The antie
pile
ptic drug vigabatrin is known to cause
permanent loss of vision. Both visual field testing and electroretinogram are used to detect retinal damage. Adult data on o
ptical coherence tomogra
phy (OCT) shows that retinal nerve fiber layer (RNFL) thinning may be an early indicator of vigabatrin-induced retinal toxicity. The
pur
pose of this study was to investigate whether OCT can detect early vigabatrin-induced retinal toxicity in children.
p>
Methods
<
p id="abs
para0015">Pediatric
patients (≤18 years of age) requiring vigabatrin for seizure control who were followed at our institution were invited to
partici
pate. Patients were examined according to manufacturer guidelines, with most examinations taking
place under general anesthesia. RNFL thickness was measured by OCT (Stratus Model 3000, Zeiss) and com
pared to total cumulative dose of vigabatrin. In most cases, indirect o
phthalmosco
py, fundus
photogra
phy, and electroretinogra
phy were also
performed.
p>
Results
<
p id="abs
para0020">OCT and com
plete dosing data was available for 19
patients. Patients with tuberous sclerosis (TS, n = 12) received higher cumulative doses (mean, 1463 g) than non-TS
patients (mean, 351 g,
P = 0.044). RNFL thinning was detected in the nasal (
P < 0.01), su
perior (
P < 0.01), and inferior (
P < 0.05) quadrants in
patients with TS,
particularly once cumulative dose exceeded 1500 g.
p>
Conclusions
<
p id="abs
para0025">In our study
po
pulation of
patients with TS, higher cumulative doses of vigabatrin were associated with RNFL thinning in the nasal, su
perior, and inferior quadrants. These findings were
pronounced once cumulative dose exceeded 1500 g. This
pattern of RNFL thinning is similar to what has been shown in adult
patients taking vigabatrin.
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