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Optic disc Morphology Changes following Long-term Application of Sabril - A Case Report

Viestenz A., Viestenz A., Mardin C. Y.,
Friedrich-Alexander-Universität, Augenklinik (Erlangen)

Purpose: Antiepileptic drugs may induce simple optic nerve atrophy and visual field constriction.
Methods: Examination of a 70-year old male with a cumulative dosage of 3.7 kg Sabril (optic disc morphometry, visual field, HRT, Gdx, sensoric physilogy).
Results: We found a bilateral simple optic nerve atrophy. The size of the optic disc measured R/L 2,1mm2. The thickness of the neuroretinal rim was smaller as the 90. percentile with the HRT. The Gdx showed multiple defects in the nerve fiber layer and an increased number (R=79, L=74). Goldmann-visual field was bilaterally concentric narrowed (nasal 20° and temporal 35°). The latency of visual evoced potentials was prolonged (> 125 ms). The Arden-quotient measured R=1.6 and L=2.2. ERG-b-wave was significantly reduced.
Conclusions: Sabril (Vigabatrin) is an antiepileptic drug and may increase the intraretinal GABA-level due to an inhibition of the enzyme GABA-transaminase and may induce an ascending optic nerve atrophy. Sabril-associated visual field defects may be asymptomatic and irreversible. Mostly, there will persist the pathologic ERG-changes, otherwise the EOG comes to a normal level if the Sabril is stopped. A visual field control is recommended before starting the treatment with Sabril and at regular half year intervals thereafter. In case of visual field constriction, the therapy should be stopped. If the cumulative dosage is more than 3 kg of sabril, the visual field controls should be performed more frequently because of the dosage-toxicity-relationship.