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Robert Casson, Glyn Chidlow, Andreas Ebneter, Guoge Han, Jolly Gilhotra, John Wood; Glucose-induced Temporary Visual Recovery in Human Glaucoma: A Prospective, Double-blind, Randomised Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4009.
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We have previously shown that elevated vitreal glucose levels provide robust neuroprotection against acute and chronic experimental retinal ischemia, and experimental glaucoma. In vitro, the effect is mediated by glycolytic energy supply and the pentose phosphate pathway. In this early translational study, we hypothesised that elevated vitreal glucose levels could temporarily improve psychophysical parameters of visual function in patients with primary open-angle glaucoma (POAG).
In a preliminary study on non-diabetic patients scheduled for vitrectomy, we showed that intensive topical application of glucose (50% glucose 5 minutely for 1 hour) significantly elevated the vitreous glucose concentration in pseudophakic but not phakic patients. We then conducted a double-blind, randomized crossover study on 28 pseudophakic eyes of 15 patients with POAG but no other ocular pathology. The main outcome measure was change from baseline in contrast sensitivity (CS) at 12 cycles/degree (using the CSV-1000). CS at 3, 6, and 18 cycles/degree, and the logarithm of the minimum angle of resolution (logMAR) visual acuity (VA) were secondary outcomes. Topical saline was used as a control, with a washout interval of 2-3 weeks. Patients randomly received either glucose/saline or saline/glucose. We applied the same glucose-dosing regimen as per the preliminary study, measuring CS, logMAR VA, refraction, intraocular pressure (IOP), and central corneal thickness (CCT) at baseline and 15-30 minutes after drops. The effect of treatment was modeled by linear regression using a generalized estimating equation approach to parameter estimation.
There were no adverse effects. Saline had negligible effect on visual function. The mean change from baseline after glucose treatment on the CS at 12 cycles /degree was 0.25 log units (95% C.I 0.09 -0.42) greater than saline (P = 0.003). CS was also significantly enhanced compared to controls at 3, 6, and 18 cycles/degree (P = <0.000; P = 0.006; P = 0.042). The mean change in logMAR VA was 2 letters (95% C.I. 0.7 -3.3) greater after glucose (P = 0.002). The glucose treatment had no significant effect on refraction, IOP, or CCT.
Intensive topical glucose reached the vitreous in pseudophakes, and improved the mean CS and VA in a group of pseudophakic patients with POAG, suggesting possible temporary neurorecovery at the level of the retina.
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