Lars Frisén1, Kristina Malmgren. 1. Institute of Clinical Neuroscience, Sahlgren's Academy at Gothenburg University, SE-413 45 Gothenburg, Sweden. lars.frisen@neuro.gu.se
Abstract
AIMS: To report the discovery of a previously unknown form of optic atrophy associated with use of the anti-epileptic drug vigabatrin. METHODS: We conducted a retrospective analysis of digitally enhanced ocular fundus photographs, kinetic visual field maps and treatment parameters for 25 patients, who were selected to represent a large spectrum of visual field defects. RESULTS: In all, 21 patients (84%) evidenced subtle, diffuse atrophy of the retinal nerve fibre layer, in a pattern accessible to scoring. Atrophy scores correlated with visual field remains and cumulative vigabatrin doses. A pathophysiological model is proposed that involves the lengths of intraocular (unmyelinated) retinal ganglion cell axons. CONCLUSION: Optic atrophy attests to the irreversible nature of vigabatrin's visual toxicity. Ocular fundus imaging should prove useful for objectively monitoring vigabatrin-treated subjects for visual toxicity.
AIMS: To report the discovery of a previously unknown form of optic atrophy associated with use of the anti-epileptic drug vigabatrin. METHODS: We conducted a retrospective analysis of digitally enhanced ocular fundus photographs, kinetic visual field maps and treatment parameters for 25 patients, who were selected to represent a large spectrum of visual field defects. RESULTS: In all, 21 patients (84%) evidenced subtle, diffuse atrophy of the retinal nerve fibre layer, in a pattern accessible to scoring. Atrophy scores correlated with visual field remains and cumulative vigabatrin doses. A pathophysiological model is proposed that involves the lengths of intraocular (unmyelinated) retinal ganglion cell axons. CONCLUSION:Optic atrophy attests to the irreversible nature of vigabatrin's visual toxicity. Ocular fundus imaging should prove useful for objectively monitoring vigabatrin-treated subjects for visual toxicity.
Authors: John M Wild; David L Fone; Saleh Aljarudi; Charlotte Lawthom; Philip E M Smith; Robert G Newcombe; Gareth D Lewis Journal: CNS Drugs Date: 2013-10 Impact factor: 5.749