視神經萎縮早中期中醫診療

  視神經萎縮的簡介

        視神經萎縮不是一個疾病的名稱,而是指任何疾病引起視網膜神經節細胞和其軸突發生病變,致使視神經全部變細的一種形成學改變,為病理學通用的名詞,一般發生于視網膜至外側膝狀體之間的神經節細胞軸突變性。視神經萎縮是視神經病損的最終結果。表現為視神經纖維的變性和消失,傳導功能障礙,出現視野變化,視力減退并喪失。一般分為原發性和繼發性兩類,針灸主要治療原發性和炎癥引起的繼發性視神經萎縮。除上述癥狀外,眼底檢查尚可見視乳頭顏色為淡黃或蒼白色,境界模糊,生理凹陷消失,血管變細等。

臨床表現:主要表現視力減退和視盤呈灰白色或蒼白。正常視盤色調是有多種因素決定的。正常情況下,視盤顳側顏色大多數較其鼻側為淡,而顳側色淡的程度又與生理杯的大小有關。

   嬰兒視盤色常淡,或是檢查時壓迫眼球引起視盤缺血所致。因此不能僅憑視盤的結構和顏色是否正常診斷視神經萎縮,必須觀察視網膜血管和視盤周圍神經纖維層有無改變,特別是視野色覺等檢查,綜合分析,才能明確視盤顏色蒼白的程度。   視盤周圍神經纖維層病損時可出現裂隙狀或楔形缺損,前者變成較黑色,為視網膜色素層暴露;后者呈較紅色,為脈絡膜暴露。如果損害發生于視盤上下緣區,則更易識別,因該區神經纖維層特別增厚,如果病損遠離視盤區,由于這些區域神經纖維導變薄,則不易發現。視盤周圍伴有局灶性萎縮常提示神經纖維層有病變,乃神經纖維層在該區變薄所致。

  雖然常用眼底鏡檢查即可發現,但用無赤光檢眼鏡和眼底照像較易檢查。視盤小血管通常為9~10根,如果視神經萎縮,這些小血管數目將減少。同時尚可見視網膜動脈變細和狹窄、閉塞,但該現象不是所有視神經萎縮皆有,一般球后視神經萎縮無影響,如果視神經萎縮伴有視網膜血管改變,則必須直接影響視網膜血管,才能發生視網膜血管的改變。

  常用的視神經萎縮分原發性和繼發性二種:前者視盤境界清晰,生理凹陷及篩板可見;后者境界模糊,生理凹陷及篩板不可見。視野檢查應注意適用小的紅色視標,可見中心暗點,鼻側缺損、顳側島狀視野、向心性視野縮小至管狀視野雙顳側偏盲等。色覺障礙多為后天獲得性,紅綠色障礙多見,色相排列檢查法優于一般檢查法。眼底熒光血管造影早期意義不大,晚期可見視盤熒光減弱和后期強熒光。視覺電生理檢測包括視網膜電圖(ERG)、眼電圖(EOG)和視誘發電位(VEP)等對診斷病情及預后等均有一定的輔助意義。

病因病理: 視神經萎縮由多種原因均可引起,常見有缺血、炎癥、壓迫、外傷和脫髓鞘疾病等如下: 1.顱內高壓致繼發性視神經萎縮 2.顱內炎癥,多見于結核性腦膜炎或視交叉蛛網膜炎 3.視網膜病變 1)炎癥 2)青光眼后。 3)視網膜色素變性 4)Refsum病 5)黑蒙性家族性癡呆 . 4.視神經炎和視神經病變 ⑴血管性,如缺血性視神經病變 視神經萎縮 ⑵脫髓鞘病 ⑶維生素缺乏 ⑷由于鉛或其他金屬類等中毒 ⑸帶狀皰疹 ⑹梅毒性 5.壓迫性所致 6.外傷 7.代謝性疾病,如糖尿病、神經節苷脂病等 8.遺傳性疾病 眼電圖 9.營養性視神經萎縮 10.雜類

常規治療措施

  病因治療為首要的。一旦視神經萎縮,要使之痊愈幾乎不可能,但是其殘余的神經纖維恢復或維持其功能是完全可能的。因此應使患者充滿信心及堅持治療。 常規藥物治療中常用的包括神經營養藥物如維生素B1、B12、ATP及輔酶A等,血管擴張藥及活血化淤藥類如菸酸、地巴唑、維生素E、維腦路通、復方丹參等。近年來通過高壓氧、體外反搏穴位注射654-2等均已取得一定效果。針刺治療早已證明有效。尚應提及的是,禁止吸煙及飲烈性酒,增強機體體質,對于病情的恢復有著不可或缺的作用。 中醫的辯證施治

中醫稱為青盲,青盲多由視瞻昏渺、高風內障等瞳神疾病日久失治演變而成。

魏氏中醫眼科的治療經驗:

視神經萎縮因為具有不可逆性的特點,即視神經一旦受損,很難恢復,故我們提倡早期治療,魏氏中醫眼科魏鴻友主任多年來通過運用祖輩秘方驗方,結合四十多年來臨床實踐對于診療該病早中期在控制病情發展,改善視力等方面取得了豐富的治療經驗。許多患者視力得到了恢復和改善。使許多失去治療信心的患者重新燃起了對光明的希望,事實說明有些疾病并不是不能治療的,關鍵在于診斷病因明確、抓住時機盡早治療很關鍵。

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