Central Retinal
Vein Occlusion (CRVO) is a common and serious retinal
vascular disorder which causes sudden, painless loss of vision of the affected
eye. The etiology is the blockage of the central retinal vein. The condition
may be associated with hypertension, diabetes mellitus, etc.
There is no known effective treatment for the case by
western medicine, but some measures on preventing complications (e.g. macular edema) and preserving vision.
Because of its presentation of sudden loss of vision,
it is classified as “Sudden Blindness”(暴盲) or
“Blurring Vision” (視瞻昏渺) in
Ophthalmology of TCM. The common mechanisms are “qi stagnation and blood
stasis”(氣滯血瘀),
“phlegm-heat obstructing the upper”(痰熱上壅), “yin
deficiency with effulgent fire”(陰虛火旺), etc.
Case Study:
The patient (age
19, male) came with a chief complaint of right eye blur vision for 2 weeks. His
history was summarized as follows:
— Slept late & watched a lot. He was examined with right eye optic
disc edema in mainland 2 weeks before and was diagnosed as right eye CRVO for a
week. The patient claimed platelet count was a bit higher than the norms.
— His vision was getting blur progressively in the last 2 weeks.
— With belching, not good appetite, sleep well, defecation1-2 days/times
Examination:
Unaided VA (Decimal Scale):
R: 0.6-1
L: 1.2-1
Tonometry:
R:
11.7 mmHg
L:
12.7 mmHg
Fundus Examination:
Cup/Disc
ratios: 0.3 (both eyes)
R: Optic disc edema, tortuous retinal
vein with hemorrhage & retinal swelling.
L: No abnormality found
Tongue inspection: red tongue with thin
white coating (舌紅苔薄白)
Pulse manifestation: wiry & thread,
slightly rapid (弦細略數)
Diagnosis:
Diagnosis: Right
eye Central Retinal Vein
Occlusion (CRVO)
TCM diagnosis:
Right eye “Sudden Blindness”(暴盲)
Syndrome: Symdrome
of yin deficiency and stirring wind (陰虛風動)
TCM Treatments:
Therapeutic
Principles: Nourishing yin and extinguishing wind, dredging collaterals and
activating blood (熄風益陰，通絡活血)
Discussion：
Before TCM treatment, the patient
expressed his central vision deteriorating. His right visual acuity (VA) was
getting worse from 0.6-1 to 0.1-1 in the first 3 days of
TCM treatment (Table
1), but
the patient claimed the speed had been slower than before. From the 3rd
to 7th day, the VA had been stabilized & improved slightly.
The patient had received 100 doses of Chinese medicines and acupuncture
for 16 times (till 2014/5/19) within 4 months. He discontinued his acupuncture
treatment in HK because he left for studying in Mainland. The patient had not
had any western medical treatment within the period.
Till 2014/4/4, the VA (Table 1) and the
retinal condition (See Below) had not been improved significantly.
Then, we adjusted the “Therapeutic Principles” to stress more on “dredging collaterals” (通絡). 5 days later (2014/4/9), the photo (See Below) showed the retinal edema had been resolved markedly and the VA improved to 0.3+2 from 0.2+2. The
photo on 2014/4/28 (the 43rd day of TCM treatment) showed a
continuous progress of the retinal condition including the recovery of tortuous
and dilated retinal veins. At the same time, VA had been improved to 0.7-2.
On 2014/5/29 (the 74rd day of TCM treatment), affected right eye had
been recovered to normal vision (1.2-2). On 2014/7/28 (the 132nd
day of TCM treatment), the VA was 1.2 while the fundus showed nearly normal
appearance.
Even the patient received TCM
treatment only in the entire course, it showed the treatment a promising
result. From the case, a fine tune of “Therapeutic Principles” affected the
therapeutic effect significantly. It is critical to make a right approach, “Principle-method-recipe-medicinal”
(理法方藥), for curing disease in TCM,
otherwise resulting in ineffective treatment.
Table 1 Visual Acuity of CRVO case
Date
|
VA (RE)
|
VA (LE)
|
2014/3/17
|
0.6-1
|
1.2-1
|
2014/3/18
|
0.5-2
|
|
2014/3/20
|
0.1-1
|
|
2014/3/24
|
0.2-1
|
|
2014/3/25
|
0.2+2
|
|
2014/3/27
|
0.2
|
|
2014/4/4
|
0.2+2
|
1.2
|
2014/4/7
|
0.2+2
|
1.2
|
2014/4/9
|
0.3+2
|
|
2014/4/28
|
0.7-2
|
1.2
|
2014/4/29
|
0.8-2
|
|
2014/4/30
|
0.8-3
|
|
2014/5/2
|
0.8-1
|
1.5
|
2014/5/29
|
1.2-2
|
1.5
|
2014/7/28
|
1.2
|
1.5-1
|
 |
2014/3/17 (The 1st day)
|
 |
| 2014/3/20 (The 4th day) |
 |
| 2014/3/28 (The 12th day) |
 |
| 2014/4/4 (The 19th day) |
 |
| 2014/4/9 (The 24th day) |
 |
| 2014/5/29 (the 74th day) |
 |
|
| 2014/7/28 (The 132nd day) |
|
