Visual field defects after vigabatrin treatment during infancy: retrospective population‐based study

Abstract

ABBREVIATIONS OCTOptical coherence tomography RNFL Retinal nerve fiber layer TSC Tuberous sclerosis complex VAVFD Vigabatrin-attributed visual field defect AIM To investigate the prevalence of vigabatrin-attributed visual field defect (VAVFD) in infantile spasms and the utility of optical coherence tomography (OCT) in detecting vigabatrin-related damage. METHOD We examined visual fields by Goldmann or Octopus perimetry and the thickness of peripapillary retinal nerve fiber layer (RNFL) with spectral-domain OCT at school age or adolescence. RESULTS Out of 88 patients (38 females, mean age at study 15y, SD 4y 3mo, range 6y 4mo-23y 3mo [n=65] or deceased [n=21] or moved abroad [n=2]) exposed to vigabatrin in infancy, 28 were able to perform formal visual field testing. Two had visual field defect from structural causes. We found mild VAVFD in four patients and severe VAVFD in one patient. Median vigabatrin treatment duration for those with normal visual field was 11 months compared to 19 months for those with VAVFD (p=0.04). OCT showed concomitant attenuated RNFL in three children with VAVFD, and was normal in one. The temporal half of the peripapillary RNFL was significantly thinner in the VAVFD group compared to the normal visual field group. INTERPRETATION The overall prevalence of VAVFD is lower after exposure in infancy compared to 52% which has been reported after exposure in adulthood. The risk increases with longer treatment duration. Further studies should identify infants particularly susceptible to VAVFD and clarify the role of OCT.

Effect of levetiracetam on ocular perfusion measure with optical coherence tomography angiography

“…Vigabatrin is contraindicated in the case of adverse effects on the visual field. Jonsson et al evaluated the effects on long-term visual field in children who received vigabatrin and found the risk of developing ocular side effects at a rate of 31% with the use of vigabatrin in children for more than 6 months (17) . Biswas et al reported retinal toxicity rate of 29% in patients who were diagnosed with epileptic spasm and were using vigabatrin (18) .…”

Adverse Ocular Effects of Systemic Medications

“…Vigabatrin is an antiepileptic used in the treatment of seizure disorders in childhood and adulthood. It has the potential to cause irreversible dose-dependent [ 37 ] visual field loss, which led to its FDA approval being accompanied by a mandatory Risk Evaluation and Mitigation Strategy program. While not fully understood, vigabatrin-associated visual field loss (VAVFL) is thought to occur as a result of toxicity to retinal photoreceptor and ganglion cells [ 38 ].…”

Exogen bedingte Retinopathien

“…Heute wird Vigabatrin (Antikonvulsivum für schwere Epilepsien vor allem bei Kindern) nur noch bei Fehlen anderer Therapiemöglichkeiten eingesetzt. Unter Therapie können irreversible konzentrische Gesichtsfeldeinschränkungen auftreten [29]. Zur Früherkennung einer beginnenden Schädigung ist ein Ganzfeld-ERG einsetzbar, im Verlauf zeigt sich eine Reduktion der Nervenfaserschicht in der OCT. Eine Therapieänderung ist mangels Alternativen meist nicht möglich.…”