Citicoline May Effectively Reduce Hard Exudates in Diabetic Retinopathy

<b>Background/Objectives:</b> Diabetic retinopathy (DR) develops from the interplay of vascular, inflammatory, and neurodegenerative processes. Citicoline, a natural compound essential for cell membranes, enhances neurotransmitter levels, has a neuroprotective effect, reduces oxidative stress by increasing glutathione, and decreases glutamate toxicity. Studies suggest that a citicoline liposomal formulation (eye drops) may prevent diabetes-induced retinal neurodegeneration. This study aimed to evaluate the impact of citicoline eye drops on the clinical signs of DR in clinical settings. <b>Methods:</b> More than 100 patients with nonproliferative DR (NPDR) were selected consecutively from the DR screening program and included in this real-life prospective observational clinical study. Each patient underwent color-fundus photography of two fields (macular field and disk/nasal field) in both eyes using a standard 45° fundus camera. Patients were prescribed citicoline eye drops and followed for a period of one year or longer. <b>Results:</b> In 4 patients with NPDR and macular hard exudates, the application of citicoline (Omk1^®) eye drops three times a day for at least six months to a year resulted in a reduction or complete disappearance of hard exudates. <b>Conclusions:</b> Our study, to the best of our knowledge, is the first one that establishes a clinically positive effect of citicoline eye drops on hard exudates in DR. However, to support the potential value of citicoline in the treatment of DR, the conclusions of this study still need to be confirmed by statistical analysis of a larger sample size and prospective studies with longer follow-up periods.