Non-surgical treatment of integrated Chinese herbal medicine and Western medicine to cure rhegmatogenous retinal detachment: a case report

Non-surgical treatment of integrated Chinese herbal medicine and Western medicine to cure rhegmatogenous retinal detachment: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Non-surgical treatment of integrated Chinese herbal medicine and Western medicine to cure rhegmatogenous retinal detachment: a case report Feifei Li, Yanhong Ding, Xin Zhang, Jinfei Tang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4410208/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Surgery is the main treatment option for rhegmatogenous retinal detachment (RRD). However, the choice of the appropriate surgical method and the risk of surgical complications are key challenges. Based on the traditional Chinese medicine theory of "invigorating spleen, invigorating qi and promoting water", we report a patient who treated by a combination of Chinese herbal medicine (CHM) and Western medicine quickly resolved RRD and improved vision while avoiding the need for invasive surgery. Methods: A 27-year-old Chinese man with a history of trauma to his right eye was diagnosed with RRD on 3 rd Jan 2022. He underwent retinal laser photocoagulation and received oral Chinese medicine for retinal attachment and absorption of sub-retinal fluid (SRF). Results： A marked decline in SRF along with nearly complete resolution of RRD was observed within a few days after initial therapy. Conclusion : Our experience with this case suggests that CHM combined with retinal laser photocoagulation may serve as a therapeutic option for RRD, which may be suitable for small retinal detachment with small holes. Rhegmatogenous retinal detachment Non-surgical treatment Retinal laser photocoagulation Chinese herbal medicine Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Rhegmatogenous retinal detachment (RRD) is a common type of retinal detachment (RD) characterized by the formation of retinal hole and separation of the retinal neurosensory layer (RNL) and the retinal pigment epithelium (RPE) [ 1 ] . The condition causes severe visual impairment. There are several common predisposing factors for RRD, such as increasing age, myopia, previous cataract surgery, and trauma [ 2 ] . the estimated incidence of RRD is 1 in 10000 persons per year. Surgery is often the treatment of choice to prevent further progression of detachment and restore visual function. The currently used surgical methods include scleral buckling, episcleral compression, and pars plana vitrectomy. Each method has its advantages and disadvantages, and the appropriate surgical method should be chosen depending on the characteristics of each case and the corresponding indications [ 3 ] . Any type of surgery entails a certain degree of risk, and although surgical treatment can achieve anatomical reduction, good postoperative visual function cannot be guaranteed. RRD belongs to the scope of retina detachment in ophthalmology of traditional Chinese medicine. According to traditional Chinese medicine [ 4 ] , the patient is overtired, consumes air and hurts the spleen, and when spleen qi is deficient, there is no way to transport water fluid and immobilize the retina, so that water is stagnant under the retina, leading to retinal detachment and subretinal fluid accumulation. Traditional Chinese medicine (TCM) can accelerate the absorption of the sub-retinal fluid (SRF) and promote the reattachment of the detached retina, thereby promoting the recovery of visual function [ 5 ] . The Zhi zhen Yao Da Lun of Su Wen said that "all dampness and swelling belong to the spleen". It can be seen that the relationship between the spleen and the metabolism of water and fluid of the whole body is also very close. According to the Tibetan image theory of traditional Chinese Medicine, the spleen mainly transported and metabolized water and fluid, and played an important role in the absorption and distribution of water and fluid. The spleen has abnormal movement, weak promotion, and abnormal metabolism of water and fluid, which eventually causes phlegm and dampness to condense under the retina, therefore, the treatment should strengthen the spleen, invigorate qi and promote water. Buzhong and Yiqi decoction is a classic prescription commonly used in clinical practice for spleen qi deficiency and Qingyang deficiency. Wuling Powder is a good prescription for treating all kinds of adverse gasification and accumulation of water and dampness. The combination of the two herbs can benefit qi and promote water together. The principle of treatment for RRD is to identify and close all holes [ 6 ] . This paper describes a patient with RRD who was treated by non-surgical treatment, i.e., closure of peripheral retinal hole with retinal laser photocoagulation combined with Chinese herbal medicine (CHM). In addition, we present the findings of a literature review about non-surgical treatment of RRD. Case presentation A 27-year-old Chinese man was admitted to our hospital on 3rd Jan 2022 because of blurry vision and an inferior visual field defect in his right eye for more than half a month. He had a history of moderate myopia and a history of trauma to his right eye sustained 3 years ago. His family history was unremarkable. On presentation, the best-corrected visual acuity (BCVA) in the right eye was 20/40. The rest of the anterior segment examinations were within the normal range. Dilated fundus examination (DFE) demonstrated RD and retinal fold proliferation from 10 to 2 o'clock, involving the macula, with an oval retinal hole at 12 o'clock in the periphery (Fig. 1 A). Optical coherence tomography (OCT) (Cirrus 5000, Carl Zeiss Meditec Inc., Singapore) of the macula showed RD and foveal involvement (Fig. 2 A). Visual field examination (Octopus 900, Haag-Streit Inc, Switzerland) revealed extensive inferior visual field defect (Fig. 4 A). The patient received retinal laser photocoagulation on 4th Jan 2022. Retinal laser photocoagulation (VISULAS 532s, Carl Zeiss Meditec Inc., Germany) was performed with 3–4 circles around the retinal tear using established parameters (300 µm spot diameter, 150 ms duration, 200–240 milliwatt power, III thick white spots, and a total of 305 spots). A CHM prescription, mainly consisting of a modified Buzhong Yiqi Decoction and Wuling Powder, which contains Radix astragali, Ginseng, Cimicifuga foetida, Radix Bupleuri, Pericarpium Citri Reticulatae, Angelica sinensis, Atractylodes macrocephala koidz, Polyporus umbellatus, Alisma Orientalis, Poria cocos, Ramulus Cinnamomi, Glycyrrhiza uralensis was also prescribed. The herbal materials were decocted with water (soaked in 1,500–2,000 mL of water for 30 minutes, allowed to simmer for 40 minutes, followed by extraction of 300 mL of preparation). The patient was administered 150 mL decoction twice a day starting from the day of hospitalization until hospital discharge. Improvement in SRF and clinical symptoms was noticed from 5th Jan 2022. The OCT showed longitudinal change in central foveal and superior temporal retinal detachment area thickness (Fig. 2 B, C, Fig. 3 A, B, C, D). The BCVA improved from 20/40 to 20/25, with significant improvement in blurriness and visual field defect on 10th Jan 2022 (Fig. 4 B). As the SRF around the hole was absorbed, the patient underwent repeat retinal laser photocoagulation, which was performed with 7–8 circles around the retinal hole, avoiding the proliferative area, applying the laser in the degeneration area, using established parameters (300 µm spot diameter, 150 ms duration, 170 milliwatt power, III white spots, and a total of 689 spots). At discharge, the patient's raised retina was largely flattened (Fig. 1 B) with complete absorption of SRF of macula fovea (Fig. 2 C). Two months after the initial presentation, the patient's condition was stable (Fig. 2 D). Ethical issues were completely observed by the author (the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine) 2021-KL-047-01). Discussion Currently, drugs and alternative therapies are mainly used as auxiliary therapy for RRD to promote absorption of persistent SRF following retinal detachment surgery [ 7 – 10 ] . The non-surgical treatment of this case using fundus laser combined with traditional Chinese medicine has not been reported.In this case, guided by the theory of "invigorating spleen, invigorating qi and promoting water", Buzhong Yiqi decoction and Wuling powder were used to promote the absorption of subretinal fluid, which created conditions for further expanding the laser area. Photoreceptor apoptosis is the main factor that hinders recovery from visual damage caused by RD. Atractylodes polysaccharide has been shown to reduce the changes in mitochondrial dynamics-related genes, increase the activity of ATPase, repair the number of mitochondria, and restore their function [ 11 ] . Radix astragali can act on the Müller apoptosis pathway of the mitochondrial signaling pathway, reduce the activity of intracellular Caspase-3 and the expression of nuclear transcription factor-kappa B, reduce cell apoptosis, and maintain the normal structure and function of retina [ 12 ] . Polyporus umbellatus, Alisma Orientalis, and Glycyrrhiza uralensis all have antioxidant effects [ 13 – 16 ] . The above medicinal materials in this prescription can improve the activity of Na + -K + -ATPase through various pathways, enhance the transport and phagocytosis of retinal cells, and promote the absorption of SRF, thereby accelerating the adhesion of the retinal neuroepithelial layer and the RPE layer. Conclusions In summary, our experience with this patient suggests that CHM may hasten the resolution of SRF following RRD repair. Surgery is usually performed to seal the retinal hole in clinical settings. In this case, because of the small detachment range and the small hole, closure of the peripheral retinal hole was achieved with retinal laser photocoagulation. Further research is necessary to confirm the timing, efficacy, and safety of this treatment in restoring retinal structure and visual function. Abbreviations RRD Rhegmatogenous retinal detachment CHM Chinese herbal medicine SRF Sub-retinal fluid RNL Retinal neurosensory layer RPE Retinal pigment epithelium TCM Traditional Chinese medicine BCVA Best-corrected visual acuity DFE Dilated fundus examination OCT Optical coherence tomography RD Retinal detachment Declarations The patient has provided informed consent for publication of the case. Conflicts of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Author Contributions Treatment of patient: LFF, TJF; Data collection: LFF, ZX, DYH; Analysis and interpretation of results: LFF, TJF; Drafting the manuscript: LFF, ZX. Consent for publication All authors reviewed the results and approved the final version of the manuscript. Availability of data and materials All data generated and analyzed during this study are included in this article. Funding This work was supported by the Project of Zhejiang Provincial TCM Science and Technology(No.2023ZR092), the Research Project of Zhejiang Chinese Medical University(No.2021JKZKTS040B), foundation of Zhejiang Medical and Health Science and Technology Project(NO.2024KY1211). References Feltgen, N. and P. Walter, Rhegmatogenous retinal detachment–an ophthalmologic emergency. Dtsch Arztebl Int, 2014. 111(1–2): p. 12–21; quiz 22. Mitry, D., et al., Pathogenesis of rhegmatogenous retinal detachment: predisposing anatomy and cell biology. Retina, 2010. 30(10): p. 1561–72. Garcia-Arumi, J., et al., Rhegmatogenous retinal detachment treatment guidelines. Arch Soc Esp Oftalmol, 2013. 88(1): p. 11–35. Peng Qinghua. [M]. Beijing: China Traditional Chinese Medicine Press, 202:173–175. Zhao Jianying, Hu Qiuming, Hao Xiaobo. Review and meta-analysis of integrative therapy on subretinal fluid after rhegmatogenous retinal detachment surgery. China Journal of Chinese Ophthalmology, 2016, 26 (06): 401–404. Sodhi, A., et al., Recent trends in the management of rhegmatogenous retinal detachment. Surv Ophthalmol, 2008. 53(1): p. 50–67. Mao, J.B., et al., [The efficiency of 23 G vitrectomy combined with preoperative subtenon injection of triamcinolone acetonide for treatment of retinal detachment associated with choroidal detachment]. Zhonghua Yan Ke Za Zhi, 2018. 54(4): p. 252–257. Haghighi, A., J. Do and H. Ameri, Eplerenone as a novel treatment for persistent subretinal fluid following retinal detachment surgery. Am J Ophthalmol Case Rep, 2018. 10: p. 261–263. Aydin, E., et al., Reattachment of Rhegmatogenous Retinal Detachment via Fibrin Tissue Adhesive. Korean J Ophthalmol, 2021. 35(3): p. 173–178. Landa, G., Micropulse Laser for Persistent Sub-Retinal Fluid in a Patient Previously Treated for Rhegmatogenous Retinal Detachment. Med Hypothesis Discov Innov Ophthalmol, 2018. 7(4): p. 190–194. Xu, D., et al., The protective effects of polysaccharide of Atractylodes macrocephala Koidz (PAMK) on the chicken spleen under heat stress via antagonizing apoptosis and restoring the immune function. Oncotarget, 2017. 8(41): p. 70394–70405. Adesso, S., et al., Astragalus membranaceus Extract Attenuates Inflammation and Oxidative Stress in Intestinal Epithelial Cells via NF-kappaB Activation and Nrf2 Response. Int J Mol Sci, 2018. 19(3). Li, B., et al., SWATH label-free proteomics analyses revealed the roles of oxidative stress and antioxidant defensing system in sclerotia formation of Polyporus umbellatus. Sci Rep, 2017. 7: p. 41283. Nie, A., et al., Phytochemistry and Pharmacological Activities of Wolfiporia cocos (F.A. Wolf) Ryvarden & Gilb. Front Pharmacol, 2020. 11: p. 505249. Han, C.W., et al., Antioxidative effects of Alisma orientale extract in palmitate-induced cellular injury. Pharm Biol, 2012. 50(10): p. 1281–8. Wang, Q., et al., Dietary Glycyrrhiza uralensis extracts supplementation elevated growth performance, immune responses and disease resistance against Flavobacterium columnare in yellow catfish (Pelteobagrus fulvidraco). Fish Shellfish Immunol, 2020. 97: p. 153–164. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4410208","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":304231364,"identity":"7236c4b0-11f3-4930-89af-0cb791910681","order_by":0,"name":"Feifei Li","email":"","orcid":"","institution":"the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Li","suffix":""},{"id":304231365,"identity":"f03482c6-9464-44e7-bf86-8ff5f117d945","order_by":1,"name":"Yanhong Ding","email":"","orcid":"","institution":"the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yanhong","middleName":"","lastName":"Ding","suffix":""},{"id":304231366,"identity":"a8e02d5a-81a7-4322-801e-b5e0bb7ebdfb","order_by":2,"name":"Xin Zhang","email":"","orcid":"","institution":"the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhang","suffix":""},{"id":304231367,"identity":"d32fd478-3f1a-4977-89c5-4d955ba44162","order_by":3,"name":"Jinfei Tang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYBACef7mww8+/JCQY2xvgAodIKDFcMaxNMOZPRbGzD0wpYS0MBzIMZDmYatIZJ+RQKQWxoYzBoYzeCQSeGc+f/jpZhuDHN+NBMbPBXi0sDO3FTz4YCGRJzk7IVk6t43BWPJGArP0DLy2HN4AsqXYcHbCMWaglsQNNxLYmHnw+iUB5BeJxP03D7aBtNQToSUFoqVxBjMbSEuCASEt0ECWMGbsSWOWzjknYTjzzMNmaXxaoFFZB4zK4w8/55TZyPMdTz74Ga/D0IAEAyhISNAwCkbBKBgFowAbAADu5E9yg0+oTQAAAABJRU5ErkJggg==","orcid":"","institution":"the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Jinfei","middleName":"","lastName":"Tang","suffix":""}],"badges":[],"createdAt":"2024-05-13 02:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4410208/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4410208/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57306392,"identity":"58a7d166-f2a1-480c-a9f6-f975b987bf2f","added_by":"auto","created_at":"2024-05-29 01:59:30","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":390742,"visible":true,"origin":"","legend":"\u003cp\u003eRetinal detachment and retinal hole at various time-points. A) After the first retinal laser: “a” indicates the oval retinal tear; B) 2 days after the second retinal laser–CHM for the 10\u003csup\u003eth\u003c/sup\u003e day: “b” indicates the oval retinal tear.\u003c/p\u003e\n\u003cp\u003eCHM, Chinese herbal medicine\u003c/p\u003e","description":"","filename":"floatimage5.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4410208/v1/48339ecb6c5a465447d1687d.jpeg"},{"id":57306393,"identity":"851b60d0-ccf5-44cf-a124-8048e051d829","added_by":"auto","created_at":"2024-05-29 01:59:31","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":519017,"visible":true,"origin":"","legend":"\u003cp\u003eSerial SD-OCT Scans showing the extent of retinal detachment in the macula at various time-points. A) On initial presentation; B) 2 days after the first retinal laser photocoagulation–CHM for the third day; C) 2 days after the second retinal laser photocoagulation–CHM for the 10\u003csup\u003eth\u003c/sup\u003e day; D) 1.5 months after the second retinal laser photocoagulation–CHM for nearly 2 months.\u003c/p\u003e\n\u003cp\u003eCHM, Chinese herbal medicine\u003c/p\u003e","description":"","filename":"floatimage6.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4410208/v1/5c7eadaeaaf071976333bb6b.jpeg"},{"id":57306391,"identity":"5dda2db1-1df1-481e-bcf0-67f2c50143d2","added_by":"auto","created_at":"2024-05-29 01:59:30","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":377837,"visible":true,"origin":"","legend":"\u003cp\u003eSerial SD-OCT Scans showing the extent of retinal detachment in the superior temporal retinal detachment area at various time-points. A) 2 days after the first retinal laser photocoagulation–CHM for the third day; B) 4 days after the first retinal laser photocoagulation–CHM for the 5\u003csup\u003eth\u003c/sup\u003e day; C) day of the second retinal laser photocoagulation–CHM for the 8\u003csup\u003eth\u003c/sup\u003e day; D) 2 days after the second retinal laser photocoagulation–CHM for the 10\u003csup\u003eth\u003c/sup\u003e day.\u003c/p\u003e\n\u003cp\u003eCHM, Chinese herbal medicine\u003c/p\u003e","description":"","filename":"floatimage7.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4410208/v1/933b477875627fbbb7912171.jpeg"},{"id":57306394,"identity":"a22ee3d5-5dc9-4144-9659-766ab9719331","added_by":"auto","created_at":"2024-05-29 01:59:31","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":660576,"visible":true,"origin":"","legend":"\u003cp\u003eVisual field examination showing changes in visual field at different time-points. A) On initial presentation; B) day of the second retinal laser photocoagulation–CHM for the 8\u003csup\u003eth\u003c/sup\u003e day.\u003c/p\u003e\n\u003cp\u003eCHM, Chinese herbal medicine\u003c/p\u003e","description":"","filename":"floatimage8.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-4410208/v1/024b3b2365005a824edbcd68.jpeg"},{"id":58432373,"identity":"a0e5741a-29bb-4a07-afd2-d85d41060dec","added_by":"auto","created_at":"2024-06-16 04:31:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2222528,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4410208/v1/5bab01d4-d5c3-44cf-bdec-85ba11593267.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Non-surgical treatment of integrated Chinese herbal medicine and Western medicine to cure rhegmatogenous retinal detachment: a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRhegmatogenous retinal detachment (RRD) is a common type of retinal detachment (RD) characterized by the formation of retinal hole and separation of the retinal neurosensory layer (RNL) and the retinal pigment epithelium (RPE)\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. The condition causes severe visual impairment. There are several common predisposing factors for RRD, such as increasing age, myopia, previous cataract surgery, and trauma\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. the estimated incidence of RRD is 1 in 10000 persons per year. Surgery is often the treatment of choice to prevent further progression of detachment and restore visual function. The currently used surgical methods include scleral buckling, episcleral compression, and pars plana vitrectomy. Each method has its advantages and disadvantages, and the appropriate surgical method should be chosen depending on the characteristics of each case and the corresponding indications\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Any type of surgery entails a certain degree of risk, and although surgical treatment can achieve anatomical reduction, good postoperative visual function cannot be guaranteed.\u003c/p\u003e \u003cp\u003eRRD belongs to the scope of retina detachment in ophthalmology of traditional Chinese medicine. According to traditional Chinese medicine \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e, the patient is overtired, consumes air and hurts the spleen, and when spleen qi is deficient, there is no way to transport water fluid and immobilize the retina, so that water is stagnant under the retina, leading to retinal detachment and subretinal fluid accumulation. Traditional Chinese medicine (TCM) can accelerate the absorption of the sub-retinal fluid (SRF) and promote the reattachment of the detached retina, thereby promoting the recovery of visual function\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. \u003cem\u003eThe Zhi zhen Yao Da Lun of Su Wen\u003c/em\u003e said that \"all dampness and swelling belong to the spleen\". It can be seen that the relationship between the spleen and the metabolism of water and fluid of the whole body is also very close. According to the Tibetan image theory of traditional Chinese Medicine, the spleen mainly transported and metabolized water and fluid, and played an important role in the absorption and distribution of water and fluid. The spleen has abnormal movement, weak promotion, and abnormal metabolism of water and fluid, which eventually causes phlegm and dampness to condense under the retina, therefore, the treatment should strengthen the spleen, invigorate qi and promote water. Buzhong and Yiqi decoction is a classic prescription commonly used in clinical practice for spleen qi deficiency and Qingyang deficiency. Wuling Powder is a good prescription for treating all kinds of adverse gasification and accumulation of water and dampness. The combination of the two herbs can benefit qi and promote water together.\u003c/p\u003e \u003cp\u003eThe principle of treatment for RRD is to identify and close all holes\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This paper describes a patient with RRD who was treated by non-surgical treatment, i.e., closure of peripheral retinal hole with retinal laser photocoagulation combined with Chinese herbal medicine (CHM). In addition, we present the findings of a literature review about non-surgical treatment of RRD.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 27-year-old Chinese man was admitted to our hospital on 3rd Jan 2022 because of blurry vision and an inferior visual field defect in his right eye for more than half a month. He had a history of moderate myopia and a history of trauma to his right eye sustained 3 years ago. His family history was unremarkable. On presentation, the best-corrected visual acuity (BCVA) in the right eye was 20/40. The rest of the anterior segment examinations were within the normal range. Dilated fundus examination (DFE) demonstrated RD and retinal fold proliferation from 10 to 2 o'clock, involving the macula, with an oval retinal hole at 12 o'clock in the periphery (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). Optical coherence tomography (OCT) (Cirrus 5000, Carl Zeiss Meditec Inc., Singapore) of the macula showed RD and foveal involvement (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). Visual field examination (Octopus 900, Haag-Streit Inc, Switzerland) revealed extensive inferior visual field defect (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient received retinal laser photocoagulation on 4th Jan 2022. Retinal laser photocoagulation (VISULAS 532s, Carl Zeiss Meditec Inc., Germany) was performed with 3\u0026ndash;4 circles around the retinal tear using established parameters (300 \u0026micro;m spot diameter, 150 ms duration, 200\u0026ndash;240 milliwatt power, III thick white spots, and a total of 305 spots). A CHM prescription, mainly consisting of a modified Buzhong Yiqi Decoction and Wuling Powder, which contains Radix astragali, Ginseng, Cimicifuga foetida, Radix Bupleuri, Pericarpium Citri Reticulatae, Angelica sinensis, Atractylodes macrocephala koidz, Polyporus umbellatus, Alisma Orientalis, Poria cocos, Ramulus Cinnamomi, Glycyrrhiza uralensis was also prescribed. The herbal materials were decocted with water (soaked in 1,500\u0026ndash;2,000 mL of water for 30 minutes, allowed to simmer for 40 minutes, followed by extraction of 300 mL of preparation). The patient was administered 150 mL decoction twice a day starting from the day of hospitalization until hospital discharge. Improvement in SRF and clinical symptoms was noticed from 5th Jan 2022. The OCT showed longitudinal change in central foveal and superior temporal retinal detachment area thickness (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB, C, Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, B, C, D). The BCVA improved from 20/40 to 20/25, with significant improvement in blurriness and visual field defect on 10th Jan 2022 (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). As the SRF around the hole was absorbed, the patient underwent repeat retinal laser photocoagulation, which was performed with 7\u0026ndash;8 circles around the retinal hole, avoiding the proliferative area, applying the laser in the degeneration area, using established parameters (300 \u0026micro;m spot diameter, 150 ms duration, 170 milliwatt power, III white spots, and a total of 689 spots). At discharge, the patient's raised retina was largely flattened (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB) with complete absorption of SRF of macula fovea (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC). Two months after the initial presentation, the patient's condition was stable (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD). Ethical issues were completely observed by the author (the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine) 2021-KL-047-01).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCurrently, drugs and alternative therapies are mainly used as auxiliary therapy for RRD to promote absorption of persistent SRF following retinal detachment surgery\u003csup\u003e[\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. The non-surgical treatment of this case using fundus laser combined with traditional Chinese medicine has not been reported.In this case, guided by the theory of \"invigorating spleen, invigorating qi and promoting water\", Buzhong Yiqi decoction and Wuling powder were used to promote the absorption of subretinal fluid, which created conditions for further expanding the laser area.\u003c/p\u003e \u003cp\u003ePhotoreceptor apoptosis is the main factor that hinders recovery from visual damage caused by RD. Atractylodes polysaccharide has been shown to reduce the changes in mitochondrial dynamics-related genes, increase the activity of ATPase, repair the number of mitochondria, and restore their function\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Radix astragali can act on the M\u0026uuml;ller apoptosis pathway of the mitochondrial signaling pathway, reduce the activity of intracellular Caspase-3 and the expression of nuclear transcription factor-kappa B, reduce cell apoptosis, and maintain the normal structure and function of retina\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Polyporus umbellatus, Alisma Orientalis, and Glycyrrhiza uralensis all have antioxidant effects\u003csup\u003e[\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The above medicinal materials in this prescription can improve the activity of Na\u003csup\u003e+\u003c/sup\u003e-K\u003csup\u003e+\u003c/sup\u003e-ATPase through various pathways, enhance the transport and phagocytosis of retinal cells, and promote the absorption of SRF, thereby accelerating the adhesion of the retinal neuroepithelial layer and the RPE layer.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, our experience with this patient suggests that CHM may hasten the resolution of SRF following RRD repair. Surgery is usually performed to seal the retinal hole in clinical settings. In this case, because of the small detachment range and the small hole, closure of the peripheral retinal hole was achieved with retinal laser photocoagulation. Further research is necessary to confirm the timing, efficacy, and safety of this treatment in restoring retinal structure and visual function.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eRRD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eRhegmatogenous retinal detachment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eCHM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eChinese herbal medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eSRF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eSub-retinal fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eRNL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eRetinal neurosensory layer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eRPE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eRetinal pigment epithelium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eTraditional Chinese medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eBCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eBest-corrected visual acuity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eDFE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eDilated fundus examination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eOCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eOptical coherence tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.274647887323944%\" valign=\"top\"\u003e\n \u003cp\u003eRD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"66.72535211267606%\" valign=\"top\"\u003e\n \u003cp\u003eRetinal detachment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe patient has provided informed consent for publication of the case.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTreatment of patient: LFF, TJF; Data collection: LFF, ZX, DYH; Analysis and interpretation of results: LFF, TJF; Drafting the manuscript: LFF, ZX.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated and analyzed during this study are included in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Project of Zhejiang Provincial TCM Science and Technology(No.2023ZR092), the Research Project of Zhejiang Chinese Medical University(No.2021JKZKTS040B), foundation of Zhejiang Medical and Health Science and Technology Project(NO.2024KY1211).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeltgen, N. and P. Walter, Rhegmatogenous retinal detachment\u0026ndash;an ophthalmologic emergency. Dtsch Arztebl Int, 2014. 111(1\u0026ndash;2): p. 12\u0026ndash;21; quiz 22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitry, D., et al., Pathogenesis of rhegmatogenous retinal detachment: predisposing anatomy and cell biology. Retina, 2010. 30(10): p. 1561\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarcia-Arumi, J., et al., Rhegmatogenous retinal detachment treatment guidelines. Arch Soc Esp Oftalmol, 2013. 88(1): p. 11\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng Qinghua. [M]. Beijing: China Traditional Chinese Medicine Press, 202:173\u0026ndash;175.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Jianying, Hu Qiuming, Hao Xiaobo. Review and meta-analysis of integrative therapy on subretinal fluid after rhegmatogenous retinal detachment surgery. China Journal of Chinese Ophthalmology, 2016, 26 (06): 401\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSodhi, A., et al., Recent trends in the management of rhegmatogenous retinal detachment. Surv Ophthalmol, 2008. 53(1): p. 50\u0026ndash;67.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMao, J.B., et al., [The efficiency of 23 G vitrectomy combined with preoperative subtenon injection of triamcinolone acetonide for treatment of retinal detachment associated with choroidal detachment]. Zhonghua Yan Ke Za Zhi, 2018. 54(4): p. 252\u0026ndash;257.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaghighi, A., J. Do and H. Ameri, Eplerenone as a novel treatment for persistent subretinal fluid following retinal detachment surgery. Am J Ophthalmol Case Rep, 2018. 10: p. 261\u0026ndash;263.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAydin, E., et al., Reattachment of Rhegmatogenous Retinal Detachment via Fibrin Tissue Adhesive. Korean J Ophthalmol, 2021. 35(3): p. 173\u0026ndash;178.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanda, G., Micropulse Laser for Persistent Sub-Retinal Fluid in a Patient Previously Treated for Rhegmatogenous Retinal Detachment. Med Hypothesis Discov Innov Ophthalmol, 2018. 7(4): p. 190\u0026ndash;194.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu, D., et al., The protective effects of polysaccharide of Atractylodes macrocephala Koidz (PAMK) on the chicken spleen under heat stress via antagonizing apoptosis and restoring the immune function. Oncotarget, 2017. 8(41): p. 70394\u0026ndash;70405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdesso, S., et al., Astragalus membranaceus Extract Attenuates Inflammation and Oxidative Stress in Intestinal Epithelial Cells via NF-kappaB Activation and Nrf2 Response. Int J Mol Sci, 2018. 19(3).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, B., et al., SWATH label-free proteomics analyses revealed the roles of oxidative stress and antioxidant defensing system in sclerotia formation of Polyporus umbellatus. Sci Rep, 2017. 7: p. 41283.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNie, A., et al., Phytochemistry and Pharmacological Activities of Wolfiporia cocos (F.A. Wolf) Ryvarden \u0026amp; Gilb. Front Pharmacol, 2020. 11: p. 505249.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHan, C.W., et al., Antioxidative effects of Alisma orientale extract in palmitate-induced cellular injury. Pharm Biol, 2012. 50(10): p. 1281\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang, Q., et al., Dietary Glycyrrhiza uralensis extracts supplementation elevated growth performance, immune responses and disease resistance against Flavobacterium columnare in yellow catfish (Pelteobagrus fulvidraco). Fish Shellfish Immunol, 2020. 97: p. 153\u0026ndash;164.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rhegmatogenous retinal detachment, Non-surgical treatment, Retinal laser photocoagulation, Chinese herbal medicine","lastPublishedDoi":"10.21203/rs.3.rs-4410208/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4410208/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Surgery is the main treatment option for rhegmatogenous retinal detachment (RRD). However, the choice of the appropriate surgical method and the risk of surgical complications are key challenges. Based on the traditional Chinese medicine theory of \"invigorating spleen, invigorating qi and promoting water\", we report a patient who treated by a combination of Chinese herbal medicine (CHM) and Western medicine quickly resolved RRD and improved vision while avoiding the need for invasive surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A 27-year-old Chinese man with a history of trauma to his right eye was diagnosed with RRD on 3\u003csup\u003erd\u003c/sup\u003e Jan 2022. He underwent retinal laser photocoagulation and received oral Chinese medicine for retinal attachment and absorption of sub-retinal fluid (SRF).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults：\u003c/strong\u003eA marked decline in SRF along with nearly complete resolution of RRD was observed within a few days after initial therapy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Our experience with this case suggests that CHM combined with retinal laser photocoagulation may serve as a therapeutic option for RRD, which may be suitable for small retinal detachment with small holes.\u003c/p\u003e","manuscriptTitle":"Non-surgical treatment of integrated Chinese herbal medicine and Western medicine to cure rhegmatogenous retinal detachment: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-29 01:59:25","doi":"10.21203/rs.3.rs-4410208/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"383e6241-5a9d-418a-8aa6-83fb77a09001","owner":[],"postedDate":"May 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-16T04:23:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-29 01:59:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4410208","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4410208","identity":"rs-4410208","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}