|Year : 1989 | Volume
| Issue : 3 | Page : 121-126
Topical glutathione therapy in senile cataracts Cataract III
YR Sharma, RB Vajpayee, R Bhatnagar, Madan Mohan, RV Azad, Mukesh Kumar, Ram Nath
R. P. Centre for Oph. Sciences, AIIMS, Ansari Nagar,New Delhi - 110 029, India
Y R Sharma
R. P. Centre for Oph. Sciences, AIIMS, Ansari Nagar,New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
We undertook a prospective study in 66 cataract patients to study if topical glutathione has any effects on the progression of cataracts. The eye with more advanced cataract received topical glutathione drops q.i.d. and contralateral eye served as control. Only 32 patients completed the follow-up of three months or more. Data analysis revealed no beneficial effect of topical glutathione drops on any of the parameters studied. PSC opacity density in eyes treated with topical glutathione showed significant increase as compared to control eyes.
Keywords: Cataract medical therapy, glutathione
|How to cite this article:|
Sharma Y R, Vajpayee R B, Bhatnagar R, Mohan M, Azad R V, Kumar M, Nath R. Topical glutathione therapy in senile cataracts Cataract III. Indian J Ophthalmol 1989;37:121-6
|How to cite this URL:|
Sharma Y R, Vajpayee R B, Bhatnagar R, Mohan M, Azad R V, Kumar M, Nath R. Topical glutathione therapy in senile cataracts Cataract III. Indian J Ophthalmol [serial online] 1989 [cited 2020 Jun 3];37:121-6. Available from: http://www.ijo.in/text.asp?1989/37/3/121/26070
| Introduction|| |
Cataract remains the leading cause of treatable blindness throughout the world.  In India, 55 percent of blindness is due to cataracts.  In the US, the national estimates indicate that 57.6 percent of population in the age group 65-74 have lens opacities of which 28.5 percent suffer visual loss due to lens opacities  The only available treatment remains surgical  Various forms of medical therapies have been proposed from time to time but none have found scientific acceptance. 
The tripeptide glutathione has been found in very high concentration in the mammalian lenses  The high concentration of reduced glutathione in a normal lens and the decreased concentration in most types of cataracts have led to many hypothesis on its role in cataract formation  The suggested mechanisms of glutathiones protective role in the lens include maintenance of thiol (SH) groups of proteins in reduced state, regulation of cation transport and protection against oxidative damage to the lens by superoxide and other reactive species. ,, Prevention and reversal of cataracts in vitro and in vivo has been reported.  Glutathione (Gamma-L-glutamyl-L-Cysteinyl-glycine) eye drops have been marketed in Japan among other conditions, for cataracts. Product information booklet on these drops (trade name TATHION) claims slowing down and actual reversal of cataracts in experimental as well as in clinical studies  We planned prospective cataract studies which included medical. therapy studies. Reduced glutathione eye drops was one of the drugs studied.
| Material and methods|| |
The classification system used in classifying lens opacities and methodology adopted and constraints encountered have been outlined , Cataracts patients attending the cataract cell who consented to participate in medical therapy studies were randomly allocated to different treatment groups one of which was the glutathione group. In the glutathione group known diabetic patients were excluded. Patient records included best corrected visual acuity and lens examination carried on a separate printed sheet according to the proposed cataract classification scheme  Patients were put on 2 percent reduced glutathione eye drops and placebo drops containing vehicle only. The Vehicle used for dissolving glutathione was phosphate buffer (0.05 M ph 7.4). Adequate supply for one month (or in few patients for 3 months) was made. Patients were instructed to instill glutathione and placebo drops in the eye indicated four times a day. The vial containing glutathione was labeled "G" and the placebo vial was unlabelled. All patients in the study were instructed to put drops labeled 'G' in the eye, which was judged to be more severely affected and unlabelled drops in the eye which was judged to be less affected. Judgment on the eye more affected was based on slit lamp and ophthalmoscopic examination by the investigators and did not always correlate with visual acuity and patients' perception. Patients were requested to come for regular follow up for re-examination and supply of medications. In ten percent of patients included in the study lens photographs were taken at each follow up using Zeiss slit lamp camera or Nikon zoom anterior segment camera. 66 patients were included in the glutathione groups during the period of study. A follow up of 2 years was planned for each patient.,
| Results|| |
The constraints and difficulties in carrying out these studies have been described earlier . A major problem was a very high drop out rate and very few patients completed the initially envisaged 2 years follow up.
Thus all patients who had completed at least 3 months follow up were included in data analysis. There were 32 such patients whose follow up ranged from 2 to 24 months (10.75±5.68 months m±SD) [Table - 1]. Most of the cataracts were of mixed type [Table - 2].6 patients had pure cortical cataracts initially. There were no significant differences in distribution of types of opacities initially or at final follow up in two groups. In both control and glutathione treated eyes 12 eyes (37.5%) maintained the initial vision [Table - 3]. Loss of visual acuity of upto 2 lines, loss of upto 4 lines and loss of upto 6 lines was also not statistically different in the two groups. The same trend was observed in 6 cases who had pure type of cataract initially, all cortical (Table 4). Mean increase in percentage visual acuity loss in control eyes was 17.34 and in glutathione treated eyes it was 18.47 (Not significant: [Table - 5]). In eyes which had pure cortical cataracts initially, percentage visual acuity loss was more in glutathione treated eyes (NS: [Table - 6]). To study if treatment had any different effect on the extent of opacity or its density each subtype was analysed separately. Both the cortical opacity extent and density showed the reverse trend. Mean increase of both these parameters was less than that in control eyes; statistically the difference was not significant [Table - 9][Table - 10]. No significant difference was found in mean increase in extent of PSC opacity but the density was significantly higher in glutathione treated eyes (P < 0.05) (Table 11][Table - 12]. The mean increase in extent and density of ophthalmoscopically observed opacity was similar in the two groups (Table 13][Table - 14]. Only two patients reported minor ocular side effects in glutathione treated eyes and in both therapy was discontinued.
| Discussion|| |
Of the total 66 patients enrolled in the study, only 32 patients completed follow up of 3 months or more (10.75 ±5.86 months m± SD) though intifially2 years follow up was planned. One advantage of topical therapy in cataract studies is that the contralateral eye can be used as control. Though cataract severity at least initially tends to be similar in the eyes,. this is not always so. It is for this reason that the eye judged to have more advanced opacities was put on glutathione and ten follow eye served as control. Topical glutathione has been claimed to slow down the progression of lens opacities and actual visual improvement has been reported . We noted no difference in visual acuity loss between glutathione treated and control eyes. The mean percentage visual acuity loss was also similar in two groups. Six of our 32 patients had pure cortical cataracts initially. Visual acuity loss and mean percentage visual acuity loss in these was unaffected by treatment. Because therapy may specifically affect extent or density of opacity, each sub-type of lens opacities was analysed separately. In none of the sub-types of opacities glutathione treated eyes showed significant less progression, both extent or density wise. Indeed, the glutathione treated eyes showed significant greater increase in PSC opacity density as compared to control eyes.
In our study, all parameters were recorded objectively by the authors. Patient's subjective feeling on improvement or otherwise was not taken into consideration. We also found that photographs taken with routine anterior segment cameras were not of much help in quantitating the cataract progression. We recognise various constraints and pitfalls of our study but our findings suggest that topical glutathione therapy in the concentration and dosage used in the present study does not merit expense of a large scale photo-documented double blind study. Such a study should wait more compelling relevant basic and pharmacological data.
| Acknowledgement|| |
We gratefully thank ICMR, India, for partly supporting these studies. During part of this study, Dr. Y. R. Sharma was appointed under the supernumerary research cadre scheme at Dr. R. P. Centre. We also sincerely thank, all residents who referred their patients to the cataract cell.
| References|| |
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Shara YR, Vajpayee RB, Madan Mohan, Azad RV, Mukesh Kumar. A simple accurate method of cataract classification. Cataract 1. Submitted for publication.
Ibid. Methodology for studies on medical therapy of cataracts: Cataract II. Manuscript submitted for publication.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10], [Table - 11], [Table - 12], [Table - 13], [Table - 14]
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