Kim, Na-Rae
(Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine)
,
Kim, Ji-Hyun
(Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine)
,
Kim, Chan-Yun
(Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine)
The purpose of this study was to evaluate the effect of Korean red ginseng (KRG) on ocular blood flow in patients with glaucoma. In a prospective, randomized, placebo-controlled, double-masked crossover trial, 36 patients with open-angle glaucoma were consecutively recruited. Subjects were randomly ...
The purpose of this study was to evaluate the effect of Korean red ginseng (KRG) on ocular blood flow in patients with glaucoma. In a prospective, randomized, placebo-controlled, double-masked crossover trial, 36 patients with open-angle glaucoma were consecutively recruited. Subjects were randomly assigned into two groups. Group A received 1.5 g KRG, administered orally three times daily for 12 weeks, followed by a wash-out period of 8 weeks and 12 weeks of placebo treatment (identical capsules filled with 1.5 g corn starch). Group B underwent the same regimen, but took the placebo first and then KRG. Blood pressure, heart rate, and intraocular pressure were measured at baseline and at the end of each phase of the study. Visual field examination and ocular blood flow measurements by the Heidelberg Retina Flowmeter were performed at baseline and at the end of each phase of the study. Changes in blood pressure, heart rate, intraocular pressure, visual field indices, and retinal peripapillary blood flow were evaluated. Blood pressure, heart rate, intraocular pressure, and visual field indices did not change after placebo or KRG treatment. After KRG treatment, retinal peripapillary blood flow in the temporal peripapillary region significantly improved (p=0.005). No significant changes were found in retinal peripapillary blood flow in either the rim region or the nasal peripapillary region (p=0.051 and 0.278, respectively). KRG ingestion appears to improve retinal peripapillary blood flow in patients with open-angle glaucoma. These results imply that KRG ingestion might be helpful for glaucoma management.
The purpose of this study was to evaluate the effect of Korean red ginseng (KRG) on ocular blood flow in patients with glaucoma. In a prospective, randomized, placebo-controlled, double-masked crossover trial, 36 patients with open-angle glaucoma were consecutively recruited. Subjects were randomly assigned into two groups. Group A received 1.5 g KRG, administered orally three times daily for 12 weeks, followed by a wash-out period of 8 weeks and 12 weeks of placebo treatment (identical capsules filled with 1.5 g corn starch). Group B underwent the same regimen, but took the placebo first and then KRG. Blood pressure, heart rate, and intraocular pressure were measured at baseline and at the end of each phase of the study. Visual field examination and ocular blood flow measurements by the Heidelberg Retina Flowmeter were performed at baseline and at the end of each phase of the study. Changes in blood pressure, heart rate, intraocular pressure, visual field indices, and retinal peripapillary blood flow were evaluated. Blood pressure, heart rate, intraocular pressure, and visual field indices did not change after placebo or KRG treatment. After KRG treatment, retinal peripapillary blood flow in the temporal peripapillary region significantly improved (p=0.005). No significant changes were found in retinal peripapillary blood flow in either the rim region or the nasal peripapillary region (p=0.051 and 0.278, respectively). KRG ingestion appears to improve retinal peripapillary blood flow in patients with open-angle glaucoma. These results imply that KRG ingestion might be helpful for glaucoma management.
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가설 설정
The use of topical antiglaucomatous therapy may also have affected the study results, but the effects are generally considered small. Third, HRF system measurements reflect only retinal blood flow. As mentioned above, it is unknown which source of blood flow plays a key role in the pathogenesis of glaucoma.
제안 방법
August 2009. All patients were examined in a prospective, randomized, placebo-controlled, double-blind, crossover study. The study was conducted in accordance with the Declaration of Helsinki, and informed written consent was obtained from each participant.
Backscattered intensities of each scanned point were obtained as a function of time, resulting in 16, 384 intensity-time curves. Collected intensity data of each retinal point of measurement were analyzed by discrete fast Fourier transformation, calculating the frequency laser Doppler shift for each point of measurement.
The AFFPIA full-field option provides the highest reliability because it includes the largest possible image area for analysis and automatically adjusts for the quality of the topographic image, “auto-cleaning” and masking any extra-wide vessels, ONH, and over- or under-exposed pixels [37]. In addition, each measurement was performed ten times in a chosen region to improve accuracy in ocular blood flow assessment.
, ophthalmic artery, posterior ciliary arteries, or central retinal artery) are appropriate to investigate with respect to the pathogenetic aspects of glaucoma. In this study, we utilized a commonly used SLDF device, HRF, which measures peripapillary retinal blood flow. Previous studies using HRF have reported significant decreases in ONH blood flow and juxtapapillary blood flow in open-angle glaucoma [41-43].
Patients were randomly assigned to one of two treatments: oral administration of 1.5 g of KRG three times daily for 12 weeks, followed by a washout period of 8 weeks and then 12 weeks of placebo, or the same scheme, but with the placebo first. Eighteen patients were allocated to group A (regimen, KRG-washout-placebo) and 18 to group B (regimen, placebo-washout-KRG).
selected. Statistical analyses of the data were performed using the Wilcoxon signed-rank test, comparing blood pressure, heart rate, IOP, VF indices (including mean deviation and pattern standard deviation), and retinal blood flow parameters for each phase of the study. The Wilcoxon rank-sum test was used for the comparison of the two groups.
For valid estimation of retinal blood flow by HRF, some requirements must be fulfilled: adequate brightness, no artificial movement, and a Doppler shift lower than 2, 000 Hz. To meet these requirements, the resultant perfusion images were processed by the SLDF-AFFPIA with respect to underexposed and overexposed pixels, saccades, and retinal vessel tree. In the first step of the statistical analysis, the operator marked saccades and the location of the rim area.
As mentioned above, it is unknown which source of blood flow plays a key role in the pathogenesis of glaucoma. Various techniques for the evaluation of ocular blood flow, including in the ophthalmic artery, short posterior ciliary arteries, and the central retinal artery, could strengthen the results of this study. Finally, the main limitation of this study is the small sample size.
대상 데이터
We recruited 36 consecutive patients (11 men and 25 women) with open-angle glaucoma between May 2009 and August 2009. All patients were examined in a prospective, randomized, placebo-controlled, double-blind, crossover study.
이론/모형
VF examinations were also performed at the same time. All tests were performed using standard automated perimetry (Humphrey Field Analyzer II with Swedish interactive thresholding algorithm standard 24-2; Carl Zeiss Meditec, Dublin, CA, USA). Each test included in the final analysis met the reliability criteria set by the manufacturer.
When the operator drew the inner and outer rim contour lines, the program automatically calculated the flow. In each HRF image, the central rim area and the adjacent temporal and nasal peripapillary areas were analyzed by the AF-FPIA program. All optic nerve heads (ONHs) were theoretically divided into three horizontal sections (superior, central, and inferior sections) (Fig.
[37, 38]. SLDF-AFFPIA was used to analyze the perfusion images off-line after the experiments. For valid estimation of retinal blood flow by HRF, some requirements must be fulfilled: adequate brightness, no artificial movement, and a Doppler shift lower than 2, 000 Hz.
성능/효과
First, the limited duration of our study did not allow us to predict how long the effects of KRG administration would last. The duration of the effect and optimal administration schedule for KRG treatment must be investigated in future studies of glaucoma patients.
In conclusion, significant increases in retinal blood flow were found in the temporal peripapillary areas after treatment with KRG as measured by HRF. Because numerous risk factors of a vascular nature have been reported to contribute to the pathogenesis of glaucoma, treatment to improve the ocular blood flow has some possibility of being helpful to prevent glaucoma progression.
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