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Rachel Dragas, Carol A Westall, Thomas Wright; Changes in the ERG D-wave with Vigabatrin Treatment in a Pediatric Cohort. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1922.
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© ARVO (1962-2015); The Authors (2016-present)
Vigabatrin (VGB), a common treatment for the childhood epilepsy, infantile spasms (IS), is implicated in visual field reduction. Electroretinograms (ERGs) are a substitute to visual field testing in infants and VGB-associated ERG reduction (VAER) is a reduction in age-corrected light adapted 3.0 flicker response amplitude from a pre-treatment measurement. The d-wave ERG response is the result of OFF bipolar cell depolarization to light offset. The purpose of this study is to evaluate if the ERG d-wave response is a marker for VAER toxicity in a pediatric population.
Eighty-seven children with IS treated with VGB were assessed prospectively and tested for the cone-OFF response elicited to a 250 cd.s.m2 flash with 200 ms duration. Twenty with IS had been tested before VGB and 9 of the 87 developed VAER during the time frame of the study. Thirteen retinally normal controls were also tested. Amplitude and implicit timing of the d-wave response were measured manually.
There was no difference in d-wave amplitude between the IS group tested before VGB treatment (IS-baseline) and controls. Combining data from the IS-baseline and control group, there was no effect on d-wave amplitude whilst there was a reduction in implicit time with increasing age. The d-wave amplitude was reduced in the IS group with VAER compared to those without VAER (p<0.01). Longer duration of treatment was associated with reduced d-wave amplitude (anova p=0.054) in those with and without VAER.
Reduced amplitude of the cone OFF response may be good indicator for VGB-induced adverse retinal changes.
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