1. Clinical effect of citicoline combined with choline alfoscerate for treatment of glaucomatous optic neuropathy
Karliychuk M.A., Pinchuk S.V. Department of Ophthalmology,
Bukovinian State Medical University,
Chernivtsi, Ukraine

2. Background. Glaucoma is a neurodegenerative disease characterized by progressive loss of retinal ganglion cells. Citicoline is nootropic and neuroprotective drug that is able to increase neurotrasmitters levels in the central nervous system. It is known that choline alfoscerate improves the cerebral blood flow and the transfer of nervous impulses in cholinergic neurons, positively influences on plasticity of neuronal membranes and receptor functioning.

3. The purpose was to assess the clinical efficacy of citicoline combined with choline alfoscerate for treatment of glaucomatous optic neuropathy in patients with primary open-angle glaucoma with normalized intraocular pressure (IOP).
Methods: The study comprised 27 patients (36 eyes) with the same stage of primary open-angle glaucoma with normalized IOP who were divided into 2 groups. The intraocular pressure was stable (≤ 15 mmHg) with or without local medications. 16 patients of main group (21 eyes) received citicoline in dose of 500 mg twice a day during 2 months and choline alfoscerate in dose of 400 mg twice a day during 2 months. The retinal threshold sensitivity in 76 points of central visual field was assessed with the Humphrey Field Analyzer (HFA II 720, central 30-2 test) before and every three month during 1 year. Optical coherent tomography with assessment of cup-to-disk area ratio and average thickness of retinal ganglion cells complex) was performed by RTVue-100 (Optovue, Inc., Fremont, USA).
GCC

4. Results: Before the treatment the patients of the both groups had depression of retinal threshold sensitivity in paramacular zone 7,87-11,67 dB deep with the most intensive depression in the superior nasal area in 5-10° to fixation and 15-20° inferior and external to fixation. After the treatment with citicoline combined with choline alfoscerate the results of central 30-2 threshold test indicated that retinal threshold sensitivity in the patients of main group was at an average on 3,45 dB higher than initial and statistically significantly greater (р<0,05) than in patients of control group according to data of Mean Deviation. In main group in 61,9% of cases (13 eyes) the decrease of sizes of paracentral scotomata was observed. These results suggest that therapeutic schema of using citicoline and choline alfoscerate improves the retinal threshold sensitivity. The statistic analysis of the parameter Mean Deviation as well as Loss Variance at 3-, 6-, 9-, and 12-months follow-up took place. We found no statistically significant changes (no worsening) of the parameters at each time points. So, we found stabilization in visual fields in one year. Cup-to-disk area ratio and average thickness of retinal ganglion cells complex were stable in one year follow-up only in patients of main group. Average thickness of retinal ganglion cells complex was significantly worse in patients of control group within 6 months: 79,85±9,12 μm at the beginning of the study and 54,23±8,24 μm in 6-month follow-up (p<0,05).

5. Changes of structural and functional parameters in patients of main and control groups before and after treatment
Parameter
Group
Before treatment
In 3 months
In 6 months
Avg. GCC
(μm)
main, n=21
83,25±10,18
78,44±9,38
79,52±9,32
p1>0,05
control, n=15
79,85±9,12
68,46±9,87
54,23±8,24
p1<0,05
p2<0,05
Cup/disc area ratio
0,51±0,17
0,53±0,16
0,52±0,19
0,54±0,2
0,58±0,21
0,69±0,18
MD (dB)
-9,4±0,72
-7,3±0,69
-6,5±0,74
-9,6±0,86
-7,5±0,89
-8,4±0,74
PSD (dB)
8,7±0,95
6,2±0,65
6,1±0,76
8,6±0,85
6,1±0,63
6,8±0,79
p1 – significance of differences in parameters before and after treatment;
p2 - significance of differences in parameters of main and control groups.

6. CONCLUSIONS:
It was established that therapeutic schema of using citicoline and choline alfoscerate in combination is effective in complex treatment of glaucomatous optic neuropathy in patients with primary open-angle glaucoma with normalized IOP.
Disclosure statement: no financial support