Use and outcomes of antioxidant therapy in ophthalmic practice


1Hospital for War Veterans No. 2, Moscow, Russia;

2Pirogov Russian National Research Medical University, Moscow, Russia;

3N.P. Bochkov Research Centre for Medical Genetics, Moscow, Russia

Advances in medical diagnostic technologies, particularly in ophthalmology, help researchers understand histological characteristics of the human eye and study vision at the cellular level. In addition to its role in the ocular function associated with the control of movements, senses and protective responses, the nervous system plays a key role in regulation of the visual process. Neurodegenerative disorders hold a special place among systemic diseases. Presently, the development of such pathologies are associated with neuroinflammation, which has been proven to also contribute to the glaucomatous process. For this reason, achieving target intraocular pressure does not always guarantee stabilization of the degenerative process. In this context, neuroprotective agents are recommended for glaucoma management to all patients taking into consideration pathogenetic characteristics of the disease. Based on its antioxidative and neuroprotective effects, ethylmethylhydroxypyridine succinate (Mexidol) is commonly used in ophthalmic practice, specifically in the treatment of patients with glaucomatous optic neuropathy and retinal diseases. The results of studies demonstrate that Mexidol is effective in slowing down neurodegeneration and stabilizing visual functions in patients with primary open-angle glaucoma due to its antihypoxic, antioxidant and membrane-stabilizing properties, as well as its positive impact on the neuromediator balance and ocular blood flow.
Keywords: ophthalmology, eye, neuroinflammation, glaucoma, glaucomatous optic neuropathy, neuroprotective therapy, ethylmethylhydroxypyridine succinate, Mexidol, Mexidol FORTE 250.

Use of Mexidol in the Therapy of Primary Open-angle Glaucoma


M.F. Vladimirsky Moscow Regional Research Clinical Institute

The article focuses on the complex therapy of primary open-angle glaucoma, namely the application and understanding of the principles of neuroprotection in the pathogenesis of the development of glaucomatosis optic neuropathy. Various biochemical reactions involved in the apoptosis of the retinal nerve fiber layer and in neurodegeneration processes are described. In Russian Federation, a reference antioxidant with a multimodal mechanism of action – Mexidol (ethylmethylhydroxypyridine succinate) has been registered and actively used actively used. Due to its unique complex molecule – the pyrimidine base and succinic acid derivative of compounds, Mexidol has high bioavailability and the ability to pass through the hematoencephalic barrier. The presence of succinate in the molecule also enhances the antioxidant effect, which is a fundamental difference between the drug and other antioxidant analogues presented on Russian pharmaceutical market. The mechanism of action of Mexidol is based on antioxidant, antihypoxant and membraneotropic effects. Given the wide range of action of this molecule, Mexidol acts on different links of oxidative stress, which is justifed in the complex treatment of primary open-angle glaucoma, in connection with which the drug is included in the standards of medical care in patients with glaucoma. The analysis of publications of the results of the study of ethylmethylhydroxypyridine succinate by various authors in primary open-angle glaucoma of stages I–III was carried out. A sequential scheme of therapy with Mexidol has been developed, with proven efficacy, slowing down neurodegeneration processes and stabilizing visual functions in patients with primary open-angle glaucoma.

Key words: glaucoma, Mexidol, antioxidant, neuroprotection, oxidative stress.

An experience with neuroprotective therapy of primary open-angle glaucoma based on the use of different dosage forms of Mexidol

1Railway Clinical Hospital on the Station Gor’kiy, JSC Russian Railways, Inter Railway Center of Ophthalmology, 18 Lenina prospect, Nizhny Novgorod, Russian Federation, 603140; 2Nizhny Novgorod State Medical Academy, 10/1 Minina i Pozharskogo Sq., Nizhny Novgorod, Russian Federation, 603950; 3Nizhny Novgorod City Hospital No. 35, City Center of Glaucoma, 15 Osharskaya St., Nizhny Novgorod, Russian Federation, 603005

Aim - to develop an algorithm to guide neuroprotective therapy in railway workers undergoing long-term follow-up for primary open-angle glaucoma (POAG) judging from the efficacy of sequential administration of intravenous dosage form of Mexidol and oral tablets. Material and methods. All sorts of JSC Russian Railways employees with stage I-III POAG and well-controlled intraocular pressure were enrolled. Mexidol was first to be administered intravenously by a dropper in a day hospital (250 mg daily for 5 days) and then taken orally at home (125 mg t.i.d. for 3 months). A comprehensive ophthalmic examination with hightechnology control was performed in all patients at their first, second, and third follow-up visits. Results. Data from 58 patients (96 eyes) were analyzed. Statistically significant improvements in perimetry and optical coherence tomography results were only obtained at a third visit, i.e. at the end of the course of Mexidol tablets. The treatment effect was most pronounced in stage I-II patients. Conclusion. The results suggest that combination therapy with intravenous and oral Mexidol received sequentially as well as long-term (3-month) administration of Mexidol tablets can both be recommended in POAG patients. It has been also found that neuroprotective therapy with Mexidol performs best for early stages of the disease.

Keywords: glaucoma, neuroprotective therapy, Mexidol, long-term follow-up.

Antioxidant agents in neuroprotection treatment of glaucoma

1The Russian National Research Medical N.I. Pirogov University; 2Helmholtz Moscow Research Institute of Eye Diseases

Purpose was to study efficiency and safety of mexidol in combined therapy in patients with primary open-angle glaucoma (POAG). 94 patients (185 eyes) at the age of 18—75 years old with POAG I—III stages were divided into 3 groups: 50 patients received combined therapy of mexidol 100 mg and picamilon 150 mg, 22 patients received combined therapy of mexidol 300 mg and picamilon 150 mg, 22 patients received only picamilon 150 mg. All medicine was administered qd during 14 or 21 days. Examination included standard ophthalmologic methоds, perimetry, electroretinography, retinal and optic nerve heard arterial blood flow. Improvement of visual acuity, perimetric, electrofisiological indicies and increased blood flow velocity of central retinal artery were registrated. Combined mexidol therapy allows improving results in treatment of patients with POAG.

Keywords: Mexidol, picamilon, primary open-angle glaucoma, glaucomatous optic neuropathy, optic nerve heard.

The influence of water soluble antioxidant agent (mexidol) on optic nerve and blood flow velocity in ocular and orbital arteries in patients with primary open-angle glaucoma

1Chelyabinsk State Medical Academy; 2Chelyabinsk Regional Clinical Hospital

The prospective single-blind placebo-controlled randomized trial is devoted to influence of mexidol (2-ethil-6-methil-3-hydroxipiridine succinate) on dynamics of optic nerve electrophysiologic profile and velocity indices of blood flow in ocular and orbital arteries in correlation with changes of retinal photosensitivity, visual acuity and visual field size during course of intravenous mexidol infusions and standard treatment of primary open-angle glaucoma. 2 weeks of intravenous infusions of 300 mg mexidol daily was found to cause depression of optic nerve electrical sensitivity threshold and widening of total visual field (16 mm2 test stimulus) after 14 days of treatment. These effects were not associated with changes of blood flow velocity in ocular and orbital arteries, were transient and came to initial indices 3 months after the end of treatment. Delayed vasotropic effect of mexidol manifested in increase of blood flow velocity in central retinal artery in 90 days after the end of infusions.

Keywords: mexidol, primary open-angle glaucoma, blood flow velocity in ocular and orbital arteries, optic nerve sensitivity.

Mexidol in complex treatment of glaucoma

FGU «MNII GB named after Gelmgoltsa Rosmedbiotechnology»
Department of Ophthalmology of Medical Faculty
GBOU VPO RNIMU Russian National Research Medical University

Purpose: to evaluate efficiency and safety of Mexidol solution in complex treatment in patients with POAG of I–III stages. Materials and methods: patients with POAG I–III stages with compensated IOP level (not more than 21 mmHg) were included into the study. All patients were divided into 3 groups: in 1st group Mexidol was prescribed on the background of standard treatment by 100 mg per day intramuscularly, in the 2nd group – on the background of standard treatment by 300 mg per day intramuscularly, 3rd group received standard treatment (picamilonum – by 1 tablet 3 times per day). Patients with I–II stages of glaucoma received treatment during 14 days, with III stage – 21 days. Evaluation of treatment effect was carried out in 30 days after it’s start. External eye examination, visometry, biomicroscopy, ophthalmoscopy, tonometry, computer perimetry, electrophysiologic examination, arterial pressure and heart rate measurements were proceeded on the first, intermediate and last control visits. Results: Visual acuity was improved in 1st and 2nd group more evidently than in the 3rd one. There was a tendency of improvement of the condition of the visual field (decreasing of the scotoma amount in patients which received Mexidol by 100 mg per day). Increased at the beginning electrosensitivity threshold in patients with I–III stages of glaucoma reduced by the end of the study, and decreased level of the electrical lability of optic nerve raised. Dosage of 300 mg per day was found more efficient than 100 mg per day. Conclusion: Mexidol could be recommended for inclusion into the complex treatment of patients with glaucomatous neuropathy.

Usage of Mexidol in patients with dystrophic diseases of posterior eye segment

Department of Ophthalmology, GOU VPO Russian State Medical University of Roszdrav Municipal Clinical Hospital 15, named after Filatov

Purpose: to evaluate the efficacy of Mexidol in patients with glaucomatous optic neuropathy. Materials and methods: 139 patients with glaucomatous optic neuropathy were divided into 3 groups: 45 patients received Mexidol, 46 – combined treatment by Mexidol, Treantal, Kavinton and Solcoseryl, 48 – were included in the control group. Examination was carried out before treatment and in 10 days after the beginning: evaluation of visual acuity, retinal light sensitivity, perimetry, retinotomography. Results: Visual acuity increased by 0.05–0.2 in 41 patients of the first group. Average peripheral visual field enlarging by 60–110 degrees was found in 35 patients. In 38 patients light sensitivity of the retina improved
by 3–5.9. In the second group improvement of visual acuity was detected in 39 subjects by 0.05–0.3, peripheral field enlargement– by 80–140 degrees in 41 patients and light sensitivity by 4.71 – in 42 patients.

Conclusion: Combined treatment including Mexidol allows achieving better results in treatment of patients with glaucomatous optic neuropathy.