Neuroprotection in Primary Open-Angle Glaucoma: The Role of a Fixed Citicoline-Homotaurine-Vitamin E Combination

Camillo Cornelio, Lorenzo Crisigiovanni, Virginia Limardo, David J. Nuzzo, P. Troiano
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Abstract

Glaucomatous optic neuropathy is a chronic degenerative neuropathy characterized by progressive damage of the retinal ganglion cells despite good compensation of intraocular pressure. The purpose of this study was to assess the effect of oral administration of a fixed combination of citicoline 500 mg + homotaurine 50 mg + vitamin E 12 mg (CIT/HOMO) on retinal ganglion cell function as examined by pattern electroretinogram (PERG) in subjects with primary open-angle glaucoma. A prospective, randomized, single-blind, balanced, crossover study was performed on a population of 40 patients with POAG-HT and fully-compensated IOP with topical hypotensive therapy. Recruited patients were allocated by balancing randomization to two treatment groups: - group A: patients continued current hypotensive eye-drop for 4 months and subsequently took 1 tablet of CIT/HOMO each morning for 4 months; - group B: patients took 1 tablet of CIT/HOMO each morning for 4 months in addition to current hypotensive eye-drop and subsequently continued with current hypotensive eye-drop alone for 4 months. Patients were examined at baseline (T0), after 4 (T1) and 8 months (T2). At every single time was performed a whole eye examination, 3 IOP measurements, 30.2 SITA Standard Humphrey visual field test, OCT cup/disc ratio and PERG glaucoma Hemifield test with central amplitude analysis. 38 patients completed the study for a total of 76 eyes. In both groups of patients tonometry, cup/disc ratio and visual field did not reveal any statistically significant difference. In both groups, adding the CIT/HOMO at hypotensive eye-drop resulted in an improvement in PERG after 4 months of therapy that disappeared when CIT/HOMO was withdrawn. Four months supplementation with a fixed combination of citicoline, homotaurine and vitamin E was seen to significantly increase the amplitude of the PERG bioelectric potential transmitted by the optical pathway to the visual cortex in subjects with primary open-angle glaucoma with compensated IOP and initial damage of the visual field and optic disc. During this study, the IOP remained compensated with the current hypotensive therapy and no deterioration was observed in the visual field or the cup/disc ratio.
原发性开角型青光眼的神经保护作用:固定胞胆碱-同牛磺酸-维生素E组合的作用
青光眼视神经病变是一种慢性退行性神经病变,其特征是视网膜神经节细胞进行性损伤,尽管眼压补偿良好。本研究的目的是评估口服胞胆碱500 mg +同型牛磺酸50 mg +维生素E 12 mg (CIT/HOMO)固定组合对原发性开角型青光眼患者视网膜神经节细胞功能的影响。一项前瞻性、随机、单盲、平衡、交叉研究对40例POAG-HT和全代偿性IOP患者进行了局部降压治疗。采用平衡随机法将入选患者分为两组:A组:患者连续4个月滴降压眼液,随后每天早晨服用1片CIT/HOMO,连续4个月;- B组:患者在当前降压滴眼液的基础上,每天早晨服用1片CIT/HOMO,连续4个月,随后继续单独使用当前降压滴眼液,连续4个月。分别在基线(T0)、4个月(T1)和8个月(T2)后对患者进行检查。每次进行全眼检查,3 IOP测量,30.2 SITA标准Humphrey视野测试,OCT杯盘比和PERG青光眼半视野测试,中心振幅分析。38名患者完成了总共76只眼睛的研究。两组患者血压计、杯盘比、视野差异无统计学意义。两组患者在降压滴眼液中加入CIT/HOMO后,治疗4个月后PERG改善,停用CIT/HOMO后消失。在伴有代偿性IOP、视野和视盘初始损伤的原发性开角型青光眼患者中,四个月的胞胆碱、同型牛磺酸和维生素E固定组合补充可显著增加经光学通路传递到视觉皮层的PERG生物电电位振幅。在本研究中,目前的降压治疗仍然补偿了IOP,视野或杯盘比未见恶化。
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