Cover Image

Clinical Efficacy of Topical CoQ10 and Vitamin-E Eye-drop in Retinopathy of Prematurity

Muberra Akdogan, Onur Polat


Treatment strategy for retinopathy of prematurity (ROP) includes anti-vascular endothelial growth factor (anti-VEGF) and/or laser therapy. The aim of this study was to investigate the clinical effects of topical Coqun® eye drop (CoQ10 and Vitamin-E) on the progression and treatment of ROP. One hundred and ten infants with type 1 ROP who received Coqun® (Coqun group) and 131 infants with type 1 ROP who did not receive Coqun® (control group) were included in this retrospective analysis. All patients were follow-up until retinal vascular maturation was complete. Intravitreal bevacizumab (IVB) injection or laser photocoagulation (LPC) were apply if needed. Treatment frequency, treatment response and mean follow-up time were compare. The number of IVB was similar between the groups, but infants in the Coqun group underwent significantly fewer LPC procedure than those in the control group (P = 0.022). The mean follow-up time was significantly shorter in infants receiving Coqun® in stage 1 ROP (P = 0.017) and similar in stages 2-4 ROP and aggressive posterior retinopathy of prematurity (APROP). The number of LPC procedure was fewer in the Coqun group in APROP (P = 0.043). These results indicate that faster retinal vascular maturation in infants with low-grade ROP and lower number of treatments with APROP could be achieve with Coqun® therapy. Epub: October 1, 2019.


Good WV, Gendron RL. Retinopathy of prematurity. Ophthalmol Clin North Am. 2001;14(3):513-9. doi: 10.1016/S0896-1549(05)70249-2 pmid: 11705151

Heidary F, Gharebaghi R. Outcomes of Retinopathy of Prematurity. Med Hypothesis Discov Innov Ophthalmol. 2016;5(4):112-4. pmid: 28293657

Rudanko SL, Fellman V, Laatikainen L. Visual impairment in children born prematurely from 1972 through 1989. Ophthalmology. 2003;110(8):1639-45. doi: 10.1016/S0161-6420(03)00498-6 pmid: 12917186

Akkoyun I, Oto S, Yilmaz G, Gurakan B, Tarcan A, Anuk D, et al. Risk factors in the development of mild and severe retinopathy of prematurity. J AAPOS. 2006;10(5):449-53. doi: 10.1016/j.jaapos.2006.05.007 pmid: 17070481

Akdogan M, Sabaner MC, Karabas VL. Epidemiological and Clinical Features of the Preterms Followed-Up at Our Clinic in Turkey: A Study about 458 Infants. Open J Ophthalmol. 2018;08(04):214-23. doi: 10.4236/ojoph.2018.84025

McLoone E, O'Keefe M, McLoone S, Lanigan B. Effect of diode laser retinal ablative therapy for threshold retinopathy of prematurity on the visual field: results of goldmann perimetry at a mean age of 11 years. J Pediatr Ophthalmol Strabismus. 2007;44(3):170-3. doi: 10.3928/0191-3913-20070301-10 pmid: 17542439

Hartnett ME. The effects of oxygen stresses on the development of features of severe retinopathy of prematurity: knowledge from the 50/10 OIR model. Doc Ophthalmol. 2010;120(1):25-39. doi: 10.1007/s10633-009-9181-x pmid: 19639355

Pinazo-Duran MD, Zanon-Moreno V, Gallego-Pinazo R, Garcia-Medina JJ. Oxidative stress and mitochondrial failure in the pathogenesis of glaucoma neurodegeneration. Prog Brain Res. 2015;220:127-53. doi: 10.1016/bs.pbr.2015.06.001 pmid: 26497788

Negida A, Menshawy A, El Ashal G, Elfouly Y, Hani Y, Hegazy Y, et al. Coenzyme Q10 for Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. CNS Neurol Disord Drug Targets. 2016;15(1):45-53. doi: 10.2174/1871527314666150821103306 pmid: 26553164

Isobe C, Abe T, Terayama Y. Levels of reduced and oxidized coenzyme Q-10 and 8-hydroxy-2'-deoxyguanosine in the CSF of patients with Alzheimer's disease demonstrate that mitochondrial oxidative damage and/or oxidative DNA damage contributes to the neurodegenerative process. J Neurol. 2010;257(3):399-404. doi: 10.1007/s00415-009-5333-x pmid: 19784856

Nucci C, Tartaglione R, Cerulli A, Mancino R, Spano A, Cavaliere F, et al. Retinal damage caused by high intraocular pressure-induced transient ischemia is prevented by coenzyme Q10 in rat. Int Rev Neurobiol. 2007;82:397-406. doi: 10.1016/S0074-7742(07)82022-8 pmid: 17678974

Beharry KD, Cai CL, Siddiqui F, Chowdhury S, D'Agrosa C, Valencia GB, et al. Comparative Effects of Coenzyme Q10 or n-3 Polyunsaturated Fatty Acid Supplementation on Retinal Angiogenesis in a Rat Model of Oxygen-Induced Retinopathy. Antioxidants (Basel). 2018;7(11). doi: 10.3390/antiox7110160 pmid: 30423931

Akdogan M, Ustundag Y, Akdağ A, Neselioglu S, Erel O. The Thiol-Disulfide Homeostasis and Coenzyme Q10 in Conjunction with Vitamin E Effect on Retinopathy Prematurity. Open Ophthalmol J. 2019;13(1):23-8. doi: 10.2174/1874364101913010023

Good WV, Early Treatment for Retinopathy of Prematurity Cooperative G. Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc. 2004;102:233-48; discussion 48-50. pmid: 15747762

International Committee for the Classification of Retinopathy of P. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123(7):991-9. doi: 10.1001/archopht.123.7.991 pmid: 16009843

Zhou J, Liu Z, Ying HY, Liu T. Aggressive Posterior Retinopathy of Prematurity in a Premature Male Infant. Case Rep Ophthalmol. 2017;8(2):396-400. doi: 10.1159/000478694 pmid: 28924435

Mintz-Hittner HA, Kennedy KA, Chuang AZ, Group B-RC. Efficacy of intravitreal bevacizumab for stage 3+ retinopathy of prematurity. N Engl J Med. 2011;364(7):603-15. doi: 10.1056/NEJMoa1007374 pmid: 21323540

Wallace DK, Kraker RT, Freedman SF, Crouch ER, Hutchinson AK, Bhatt AR, et al. Assessment of Lower Doses of Intravitreous Bevacizumab for Retinopathy of Prematurity: A Phase 1 Dosing Study. JAMA Ophthalmol. 2017;135(6):654-6. doi: 10.1001/jamaophthalmol.2017.1055 pmid: 28448664

Singer D, Muhlfeld C. Perinatal adaptation in mammals: the impact of metabolic rate. Comp Biochem Physiol A Mol Integr Physiol. 2007;148(4):780-4. doi: 10.1016/j.cbpa.2007.05.004 pmid: 17561425

Pelken L, Maier RF. [Risk factors and prevention of retinopathy of prematurity]. Ophthalmologe. 2008;105(12):1108-13. doi: 10.1007/s00347-008-1788-x pmid: 19066907

Wang H, Zhang SX, Hartnett ME. Signaling pathways triggered by oxidative stress that mediate features of severe retinopathy of prematurity. JAMA Ophthalmol. 2013;131(1):80-5. doi: 10.1001/jamaophthalmol.2013.986 pmid: 23307212

Smith LE. Through the eyes of a child: understanding retinopathy through ROP the Friedenwald lecture. Invest Ophthalmol Vis Sci. 2008;49(12):5177-82. doi: 10.1167/iovs.08-2584 pmid: 18708611

Young TL, Anthony DC, Pierce E, Foley E, Smith LE. Histopathology and vascular endothelial growth factor in untreated and diode laser-treated retinopathy of prematurity. J AAPOS. 1997;1(2):105-10. doi: 10.1016/S1091-8531(97)90008-2 pmid: 10875087

Qanungo S, Mukherjea M. Ontogenic profile of some antioxidants and lipid peroxidation in human placental and fetal tissues. Mol Cell Biochem. 2000;215(1-2):11-9. doi: 10.1016/S0009-8981(99)00051-0 pmid: 11204445

Ates O, Alp HH, Caner I, Yildirim A, Tastekin A, Kocer I, et al. Oxidative DNA damage in retinopathy of prematurity. Eur J Ophthalmol. 2009;19(1):80-5. doi: 10.1177/112067210901900112 pmid: 19123153

Turunen M, Olsson J, Dallner G. Metabolism and function of coenzyme Q. Biochim Biophys Acta. 2004;1660(1-2):171-99. doi: 10.1016/j.bbamem.2003.11.012 pmid: 14757233

Nakajima Y, Inokuchi Y, Nishi M, Shimazawa M, Otsubo K, Hara H. Coenzyme Q10 protects retinal cells against oxidative stress in vitro and in vivo. Brain Res. 2008;1226:226-33. doi: 10.1016/j.brainres.2008.06.026 pmid: 18598676

Lee D, Shim MS, Kim KY, Noh YH, Kim H, Kim SY, et al. Coenzyme Q10 inhibits glutamate excitotoxicity and oxidative stress-mediated mitochondrial alteration in a mouse model of glaucoma. Invest Ophthalmol Vis Sci. 2014;55(2):993-1005. doi: 10.1167/iovs.13-12564 pmid: 24458150

Beharry KD, Cai CL, Henry MM, Chowdhury S, Valencia GB, Aranda JV. Co-Enzyme Q10 and n-3 Polyunsaturated Fatty Acid Supplementation Reverse Intermittent Hypoxia-Induced Growth Restriction and Improved Antioxidant Profiles in Neonatal Rats. Antioxidants (Basel). 2017;6(4). doi: 10.3390/antiox6040103 pmid: 29258174

Lulli M, Witort E, Papucci L, Torre E, Schipani C, Bergamini C, et al. Coenzyme Q10 instilled as eye drops on the cornea reaches the retina and protects retinal layers from apoptosis in a mouse model of kainate-induced retinal damage. Invest Ophthalmol Vis Sci. 2012;53(13):8295-302. doi: 10.1167/iovs.12-10374 pmid: 23154463

Fato R, Bergamini C, Leoni S, Pinna A, Carta F, Cardascia N, et al. Coenzyme Q10 vitreous levels after administration of coenzyme Q10 eyedrops in patients undergoing vitrectomy. Acta Ophthalmol. 2010;88(4):e150-1. doi: 10.1111/j.1755-3768.2009.01632.x pmid: 19799594

Parisi V, Centofanti M, Gandolfi S, Marangoni D, Rossetti L, Tanga L, et al. Effects of coenzyme Q10 in conjunction with vitamin E on retinal-evoked and cortical-evoked responses in patients with open-angle glaucoma. J Glaucoma. 2014;23(6):391-404. doi: 10.1097/IJG.0b013e318279b836 pmid: 25079307

Ozates S, Elgin KU, Yilmaz NS, Demirel OO, Sen E, Yilmazbas P. Evaluation of oxidative stress in pseudo-exfoliative glaucoma patients treated with and without topical coenzyme Q10 and vitamin E. Eur J Ophthalmol. 2019;29(2):196-201. doi: 10.1177/1120672118779486 pmid: 29869538

Full Text: Full Text PDF. Epub:Oct. 1, 2019

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.