Johannes Nepp

Pain that does not responde to conventional treatment procedures makes it necessary to look for alternative methods. Acupuncture is an ancient procedure with empirical effects on pain. Previous studies established the increased output of messangers at neuronal junctions in spinal cord and hypothalamic locations , especially of endorphins which inhibit the perception of pain. We treated several painful symptoms with acupuncture and evaluated the outcome of the treatment. Patients with various kinds of therapy-refractory pain and patients in whom conventional treatment methods could not be applied were included in the study. The diagnoses included glaucoma. Tolosa-Hunt-Syndrome, ophthalmic migraine, blepharospasm, and dry eyes. In one case acupuncture was used for analgesia during surgery. Acupuncture was performed with sterile disposable needles, at points known to have an empirical analgesic effect. The stimulation was adapted to the patient’s individual needs. VAS assessments before and after acupuncture were compared. The t-test was used for statistical evaluation. Acupuncture had no side effects, but reduced pain to a variable extent. Especially in cases of severe pain and in surgery, very effective pain reduction was achieved. In general, pain was significantly reduced in all patients by the use of acupuncture. A statistically significant effect was noted (p<0.05). Further studies should be conducted to demonstrate the specific effect in larger patient populations. Monitoring neurotransmitter activity will possibly help to illustrate the effect.

Patients with diabetic retinopathy (DRP) seldom report symptoms of ocular surface irritation, but evaluations of dryness are pathologic. This study was designed to evaluate the correlation between the severity of DRP and dry eyes. We included 144 eyes of 72 patients. Severity of retinopathy was graded according to the Early Treatment Diabetic Retinopathy Study. The examinations for dry eyes included Schirmer's test, break-up time, lipid layer thickness, fluorescein and rose bengal staining of the cornea, impression cytology, and a questionnaire. A sicca severity score was calculated using a point system of the results of these tests. Patients were divided into three groups: postpanretinal laser coagulation (PPL), postcentral laser coagulation (PCL), and those with no laser treatment (0-L). For statistics, we used the correlation coefficient to determine relationships and the unpaired Student t test for statistical difference. The correlation (c) of keratoconjunctivitis sicca (KCS) and DRP after laser treatment was c = 0.24 and after central laser treatment was c = 0.22; the correlation without laser treatment was 0.54. The best correlation is 1 or -1, the worst was 0. The score of those patients with mild to moderate retinopathy was compared to that of patients with severe to proliferative disease. There was a significant statistical difference in the sicca severity score between both groups, (p < 0.006. Student t test). KCS represents another manifestation of diabetes mellitus and its severity--measured by a many-membered score--correlates with the severity of the DRP.

Hintergrund Nicht penetrierende Hornhautverletzungen durch Fremdkörper sind häufig und können schwere Komplikationen, wie Hornhautinfiltrate oder Ulzera zur Folge haben. Material und Methoden In dieser prospektiven Studie wurden 144 Patienten mit nicht penetrierenden Hornhautverletzungen mittels Fragebogen nach epidemiologischen Daten, Art der Tätigkeit, auslösenden Ursachen, Begleitumständen der Verletzung, sowie nach Belastungsfaktoren und der Verwendung von Schutzmaßnahmen gefragt. Ergebnisse 97% der Patienten waren Männer. 78% der Unfälle ereigneten sich während der Arbeitszeit. 41% aller Verletzungen stammen aus Metallbearbeitungsberufen. Die Verletzung erfolgte zu 73% an Schleif- und Bohrgeräten. Nur 6,9% der Patienten verwendeten adäquate Schutzbrillen. Als Unfallursache wurde zumeist Ablenkung oder das Arbeiten ohne Schutzbrille angegeben. Bei 32% der Patienten spielten Streßfaktoren eine Rolle. Schlußfolgerung Diese Studie zeigt, dass die meisten nicht penetrierenden Hornhautverletzungen während der Arbeitszeit, ohne Verwendung von Schutzbrillen bzw. durch Ablenkung, erfolgte. Die Verwendung von geeigneten Schutzmaßnahmen könnte die Zahl der Verletzungen entscheidend verringern, und damit durch Arbeitsunfähigkeit bedingte Ausfälle und volkswirtschaftlichen Kosten vermeiden. Background Non-penetrating injuries of the cornea are frequent. Complications like corneal infiltrations, or corneal ulcera, may follow. Material and methods This prospective study included 144 patients with non-penetrating corneal injuries. Records contained epidemiological data, field of activity, profession, cause of the injury, and stress during the trauma. Results 97% of the patients were men, 78% of the injuries occurred during working hours, 41% of the patients were from metal working professions. 73% of the accidents happened with grinding machines and drilling machines. Only 6.9% of patients weared adequate glasses. The cause of trauma was deflection and working without glasses. In 32% of patients stress played a role in the cause of injuries. Conclusions Most of the corneal, non penetrating injuries happened during the working hours by deflection, and by neglecting safety glasses. With the use of safety glasses the number of corneal non-penetrating injuries could definitely be reduced.

Conjunctivitis sicca is a chronic disease of the ocular surface. The substitution of tear deficiency with artificial tears is not satisfying in many patients. In a series of patients successfully treated with acupuncture we observed very different effects on each patient. In this study we evaluate the correlation between the effect of acupuncture and the etiology of the dry eyes treated. 102 patients (87 women, 15 men) with dry-eye syndrome have been needed 10 sessions, once per week, for 30 minutes. We recorded causal factors according to the traditional chinese medicine (TCM): external and internal factors. External factors were: toxic, allergic, drug-induced, ocular surface inflammation and infection, contact lens and generally external irritations. Internal factors were disorders of hormones, immune system, psychic, and vitamin-A deficiency. Ophthalmologic observation included the slit-lamp examination, Schirmers test II, break-up time of tear film (BUT) and a drop-frequency protocol--before and 1 week after acupuncture treatment. There was a statistically significant difference (p < 0.001) in Schirmers test, BUT and drop frequency between before and after acupuncture. There was no significant difference between internal and external factors, but the effect on external induced sicca was better. The best effect of acupuncture was found in external factors after inflammation and in patients with imbalance of the autonomic nervous system, the least effects in Sjögren Syndrome. The effect was better in younger then in patients over 50 years. The study demonstrate, according DeLa Fuye that the best effect of acupuncture is seen on functionally disorders.

Blepharospasm is a dystonia of the orbicularis muscle. The background is still unknown, but it appears together with organic and psychic diseases. The therapy with botulinum toxine is symptomatically but efficient. Because of the relaxing effect on the psychological and autonomous nervous disorders we performed a pilot study with acupuncture. There was a neurological observation first, then a ophthalmologic examination of the ocular surface. Blepharospasm was measured by the Visual Analogue Scale (VAS), the social disorders by the Elston-Score. We performed acupuncture treatment 10 times once weekly. The used points were local points with higher sensitivity, and points with empiric relaxation effect. 5 patients were included. The mean of Elston score was 3 before acupuncture and 4 after acupuncture. The VAS increased from 33.3 to 69/100 points. But there were fluctuations of dystonias. In conclusion acupuncture maybe a good method for this difficult disease additionally.