Management of macular fluid retention by Kampo medicine “1st International Symposium on Kampo Medicine”

To The Editor Macular edema can result from a variety of diseases. Fluid retention in the macula can result in deterioration of visual acuity and metamorphopsia. Treatment usually involves direct management of the primary disease; however, such management or treatment is not always effective. Prolonged retention of macular fluid may lead to irreversible damage to macular function. The main treatment protocols currently recommended by Western ophthalmologists include retinal photocoagulation, vitrectomy, steroid injection, and anti-vascular endothelial growth factor (anti-VEGF). Anti-VEGF injection into the vitreous is currently the standard treatment for intraretinal fluid retention in Japan. However, this method is sometimes ineffective and is not considered curative. In addition, there are some cases where this treatment cannot be performed for various reasons. Kampo medicine may be very effective in cases that have been resistant to treatment strategies employed in Western medicine. Therefore, Kampo medicine has been examined as a possible means for the management of macular fluid retention. Herein, we present recent findings suggesting novel approaches to the treatment of macular edema, one of the most refractory eye diseases, using Kampo medicine. The first presentation is “Several Cases of Macular Edema Managed by Kampo Medicine.” Many macular diseases are known to be complicated by retinal fluid retention. Macular fluid retention can result in deterioration of visual acuity and metamorphopsia. Although anti-VEGF injections are standard treatment in Western ophthalmology, the treatment is not always effective. Further, they do not represent a radical treatment option, with need for long-term additional treatment. I have sought to manage macular fluid retention using Kampo medicine and found that some cases of refractory macular edema were resolved by treatment with Kampo medicine. Herein, I present various well-managed cases together with the results of optical coherent tomography. The Kampo medicine formulas used for each disease were as follows; yokukansankachinpihange for diabetic diffuse macular edema, keishibukuryogan + shosaikoto for age-related macular degeneration, daisaikoto for retinal vein occlusion, shinbuto for epiretinal membrane, and tokishakuyakusan for central serous chorio-retinopathy. The second presentation is “Six Cases of Diabetic Macular Edema Successfully Treated with Kampo Medicine.” Medical treatment for diabetic macular edema (DME) includes control of blood glucose, retinal photocoagulations, and intravitreous injections of anti-VEGF but no definitive treatment has been established. The last carries a serious risk of infection. The author prescribed Chinese herbal medicine according to oriental treatment patterns for six cases of DME not improved by the above treatments. Patients showed various conditions, such as blood stasis, yang deficiency of the kidney, qi deficiency of the whole body, dampness-heat of the spleen and stomach, dampness-heat of the liver and gallbladder, qi deficiency of the spleen, fire heat and wind of the liver, both yin and yang deficiency of the kidney, and fluid retention. The prescribed drugs and herbs were keppuchikuoto, hochuekkito, goshajinkigan, hoyokangoto, inchingoreisan, keishibukuryogan, boiogito, chotosan, Astragalus root and Japanese Gentian root, and were given as a decoction in five cases and an extracted powder in one case. Drugs for blood stasis and the Astragalus root for qi deficiency and fluid retention were both given in six cases. Treatment with Kampo medicine was effective for all six cases. This report suggests that Kampo therapy, in accordance with oriental treatment patterns, is both safe and effective for DME. The third presentation is “Treatment of Macular Edema Followed by Retinal Vein Occlusion.” Retinal vein occlusion (RVO) is broadly divided into central retinal vein occlusion and branch retinal vein occlusion. Intravitreal injections of anti-VEGF agents are used to treat macular edema, the most common cause of visual dysfunction due to each RVO type. Reduction of edema and improvement in visual acuity can be achieved early after treatment. Kampo medicine for RVO is not common in Japan. However, many cases of macular edema recur, and some cases are resistant to treatment or have poor visual prognoses. Kampo medicine including dietary therapy is effective in some cases. Although slow-release drugs are being developed for cases refractory to standard treatment, which may Received: 24 May 2022 Revised: 22 June 2022 Accepted: 22 June 2022