Department of Ophthalmology, University of Lund, Lund, Sweden.
Acta Ophthalmol. 2014 Mar;92(2):149-57. doi: 10.1111/aos.12030. Epub 2013 Feb 7.
To investigate the clinical value of assessment of peripapillary retinal nerve fibre layer (RNFL) thickness with OCT in addition to the evaluation of retinal function measured by full-field electroretinography (ff-ERG) in patients with suspected vigabatrin (VGB)-attributed visual field defects.
Visual fields from adult patients in our clinical follow-up program for VGB medication were analysed. Twelve patients with suspected VGB-attributed visual field defects were selected for the study. They were re-examined with computerized kinetic perimetry, ff-ERG and OCT (2D circle scan).
Constricted visual fields were found in all patients. Comparative analysis of ff-ERG parameters showed reduced b-wave amplitudes for the isolated and the combined rod and cone responses (p < 0.0001). The a-wave, reflecting photoreceptor activity, was reduced (p = 0.001), as well as the summed amplitude of oscillatory potentials (p = 0.029), corresponding to inner retinal function. OCT measurements demonstrated attenuation of the RNFL in nine of 12 patients, most frequently superiorly and/or inferiorly. No temporal attenuation was found. Significant positive correlations were found between the total averaged RNFL thickness, superior and inferior RNFL thickness and reduced ff-ERG parameters. Positive correlations were also found between RNFL thickness and isopter areas.
OCT measurements can detect attenuation of the RNFL in patients exposed to VGB medication. RNFL thickness correlates with reduced ff-ERG parameters and isopter areas of constricted visual fields, indicating that VGB is retino-toxic on several levels, from photoreceptors to ganglion cells. The study also supports previous studies, suggesting that OCT measurement of the RNFL thickness may be of clinical value in monitoring patients on vigabatrin therapy.
研究在疑似氨己烯酸（VGB）引起的视野缺损患者中，除了用全视野视网膜电流图（ff-ERG）评估视网膜功能外，还用 OCT 评估视盘周围视网膜神经纤维层（RNFL）厚度的临床价值。
对我院 VGB 药物治疗临床随访计划中的成人患者的视野进行分析。选择 12 例疑似 VGB 引起的视野缺损患者进行研究。他们重新接受了电脑动态视野检查、ff-ERG 和 OCT（2D 圆扫描）检查。
所有患者均发现视野缩小。ff-ERG 参数的比较分析显示，孤立和联合的杆和锥反应的 b 波振幅降低（p<0.0001）。反映光感受器活性的 a 波降低（p=0.001），以及振荡电位的总和幅度（p=0.029），对应于内层视网膜功能。OCT 测量显示 12 例患者中有 9 例 RNFL 衰减，最常见于上方和/或下方。未发现颞侧衰减。总平均 RNFL 厚度、上方和下方 RNFL 厚度与降低的 ff-ERG 参数之间存在显著正相关。RNFL 厚度与视野等高点面积之间也存在正相关。
OCT 测量可检测到暴露于 VGB 药物治疗的患者的 RNFL 衰减。RNFL 厚度与降低的 ff-ERG 参数和缩小的视野等高点面积相关，表明 VGB 对光感受器到节细胞的多个水平具有视网膜毒性。该研究还支持了先前的研究，表明 OCT 测量 RNFL 厚度可能对监测氨己烯酸治疗患者具有临床价值。
