University of Florida, College of Medicine, Gainesville, Florida 32610-0284, USA.
Br J Ophthalmol. 2013 Jul;97(7):895-9. doi: 10.1136/bjophthalmol-2013-303084. Epub 2013 Apr 20.
The purpose of this study was to determine the long-term efficacy and safety of valproic acid (VPA) treatment in patients with pigmentary retinal dystrophies.
A retrospective chart review was conducted on 31 patients with a diagnosis of pigmentary retinal dystrophy prescribed VPA at a single centre. Visual field (VF), visual acuity (VA), length of treatment, liver enzymes and side effects were analysed. VF areas were defined using Goldmann VF (GVF) tracings recorded before, during and after VPA treatment using the V4e isopter for each eye. Using custom software, planimetric areas of VF were calculated.
Five of the patients (10 eyes) had two Goldmann VF tracings, allowing comparison between baseline and follow-up VF. After 9.8 months of VPA, VF decreased by 0.145 cm(2) (26.478%) (p=0.432). For 22 of the patients (41 eyes), VA data was available, and logarithm of the minimum angle of resolution (logMAR) score changed by 0.056 log units (representing a decline in VA) after 14.9 months on VPA (p=0.002). Twelve patients (38.7%) reported negative side effects related to VPA use.
VPA plays a complex role in patients with pigmentary retinal dystrophies and may be associated with VA and field decline as well as adverse side effects. Physicians should use caution with using VPA for pigmentary retinal dystrophies.
本研究旨在确定丙戊酸（VPA）治疗色素性视网膜营养不良患者的长期疗效和安全性。
对单一中心 31 例诊断为色素性视网膜营养不良并开具 VPA 处方的患者进行回顾性图表审查。分析视野（VF）、视力（VA）、治疗时间、肝酶和副作用。使用 Goldmann VF（GVF）追踪记录在 VPA 治疗前后的每个眼睛的 V4e 等立体，定义 VF 区域。使用定制软件计算 VF 的平面区域。
5 名患者（10 只眼）有两个 Goldmann VF 追踪记录，允许在基线和随访 VF 之间进行比较。在 VPA 治疗 9.8 个月后，VF 减少了 0.145cm²（26.478%）（p=0.432）。对于 22 名患者（41 只眼），有 VA 数据，在 VPA 治疗 14.9 个月后，对数最小角度分辨率（logMAR）评分变化了 0.056 对数单位（代表 VA 下降）（p=0.002）。12 名患者（38.7%）报告了与 VPA 使用相关的不良反应。
VPA 在色素性视网膜营养不良患者中发挥着复杂的作用，可能与 VA 和视野下降以及不良反应有关。医生在使用 VPA 治疗色素性视网膜营养不良时应谨慎。
