The potential of nootropic drugs in complex treatment of patients with primary open-angle glaucoma

PURPOSE: Investigation of neuroprotective efficacy of Ronocite in complex treatment of patients with primary open-angle glaucoma (POAG) with normal intraocular pressure (IOP) level based on clinical and functional evaluation of ophthalmological indices. METHODS: Sixty patients (38 women and 22 men) aged 60.75±12.83 years with POAG stages I-III have been examined. The duration of the disease varied from 6 months to 10 years, 3.1±0.6 years on average. All the patients were divided into 2 groups: the main group and the control group. The control group included 28 patients (47 eyes) who received a traditional treatment scheme. The main group (32 patients, 58 eyes) was treated with traditional therapy combined with Ronocite. All patients underwent the following examinations: best corrected visual acuity definition, biomicroscopy, goniosco-py, automated static perimetry on the Humphrey visual field analyzer (HFA II 740), tonography, eyeground examination with VOLK lens, optic coherent tomography (OCT), definition of electrical sensitivity threshold and optic nerve lability by phosphene, compliance monitoring. RESULTS: Good local and systemic Ronocite tolerance was noted through all periods of investigation. The use of the recommended scheme in the treatment of POAG patients demonstrated a reliable improvement in visual acuity up to 20/250-20/100 (0.08-0.2), which is 4 times higher than in patients treated with the generally accepted scheme. The patients of the main group showed a reliable improvement of fusion of flickering phosphenes (FFP indices): up to 14.5% at I stage, 13.9% - II stage in the main group, and 2.7 and 2.4% respectively in the control group. Ronocite provided a more marked neuroprotective effect in POAG patients, rendering an effective protection of the nervous tissue and delaying apoptosis. Along with the improvement of clinical and functional indices of the eye, we have noted an improvement of the general state, attention and working ability of the patients too. CONCLUSION: Analysis of the obtained results indicated a good clinical effect of Ronocite (Citicoline) in conservative treatment of POAG patients with compensated IOP. This drug may be recommended as an adjunctive to neuroprotective therapy of primary open-angle glaucoma.

лечение, глаукома, нейропротекторная терапия, роноцит, treatment, glaucoma, neuroprotective therapy, ronocite

1. Алексеев В.Н., Мартынова Е.Б. Новые подходы к гипотензивной терапии первичной открытоугольной глаукомы. Consilium Medicum 2001; 3(12): 3-9

2. Егоров Е.А., Алексеев В.Н. и др. Рациональная терапия в офтальмологии. Москва: Литтера; 2006; 953 с

3. Волков В.В. Глаукома открытоугольная. Москва: МИА; 2008; 348 с

4. Курышева Н.И. Роль методов визуализации диска зрительного нерва и слоя нервных волокон сетчатки в ранней диагностике глаукомы. Глаукома 2007; 1: 16-22

5. Курышева Н.И. Глаукомная оптическая нейропатия. Москва: МЕДпресс-информ; 2006; 315 с

6. Куроедов А.В., Городничий В.В. Компьютерная ретинотомография (HRT): диагностика, динамика, достоверность. Москва; 2007; 126 с

7. Шкарлова С.И. Глаукома и катаракта. Серия «Медицина для вас». Ростов н/Д: Феникс; 2001; 192 с

8. Нестеров А.П. Глаукома. Москва: МИА; 2008; 357 с

9. Cohen J.D., Drury J.H., Ostdiek J., et al. Benefits of lipid lowering on vascular reactivity in patients with coronary artery disease and average cholesterol levels: a mechanism for reducing clinical events? Am Heart J 2000; 139: 734-738.

10. Kaushik S., Pandav S.S., Ram J. Neuroprotection in glaucoma. J Postgrad Med 2003; 49(1): 90-95.

11. Schmidl D., Boltz A., Kaya S., et al. Role of nitric oxide in optic nerve head blood flow regulation during isometric exercise in healthy humans. Invest Ophthalmol Vis Sci 2013; 54(3): 1964-1970.

12. Han Y.S., Chung I.Y., Park J.M., et al. Neuroprotective effect of citicoline on retinal cell damage induced by kainic acid in rats. Ophthalmol 2005; 19: 219-226.

13. Haefliger I., Fleischhauer J., Flammer J. In glaucoma, should enthusiasm about neuroprotection be tempered by the experience obtained in other neurodegenerative disorders? Eye 2000; 14: 464-472.

14. Neufeld A. Nitric oxide synthase in glaucoma. International Glaucoma Review 2005; 7: 21.

15. Егоров Е.А., Астахов Ю.С., Щуко А.Г. Национальное руководство (путеводитель) по глаукоме для поликлинических врачей. Москва, Столичный бизнес, 2008; 136 c.

16. Авдеев Р.В., Александров А.С., Басинский А.С., Блюм Е.А., Брежнев А.Ю., Волков Е.Н. и др. Клинико-эпидемиологическое исследование факторов риска развития и прогрессирования глаукомы. Российский офтальмологический журнал 2013; 6(3): 4-11

17. Шмырева В.Ф., Петров С.Ю., Козлова И.В., Антонов А.А. Применение препарата нобен в терапии глаукомной оптической нейропатии. Глаукома 2007; 3: 29-34

18. Шмырева В.Ф., Петров С.Ю., Антонов А.А., Стратонников А.А., Савельева Т.А., Шевчик С.А., Рябова А.В., Урываев Ю.В. Исследование метаболизма тканей переднего отрезка глаза по уровню оксигенации гемоглобина в венозном русле при первичной открытоугольной глаукоме. Глаукома 2008; 3: 3-10

19. Петров С.Ю. Лимфатическая система глаза. Глаукома. Журнал НИИ ГБ РАМН 2011; 3: 58-62

20. Шмырева В.Ф., Петров С.Ю., Макарова А.С. Причины снижения отдаленной гипотензивной эффективности антиглаукоматозных операций и возможности ее повышения. Глаукома 2010; 2: 43-49