Ocular hemodynamics in epileptic children treated with antiepileptic drugs

Abstract

Purpose To evaluate the quantitative measurements obtained for vessel density (VD) of the optic nerve head, macula, peripapillary retinal nerve fibre layer (p-RNFL) and total retinal thicknesses (Trt) by optical coherence tomography angiography (OCT-A) and the choroidal vascular structure using an image binarization method in children with epilepsy using three different antiepileptic drugs (AEDs) and to compare these measurements with healthy participants. Methods This observational, cross-sectional study included 124 patients divided into 4 groups: Group-1: patients receiving carbamazepine(n = 30), group-2: patients receiving levetiracetam (n = 31), group-3: patients receiving valproic acid (n = 32), and group 4: healthy controls (n = 31).A fully automated microstructural analysis of the VD of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and the choriocapillaris (CC) layers and radial peripapillary capillary, and Trt, p-RNFL thickness were analyzed by using OCT-A. Enhanced depth imaging (EDI)-OCT scans of the macula were obtained and the images were binarized using the ImageJ software. Results The mean age, gender distribution and the duration of epilepsy were similar in all groups. Evaluation of the p-RNFL thickness and perifoveal Trt between the groups showed a statistically significant difference in all quadrants.The p-RNFL thickness was lower in patients receiving carbamazepine and valproic acid. The lowest values of the luminal area and choroidal vascular index (CVI) were found in patients receiving valproic acid; comparison with matched healthy controls showed statistically significant differences. Conclusion Valproic acid and carbamazepine are associated with thinning of the p-RNFL in epilepsy patients, but the macular and radial peripapillary VD were not affected.However, a reduction of choroidal vascular blood flow was found in epilepsy patients taking valproic acid.

Papillary and peripapillary vascular densities and corresponding correlation with peripapillary retinal thicknesses using optical coherence tomography angiography in healthy children and adolescents

“…The study of optic nerve head (ONH) perfusion has been recently popularized after progression in understanding glaucoma and ONH disease pathogeneses. It has been revealed that optic nerve circulation and anatomy may be altered by ocular diseases like high myopia 2 , infantile nystagmus 3 , optic disc drusen 4 , uveitis 5 , optic neuritis 6 , optic neuropathies 7 , glaucoma 8 , 9 , central nervus system (CNS) related disorders such as migraine 10 , epilepsy 11 , CNS tumors 12 , 13 , and systemic conditions like diabetes 14 and thalassemia 15 or drug induced changes 11 , 16 in both children and adults 12 , 17 , 18 . Prompt diagnosis and management are crucial to prevent further visual impairment and promote optimal visual development.…”