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

Area of Science:

• Ophthalmology
• Neurology
• Pediatrics

Background:

• Vigabatrin is a crucial antiepileptic drug for infantile spasms.
• Vigabatrin use, particularly in adults, is associated with visual field defects.
• The long-term visual outcomes in infants treated with vigabatrin require further investigation.

Purpose of the Study:

• To determine the prevalence of vigabatrin-attributed visual field defect (VAVFD) in patients with infantile spasms.
• To evaluate the effectiveness of optical coherence tomography (OCT) in identifying vigabatrin-induced retinal damage.

Main Methods:

• Visual fields assessed using Goldmann or Octopus perimetry.
• Retinal nerve fiber layer (RNFL) thickness measured with spectral-domain OCT.
• Evaluations conducted at school age or adolescence in patients exposed to vigabatrin during infancy.

Main Results:

• Out of 88 patients exposed to vigabatrin, 5 developed VAVFD (mild in 4, severe in 1).
• Longer vigabatrin treatment duration correlated with increased risk of VAVFD (median 19 months vs. 11 months).
• OCT revealed attenuated RNFL in most VAVFD patients, with significant thinning in the temporal peripapillary region.

Conclusions:

• VAVFD prevalence appears lower with infant exposure compared to adult exposure.
• Treatment duration is a key risk factor for VAVFD.
• Further research is needed to identify susceptible infants and clarify OCT's role in monitoring.