Oral Citicoline and Diabetic Retinopathy: Effects on Macular Ganglion Cell Layer Thickness

Abstract

Diabetic retinopathy (DR) is the main cause of blindness at a productive age, especially in developing countries including Indonesia. Damage to the retinal neural unit occurs to precede vascular disorders and inflammation. Citicoline has been used widely as a neuroprotector and proven in vitro and in vivo to maintain the function of retinal ganglion cells (RGC) in glaucoma. The objective of the study is to measure the macular GCL thickness after administration of citicoline in patients with DR. All subjects with DR receive 500 mg citicoline administered orally once daily for 2 weeks. Before and after citicoline administration, all subjects undergo examinations of visual acuity, funduscopy, intraocular pressure (IOP), fundus photos, and measurements of retinal ganglion cells (GCL) thickness of the macula by ocular computed tomography (OCT). There are 13 subjects with DR, most of whom are female (69.2%), aged between 40-60 years (53.6%), and have bilateral DR (65%). Non-proliferative diabetic retinopathy- NPDR is found in 30.8% of subjects and macular edema in 53.8% of subjects. The average macular ganglion cell layer (GCL) thickness is 59.23 + 31.83 um. After citicoline administration, there is a GCL thickness increase significantly in subjects with proliferative diabetic retinopathy (PDR). The thinning of GCL is shown in subjects with DME. Citicoline may play a role in maintaining the neural unit of the retina, especially the ganglion cell layer. Further studies are needed to explore the effect of citicoline on each stage of diabetic retinopathy.