Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
Department of Ocular Pharmacology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Ophthalmol. 2018 Aug;66(8):1104-1108. doi: 10.4103/ijo.IJO_108_18.
Oral valproic acid (VPA) used as an anticonvulsant has been shown to improve contrast threshold sensitivities in patients receiving it on long-term. This study aimed to evaluate the efficacy of oral VPA in improving visual function in eyes with advanced stage glaucoma.
In this prospective randomized study, 31 patients (n = 31 eyes) with advanced stage glaucoma (with an intraocular pressure <16 mmHg) in at least one eye received oral VPA 500 mg once a day for 3 months and 33 patients (n = 33 eyes) continued on glaucoma therapy. Patients were followed up at 3 and 12 months (to evaluate the legacy effect of the drug). Blood VPA concentrations were measured at 3 months. Following parameters were assessed at baseline, 3 months and 12 months: log of the minimum angle of resolution (LogMAR) visual acuity, mean deviation on visual fields, and multifocal electroretinogram (ERG).
Median LogMar visual acuity in the VPA group improved from 0.3 at baseline to 0.18 and 0.18 at 3 and 12 months, respectively (P < 0.01). In comparison, the median visual acuity in control group at baseline was 0.18 and showed neither worsening nor improvement over 3 and 12 months (P = 0.56). The improvement in VPA group was significant compared to the control group (P < 0.01; Wilcoxon Signed-rank test). An improvement in one line was experienced in 11 out of 31 eyes in the VPA group compared to 1 out of 33 eyes among controls (P = 0.003). No significant improvement was noted in the mean deviation, and the multifocal ERG (Latency and amplitudes) in the VPA-treated patients. The average blood VPA concentration measured at 3 months of therapy was 26 ± 8.9 μg/ml (range 8-55 μg/ml) which is much lower than that achieved during anticonvulsant therapy. None of the patients complained of any adverse effects that required stopping VPA therapy.
A 3 months oral VPA therapy results in some improvement in visual acuity in a subgroup of eyes with advanced glaucoma and the effect was seen to persist 9 months after the drug was stopped.
已证实，作为抗惊厥药物的口服丙戊酸（VPA）可提高长期接受治疗的患者的对比敏感度阈值。本研究旨在评估口服 VPA 改善晚期青光眼患者视力的疗效。
在这项前瞻性随机研究中，31 名（n = 31 只眼）晚期青光眼患者（至少一只眼眼压<16mmHg）接受口服 VPA 500mg，每日一次，治疗 3 个月，33 名（n = 33 只眼）患者继续接受青光眼治疗。患者在 3 个月和 12 个月时进行随访（评估药物的遗留效果）。在 3 个月时测量血 VPA 浓度。在基线、3 个月和 12 个月时评估以下参数：最小分辨角对数（LogMAR）视力、视野平均偏差和多焦视网膜电图（ERG）。
VPA 组的中位 LogMar 视力从基线时的 0.3 分别改善至 3 个月时的 0.18 和 12 个月时的 0.18（P < 0.01）。相比之下，对照组基线时的视力中位数为 0.18，在 3 个月和 12 个月时既未恶化也未改善（P = 0.56）。VPA 组的改善与对照组相比具有统计学意义（P < 0.01；Wilcoxon 符号秩检验）。与对照组相比，VPA 组中有 11 只眼（31 只眼中的 11 只）视力提高了一行，而对照组中只有 1 只眼（33 只眼中的 1 只）视力提高（P = 0.003）。VPA 治疗患者的平均偏差和多焦 ERG（潜伏期和振幅）未见显著改善。治疗 3 个月时测量的平均血 VPA 浓度为 26 ± 8.9μg/ml（范围 8-55μg/ml），远低于抗惊厥治疗时的浓度。无患者因任何不良反应而需要停止 VPA 治疗。
口服 VPA 治疗 3 个月可使晚期青光眼患者的视力在亚组中有所提高，且停药 9 个月后仍可观察到疗效。
