Liu Fei, Li Bang-lei, Yang Jing-feng, Song Li-na, Tang Kai, Song Xue-ling

Department of Ophthalmology, the 89th Hospital of Chinese People's Liberation Army, Shandong 261021, China

Clinical Observation on Combining Acupuncture and Eye Drops for Primary Open Angle Glaucoma

Liu Fei, Li Bang-lei, Yang Jing-feng, Song Li-na, Tang Kai, Song Xue-ling

Department of Ophthalmology, the 89th Hospital of Chinese People's Liberation Army, Shandong 261021, China

Objective: To observe the clinical efficacy of combining acupuncture and eye drops for primary open angle glaucoma.

Methods: A total of 19 (38 eyes) cases with primary open angle glaucoma were randomized into a treatment group (10 cases) and a control group (9 cases). The treatment group was treated with acupuncture and eye drops, whereas the control group was treated with eye drops alone. Then the intraocular pressure was measured respectively prior to treatment, 1 month and 3 months after treatment to determine the differences.

Results: After 1 and 3 months of treatment, the intraocular pressure in the treatment group were significantly reduced (P＜0.05); and there was a statistical difference in intraocular pressure between the treatment and the control group (P＜0.05).

Conclusion: Combining acupuncture and eye drops is better than eye drops alone for primary open angle glaucoma.

Acupuncture Therapy; Acupuncture Medication Combined; Glaucoma; Intraocular Pressure

Primary open-angle glaucoma (POAG) is a chronic progressive optic neuropathy with extremely high incidence and blindness. It is typically associated with pathologic changes of optic disc and visual field defect. Ocular hypertension (increased pressure within the eye) is the most important risk factor, but some POAG cases may not actually have elevated ocular pressure[1]. Due to its unclear etiology, complex pathogenesis and poor treatment effect, ophthalmologists have never stopped pursuing safe, convenient and effective therapies for POAG. We treated 10 POAG cases (20 eyes) using combining acupuncture and eye drops and compared with 9 cases (18 eyes) using eye drops alone.

1 Clinical Data

A total of 19 POAG cases treated in our hospital in recent 5 years were randomized into a treatment group (10 cases) and a control group (9 cases). All cases had involvement of both eyes and wide chamber angle, coupled with one of the following symptoms: visual field (typical glaucoma damage, i.e., arcuate scotoma, paracentral scotoma or nasal side ladders) and optic disc (glaucomatous cup dilation or asymmetric cup-to-disc ratios of both eyes, and the difference ＞0.2). Of the 19 cases, six had glaucoma surgery. Since therewere no between-group statistical differences in terms of gender, age, duration, vision and intraocular pressure (P＞0.05), the two groups were comparable (table 1).

All 19 cases understood the contents of the study and signed the informed consent. The clinical treatment process of the two groups was shown in Fig.1.

Table 1. Comparison of general data between two groups ()

Table 1. Comparison of general data between two groups ()

Treatment 10 7 3 32±9 4.01±3.56 4.70±0.39 24.45±4.95 Average vision Average eye pressure (mmHg) Control 9 8 1 33±8 4.01±3.56 4.80±0.28 25.12±4.72

Fig.1 Clinical treatment process

2 Treatment Methods

2.1 Treatment group

2.1.1 Acupuncture treatment

Acupoints: Jingming (BL 1), Guangming (GB 37), Taiyang (EX-HN 5), Xingjian (LR 2), Taichong (LR 3) and Jiankang (Extra, locates between the joints of the 3rd and 4th metatarsal bones and the lateral cuneiform bone).

Method: Asked the patient to adopt a supine position and disinfect the surrounding areas of the points. Punctured Jingming (BL 1) 0.5-0.8 cun with filiform needles of 0.30 mm in diameter and slightly twirled the needle without lifting and thrusting. Punctured other point with filiform needles of 0.35 mm in diameter and then applied reducing manipulation by lifting, thrusting and twirling. The needles were retained for 20 min. The acupuncture treatment was conducted once a day, 10 d for one course of treatment, 2 courses in total. There was a 10-day interval between two courses.

2.1.2 Eye drops

Used 0.5% Timolol Maleate eye drops twice a day, 1-2 drops for each dose.

2.2 Control group

Use 0.5% Timolol Maleate eye drops alone (same dose as the treatment group).

The intraocular pressure was measured respectively prior to treatment and after 1 and 3 months of treatment.

Table 2. Comparison of intraocular pressure between the two groups (, mmHg)

Table 2. Comparison of intraocular pressure between the two groups (, mmHg)

Note: Compared with the pre-treatment result of the same group, 1) P＜0.05; compared with the concurrent control group, 2) P＜0.05

Treatment 1024.45±4.9519.73±2.481)2)21.06±2.761)2)Control 925.12±4.7222.75±3.671)23.03±3.531)

3 Treatment results

After 1 and 3 months of treatment, intraocular pressure changed significantly in both groups (P＜0.05), and there was a between-group statistical difference (P＜0.05). This indicates that both treatment protocols can reduce the intraocular pressure, and combining acupuncture and eye drops is better than eye drops alone.

4 Discussion

To date, the exact pathogenesis of POAG is not known yet, it is therefore considered as a primary disease. Pathology shows obstructed aqueous humor outflow resulting from collagen degeneration of the trabecular meshwork and substance deposit[2-3]. POAG is mainly managed by medication and surgery. The resultant drug resistance and adhesion of surgical fistula may affect the long-term effect and increase the patients’ economic cost and psychological stress. So far,intraocular pressure remains to be the most important index to be monitored.

We have studied the effect of combining acupuncture and eye drops on lowering intraocular pressure in POAG patients. The findings have shown that the intraocular pressures in both groups were significantly reduced after treatment; and the average ocular pressure in the treatment group was lower than that of the control group. After 3 months of treatment, the intraocular pressure in both groups was significantly reduced; and there was a remarkable difference when compared with pre-treatment results in the treatment group. This indicates that combining acupuncture and eye drops can obtain more notable effect in lowering POAG intraocular pressure than eye drops alone.

Chinese medicine holds that the liver opens into the eyes and is exterior-interior related with the gallbladder. Contributing factors of eye problems include liverblood insufficiency, up-flame of liver fire, hyperactivity of liver yang, and internal stirring of liver wind[4-6]. Consequently, satisfactory results for eye problems can be obtained by treating from the liver[7]. Considering the close association between the liver and eyes, Jingming (BL 1), Guangming (GB 37), Xingjian (LR 2), Fengchi (GB 20), Taiyang (EX-HN 5) and Jiankang (Extra) were selected for POAG according to the principle of treating the upper conditions with points in the lower body and treating the left conditions with points in the right side. Regarding the action mechanism of lowering the intraocular pressure, acupuncture might work in the following three ways: ① dredging meridians in the local area and entire body to allow smooth flow of aqueous humor; ②regulating the systemic equilibrium, circulating qi and invigorating blood to enable the ciliary body to secret aqueous humor; ③regulating the whole body to increase the nutrition supply to the optic nerve, decrease damage to the retina nerve fibrous tissue, and thus protect the ganglion cell functions[8-10].

In addition, we found during examination that those with POAG showed higher rheology indexes of blood than normal population. After acupuncture treatment, their rheology indexes were reduced. Though we didn’t make detailed statistical management, this can further help us understand that lowering intraocular pressure may be one benefit of the systemic regulations.

Eye drops are indicated to produce a local fast effect directly on the eye (targeting the symptoms). Acupuncture, on the other hand, aims to sensitize and facilitate the long-standing treatment effect (targeting the root cause). Combining acupuncture and eye drops minimizes the risk of drug (eye drops) resistance and overcomes the slow effect of acupuncture, thus opening up a new treatment for POAG.

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Translator: Han Chou-ping

R246.82

A

Date: December 18, 2012

Author: Liu Fei, associated chief physician.

E-mail: cigamw@163.com