Integrated Traditional Chinese and Western Medicine Treatment for Retinal Artery Occlusion
Treatment Methods:
Upon confirmation of diagnosis, immediately administer sublingual nitroglycerin 10mg, posterior orbital injection of tolazoline 1205mg, or intramuscular injections of compound acetylcholine into the temporal superficial artery and the bulbar region each 2ml, apply local pressure on the eyeball, orally take acetazolamide 500mg, and combine with oxygen therapy. Additionally, add intravenous infusion of compound danshen 16ml once daily for 10 sessions as a course of treatment; concurrently, orally take compound danshen tablets and vinpocetine to promote blood circulation and remove stasis.
Efficacy Observation:
3.1 Efficacy Criteria
Marked improvement: visual acuity ≥1.0; effective: visual acuity improved by ≥3 lines; improvement: visual acuity improved by 1–2 lines; ineffective: no change in visual acuity.
3.2 Treatment Outcomes
After one course of treatment, follow-up observation over three months showed: among 21 cases, 5 were markedly improved, 11 were effective, 4 showed improvement, and 1 was ineffective, with a total effective rate of 95.2%. The sequence of retinal vessel recovery: first nasal superior and temporal superior, then nasal inferior and temporal inferior.
Discussion:
The central retinal artery and its branches are terminal arteries supplying blood to the inner layer of the retina. The retina is extremely sensitive to circulatory disturbances. In animal (rabbit) experiments, when the central artery is completely blocked, retinal necrosis occurs within 30 minutes. Another report indicates that the retina can tolerate transient ischemia for approximately 100 minutes. Therefore, this condition is an ophthalmic emergency requiring immediate and aggressive intervention to restore circulation before retinal necrosis occurs, thereby achieving better therapeutic outcomes. Among the 5 marked improvements in this group, the success factors include: the patients being young, suggesting that central retinal artery occlusion may have been caused by fatigue and transient hypertension leading to vascular spasm, timely use of vasodilators and drugs relieving microvascular spasm allowed gradual restoration of circulation; secondly, the patients arrived early enough for treatment and we actively secured time for intervention; thirdly, we initiated the use of blood-activating and stasis-resolving traditional Chinese medicine at an early stage. Research confirms that blood-activating and stasis-resolving herbs have four major effects in treating ocular ischemic diseases: ① dilate blood vessels and reduce vascular resistance; ② improve microcirculation and enhance hypoxia tolerance; ③ inhibit fibrin synthesis, exert anticoagulant and anti-tissue proliferation effects; ④ inhibit the release of allergic mediators and suppress allergic reactions. It is precisely due to these actions that the reperfusion of obstructed arteries is accelerated. Some less-than-ideal outcomes may be related to older age, higher degrees of vascular sclerosis, and delayed presentation.
Although there are many clinical reports on central retinal artery occlusion, detailed observations are relatively scarce. Through our observations, we found that the sequence of retinal vascular reperfusion is nasal superior → temporal superior → nasal inferior → temporal inferior, i.e., from distal to proximal gradually returning to normal. Although the blood supply to the superior and inferior temporal branches has normalized, mild edema remains in the macular area, likely due to incomplete recovery of the radial vascular plexus formed by the branches of the superior and inferior retinal arteries supplying the outer margins of the macula.