ACTAOPHTHALMOLOGICA

SCANDINAVICA
2000

firmed by other authors (Brogliatti et al.

The protective effect of citicoline on the 1991; Porciatti et al. 1998; Campos, 1997;
progression of the perimetric defects in Parisi et al. 1999).
The aim of this study is to evaluate the
glaucomatous patients (perimetric study effects in glaucomatous patients of re-
peated cycles of citicoline to verify if the
with a 10-year follow-up) retinal sensitivity improvement translates
in the long term into a protective effect
M. Virno, J. Pecori-Giraldi, A. Liguori, E De Gregorio on the visual field.
Institute of Ophthalmology, La Sapienza University, Rome Materials and Methods
A prospective study has been carried out
over 10 years on 23 glaucomatous pa-
Introduction no et al. 1989; Pecori-Giraldi et al. 1989). tients (23 eyes) with precocious or moder-
The use of citicoline in ophthalmology Later, its effects on retinal sensitivity and ate perimetric deficits.
was proposed by our school in 1988 (Vir- on electroretinographic traces were con- Eleven patients were treated with citic-
oline administered intramuscularly (1 g
for 15 days repeated every 6 months),

-*I
while 12 patients received no neuropro-

I tective treatment at all. They all had an

ocular pressure normalized by topical
pharmacological treatment.
Excluded from the study were patients
with elevated myopia (>8 dioptres), mac-
ulopathies, uveitis, diabetic retinopathy,
0.6
amblyopia, corrected visus <8/10 and
opacity of the crystalline lens or other di-
optric means. Furthermore, no patient
was to be under treatment with miotics,
nor have had any neuroprotective treat-
U
0.2 ment within the 6 months preceding en-
rolment.
All the patients were clinically tested:
visus examination (every 3 months);
0 I
2
I
4
6
4 io
biomicroscopy of the optic nerve head
(every 3 months);
Time Log Rank test: tonometry (each month);
.__________ P=0.007 Video Screen Perimetry (every 6 months).
TREATED CONTROLS As chief variable of efficacy, we con-
Fig. 1. Analysis of the survival curves. End point: VF worsening (increase of NPA -300mm2). sidered the worsening fraction of the vis-
ual field, evaluated by the non-perception
area (NPA), a perimetric index obtained
12000 I I by means of the Video Screen Perimetry
ANOVA: (Accornero et a]. 1984), a perimetric
P4.001 analysis technique used habitually in our
department. NPA may be considered an
indirect retinal sensitivity measure and is
closely correlated with the MD index of
conventional automatic perimetry. A vis-
ual field was deemed to be worse (end
point for the survival curve) when an in-
crease of the NPA >SO0 mm2 was found
P4.05 and confirmed in at least 2 consecutive
2000 examinations.
The data were analyzed by applying
the Log Rank test on the survival curves
of the two groups (treated and untreated
subjects) and a variance analysis for re-
peated measurements with SNK multiple
comparison test.
The size of the experimental sample

was such that a visual field worsening
fraction S10% in the treated group and
250% in the control group with a=0.05
and l-P=0.8 could be found.
Results
Survival curves show that the visual field
worsening fraction is greater in the un-
treated patients group (Log Rank test:
p=0.007) (Fig. 1).
The citicoline-treated patients ex-
hibited a significant improvement of reti-
nal sensitivity (NPA reduction) at the first
check (1 year) (SNKtest: pc0.05) which
then remained stable for the next 9 years
(ANOVA for repeated measurements: p=
0.19).
In the control group. there was an evi-
dent tendency towards progressive retinal
sensitivity reduction (NPA increase)
(ANOVA for repeated measurements:
p<O.OOl) (Fig. 2).
Conclusions
Repeated cycles (every 6 months) of in-
tramuscular injections of citicoline seem
to prevent the progression of perimetric
deficits in glaucomatous patients.
In the mechanism of action of this ef-
A retrospective study on the effects
of laser Gabeculoplasty in open-angle
glaucoma: a 10-year follow-up
L. Arrico, L. Taverniti, S. Donati, S. M. Recupero
Institute of Ophthalmology, La Sapienza University, Rome
Introduction
Numerous clinical studies have con-
firmed both the validity of laser trabecul-
oplasty (LTP) in the tonometric control
of POAG patients and its principal limi-
tation: its progressive loss of hypotensive
efficacy in the long term.
This retrospective study has been
undertaken to evaluate LTP's success in
POAG patients in the long term (120
months), considering success an ocular
pressure of <21 mmHg.
Materials and Methods
The retrospective investigation was made
of 50 eyes of glaucomatous patients who
had undergone LTI?
L 57
ACTAOPHTHALMOLOGICA
fect, it is probable that there is both Citic-
oline's neurotrophic, amply exploited in a
neurological field in treatment of the se-
quelae of ischaemic, traumatic or de-
generative events of the central nervous
system (Clark et al. 1997; Caamano et al.
1994; Eberhardt et al. 1990) and its
haemodynamic properties, capable of in-
creasing the cerebral (Caamano et al.
1994) and ocular (Virno et al. 1993)
blood flows.
References
Virno M, Pecori Giraldi J, Grechi G, Covelli
GP & De Gregorio F (1989): Valore terapeu-
tico della citicolina nel paziente glaucomato-
so (indagine perimetrica computerizzata).
Boll OCUI68 (SUPPI.2): 251-258.
Pecori Giraldi J, Virno M, Covelli GP,Gmhi
G & De Gregorio F (1989): Therapeutic
value of citicoline in the treatment of glau-
coma. Int Ophthalmol 13: 109-115.
Brogliatti B, Rolle T, Cantatore A & B m c o
M (1991): Citicolina vs Gangliosidi vs GMI
effetti sulla sensibilitd centrale in pazienti
glaucomatosi. Boll Ocul 70 (suppl. 1): 263-
269.
Porciatti V, Schiavi C, Benedetti P, Baldi A &
Campos E (1998): Cytidine-5'-diphospho-
choline improves visual acuity, contrast sen-
The sample selected included:
POAG patients
34 males and 16 females
mean age 62.1 years (ranging from 45 to
83 years)
gonioscopic aspect grade 3 or 4 on the
Shaffer classification
local therapy with beta-blocker + miotic.
All the patients had had one only LTP
treatment with argon laser on 180" of the
angular circumference carried out with 3-
mirror Goldmann lens, using parameters:
no. of spots=50
spot diameter=50 p
exposure=O.I sec
2000
SCANDINAVICA -
sitivity and visuallyevoked potentials of am-
blyopic subjects. Curr Eye Res 141-148.
Campos EC (1997): Future directions in the
treatment of amblyopia. Lancet 26,349
(9060): 1190.
Parisi V, Manni G, Colacino G & Bucci M G:
(1999): Cytidine-5'-diphosphocoline (citico-
line) improves retinal and cortical responses
in patients with glaucoma. Ophthalmology
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Accornero N, Berardelli A, Cruccu G & Man-
fredi M. (1984): Computerized video-screen
perimetry. Arch Ophthalmol 102: 40.
Clark WM, Warach SJ, Ikttigrew LC, Gam-
mans RE & Sabounjian LA. (1997): A ran-
domized dose-response trial of citicoline in
acute ischemic stroke patients. Citicoline
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Caamano I, Gomez MJ,Franco A & Cacab-
elos R. (1994): Effects of CDPtholine on
cognition and cerebral hemodynamica in pa-
tients with Alzheimer's disease. Methods
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Eberhardt R, Birbamer G, Gerstenbrand E
Rainer E & Traegner H (1990): Citicoline in
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Virno M, Pecori Giraldi J, Pellegrino N, Tav-
erniti L, De Gregorio F & Sedran L. (1993):
Farmaci attivi sull'emodinamica oculars.
Boll Ocd 72 (SUPPI. 2): 1-20.
energy=500-1000 mW
focused on the iter between the unpjg-
mented anterior trabeculate meshwork
and the pigmented posterior trabecular
meshwork.
The results obtained were analyzed by
evaluating the ocular pressure before and
after treatment. Ocular pressure checks
(expressed as the mean of the daily tono-
metric curve) were obtained on the day
before the LTP and then during the first
month after and again after 1, 2, 3, 4, 5,
6, 7, 8, 9 and 10 years.
The progress of the intraocular press-
ure values at the different times was
examined by variance for repeated meas-
urements analysis. The multiple compari-
sons were made with the t-test for paired
data. The IOP values observed at follow-
up were evaluated by the Kaplan-Meier
survival analysis which considers ocular
pressures >21 mmHg censurable.
Eyes affected by malformative glau-
coma, narrow-angle glaucoma, second-
ary glaucoma, glaucoma associated with
pigment dispersion, glaucoma associated
with capsular pseudoexfoliation and neo-
-