Therapeutic benefit of idebenone in patients with Leber hereditary optic neuropathy: The LEROS nonrandomized controlled trial

Leber hereditary optic neuropathy (LHON) is a mitochondrial disease leading to rapid and severe bilateral vision loss. Idebenone has been shown to be effective in stabilizing and restoring vision in patients treated within 1 year of onset of vision loss. The open-label, international, multicenter, natural history-controlled LEROS study (ClinicalTrials.gov NCT02774005) assesses the efficacy and safety of idebenone treatment (900 mg/day) in patients with LHON up to 5 years after symptom onset (N = 199) and over a treatment period of 24 months, compared to an external natural history control cohort (N = 372), matched by time since symptom onset. LEROS meets its primary endpoint and confirms the long-term efficacy of idebenone in the subacute/dynamic and chronic phases; the treatment effect varies depending on disease phase and the causative mtDNA mutation. The findings of the LEROS study will help guide the clinical management of patients with LHON

Dietary Antioxidants in Age-Related Macular Degeneration and Glaucoma

Age-related macular degeneration (AMD) and glaucoma are ophthalmic neurodegenerative diseases responsible for irreversible vision loss in the world population. Only a few therapies can be used to slow down the progression of these diseases and there are no available treatment strategies for reversing the degeneration of the neural retina. In AMD, the pathological process causes the malfunction and damage of the retinal pigmented epithelium and photoreceptors in the macula. In glaucoma, damage of the retinal ganglion cells and their axons is observed and treatment strategies are limited to intraocular pressure lowering. Therefore, other prophylactic and/or therapeutic methods are needed. Oxidative stress is involved in the neurodegenerative process accompanying both AMD and glaucoma; therefore, the use of antioxidant agents would clearly be beneficial, which is supported by the decreased prevalence and progression of AMD in patients adherent to a diet naturally rich in antioxidants. Dietary antioxidants are easily available and their use is based on the natural route of administration. Many preclinical studies both in vitro and using animal models of retinal degeneration showed the efficacy of dietary antioxidants, which was further proved in clinical trials. Resveratrol is beneficial both in AMD and glaucoma animal models, but confirmed only among AMD patients. For AMD, carotenoids and omega-3 fatty acids were also proved to be sufficient in preventing neurodegeneration. For glaucoma, coenzyme Q10 and alpha-lipoic acid showed efficacy for decreasing retinal ganglion cell loss and inhibiting the accompanying destructive processes. Interestingly, the benefits of vitamins, especially vitamin E was not confirmed, neither in preclinical nor in clinical studies

The potential usage of D2 dopaminergic agonists in the treatment of VEGF-related eye diseases

Dopamine and D2 dopaminergic agonists inhibit endothelial growth factor (VEGF). This effect has been proven in many types of cancer and in ovarian hyperstimulation syndrome. Experimental studies indicate the potential use of these substances in the treatment of eye diseases with increased VEGF release, such as exudative AMD, diabetic macular edema and proliferative diabetic retinopathy. This paper presents a review of the latest literature on the potential use of D2 dopaminergic agonists in the treatment of vascular endothelial growth factor (VEGF) related diseases.Dopamina oraz agoniści receptorów dopaminergicznych D2 wykazują działanie hamujące aktywność czynnika wzrostu śródbłonka naczyniowego. Działanie to zostało udowodnione w wielu chorobach nowotworowych oraz w zespole hiperstymulacji jajników. Dotychczas przeprowadzone badania wskazują na potencjalne zastosowanie tych substancji również w leczeniu chorób oczu przebiegających ze zwiększonym uwalnianiem czynnika wzrostu śródbłonka naczyniowego, takich jak: wysiękowa postać zwyrodnienia plamki związanego z wiekiem, cukrzycowy obrzęk plamki lub proliferacyjna postać retinopatii cukrzycowej. W niniejszej pracy przedstawiono przegląd najnowszych danych literaturowych na temat potencjalnego zastosowania agonistów dopaminergicznych D2 w leczeniu chorób oczy zależnych od naczyniowo-śródbłonkowego czynnika wzrostu (VEGF