Efficacy of complex neuroprotection in glaucomatous optic neuropathy

Abstract

Background. The problem of glaucomatous optic neuropathy is not solved regardless the fact that intraocular pressure is stabilized. To manage the glaucomatous process, effective neuroprotection of the ganglion cells is required. The purpose of the paper was to study the efficacy of complex neuroprotection in patients with glaucomatous optic neuropathy using sequential laser radiation of the papillomacular bundle followed by a six-month vitamin and antioxidant supplement therapy. Material and Methods. We followed up 27 patients (43 eyes) with advanced open angle glaucoma, verified glaucomatous optic neuropathy (GON), and stabilized intraocular pressure (IOP). The patients’ age averaged 63.8 (SD; 6.8). A treatment course included 10 every-day sessions of laser stimulation (LS) using a SM-4.3 unit (wavelength, 650 nm; irradiance, 0.4 mW/cm2; treatment timing, 240 s on the papillomacular bundle) and additional directed laser radiation to the optic disc (OD) using a 90 D lens (treatment timing, 60 s). Thereafter, patients received a vitamin supplement with 1 mg resveratrol: one capsule daily for 6 months. Results. A combined treatment including LS of the optic nerve and the papillomacular bundle followed by a six-month vitamin and antioxidant supplement therapy with resveratrol in patients with glaucomatous optical neuropathy made it possible to increase visual acuity from 0.65 to 0.82 (by 26%), to increase visual system sensitivity with phosphene current threshold decreased from 84.9 μA to 76 μA (by 10%), to improve ocular blood circulation from 2.4 to 2.6‰ (by 8%), to decrease vasospasm from 26.7 to 21.8% (by 18%), significantly increase overall retinal light sensitivity from 1395.0 to 1709.0 dB (by 23%), and to stabilize the glaucomatous process within six months. Analyzing the data obtained after a neuroprotective LS course with a subsequent vitamin antioxidant supplementation therapy with reseratrol (1 mg) revealed an apparent correlation between an increase in overall light sensitivity of the retina and an increase in the blood circulation in the eye (rs=0.71, р<0.01) as well as a decrease in threshold current of visual system sensitivity (rs=-0.84, р<0.01). Conclusions. A combined treatment including LS of the optic nerve and the papillomacular bundle followed by a six-month vitamin and antioxidant supplement therapy with resveratrol (1 mg) in patients with glaucomatous optical neuropathy contributes to: an increase in visual acuity by 26%; an increase in the visual system sensitivity, evidenced by a decrease of phosphene threshold current by 10%; an improvement in ocular blood flow by 8%; a decrease of intraocular vasospasm by 18%; and a significant decrease in overall retinal light sensitivity by 23%. It also supports: an increase in conduction of optic nerve fibers; an improvement of the papillomacular bundle function; and stabilization of the glaucomatous process withing six months.

Keywords

• glaucomatous optic neuropathy
• neuroprotection
• laser stimulation
• nutrition therapy