Kälviäinen R, Nousiainen I, Mäntyjärvi M, Nikoskelainen E, Partanen J, Partanen K, Riekkinen P
Department of Neurology, University Hospital of Kuopio, Finland.
Neurology. 1999 Sep 22;53(5):922-6. doi: 10.1212/wnl.53.5.922.
To determine whether there is a causal link between vigabatrin treatment and concentric visual field defects and to evaluate the prevalence of these visual field constrictions.
While the GABAergic antiepileptic drug (AED) vigabatrin was being clinically developed, only rare cases (less than 1:1000) of symptomatic visual field constriction and retinal disorders were reported. During 1997 to 1998, concentric visual field constrictions were described in case reports of mostly drug-resistant epilepsy patients receiving vigabatrin concurrently with other AEDs.
Ophthalmologic tests including Goldmann perimetry were performed on 32 adult patients on long-term successful vigabatrin monotherapy (treatment duration 29 to 119 months) and on 18 patients on carbamazepine monotherapy (treatment duration 32 to 108 months). Eighteen healthy adults served as controls.
None of the patients complained about vision problems when asked to participate into the study. Thirteen out of the 32 (40%) epilepsy patients treated with vigabatrin monotherapy had concentrically constricted visual fields (9% severely, 31% mildly constricted), whereas none of the carbamazepine monotherapy patients or normal controls presented with a visual field defect (chi-square test, p = 0.0001). The extents of the visual fields were significantly constricted in vigabatrin group as compared with the visual fields of the patients in carbamazepine group or healthy controls (analysis of variance, Scheffe F-test, significant at 99%).
The use of vigabatrin seems to increase the risk of a unique and specific pattern of bilateral, mainly asymptomatic visual field constriction. This risk should be considered when using vigabatrin. Visual field testing should also be performed before treatment and during routine follow-up for patients on vigabatrin.
确定vigabatrin治疗与同心性视野缺损之间是否存在因果关系，并评估这些视野缩窄的患病率。
在GABA能抗癫痫药物（AED）vigabatrin的临床研发过程中，仅报告了罕见的有症状视野缩窄和视网膜疾病病例（少于1:1000）。在1997年至1998年期间，病例报告中描述了同心性视野缩窄，主要是接受vigabatrin与其他AED联合治疗的耐药癫痫患者。
对32例长期成功接受vigabatrin单药治疗（治疗时间29至119个月）的成年患者和18例接受卡马西平单药治疗（治疗时间32至108个月）的患者进行了包括Goldmann视野计检查在内的眼科检查。18名健康成年人作为对照。
当被要求参与研究时，没有患者抱怨视力问题。32例接受vigabatrin单药治疗的癫痫患者中有13例（40%）存在同心性视野缩窄（9%严重缩窄，31%轻度缩窄），而接受卡马西平单药治疗的患者或正常对照均未出现视野缺损（卡方检验，p = 0.0001）。与卡马西平组患者或健康对照的视野相比，vigabatrin组的视野范围明显缩窄（方差分析，Scheffe F检验，99%显著）。
使用vigabatrin似乎会增加出现独特且特定模式的双侧、主要无症状视野缩窄的风险。使用vigabatrin时应考虑这一风险。对于接受vigabatrin治疗的患者，在治疗前和常规随访期间也应进行视野检查。
