Open-angle glaucoma (OAG) is a progressive optic neuropathy, and intraocular pressure (IOP) is an important therapeutic target in its pathophysiological process. Pressure can significantly slow down disease progression. However, clinical trials and the clinical experience of many doctors have shown that although some patients' intraocular pressure "looks good", their glaucoma damage will still progress, so the neurodegenerative changes in glaucoma may not be related to intraocular pressure-that is, non-ocular pressure Rely on mechanism.
The optic nerve degeneration caused by glaucoma has a non-independent mechanism of intraocular pressure, that is to say, even if the intraocular pressure is controlled at a low level, the visual field damage still progresses significantly. Therefore, as early as 15 years ago, ophthalmologists began to propose the concept of neuroprotection in glaucoma. Since then, many experiments have tried a variety of molecules that may act as "neuroprotective agents" and obtained interesting results, but most of them have shown insufficient evidence based on meta-analysis.
Citicoline has "significant clinical effects" in a variety of neurodegenerative diseases such as Alzheimer's disease and stroke, and its mechanism of action may include preservation of cardiolipin and sphingomyelin, restoration of phosphatidylcholine Alkali, stimulate glutathione synthesis, reduce glutamate concentration, rescue mitochondrial function, etc. Some scholars have used citicoline to treat glaucoma before, and achieved good results. However, whether long-term application can effectively slow down the progression of glaucoma has not yet been concluded, which is exactly what the researchers want to explore.
In this randomized, double-blind, placebo-controlled trial, the researchers included 80 open-angle patients who had previously controlled intraocular pressure below 18 mmHg through medication or surgery for at least 2 years, but still had progressive mild to moderate glaucomatous visual field damage. glaucoma patients. In a follow-up 3-year trial, patients were randomized to receive citicoline/placebo eye drops in addition to previous IOP-lowering therapy. During the 3-year follow-up period, there was no significant difference in intraocular pressure between the two groups, and both were controlled below 18mmHg.
The study found:
● The progression of visual field damage in the experimental group treated with citicoline eye drops was significantly less than that in the control group: it was close to statistical significance measured by 24-2 Humphrey perimetry (-1.03 vs. -1.92, P = 0.07) , measured by 10-2 Humphrey perimetry was statistically significant (-0.41 vs. -2.22, P=0.02).
Fig. 10-2 Measurement results of Humphrey perimetry
● OCT examination of retinal nerve fiber layer thickness (Retinal Nerve Fiber Layer, RNFL) found that the RNFL damage in the experimental group was also significantly smaller than that in the control group (1.86μm vs. 2.99μm, P = 0.02).
● During the study, citicoline eye drops were well tolerated, and no local or systemic treatment-related side effects were observed, nor did it significantly alter the safety of IOP-lowering therapy.
For some patients with open-angle glaucoma, although the IOP is ≤18 mmHg, the visual field damage is still progressing; the use of citicoline eye drops, as an additional treatment besides lowering IOP, can effectively slow down the progression of optic nerve damage. Citicoline eye drops were well tolerated, with no local or systemic treatment-related side effects.
*Special note - This article is for informational purposes only and cannot replace a doctor's treatment diagnosis and advice. It should not be regarded as a recommendation or proof of efficacy of the medical products involved. If it involves disease diagnosis, treatment, and rehabilitation, please be sure to go to a professional medical institution to seek professional advice.