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Rebecca B. Mets, Brooke Geddie, Carmelina Trimboli-Heidler, Nancy Elling, Mohamad Jaafar, William McClintock, William P. Madigan; Utility of Optical Coherence Tomography in Monitoring Vigabatrin Retinal Toxicity. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3683.
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Vigabatrin is an antiepileptic medication that is often successful in treating difficult to control seizure disorders. It also has been shown to have irreversible retinal toxicity in at least 30% of adults. Adult patients taking vigabatrin are monitored by visual field (VF) testing. As this is not always possible in young or developmentally delayed children, Electroretinogram (ERG) has been suggested for monitoring children. We propose optical coherence tomography (OCT) as an alternative technique for monitoring Vigabatrin retinal toxicity in children.
All patients of Children’s National Medical Center Neurology department taking Vigabatrin are given the option of optical coherence tomography (OCT) monitoring. We performed a chart review of the first 17 patients who underwent examination under anesthesia (EUA,) OCT retinal nerve fiber layer (rNFL) analysis (StratusOCT; Carl Zeiss Meditec, Dublin, CA), and ERG.
Retrospective review yielded 34 eyes of 17 patients ages 12 months to 15 years taking Vigabatrin, who had an EUA with OCT testing, 11 of whom had at least one follow-up exam. Average rNFL thickness on initial exam was 103.63, with nasal and temporal quadrants being the thinnest. We compared these values to published normative values for children. While the group average fell between the 5th and 95th percentile rNFL thickness for age, 18 out of 34 eyes had rNFL thickness above the 95th percentile or below the 5th percentile on initial exam. Four patients had one or both eyes above the 95th percentile for average rNFL, and 7 patients had an OCT rNFL in one or both eyes that was below the 5th percentile on initial exam. Many of the patients with abnormal OCTs had abnormal ERGs as well. There was only one patient with an abnormal ERG but a normal OCT. In all other patients there was close correlation between the ERG and OCT (8), or the OCT was low with a normal ERG (5).
Patient’s whose neurologic condition requires vigabatrin for control of seizures may have related abnormalities in rNFL thickness which cause it to fall outside 2 SDs of the normal population. Serial OCTs may provide the best monitoring for vigabatrin toxicity, rather than relying on absolute values. OCT is faster than ERG, possibly more sensitive than ERG, and more objective than ophthalmoscopy. It may prove to be the most efficient and objective measure in monitoring for drug toxicity, particularly when visual fields cannot be obtained.
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