Research progress on combined therapy of traditional Chinese medicine with laser photocoagulation for treatment of diabetic retinopathy

国际眼科杂志摇 2015 年 7 月摇 第 15 卷摇 第 7 期摇 摇 摇 http: / / ies. ijo. cn 电话:029鄄82245172摇 摇 82210956摇 摇 摇 电子信箱:IJO. 2000@ 163. com ·Original article· Research progress on combined therapy of traditional Chinese medicine with laser photocoagulation for treatment of diabetic retinopathy Xue-Zheng Sun1 , Ya-Sha Zhou1 , Han-Yu Tan2 , Yue Liu1 , Xiang-Dong Chen3 , QingHua Peng2,3 , Yu Feng2 Foundation items: Natural Science Foundation of Hunan Province ( No. 2015JJ2109) ; 225 Engineering Project of High Lever Health Professionals of Hunan Province; Project of Administration of Traditional Chinese Medicine of Hunan Province ( No. 201463 ) ; Key Discipline Project of State Administration of Traditional Chinese Medicine of Ophthalmology of TCM; Key Discipline Project of Hunan Province of Otorhinolaryngology of TCM 1 Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China 2 Institute of International Education, Hunan University of Chinese Medicine, Changsha 410208, Hunan Province, China 3 Department of Ophthalmology, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China Correspondence to:Xiang-Dong Chen and Qing-Hua Peng. Department of Ophthalmology, the First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China. 564259166@ qq. com; pqhz_520@ 163. com Received: 2015-03-18摇 摇 Accepted: 2015-06-24 中药联合激光光凝治疗糖尿病视网膜病变 孙学争1 ,周亚莎1 ,谭涵宇2 ,刘摇 悦1 ,陈向东3 ,彭清华2,3 , 冯摇 玉2 基金项目:湖南省自然科学基金资助项目( No. 2015JJ2109) ;湖 南省高层次卫生人才“225冶 工程培养项目资助;湖南省中医药管 理局资助项目( No. 201463) ;《 中医眼科学》 国家中医药管理局 重点学科建设项目;《 中医五官科学》 湖南省重点学科建设项目 ( 作者 单 位:1 410208 中 国 湖 南 省 长 沙 市 湖 南 中 医 药 大 学;2 410208 中国 湖 南 省 长 沙 市 湖 南 中 医 药 大 学 国 际 教 育 学 院;3 410007 中国湖南省长沙市湖南中医药大学第一附属医院眼科) 作者简介:孙学争,湖南中医药大学中西医结合眼科学硕士研究 生,研究方向:中西结合防治眼科疾病。 通讯作者:陈向东,硕士,副主任医师,副教授,研究方向:中西结 合防治眼科疾病. 564259166 @ qq. com; 彭 清 华, 博 士, 主 任 医 师,二级教授,研究方向:中西结合防治眼科疾病. pqhz_520 @ 163. com 摘要 糖尿病视网膜病变( diabetic retinopathy,DR) 是糖尿病眼 病不可逆盲的最严重的并发症,严重影响患者的生存质 1128 量。 目前,我国在 DR 手术治疗方面 已 进 行 了 广 泛 的 开 展,对 于 增 殖 前 期 DR, 增 殖 期 糖 尿 病 视 网 膜 病 变 ( proliferative DR,PDR) 采取全视网膜光凝术,破坏缺血区 视网膜,减少需氧量,以防止新生血管形成,阻止病情恶 化。 中医药对治疗 DR 有着非常丰富及个性化的治疗方 案,本文就中药联合激光光凝治疗 DR 的研究进行综述。 关键词:糖尿病视网膜病变;中药联合激光光凝;研究进展 引用:孙学争,周亚莎,谭涵宇,刘悦,陈向东,彭清华,冯玉. 中 药联合激光光凝治疗糖尿病视网膜病变. 国际眼科杂志 2015;15 (7) :1128-1133 Abstract retinopathy ( DR ) is the most severe complication of diabetic eye disease, which can eventually lead to irreversible blindness, thus seriously impacting on patients蒺 quality of life. At present, surgical operation has been widely carried out on the treatment of DR in China. For the pre proliferative DR ( PDR) and PDR, panretinal photocoagulation has often been adopted. By damaging the retina in ischemic area so as to reduce oxygen demand, the neovascularization can be prevented and the patient蒺s condition can be stopped from getting worse. Traditional Chinese medicine ( TCM ) has an abundant and personalized therapeutic regimen for the treatment of DR. This paper reviews the research progress on combined therapy of TCM with laser photocoagulation for treatment of DR. 誗KEYWORDS:diabetic retinopathy; combined therapy of traditional Chinese medicine with laser photocoagulation; research progress 誗 Diabetic DOI:10. 3980 / j. issn. 1672-5123. 2015. 7. 03 Citation:Sun XZ, Zhou YS, Tan HY, Liu Y, Chen XD, Peng QH, Feng Y. Research progress on combined therapy of traditional Chinese medicine with laser photocoagulation for treatment of diabetic retinopathy Guoji Yanke Zazhi( Int Eye Sci) 2015;15 (7) : 1128-1133 INTRODUCTION iabetic retinopathy ( DR) is the most severe complication of diabetic eye disease, which can eventually lead to D Int Eye Sci, Vol. 15, No. 7, Jul. 2015摇 摇 Tel:029鄄82245172摇 82210956摇 摇 permanent loss of vision. DR is the result ofhyperglycemia induced microvascular retinal changes. The capillary pericyte necrosis and thinning of the endothelial cells lead to incompetence of the inner barriers. These damages make the retinal blood vessels become more permeable, allowing effusion of fluid into the surrounding tissue, causing retinal pathological changes and dysfunction. With the rising number of diabetic patients and prolonging of human蒺s life span, DR, which rates are also on the rise, has become the most common cause of blindness in the elderly. Therefore, the prevention of the occurrence and development of DR is particularly important. The advantage of the combined therapy of traditional Chinese medicine ( TCM ) with laser photocoagulation in the treatment of DR is ceaselessly highlighted, which has become an important part in the prevention and treatment of DR. Here follows the research results of the recent 5y. THEORETICAL RESEARCH The Mechanism of Laser on Diabetic Retinopathy 摇 The mechanism of panretinal photocoagulation on DR: it is now widely accepted that [1] the mechanism of panretinal photocoagulation is laser destroyed part of the photoreceptor pigment epithelial complex whose oxygen consumption is high, which reduces oxygen demand. At the same time it increased oxygen supply of the inner retina from choroidal capillary and reduce the synthesis of angiogenesis growth factor because of ischemia. Thus, laser prevents the formation of new blood vessels and promotes the extinction of angiogenesis that has been formed. Finally, Laser delays the progress of proliferative DR ( PDR ) . Binz et al [2] think that laser treatment can inhibit the neovascularization and has long-term effect. It is because laser treatment changes genes expression in retinal which is closely related to angiogenesis. After retinal pigment epithelium ( RPE) absorbing laser energy, the temperature of local tissue rises and the protein comes to be degenerative, thus can effectively reduce the metabolism and the oxygen consumption of retinal, as well as reduce the factor of promoting neovascularization [3] . At the same time, those lead to the thinning of retinal and the reduction of the barrier function between choroid and retinal [4] . Mechanism of local / grid laser treatment for diabetic macular edema ( DME) : the mechanism of laser treatment inducing DME mainly relates to laser damaged the oxygen consumption of retina photoreceptor [5] . Stef伽nsson [6] , Wolbarsht and Landers [7] find that the oxygen partial pressure of preretinal increases and retinal capillaries decrease in laser photocoagulation area. Oxygen content in treated retinal region is higher than untreated. It prompts that laser treatment makes the leakage area of abnormal vascular and the exudates from intravascular liquid to the inter organizational greatly reduced. Then macular edema ( ME ) eliminated. It is peripheral retinal scarring that reduces the oxygen consumption and conducive to the improvement of hypoxia in the macular area [8] . Proliferation of pigment epithelium cells recover with light solidification zone and release anti vascular growth factor after http: / / ies. ijo. cn Email:IJO. 2000@163. com (...truncated)