Elsevier

Ophthalmology

Volume 106, Issue 6, 1 June 1999, Pages 1126-1134
Ophthalmology

Cytidine-5′-diphosphocholine (citicoline) improves retinal and cortical responses in patients with glaucoma1

Presented in part at the Association for Research in Vision and Ophthalmology annual meeting, Fort Lauderdale, Florida, May 1998.
https://doi.org/10.1016/S0161-6420(99)90269-5Get rights and content

Abstract

Purpose

To evaluate the effects of cytidine-5′-diphosphocholine (citicoline) on retinal function and on cortical responses in patients with glaucoma.

Participants

Forty patients with open-angle glaucoma were randomly divided into two age-matched groups: citicoline group ([GC] n = 25) and placebo group ([GP] n = 15).

Methods

The GC patients were treated with Neuroton (citicoline, 1000 mg/day intramuscularly) for 60 days; GP patients were treated with placebo (physiologic solution with additives) for 60 days. After 120 days of washout (day 180), the GC patients were divided into two age-matched groups: in 10 patients (GC1 group) the washout was prolonged for a further 120 days; in 15 patients (GC2 group) a second 60-day period of citicoline treatment was followed by a second 120-day period of washout. At day 180, the washout was extended for another 180 days in GP patients. In all subjects, retinal and cortical responses were evaluated by simultaneous recordings of visual evoked potentials (VEPs) and pattern-electroretinograms (PERGs) at baseline, after 60 days, and after 180 days. At day 300, VEPs and PERGs were also evaluated in GC1 patients, and at 240 and 360 days in GC2 and GP patients.

Main outcome measures

Visual evoked potential parameters (P100 latency and N75-P100 amplitude); PERG parameters (P50 latency and P50-N95 amplitude); and intraocular pressure.

Results

The GP patients displayed similar VEP and PERG parameters in all examinations performed. In GC patients, the treatment with citicoline induced a significant (P < 0.01) improvement of VEP and PERG parameters, and their values were significantly different (P < 0.01) with respect to those of GP patients (P < 0.01). Visual evoked potentials and PERGs, recorded in GC patients after washout, revealed that although there was a worsening trend, the electrophysiologic improvement was still maintained. After a second period of washout, GC1 patients had VEP and PERG parameters similar (P > 0.05) to baseline ones and to those of GP patients. In GC2 patients, a second period of citicoline treatment induced a further (P < 0.01) improvement of VEP and PERG parameters

Conclusion

Citicoline may induce an improvement of the retinal and of the visual pathway function in patients with glaucoma.

Section snippets

Materials and methods

Forty volunteer patients with open-angle glaucoma took part in the study. In all patients enrolled, when the diagnosis of glaucoma was made, the IOP was greater than 21 mmHg without any topical treatment (range, 23–27 mmHg; mean, 25.10 ± 1.55 mmHg). Each patient received topical treatment with beta-blockers only, and an IOP less than 21 mmHg was observed (mean, 17.5 ± 1.3 mmHg). Filtration surgery had never been performed in any of the patients participating in this study. Other inclusion

Results

Examples of simultaneous recordings of VEP and PERG before and after the medical treatment with citicoline or placebo are displayed in Figure 1. The mean data and the statistical analysis are shown in Table 1 and Figure 2, Figure 3, Figure 4, Figure 5, Figure 6.

At baseline, similar values for VEP and PERG parameters (P > 0.05) in GC and GP patients were observed (Figure 2, Figure 3, Figure 4, Figure 5, Figure 6 “basal”).

Discussion

The present study was designed to evaluate the retinal and visual cortical responses in patients with glaucoma treated with citicoline using simultaneous recordings of VEPs and PERGs.

We observed an improvement of cortical responses (VEP) in our glaucoma patients after treatment with citicoline, together with an improvement of retinal responses (PERG) and an improvement of the index of neural conduction in the postretinal visual pathways (RCT).

Although our results clearly show the effects of

Acknowledgements

We thank Dr. Vittorio Porciatti for helpful discussion and critical reading of the manuscript. The authors also thank Nuovo Consorzio Sanitario Nazionale, Rome, Italy, for kindly providing Neuroton and placebo.

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