Is There a Benefit of Systemic Citicoline Administration in End-Satge Glaucoma Patients?

Abstract

Purpose : Glaucoma is the leading cause of irreversible blindness in the general population. End-stage glaucoma carries a relevant challenge in its clinical management. Some scientific evidence has suggested that citicoline can be used as a supplement to preserve vision in glaucoma patients. The aim of this study is to investigate the effect of systemically administered citicoline in the visual function in patients with end-stage glaucoma in a real-world setting.

Methods : A retrospective assessment of 134 electronic medical records of consecutive patients with end-stage glaucoma under treatment with citicoline (orally, 500 mg BID) for at least three months was performed. Clinical data including best-corrected visual acuity (BCVA), IOP, number of glaucoma medications, visual field indexes (VFI) evaluated by applanation tonometry, cup-to-disc (CD) ratio, peripapillary retinal nerve fiber layer (RNFL) and perimacular ganglion cell complex (GCC) thickness by OCT. Tolerability and safety issues were also recorded.

Results : From 134 patients under oral citicoline treatment, 27 were excluded; therefore, 206 eyes from 107 patients were analyzed in this study (58 females, 49 males). This population had a mean age of 68.0±17.6 years and a greater proportion of primary open-angle glaucoma (60.7%), as well as at least two glaucoma medications (70.8%) for topical administration. Mean time of citicoline administration was 5.1±0.7 months. Baseline measurements of IOP of both eyes (RE, 13.6±6.3 mmHg; LE, 13.4±5.8 mmHg; P=0.80) was not significantly different as compared to the last follow-up quantification (RE, 13.4±6.1 mmHg; LE, 13.3±6.0 mmHg; P=0.86). BCVA, VFI (with exception of LE mean deviation), CD ratio, CFNR and GCC were not statistically different when baseline mean values were compared to the ones measured in the last visit (p>0.05). Only mean deviation for the left eyes was different after comparison (-21.53±10.36 mmHg; LE, -24.32±8.4 mmHg; P=0.005). Minor headache (12.1%) and intermittent diarrhea (2.8%) were the only tolerability issues recorded. Twenty three patients (21.5%) claimed to have a subjective improvement in their vision.

Conclusions : In this retrospective “real world” study of end-stage glaucoma patients, no significant improvement was observed when citicoline was orally administered during a short-term period. Safety and tolerability were acceptable. A subjective improvement perception was uncommon.

This is a 2021 ARVO Annual Meeting abstract.