【作者】 王哲；

【导师】 王静波；

【作者基本信息】 山东中医药大学 ， 中医五官科学， 2012， 博士

【摘要】 目的：通过研究除风益损汤加味治疗玻璃体手术后视神经病变的机理以及作用途径，评价其疗效，探索治疗玻璃体手术后视神经萎缩的药物方法，以期提高玻璃体切除术后病人的视觉质量，减少或是避免术后视神经萎缩的发生。评价眼内光凝、硅油填充等治疗对视神经病变的影响、全身基础疾病对玻璃体术后视神经病变的影响以及讨论除风益损汤加味治疗玻璃体手术后视神经萎缩的机理以及作用途径。方法：1、通过除风益损汤加味治疗玻璃体手术后视神经萎缩与对照组比较，总结和评价此方法的临床疗效。2、通过检测玻璃体切除术后患者视力、眼压、视野、眼底荧光造影（FFA）、眼电生理（VEP）、以及血压、血脂、血糖水平、炎症反应量表等，与术前进行比较，并将数据结果进行统计学处理，评价玻璃体手术对视神经病变的影响、全身基础疾病对玻璃体术后视神经病变的影响以及讨论除风益损汤治疗玻璃体手术后视神经病变的机理以及作用途径。3、通过实验研究，观察倍频532激光对视网膜、视神经的组织病理学损伤，以及兔眼FVEP的变化，评价激光等物理刺激对兔眼视神经、视网膜的损伤作用，探讨除风益损汤对兔眼视神经视网膜的保护作用。结果：1、除风益损汤加味应用于玻璃体切除术后，可以显著地提高患者视力、视野、使玻璃体切除术后的眼压波动更加平稳，治疗组与对照组有显著性的差异；2、全身基础疾病如高血压、糖尿病等血管系统相关疾病对术后的视神经损伤程度有一定的相关性；3、激光等物理刺激能够损伤视网膜，造成神经节细胞树突和一部分神经节细胞的坏死，视网膜内微血管受损、阻塞，引起局部组织的微循环障碍，最终造成视神经的损害，而除风益损汤对损伤后的兔眼视网膜有明显保护作用。结论：1、玻璃体切除手术相当于对眼球的一次机械性、缺血性损伤，其导致的氧化、损伤等因素可以使视网膜神经节细胞不断死亡及视神经轴突不断减少。2、术后早期辨证应用除风益损汤加味治疗玻璃体切除术后患者，可以起到显著的视神经保护作用，主要是通过减轻术后的炎症反应、控制眼压、降低血液粘稠度，改善微循环血液供应的波动水平等可能，实现视神经的保护作用，以期提高玻璃体切除术后的远期视功能。更多还原

【Abstract】 Objective:To study the methed of use main recipe of Chu feng yi sun tang to treatoptic neuropathy after vitrectomy, evaluate its efficacy.To explore the optic nerve atrophyafter the treatment of vitreous surgery, vitrectomy patients visual quality, in order to reduceor avoid the occurrence of postoperative optic atrophy. To evaluat laser, silicone oil-filledtreatment and systemic underlying diseases of optic neuropathy after intraocular on thevitreous of optic neuropathy. And to discuss the mechanism and pathways of optic atrophyin addition to main recipe of Chu feng yi sun tang to treatment of vitreous surgery. Method:1.Through comparing the control group and the treatment group, summarize and evaluatethe clinical efficacy of this method.2To compare postoperative visual acuity, detectvitreous inflammation scale, intraocular pressure, visual fields, fundus fluoresceinangiography (FFA), eye electrophysiological (VEP), as well as blood pressure, blood lipids,blood glucose levels with the data of preoperatived and statistical processing the results, toevaluat vitreous surgery for optic neuropathy, systemic underlying diseases on the vitreousof optic neuropathy after optic atrophy and to discuss mechanism and pathways in additionto the treatment by the main recipe of Chu feng yi sun tang to vitreous surgery.3. Throughexperimental study to observe the changes of the multiplier532laser on Histopathologicaldamage to the retina and optic nerve by evaluat FVEP of the rabbit eye before and afterlaser,or the silicone oil, retinal damage, as well as Chu feng yi sun tang protective effect tothe rabbit eyes of the optic nerve. Result:1. It can be significantly improve visual acuity,vision, vitrectomy intraocular pressure is more stable by used the main recipe of Chu fengyi sun tang after vitrectomy, there are significant differences between the treatment groupand control group.2. Systemic basis of diseases such as hypertension, diabetes and othervascular system-related diseases have certain injury of optic nerve after vitrectomy.3. The physical stimuli such as laser and silicone oil, can damage the retina, resulting in necrosisof the ganglion cell dendrites and part of the ganglion cell, and retinal microvasculardamage, obstruction, causing local tissue microcirculation, eventually leading to opticnerve damage. Conclusion:1. Vitrectomy is equivalent to a mechanical injury to the eye, Itcaused oxidative damage factors make the continued death and optic nerve axons of retinalganglion cells in the steady decline.2.Dialectical applications to use the treatment of Chufeng yi sun tang of early postoperative, can play a significant role of the optic nerveprotection, protective effect is to reduce the inflammatory response of the postoperativecontrol of intraocular pressure, reduce blood viscosity, improve microcirculation of bloodsupply to the way of the optic nerve to long-term visual function improve after vitrectomy.更多还原