ABSTRACT
Phenytoin is a non-sedative barbiturate derivate and has been recently rediscovered as a neuroprotective and retinoprotective compound in patients affected by optic neuritis secondary to multiple sclerosis. However, currently there are still no neuroprotective compounds registered and available in the clinic. We reviewed the literature supporting the retinoprotective properties of phenytoin and analyzed the various approaches and definitions from the first research periods onwards. The retinoprotective role of phenytoin was already known in the 1970s, but only recently has this effect been rediscovered, confirming that it could indeed provide structural protection of the retinal cells.
Subject(s)
Antineoplastic Agents/pharmacology , Enzyme Inhibitors/pharmacology , Neuroprotective Agents/pharmacology , Optic Neuritis/prevention & control , Phenytoin/pharmacology , Retina/drug effects , Antineoplastic Agents/chemistry , Drug Discovery , Enzyme Inhibitors/chemistry , Humans , Multiple Sclerosis/complications , Neuroprotective Agents/chemistry , Optic Neuritis/complications , Optic Neuritis/pathology , Phenytoin/chemistryABSTRACT
PURPOSE: To evaluate long-term follow-up of the orally administered combination of flavonoids with Centella asiatica and Melilotus for treatment of diabetic cystoid macular edema (CME) without macular thickening. METHODS: Seventy consecutive patients with type 2 diabetes and CME without macular thickening at optical coherence tomography (OCT) were prospectively and randomly enrolled in two groups of 35 subjects each (treatment and control groups). Patients in the treatment group were treated with an oral combination of diosmin (300 mg/day), with C. asiatica (15 mg/day) and Melilotus (160 mg/day). All patients underwent a complete ophthalmologic examination, OCT (Spectralis HRA-OCT), and central microperimetry (SD-SLO/OCT) at baseline, month 3, month 6, month 12, month 24, and month 36. RESULTS: No differences in HbAc1 percentage, blood pressure, microalbuminuria, visual acuity, mean central retinal thickness, and stability of fixation were present between the two groups during follow up (p>0.05). Retinal sensitivity reduced in the control group only from month 6 until month 36 (p<0.001). In the treatment group, a greater retinal sensitivity was present at month 12, month 24, and month 36 (p=0.001). No side effects of treatment were observed. CONCLUSION: Oral administration of flavonoids, C. asiatica and Melilotus, in patients with CME without macular thickening provided preservation of retinal sensitivity during 36 months of follow up when compared with untreated patients.
Subject(s)
Centella/chemistry , Diabetes Complications/drug therapy , Diosmin/therapeutic use , Macular Edema/drug therapy , Melilotus/chemistry , Plant Preparations/therapeutic use , Administration, Oral , Aged , Diabetes Complications/etiology , Diabetes Complications/physiopathology , Diosmin/administration & dosage , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Macular Edema/etiology , Macular Edema/physiopathology , Male , Middle Aged , Plant Preparations/administration & dosage , Prospective Studies , Treatment Outcome , Visual Acuity/drug effectsABSTRACT
Corneal oedema is a common sign of acute or protracted corneal disease of various aetiologies. In this paper, we review the causes and pathophysiological bases of corneal oedema, as well as discussing the goals and modalities of its medical treatment. Corneal oedema, if adequately understood and appropriately treated, generally shows a good prognosis.
