Retinal Nerve Fiber Layer and Macular Thickness in Adolescents with Epilepsy Treated with Valproate and Carbamazepine

Abstract

Summary:Purpose: To evaluate retinal nerve retinal nerve fiber layer (RNFL) and macular thickness by using optical coherence tomography (OCT) in epileptic adolescents before and during monotherapy with valproic acid (VPA) and carbamazepine (CBZ).Methods: We examined prospectively 45 epilepsy patients with partial and generalized epilepsy. The patients were evaluated before the beginning of therapy and after 1 year of VPA or CBZ monotherapy. Forty-five untreated healthy controls were evaluated at baseline and after 1 year. Results:At the beginning of the study, the two groups of patients showed RNFL and macular thickness measurements similar to control values. At the end of the follow-up, the data of the three groups were similar to baseline, showing no significant differences in the evaluated parameters.Conclusions: The present study demonstrates that no modification of RNFL and macular thickness parameters is found after 1 year of treatment with VPA and CBZ monotherapy. Key Words: Valproate-Carbamazepine-EpilepsyRetinal nerve fiber layer thickness-Macular thickness.In recent years, alterations of visual function have been studied extensively in epilepsy patients treated with different antiepileptic drugs (AEDs); in particular, carbamazepine (CBZ) and valproic acid (VPA) can produce significant impairment of color perception (1-3). However, no data exist about possible morphologic retinal alterations related to this impairment. In a previous study (3), we demonstrated that epilepsy patients treated with VPA and CBZ can show color vision defects, in particular for blue vision, and that these abnormalities are present not only in the foveal area but also in peripheral macular areas. Optic nerve end and macula measurements may provide complementary structural information in assessing the pathogenetic mechanisms of the color-vision impairment induced by VPA and CBZ.In the present study, we studied the same patients who showed color-vision impairment to determine whether such impairment is related to anatomic changes, particularly in retinal and nerve fiber layer thickness. MATERIALS AND METHODSWe studied 45 adolescents (16 boys and 29 girls; mean age, 15.71 ± 2.01 years; range, 11.0-18.1) with partial and generalized cryptogenic epilepsy. A description of patients is reported in our previous article (3). We measured macular thickness and retinal nerve fiber layer (RNFL) before the beginning of AED therapy and after one year of therapy.Forty-five untreated healthy sex-and age-matched adolescents served as controls.Each subject underwent a comprehensive ophthalmologic examination performed by one of the authors (L.L.), including review of medical history, best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement with Goldmann applanation tonometry, dilated funduscopy examination with a 90-diopter lens and seven-field fundus photography of the retina.Eyes with coexisting retinal disease, uveitis, or optic neuropathy were excluded from this investigation.The ophthalmologic evaluation...

Valproic Acid–Mediated Neuroprotection and Regeneration in Injured Retinal Ganglion Cells

“…Furthermore, morphologic retinal alterations (modifications of retinal nerve fiber layer or macular thickness) have not been reported in patients after 1 year of VPA treatment. 53 In accordance with our results, VPA treatment per se had no effect on RGC number even after 90 days of VPA treatment. 54 If VPA will be considered in future for the treatment of a chronic retinal neurodegenerative disease such as glaucoma, possible effects of VPA on retinal function have to be monitored carefully.…”

Optical coherence tomography parameters in patients with photosensitive juvenile myoclonic epilepsy

“…In epileptic patients another OCT study investigated RNFL and macular thickness in adolescents with newly diagnosed patients with epilepsy before and during monotherapy with valproate or carbamazepine over a period of one year [24]. There was no difference in the values of RNFL and macular thickness following the use of either valproate or carbamazepine after this one year period.…”

Ocular Adverse Effects of Common Psychotropic Agents

“…[80] In fact, valproate (a widely used mood stabilizer and antiepileptic drug) has not been shown to cause any significant or irreversible ocular disturbance. [9,80] Carbamazepine use has been possibly associated with only two case reports of retinopathy; [81] this association has not been described as causative. These reports were of two epileptic, middleaged women treated with carbamazepine for >7 years.…”