Abstract
Purpose To survey clinical visual function including quantitative manual perimetry results in a group of patients taking vigabatrin; to assess the severity of any field defects; to tabulate cumulative and daily doses of medication and to assess possible changes in visual function over time.
Method A prevalence study of 100 out of 183 patients currently attending a tertiary referral epilepsy centre who were taking or had recently discontinued vigabatrin (duration 83–3570 days; mean 1885 days) as part of combination anticonvulsant therapy. Complete neuro-ophthalmic examination including Goldmann kinetic perimetry was performed and monocular mean radial degrees (MRD) to the I/4e isopter calculated. Patients were followed up at 6-monthly intervals for not less than 18 months.
Results Acuity and colour vision remained stable in all patients regardless of changes in visual fields. Twenty per cent of patients had significant constriction of their visual field defined as a monocular MRD of 30 degrees or less. Males were significantly more likely to be severely affected than females (P < 0.01). Twenty one patients were followed after discontinuing vigabatrin treatment. Only three of these showed a change in MRD of 10 degrees or more with two deteriorating and one improving. No correlation between treatment duration or cumulative dosage/kg and the severity of defects could be demonstrated.
Conclusions Earlier reports of a high prevalence of both moderate and more serious field defects were confirmed in patients taking vigabatrin but not in epileptic patients taking other anti-convulsants. We found no evidence of progression or resolution of visual field defects on discontinuing the drug, and no relationship between dose history and visual deficit field loss. An idiosyncratic drug reaction within the neurosensory retina may underlie the pathogenesis of the visual field loss in some patients
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References
Eke T, Talbot JF, Lawden MC . Severe persistent visual field constriction associated with vigabatrin. BMJ 1997; 314: 180–181
Wilson EA, Brodie MJ, Wong IC, Mawer GE, Sander JWAS, Blackwell N et al. Severe persistent visual field constriction associated with vigabatrin (multiple letters). BMJ 1997; 314: 1693–1695
Harding HFA, Mackenzie R, Klistorner A . Severe persistent visual field constriction associated with Vigabatrin. BMJ 1998; 316: 232–233
Beck RW, Brignell MG, Roubertie A, Bellet H, Echenne B, Krauss GL et al. Vigabatrin-associated retinal cone system dysfunction. Neurology 1998; 51: 1778
Daneshvar H, Racette L, Coupland SG, Kertes PJ, Guberman A, Zackon D . Symptomatic and asymptomatic visual loss in patients taking vigabatrin. Ophthalmology 1999; 106: 1792–1798
Lawden MC, Eke T, Degg C, Harding GF, Wild JM . Visual field defects associated with vigabatrin therapy. J Neurol Neurosurg Psychiatry 1999; 67: 716–722
Russell-Eggitt IM, Mackey DA, Taylor DS, Timms C, Walker JW . Vigabatrin-associated visual field defects in children. Eye 2000; 14: 334–339
Manuchehri K, Goodman S, Siviter L, Nightingale S . A controlled study of vigatrin and visual abnormalities. Br J Ophthalmol 2000; 84: 499–505
Ruether K, Pung T, Kellner U, Schmitz B, Hartmann C, Seeliger M . Electrophysiologic evaluation of a patient with peripheral visual field contraction associated with vigabatrin. Arch Ophthalmol 1998; 116: 817–819
Kalviainen R, Nousiainen I, Mantyjarvi M et al. Vigabatrin, a GABAergic antiepiletic drug, causes concentric visual field defects. Neurology 1999; 53: 922–926
Miller NR, Johnson MA, Paul SR, Girkin CA, Perry JD, Endres M, Krauss GL . Visual dysfunction in patients receiving vigabatrin: clinical and electrophysiologic findings. Neurology 1999; 53: 2082–2087
Arndt CF, Derambure P, Defoort-Dhellemmes S, Hache JC . Outer retinal dysfunction in patients treated with vigabatrin. Neurology 1999; 52: 1201–1205
Hardus P, Verduin WM, Postma G, Stilma JS, Berendschot TT, van Veelen CW . Long-term changes in the visual fields of patients with temporal lobe epilepsy using vigabtrin. Br J Ophthalmol 2000; 84: 788–790
Coupland SG, Zackron DH, Leonard BC, Ross TM . Vigabatrin effect on inner retinal function. Ophthalmology 2001; 108: 1493–1496
Harding GF, Wild JM, Robertson KA, Rietbrock S, Martinez C . Separating the retinal electrophysiologic effects of vigabatrin: treatment versus field loss. Neurology 2000; 55: 347–352
Krakow K, Polizzi G, Riordan-Eva P, Holder G, MacLeod WN, Fish DR . Recovery of visual field constriction following discontinuation of vigabatrin. Seizure 2000; 9: 287–290
Versino M, Viggiotti P . Reversibility of vigabatrin-induced visual field defect. Lancet 1999; 354: 486
Johnson MA, Krauss GL, Miller NR, Medura M, Paul SR . Visual function loss from vigabatrin: effect of stopping the drug. Neurology 2000; 55: 40–45
Diabetic Retinopathy Survey report 6 — Design, Methods and Baseline Results. Investig Ophthalmol Vis Sci 1981; 21: 149–209
Krauss GL, Johnson MA, Miller NR . Vigabatrin-associated retinal cone system dysfunction: electroretinogram and ophthalmologic findings. Neurology 1998; 50: 614–618
Acknowledgements
The authors gratefully acknowledge the financial support of Hoechst, Marion, Roussel/Aventis Pharmaceuticals in the running of this study.
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Newman, W., Tocher, K. & Acheson, J. Vigabatrin associated visual field loss: a clinical audit to study prevalence, drug history and effects of drug withdrawal. Eye 16, 567–571 (2002). https://doi.org/10.1038/sj.eye.6700168
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