowly penetrate into the depth of 0.7 ~ 1.5 inch along the lower edge of the orbit. After feeling angry, slowly push the potion. Fengchi point is straight and slightly inclined downward, with a depth of 1 ~ 1.5 inch; The spine is straight and the needle tip is slightly inclined upward; Dumb door, the patient's head leans forward slightly, and the needle tip is aimed at the direction of mandible. All slowly pierce 1 ~ 1.5 inch push medicine. Every other day 1 time,1time is a course of treatment, and the treatment interval is 7 ~ 10 days.
(3) Evaluation of curative effect
* * * treated 48 cases, all children aged 5-7. The results showed that 18 cases were basically cured (37.5%), 24 cases were effective (50.0%) and 6 cases were ineffective (12.5%), and the total effective rate was 87.5%. Among them, patients with encephalitis have poor curative effect [8].
Main references
[1] Preliminary experience of Zheng acupuncture in treating 4 cases of early optic atrophy in children. Shandong medical journal1958; ( 1):29。
[2] Department of Ophthalmology, Harbin Medical University. Observation on therapeutic effect of acupuncture and moxibustion on different types of optic atrophy. Heilongjiang medical journal1959; ( 1): 1 1。
Yuan Shantang, et al. Preliminary observation on therapeutic effect of acupuncture on optic atrophy and determination of meridians. Guangdong Traditional Chinese Medicine1960; (9):428。
[4] Li Renqing. Observation on therapeutic effect of acupuncture at Xin Ming point on 698 cases of optic atrophy. China Acupuncture1989; 9(2): 1。
[5] Ge et al. reported 38 cases of optic atrophy treated by acupuncture at retrobulbar point. Journal of traditional chinese medicine1988; 29(5):48。
Li Zhiming, wait. Observation on therapeutic effect of acupuncture at Fengchi point and other points on optic atrophy caused by qi reaching disease. Selected Papers on Acupuncture (Chinese Acupuncture Society) 1987: 44, Beijing.
[7] Jiao. Summary of clinical experience of acupuncture and moxibustion. Beijing: People's Health Publishing House, 198 1: 307.
[8] Shi Bingpei. 48 cases of optic atrophy treated by acupoint injection. Shaanxi Traditional Chinese Medicine1986; 7(4): 170。
[9] New Medical Law Group of Tianjin Eye Hospital. Observation on therapeutic effect of scalp acupuncture on optic atrophy. New drug miscellaneous 1977, (9): 28.
[10] Li Guisen, et al. 25 cases (39 eyes) of optic atrophy treated by penetrating He-Ne laser acupuncture. Jilin Traditional Chinese Medicine1990; (4): 15。
Wang Xuefeng, etc. Clinical observation on acupuncture treatment of optic atrophy 1 10 cases. China Acupuncture1993; 13(6):9。
diagnose
It is impossible to diagnose the gray or pale optic disc simply according to the degree of eyes, and it must be combined with visual function examination to make a diagnosis. Because the disease can be caused by many reasons, it is necessary to diagnose the cause at the same time as possible. First of all, the possibility of intracranial space-occupying lesions should be ruled out, supplemented by head X-ray examination, which can be included in the routine, and other head CT and MRI can also be used selectively.
Treatment measures
Etiological treatment is the first, followed by comprehensive treatment of traditional Chinese and western medicine. Once the optic nerve is atrophied, it is almost impossible to heal, but the remaining nerve fibers can completely recover or maintain their functions. Therefore, patients should be full of confidence and insist on treatment. It is difficult to explain which drugs and methods must be effective because the application of various drugs has not been strictly double-blind (sometimes not allowed). Commonly used drugs include neurotrophic drugs such as vitamin B 1, B 12, ATP, coenzyme A, vasodilators, nicotinic acid, dibazole, vitamin E, vincristine, and compound Danshen. In recent years, hyperbaric oxygen and external counterpulsation point injection 654-2 have achieved certain results. Traditional Chinese medicine Buzhong Yiqi decoction and acupuncture treatment have long been proved to be effective and can continue to be used for excavation and sorting. It should also be mentioned that banning smoking and drinking, strengthening physical fitness, doing sports and qigong have certain effects in some cases.
etiology
It can be caused by many reasons, such as ischemia, inflammation, oppression, trauma, demyelinating diseases and so on.
1. Secondary optic atrophy caused by intracranial hypertension
2. Intracranial inflammation, more common in tuberculous meningitis or optic chiasmatic arachnoiditis.
3. Retinopathy
(1) Obstruction of blood vessels, central retinal artery or vein, arteriosclerosis of optic nerve itself, disorder of normal nutrient vessels, bleeding (digestive tract and uterus, etc. )
⑵ Inflammation
⑶ After glaucoma
⑷ Retinitis pigmentosa
5] ⑸Refsum disease
[6] amaurotic familial dementia
4. Optic neuritis and optic neuropathy
(1) vascular, such as ischemic optic neuropathy.
Demyelinating disease
⑶ Vitamin deficiency
(4) Poisoning by lead or other metals.
5] Herpes zoster
[6] Syphilis
5. Caused by oppression
Tumors, including meningioma, craniopharyngioma, pituitary adenoma and aneurysm (anterior communicating artery aneurysm)
Osteopathy, including paget's disease, deformed osteitis, cranial cavity stenosis, etc.
Orbital tumor
6. Trauma
7. Metabolic diseases, such as diabetes and ganglioside.
8. Hereditary diseases
Leber's disease, cerebellar ataxia, peripheral neuropathy such as Chariot-Marie-Tooth disease.
9. Nutritional optic atrophy
10. Various
In children, the reasons are more complicated, as follows:
1. Chromosome abnormality
Meow syndrome, partial deletion of chromosome 18 long arm
2. Fatty diseases
Tay-Sachs disease, Sanderhoff's disease, lactosphingosine poisoning, Niemann-Pick disease, α-β-lipoproteinemia (Bassen-kornzwig syndrome).
3. Mucopolysaccharidosis
Hoels mucopolysaccharide storage disease
4. Mineral metabolism defect and its metabolism
Menkes's disease, juvenile diabetes, pancreatic cystic fibrosis, systemic gangliosidosis, Zellweger's disease, Albers-Schweitzer? Enberg's disease
5. Hereditary retinitis pigmentosa
Uther syndrome, Kaye-Seidel syndrome, Alstrom syndrome.
6. Gray matter diseases
Barton's disease, infantile axonal dystrophy, Hartmann-Stokes disease.
7. Cerebellar ataxia
Behr optic atrophy, Marie*** ataxia, hereditary motor or sensory polyneuropathy, Charcot-Marie-Tooth disease, olivopontocerebellar degeneration.
8. Primary white matter lesions
Abnormal leukodystrophy, Claubert's disease, Kanaran's disease, Sudanese leukodystrophy, May-Pey disease, Cockain syndrome.
9. Demyelinating diseases
Adrenal leukodystrophy, multiple sclerosis
10. Familial optic atrophy
Loeb's disease, infantile optic atrophy (recessive and dominant)
1 1. increased intracranial pressure.
Hydrocephalus caused by pseudotumor, intracranial hemorrhage, cranial stenosis and aqueduct obstruction
clinical picture
The main manifestations are decreased vision and gray or pale optic disc. There are many factors that determine the tone of ordinary video discs. Under normal circumstances, the temporal color of optic disc is mostly lighter than its nasal side, and the degree of temporal color is related to the size of physiological cup. The color of the baby's optic disc is often pale, or the eyeball is pressed during the examination, which leads to optic disc ischemia. Therefore, optic atrophy can not be diagnosed only by whether the structure and color of the optic disc are normal. It is necessary to observe the changes of retinal blood vessels and nerve fiber layers around the optic disc, especially the visual field color perception, and comprehensively analyze and determine the degree of light color of the optic disc. When the nerve fiber layer around the optic disc is damaged, there may be slit-like or wedge-shaped defects, the former darkens and the retinal pigment layer is exposed; The latter is relatively red, showing choroidal exposure. If the injury occurs at the upper and lower edges of the optic disc, it is easier to identify because the nerve fiber layer in this area is particularly thickened. If the injury is far away from the optic disc area, it is difficult to find it because the nerve fiber conduction in these areas is fine. Focal atrophy around the optic disc often suggests nerve fiber layer disease, which is caused by the thinning of nerve fiber layer in this area. Although ophthalmoscope is often used to find it, it is easier to find it with glasses without red light and fundus photography. There are usually 9 ~ 10 small vessels in the optic disc. If the optic nerve atrophy, the number of these small blood vessels will decrease. At the same time, the narrowing, stenosis and occlusion of retinal arteries can still be seen, but this phenomenon does not exist in all optic atrophy, and generally retrobulbar optic atrophy has no effect. If optic atrophy is accompanied by changes in retinal blood vessels, it must directly affect the retinal blood vessels before the changes in retinal blood vessels can occur. Commonly used optic atrophy can be divided into primary and secondary types: the former has clear optic disc boundary, physiological depression and cribriform plate visible; The latter is blurred, and the physiological depression and sieve plate are invisible. Visual field examination should pay attention to the application of small red markers, such as central scotoma, nasal defect, temporal island visual field, centripetal visual field reduced to tubular visual field, bilateral temporal hemianopia and so on. Color vision disorders are mostly acquired, red and green disorders are more common, and the color tone arrangement inspection method is better than the general inspection method. Fundus fluorescein angiography has little significance in the early stage, but the fluorescence of optic disc becomes weaker and stronger in the later stage. Visual electrophysiological examination, including electroretinogram (ERG), electrooculogram (EOG) and visual evoked potential (VEP), is helpful for diagnosis and prognosis.
Surgical treatment of optic atrophy
Optic atrophy is a serious eye disease. Under the influence of various reasons, optic nerve fibers degenerate and the conduction function is damaged, resulting in decreased or lost vision. The etiology is very complicated and the treatment is very difficult.
The clinical manifestations of optic atrophy are: the color of optic papilla becomes pale or pale, the visual acuity decreases in different degrees and at different speeds, the visual field shrinks centripetally, there is a defect, it is hemianopia, and even the optic nerve function is completely lost.
There are many reasons for optic atrophy. The common causes are degeneration, inflammation and atrophy of retina and choroid, which can cause optic nerve atrophy, such as retinitis pigmentosa and high myopia. Optic nerve demyelinating diseases: such as multiple sclerosis and neuromyelitis optica; Inflammation: such as optic neuritis, retrobulbar optic neuritis, meningitis, sepsis, etc. Ischemic diseases: such as central retinal artery occlusion, intracranial artery insufficiency or occlusion, arteriosclerosis, hypertension, lupus erythematosus, massive hemorrhage, hypotony glaucoma, etc. Long-term optic papilla edema; Poisoning and malnutrition: such as lead, arsenic, benzene, methanol, ethanol, tobacco, carbon monoxide, sulfur dioxide, quinine, organophosphorus, ethambutol, etc. Malnutrition, such as pernicious anemia caused by vitamin B deficiency. Compression: such as compression of intracranial and orbital tumors, congenital premature closure of cranial suture, compression of optic canal fracture fragments, etc. Hereditary diseases, the most common is Ryder's congenital optic atrophy; Tumors: primary optic nerve tumors and optic nerve metastases; Syphilis; Optic nerve trauma and direct contusion; All kinds of glaucoma.
The etiology of optic atrophy is complex and difficult to treat. In the past, people used acupuncture, traditional Chinese medicine and hyperbaric oxygen, but the effect was not obvious and lasting. Especially hereditary optic atrophy, the fundamental treatment is gene therapy. In recent years, great progress has been made in the treatment of genetic diseases, but there are still many problems to be solved in these studies, so they are still in the clinical observation stage and have not been widely used in clinic.
Optic atrophy is caused by optic nerve fiber degeneration, gliosis and capillary occlusion caused by many diseases. Based on this pathological feature, our hospital has adopted the leading surgical method at home and abroad since 1995, that is, vascular shunt and greater omental vascular replantation to treat optic atrophy, which can increase the blood flow of ophthalmic artery, central retinal artery and posterior short ciliary artery supplying optic nerve and retina, improve the ischemic state of optic nerve and retina, enrich the nutrition of optic nerve and retina, further improve patients' vision and expand their horizons.
Watch out for optic atrophy when surfing the Internet for too long.
The vision is obviously decreased, the vision is not clear or narrowed, the pupils are dilated, and they are afraid of light. If you have the above symptoms, you should see a doctor as soon as possible. Experts remind that among young people, optic neuritis caused by improper use of eyes has an increasing trend. This atrophy of the optic nerve can lead to blindness.
According to ophthalmologists, the causes of optic atrophy are congenital optic neuropathy, trauma, inflammation (most eyes are accompanied by pain), poisoning (such as ethambutol and other drugs and alcohol and tobacco poisoning), and tumor (growing in skull or orbit), which can occur in children, adults and the elderly. At present, secondary optic neuritis is more common in young people, which is closely related to long-term internet access, watching TV and improper use of eyes.
Experts remind that when there is severe eye pain, or accompanied by headache and vomiting, patients need to seek medical advice quickly. In addition, there may be no symptoms, and regular eye examinations are needed, especially those with a history of genetic diseases, or those with obvious visual acuity decline recently.