RU2379009C1 - Method of treating patients with optic nerve atrophy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to ophthalmology. Meridians with greatest deviations from standard values are detected by using Foll's method. After that, segmental massage of collar zone, mobilisation of horizontal portions of trapezius muscles and neck extensor muscles on the right and on the left, postisometric relaxation of neck and shoulder girdle muscles in sitting position are carried out. Then, in prone position - segmental massage of neck and back posterior surface, mobilisation of shoulder-blades, mobilisation and manipulation on rib-vertebral and intervertebral joints of thoracic part of spine with elimination of functional blocks, segmental massage of lumbar and gluteal areas, postisometric relaxation of gluteal muscles and deep pelvic muscles, mobilisation and manipulations on lumbosacral joint are carried out. Performed is stimulating point massage of paravertebral points of urine bladder meridian V11-V30, and symmetric points of lower extremities VB30 (huan-tiao), V36 (cheng-fu), V40 (Wei-chung), R4 (da-chung), F4 (chung-feng), VB40 (Chiu-hsu), RP5 (Shan-chiu), V60 (kun-lun), V62 (shen-mei) and R1 (Yung-chuan). After that in supine position carried out are massage and mobilisation of sternoclavicular and clavicular-acromial joints, manipulations on rib-vertebral joints of upper third of thoracic part, mobilisation and manipulations on intrervertertebral joints of cervical part with elimination of functional blocks. Performed is stimulating point massage of paraorbital points V1 (ching-min), V2 (tsuan-chu), VB1 (tun-tse-liao) TR23 (Chi-chu-kung), E1 (Cheng-Qi), and extrameridian points PC3 (Yin-Tang), PC6 (yu-yao), PC7 (Yu-wei), PC8 (Chiu-Wei), PC9 (tai yang) and other points of head and face - TR22 ((ho-Liao), IG19 (Ting-gun), VB14 (Jahn-bai), GI20 (Ying-hsiang), VC24 (cheng-chien), TR17 (and-feng), VB20 (Feng Chi), VG20 (bai-hui), then the symmetric points on hands - GI11 (Qu - chi), P7 (le tsyue), TR5 (Wai-guan), MS6 (Nei-Guan), GI4 (Hae-gu), and legs - E36 (tsu-san-li), F3 (Tai-chung). Mobilisation of knee and hip joints and pelvis tendons is performed. Then in lateral recumbent position - on the right and on the left - rotary manipulations on lumbar and lower-thoracic parts of spine with elimination of functional blocks, manipulation on thoracocervical transition in sitting position are performed. After that acupuncture is performed taking into account data of acupuncture diagnostics in accordance with Foll's method by harmonising method of influence leaving needles for 15-20 minutes. For this purpose first, auricular points are influenced, then - paraorbital points, points of face and head, symmetric corporal points of general action on upper and lower extremities. In total 13-15 acupuncture points are used during one session. In treatment course there are 9-10 sessions. 2-3 treatment courses are carried out.

EFFECT: method increases visual functions in patients with optic nerve atrophies of various genesis due to carrying out complex treatment and realisation of individual approach when performing acupuncture.

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Description

The proposed method of treatment relates to the field of ophthalmology, namely, to methods for treating patients with optic atrophy (ADS).

ADS is one of the main causes of low vision and visual disability. Numerous existing treatment methods often do not allow to achieve a stable positive result, are methodically difficult or expensive, therefore, the search for new methods of treatment of ADS remains one of the urgent problems of ophthalmology.

Drug treatment methods are effective mainly in the initial stages of the manifestation of the disease. They use vasodilating, anti-sclerotic, neurotropic drugs, B vitamins, in some cases anticoagulants, enzymes (Therapeutic Ophthalmology, edited by ML Krasnov, NB Shulpina. - M .: Medicine, 1985, p .011 -407). However, in the later stages of the disease, drug therapy is much less effective and its effect is unstable.

Currently, physical methods of treatment are considered effective, such as percutaneous electrical stimulation of the optic nerve, exposure to an alternating magnetic field, phonophoresis of vasodilator drugs and magnetophoresis of drugs that stimulate reparative processes (E.S. Weinstein et al. Alternating magnetic field in the treatment of eye diseases. Method. recommendations, 1985, pp. 12-14), as well as acupuncture.

In recent years, methods of electroacupuncture diagnostics according to R. Voll and adaptive bioresonance therapy have also spread (Samokhin A.V., Gotovskiy Yu.V. Electropuncture diagnostics and therapy according to the method of R. Voll. - Moscow. - 1995; Yu.V. Gotovsky. Bioresonance and multiresonant therapy. Materials of the first international conference "Theoretical and clinical aspects of bioresonance therapy". S.359-369. M .: IMEDIS. 1995

Acupuncture (AP) in its modern concept is currently widely and successfully used in the treatment of patients with various diseases in various fields of medicine, including in ophthalmology.

Acupuncture is a system for restoring homeostasis and treating specific diseases by activating interconnected, presumably reflex, loci with different types of physical effects: pressing, acupuncture, etc. (Agasarov L.G., Osipova N.N. Brief guide on acupuncture. M., 1996 )

The reflex response in AP includes a local, segmental, and general generalized response in response to local irritations of acupuncture points (AT). At the same time, the flow of afferent stimuli along the conduction paths reaches the subcortical and cortical structures, including hypothalamic-pituitary system, reticular formation, which determines the generalization of nervous excitation and the inclusion of neurohumoral adaptation and self-regulation mechanisms. (D.M. Tabeeva. Guidelines for acupuncture. M .: Medicine, 1982).

Adequately using specific ATs, a specific therapeutic effect can be obtained, and the general reaction of the body to acupuncture enhances the therapeutic effect.

Some ancient Chinese acupuncture guides, as well as modern authors' guides, provide formulations of recommended antipsychotics for AZN. A number of works cite data on the successful use of reflexology in ADS (Ivanova EM Vestn. Ophthalmol. - 1961 - No. 5. - P.45-50; Mustaev IA et al. Reconstructive surgery for damage to the organ of vision . - Abstracts - M. - Telavi. - 1986 - P.104-107; Beglyarbekyan V.N. et al. International Symposium on Refractive Surgery, IOL Implantation and Complex Treatment of Optic Nerve Atrophy, 2nd : Abstracts - Moscow - 1991 - P.207; MS Matevosova et al. Reflexotherapy for optic atrophy of various etiologies. - A manual for doctors. - M. - 1997. - 12 pp.).

The choice of AT for an AP session can be carried out in various ways. There are traditional methods for preparing AP formulations according to the rules known from traditional eastern medicine based on pulse diagnostics and other types of traditional diagnostics. Currently, hardware methods are widely used and most often EPD according to R. Voll. It consists in measuring the electrical parameters of certain ATs associated with various organs and tissue systems. Through a large number of experimental studies, a correlation was determined between the nature of changes in these parameters and the functional state of the corresponding organs. A scale of measurement indicators was established with a norm of 50 arbitrary units. Excessive readings indicate functional stress or inflammatory changes. If they are below the norm, degenerative changes proportional to the degree of deviation can be assumed in the relevant organs and systems. Thanks to the use of EPD, it is possible to formulate the AP and correct it taking into account the identified deviations from normal values for each individual patient.

Manual therapy (MT), acting on the most important and most reactive structures of the musculoskeletal system (ODS) - muscles, fascia, ligaments, joints, is the fastest and most effective method of eliminating functional disorders in this area, as well as the entire symptom complex of surrounding and reflex disorders reacting organs and tissues.

Despite the apparent independence of the state of the organ of vision and ODS, there is a certain correlation between them. There is evidence of the effectiveness of manual therapy methods in the treatment of children with progressive myopia, amblyopia (Kuznetsova M.V., Popov V.A. Myopia, impaired refraction, accommodation and oculomotor apparatus. Proceedings of the International Symposium. - M. - 2001 - S.50-51).

The closest analogue of the proposed method is a method for treating optic atrophy (RU 2089169, 09/10/97), including acupuncture of paraorbital, corporal and auricular points, while immediately before acupuncture, low-intensity electromagnetic radiation of the millimeter range (EHF-therapy) affects paraorbital and immunostimulating points .

As shown by lengthy and numerous clinical studies, the application of this method in practice gives a relatively small increase in the effectiveness of treatment of patients with ADS compared with conventional acupuncture. Apparently, low-intensity EHF-therapy has a rather narrow spectrum of resonant effects, which does not cover all the mechanisms that can have a positive effect on the pathogenesis links in ADS.

It seems to us that complex therapy is the most effective, rationally combining the methods of general and local effects on the body of several therapeutic factors that potentiate the effect of each other at various levels of regulation of the body.

The basis of the proposed method is an integrated approach to the treatment of patients with ADS. The method includes acupuncture, the recipe of which is individually made, taking into account the data of preliminary electroacupuncture diagnostics according to the R. Voll method, carried out after the previous complex manual exposure, combining elements of manual therapy, segmental and acupressure.

The technical result of the proposed method is to improve visual functions in patients with optic atrophy of various origins with activation of the functions of the neurons of the visual analyzer and their nerve fibers in a state of parabiosis with the restoration of membrane potential and axonoplasmic current, with activation of the overall neurohumoral response to a complex reflex effect, leading to increase the adaptive abilities of the body.

The technical result is achieved through the use of complex complex effects, including, firstly, direct reflex stimulation of neural chains along the entire path of the visual analyzer due to their generalized excitation in response to adequate irritation of certain skin neuroreceptors during acupuncture and acupressure; secondly, the improvement of blood supply to the zones of the head, face and collar zone both as a result of mechanical action during segmental massage, and due to the elimination of functional blocks, especially in the cervical spine, which impede normal blood flow in the great vessels (carotid arteries, vertebral artery), and also due to the reflex vasodilator action in response to stimulation of the structures of the autonomic nervous system; thirdly, stabilization in the thoracic and lumbar spine leads to the normalization of segmental reflex-vegetative relationships, and hence the normalization of the functions of internal organs, which is of great importance both to increase the level of health and adaptive abilities in general, and to increase visual functions .

In patients suffering from nervous and internal diseases, the development of concomitant pathology of the eye and its adnexa is often caused by impaired intracranial hemodynamics, as a result of pronounced dystrophic changes in the vertebral-motor segments of the cervical and cervicothoracic spine. Such a pathology is observed with the phenomena of cervical and cervicothoracic osteochondrosis, with the consequences of a craniocervical injury, including in patients with arterial hypertension after concussion of the brain and spinal cord.

With segmental massage (SM), the effect is on the large reflexogenic zones of the skin, as well as the underlying muscles with moderate intensity. In our case, SM has a preparatory character, creating the necessary muscle relaxation for subsequent techniques of manual therapy.

With acupressure (TM), exposure is carried out pointwise on the skin projection of AT with varying intensity and duration. In this method, a stimulating acupressure is used with short-term mild effects and the use of a large number of both local and remote ATs of general effect, including and AT used in subsequent AP. This effect has a general stimulating effect on the body, and also prepares AT well for subsequent AP, because pre-activated ATs give a faster and more pronounced reflex response.

The use of MT, CM and TM in combination with AP helps to increase the effectiveness of treatment of patients with ADS, enhancing and potentiating the therapeutic effect, thanks to the following points.

Firstly, it is a common mechanism of action, because MT, SM and TM are also powerful reflexology.

Secondly, muscle relaxation and elimination of functional blocks in the cervical spine using MT methods helps to normalize the reflex relationships between cranial nerves (including the oculomotor, visual, etc.) and the superior stem, subcortical, and cortical structures.

Thirdly, this is an effect that normalizes cerebral hemodynamics, because with instability of the vertebral-motor segments in the cervical spine, irritation of the nerve plexus of the vertebral artery, vertebral nerve is observed, and in advanced cases, compression of the vertebral artery and its surrounding nerves is observed. A prolonged violation of the statics of the cervical spine and dystrophic processes developing in it lead to chronic trauma to the neurovascular structures of the neck and, as a result, to the appearance of symptoms of chronic hemodynamic disturbances in the vertebrobasilar basin and arterial circles (Velizieva et al.), Which is pathogenetically very important in these cases.

Fourth, stabilization in the thoracic and lumbar spine leads to the elimination of failures in normal segmental reflex-vegetative relationships, and this helps to normalize the functions of internal organs, which are always responsible to one degree or another for the pathology of the organ of vision.

A method for the comprehensive treatment of patients with partial ADS, based on the use of antipsychotic drugs using data from previously conducted EPD according to R. Voll in combination with MT, SM and TM, was developed by us on the basis of the results of many years of clinical observations.

It was found out that the sequence of the procedures is important - the complex manual effect, carried out at the beginning of treatment, has a powerful stimulating effect and prepares the patient's body and its AT for the subsequent more specific effect of AP, which ensures potentiation of the therapeutic effect. The sequence of complex manual exposure is dictated by the general principles of systemic exposure: from top to bottom, from outside to inside. This logic obeys the change of patient position: sitting, lying on his stomach, on his back, on his side (right and left).

In contrast to the analogue, this method allows you to: firstly, individualize and adequately correct the acupuncture formulation in the treatment process in order to more specific and effective impact on a particular patient through the use of electroacupuncture diagnostics according to R. Voll; secondly, to improve trophic neuroreceptor and conductive structures of the visual analyzer by improving blood supply to the orbital and brain structures as a result of normalization of blood flow in the basins of the carotid and vertebral arteries; thirdly, to exert a more pronounced normalizing effect on organs and systems, the entire organism as a whole due to the potentiation of both local and general action of acupuncture by the powerful, similar in mechanism, reflex effect of manual therapy in combination with segmental and acupressure.

We observed 62 patients (92 eyes) who were treated with the proposed method, including men - 40 people, women - 22. The average age of patients was 46 + 29 years. According to etiology, patients were distributed as follows: vascular ADS was observed in 30 people (48.4%), traumatic - in 16 (25.8%), neuroinflammatory - in 8 (12.9%), toxic - in 3 (4.8 %) and ADS of unclear etiology in 5 (8.1%) subjects.

All patients had previously undergone courses of drug treatment that did not cause a lasting positive effect.

To assess the effectiveness of treatment, an initial and dynamic examination was carried out, including correction visometry, computer perimetry and electrophysiological studies (EFI): a study of visual evoked potentials of the cerebral cortex (VEP) for an outbreak in patients with low visual acuity, general and rhythmic electroretinography (ERG) in patients with higher visual acuity, as well as a complex immunological study of the state of humoral immunity by the content of immunoglobulins (Ig) of classes A, M, G and circ lining immune complexes (CEC).

After 2-3 sessions, subjective improvement in vision was noted, visual fatigue decreased. The overall treatment efficiency was 81.5% of the number of eyes examined. Visual acuity increased in 78.3% of cases (72 eyes), an average of 25% of the initial level, and in patients with low initial visual acuity (0.01-0.08), an increase in visual acuity was observed on average by 0.07 , with a higher (0.09-0.2) - by 0.12, and in the interval of the initial visual acuity of 0.3-0.8 - by 0.1-0.2.

According to computer perimetry, positive dynamics in the form of a decrease in the number of absolute cattle and an increase in the number of points with a normal threshold of sensitivity with a slight decrease or a stable number of relative cattle were noted in 80.4% of cases (74 eyes).

EFIs were performed in 13 patients, and in 10 cases a significant improvement was noted.

The absence of positive dynamics was most often observed in elderly people, in patients with a long prescription of the process and an unclear etiology of the disease, as well as very low initial visual functions. In most cases, a combination of several factors was observed.

The maximum effect was achieved in the treatment of patients with ADS of vascular and neuroinflammatory etiology with a short prescription of the process and with initially high visual functions. In all other cases, a fairly stable stabilization of the process was observed with a follow-up period of 2 years compared with other treatment methods.

According to immunological studies revealed some patterns. The concentration of CEC, initially increased in 25.9% of the examined patients, as a result of the course of treatment decreased to normal values. In 48.2% of patients with a spread of this indicator within the normal range, there was a tendency to decrease high and increase low indicators. At 25.9% - indicators are unchanged. The total positive effect on the change in the concentration of the CEC was 74.1%.

When studying the level of Ig classes A, M, G, 26.5% of patients revealed gammopathy in the form of hyperimmunoglobulinemia (14.7%) and hypoimmunoglobulinemia (11.8%). After treatment, normalization of Ig content was observed in 88.9% of patients. In 67.6% of patients for all 3 classes of immunoglobulins, an immunomodulating effect was observed. In 8.8%, no significant changes were detected. Thus, the total positive immunomodulatory effect of treatment on the production of immunoglobulins of classes A, M, G was 91.2%.

There was also a positive effect on the course of chronic concomitant pathology characteristic of this group of patients. After and during the therapy, patients noted a decrease in complaints of various pains in the neck, back and lower back, headaches, disappearance or reduction of dyspepsia symptoms, increased joint mobility, and improved sleep amid increased general physical and psycho-emotional state. In a number of patients with hypertension, a decrease in blood pressure and a decrease in the characteristic symptoms of hypertension were objectively observed.

With EPD according to R. Voll, the largest deviations from normal values were observed for meridians of the liver (F), pancreas (RP), gall bladder (VB), and kidneys (R). In general, as a result of the treatment, there was a tendency to normalize the altered EPD indicators according to R. Voll in 78% of cases.

The method is as follows.

At the beginning of complex treatment, the patient undergoes electro-acupuncture diagnostics according to the R. Voll method on the MINIEXPERT-DT apparatus, as a result of which meridians or organ systems with the largest deviations from normal values are detected. The next stage begins with a comprehensive manual exposure, including elements of manual therapy, segmental and acupressure, carried out for 20-25 minutes.

Initially, in the sitting position, SM of the collar zone is performed on the right and left, as well as the mobilization of horizontal portions of trapezius muscles and extensors of the neck symmetrically, with the active participation of the patient. After that, PIR of the muscles of the neck and shoulder girdle are performed.

Then, in the supine position, SM is performed on the posterior surface of the neck and back, starting with mobilization and massage of the skin and ending with a deep relaxing massage of the muscles, mainly of the extensor extensors. After this, mobilization of the shoulder blades, mobilization and manipulation of the costal-vertebral and intervertebral joints are carried out with the possible elimination of functional blocks in the vertebral-motor segments of the thoracic spine. Continued exposure includes Lumbar and Gluteal SM, mobilization and manipulation of the lumbosacral joint, PIR of the gluteal muscles and deep pelvic muscles (piriform, etc.), as well as stimulating TM of the paravertebral points of the inner branch of the bladder meridian V11-V30 (symmetrically to the right and left) and symmetrical points of the lower extremities: VB30 (huang-tiao), V36 (cheng-fu), V40 (wei-chjun), R4 (da-chjun), F4 (chjun-feng), VB40 (qiu-xiu), RP5 (shan-qiu), V60 (kun-lun), V62 (shen-mai) and R1 (yun-chuan).

Then, while lying on your back, massage and mobilization of the sternoclavicular and clavicular-acromial joints, manipulations on the costal-vertebral joints of the upper third of the thoracic region, mobilization and manipulation of the intervertebral joints of the cervical spine with the possible elimination of functional blocks. After this, TM of paraorbital meridian points is carried out - V1 (qing-min), V2 (tsuan-chu), VB1 (tung-tzu-liao), TR23 (si-chu-kun), E1 (cheng-tsu) and extrameridian - PC3 (yin-tan), RS6 (yu-yao), RS7 (yu-wei), RS8 (qiu-hou), RS9 (tai-yang), as well as other points on the face and head - TR22 (he-liao), IG19 (ting-gun), VB14 (yang-bai), GI20 (ying-xiang), VC24 (cheng-jian), TR17 (i-feng), VB20 (feng-chi) and VG20 (bai-hui). Then - on the symmetrical points of the upper and lower extremities: on the hands - GI11 (qui-chi), P7 (le-qui), TR5 (wai-guan), MC6 (nei-guan), GI4 (he-gu) and on the legs - E36 (tsu-san-li) and F3 (tai chun). After this, mobilization of the knee and hip joints, as well as the pelvic ligaments, is carried out.

Then, in the supine position (on the right and on the left, alternately), rotational manipulations are performed on the lumbar and lower thoracic spine. Then, in the sitting position, manipulation is performed on the cervicothoracic transition with the possible elimination of functional blocks.

After the completion of the complex manual exposure session, an acupuncture session is usually carried out in a supine position. Use both auricular and corporal points, recommended for lesions of the optic nerve.

The points recipe is selected individually taking into account the available medical history and clinical data, as well as the results of EPD according to R. Voll. Some energetically “strong” points can be set repeatedly from session to session, for example: GI 4 (he-gu), E 36 (tsu-san-li), auricular AR 55 (shen-men), others - it is better to alternate through one or several sessions.

First, APs of auricular points are carried out, and the points of organ exposure are AR 95 (kidney), AR 97 (liver) and, above all, the points related to vision are AR 24a (first view), AR 24b (second view), AR 8 ( eyes) - put on the side of the lesion, and points of more general action - AR 55 (shen-men), AR 28 (pituitary gland), AR 34 (cerebral cortex), AR 13 (adrenal glands) - symmetrically. In total, no more than 3 points on each auricle.

Then carry out AP corporal points in the direction from top to bottom, i.e. first local and segmental points on the face, head and neck, then symmetrically on the upper and lower extremities. Of the paraorbital and facial points, the following are more often used: V1 (ching-min), V2 (tsuan-chu), VB1 (tun-tszy-liao), TR23 (si-chu-kun), E1 (cheng-tsu), E 2 ( sy-buy), VB 14 (yang-buy), extra-meridian points - PC3 (yin-tan), PC6 (yu-yao), PC7 (yu-wei), PC8 (qiu-hou), PC9 (tai-yang) , as well as a point on the crown of the VG 20 (by-hui) and symmetrical points in the cervico-occipital region of the VB 20 (Feng Chi). The puncture of the latter is carried out first of all, in a sitting position, with the head bowed forward, carefully, in the exact direction and to the required depth, until the intended sensations appear. Then the patient is carefully laid on his back, after which the AP is carried out in the usual manner. On the hands more often use points: GI 4 (he-gu), GI 11 (qu-chi), P7 (le-tsu), TR5 (wai-guan; on the legs - (tsu-san-li)), RP 6 ( san-yin-jiao), VB 37 (shan-ju-syu), F 3 (tai chun).

In total, no more than 13-15 ATs are used per session. The harmonizing method of exposure. The duration of the session is 15-20 minutes. The entire session of complex therapy takes about 40-45 minutes. Repeated EPD according to R. Voll is performed 1-2 times during the course of treatment and upon its completion in order to correct the formulation of AP and determine the effectiveness of treatment according to the dynamics of the survey data.

Clinical example.

Patient P., born in 1956, with complaints of visual impairment in both eyes. As a result of the examination at the Moscow Research Institute of Eye Diseases named after Helmholtz in 2004 was diagnosed with: OU - partial atrophy of the optic nerve of vascular origin.

The patient noted a gradual decrease in vision since 1998. Repeatedly underwent courses of generally accepted drug therapy in other medical institutions. Vision continued to decline gradually. First turned to a consultation in the department of reflexology, homeopathy and physical methods of treatment in 2005

Visual acuity at admission:

OD 0.3 n / a

OS 0.4 sph + 2.0D = 0.7

IOP OD = 21 mmHg, OS = 23 mmHg

The boundaries of the visual fields OD = 495 °, OS = 525 °; multiple absolute and relative scotomas throughout the field of view.

When conducting the C-30 threshold test on a Humphrey field of view analyzer, the sensitivity of the central fossa OD = 19 DV, OS = 21 dB, the value of the main deviation MD (mean deviation) OD = -26.5 DW, OS = -13.5 DW .

According to color campimetry, the ratio is relative / absolute. scotomas

OD = 48/24, OS = 13/4, there are absolute and significant changes in color sensitivity on OD, significant - on OS.

When conducting electrophysiological studies (EFI), the threshold of electrical sensitivity for OD was 140 μa, for OS 120 μa, lability 40 Hz for OU. In the study of visual evoked potentials per flash (VIZ), the amplitude was 6 μV on OD and 9 μV on OS, time - 130 ms on OD and 120 on OS.

When conducting immunological studies, gammopathy in the form of hyperimmunoglobulinemia was detected.

According to electro-puncture diagnostics, there were changes on the meridians of the kidneys, gall bladder, liver, pancreas and nervous degeneration (points of cerebral vessels and the autonomic nervous system - 45/25 and 70/50 conventional units, respectively).

After the complex treatment according to the method described above, the patient noted an improvement in overall well-being, an increase in visual acuity on OD to 0.4, and on OS to 0.5 sph + 2.0D = 0.8, 2 months after the course of treatment, visual acuity OD 0.5 n / a, OS 0.5 sph + 2.0D = 0.9. The number of absolute and relative cattle decreased by 20% and 45%, respectively. The light sensitivity of the central fossa increased on OD to 22 dB, on OS to 26 dB, the value of the main deviation MD (mean deviation) decreased by OD = -20.5 DV, on OS = -7.5 DV.

According to color campimetry, the ratio is relative / absolute. scotomas

OD = 40/14, OS = 8/3.

According to EFI: the threshold for OD was 125 μa, for OS 110 μa, lability 40 Hz for OU; VIZ - amplitude on OD was 7 μV, on OS - 11 μV, time - 125 ms on OD and 110 on OS.

On the fundus after the course of therapy, an improvement in the microcirculation of the retinal vessels and bulbar conjunctiva on OU was observed.

With repeated immunological studies, normalization of the content of immunoglobulins was noted.

EPD indices on the meridians of the kidneys, liver, pancreas improved, normalized at the points of cerebral vessels and the autonomic nervous system.

6 months after the treatment, visual function slightly decreased, but remained above the initial level. After a second course of treatment, visual acuity increased by OD to 0.6, and on OS to 0.6 sph + 2.0D = 1.0; the number of absolute cattle decreased by 20%, and relative by 25% of the original values.

According to EPD, the degree of decompensation on the meridians of the liver and gall bladder decreased.

6 months after re-examination, visual function remained stable.

Thus, over the observation period since 2005, the absolute increase in visual acuity at OU was 0.3.

The positive dynamics after treatment in this way according to psychophysical diagnostic methods, such as visometry, computer perimetry, color campimetry, as well as according to more objective electrophysiological studies, indicates the activation of the function of the neurons of the visual analyzer and their nerve fibers. And the improvement in the general condition of patients, the normalization of the activity of internal organs and functional systems according to electroacupuncture according to R. Voll, as well as the normalization of indicators of the state of humoral immunity indicate a pronounced general normalizing neurohumoral effect on the body as a result of the above method of complex treatment.

Dynamics of increasing visual acuity

OD 0.3 n / a

OS 0.4 sph + 2.0D = 0.7

After 1 course of treatment

OD 0.4 n / a

OS 0.5 sph + 2.0D = 0.8

2 months after the course of treatment

OD 0.5 n / a

OS 0.5 sph + 2.0D = 0.9

6 months after the course of treatment

OD 0.4 n / a

OS 0.4 sph + 2.0D = 0.8

After a second course of treatment

OD 0.6 n / a

OS 0.6 sph + 2.0D = 1.0

6 months after the second course of treatment, visual acuity did not change. This confirms the stability of the effect for 6 months after the course of treatment and the possibility of a further increase in visual functions after a second course of treatment.

Thus, the data presented indicate the undoubted effect of massage, manual therapy and acupuncture on the most significant mechanisms for the development of partial optic atrophy. Their use for preserving vision in patients with partial atrophy of the optic nerve should begin as early as possible and continue as necessary.

Claims (1)

A method of treating patients with optic atrophy, characterized in that they first carry out electro-acupuncture diagnostics according to the R. Voll method with the identification of meridians with the largest deviations from normal values; then - a comprehensive manual impact, including sequentially performed segmental massage of the collar zone, mobilization of horizontal portions of trapezius muscles and extensors of the neck on the right and left, post-isometric relaxation of the muscles of the neck and shoulder girdle in a sitting position; then in the supine position - segmental massage of the back of the neck and back, mobilization of the shoulder blades, mobilization and manipulation of the rib-vertebral and intervertebral joints of the thoracic spine with the elimination of functional blocks, segmental massage of the lumbar and gluteal regions, postisometric relaxation of the gluteal muscles and deep pelvic muscle mobilization and manipulation on the lumbosacral joint, stimulating acupressure of the paravertebral points of the bladder meridian V11-V30 symmetrically, and that the same symmetrical points of the lower extremities - VB30 (huang-tiao), V36 (cheng-fu), V40 (wei-chjun), R4 (da-chjun), F4 (chjun-feng), VB40 (qiu-xiu), RP5 ( shan-qiu), V60 (kun-lun), V62 (shen-mai) and R1 (yun-chuan); in supine position - massage and mobilization of sternoclavicular and clavicular-acromial joints, manipulations on the costal-vertebral joints of the upper third of the thoracic region, mobilization and manipulation of the intervertebral joints of the cervical region with the elimination of functional blocks, stimulating acupressure of paraorbital points V1 (qing -min), V2 (quan-chu), VB1 (tun-tzu-liao) TR23 (sy-chu-kun), E1 (cheng-tsu), as well as extra-meridian points of the RSZ (yin-tan), RS6 (yu- yao), RS7 (yu-wei), RS8 (qiu-hou), RS9 (tai-yang) and other points of the head and face - TR22 (he-liao), IG19 (ting-gun), VB14 ( n-bye), GI20 (ying-xiang), VC24 (cheng-jian), TR17 (i-feng), VB20 (feng-chi), VG20 (by-hui), then the symmetrical points on the hands - GI11 (qu- chi), P7 (le-tsue), TR5 (wai-guan), MC6 (nei-guan), GI4 (he-gu) and on legs - E36 (tsu-san-li) and F3 (tai chun), mobilization of knee and hip joints and pelvic ligaments; in the supine position - on the right and left - rotational manipulations on the lumbar and lower thoracic spine with the elimination of functional blocks; manipulation of the cervicothoracic transition in a sitting position; after which acupuncture is carried out taking into account the data of electroacupuncture diagnostics according to the R. Voll method using the harmonizing method of exposure, leaving the needles for 15-20 minutes, in the recipe of which acupuncture auricular points are used first, then paraorbital points, face and head points, symmetrical corporal points of general action on the upper and lower extremities - only 13-15 acupuncture points per session and 9-10 sessions per treatment course, only 2-3 treatment courses.