Protocole de surveillance ophtalmologique des patients traités par antipaludéens de synthèse ou par vigabatrin au long cours

Vigabatrin (VGB) is an effective drug for treatment of epilepsy and has been used in the treatment of West syndrome and epilepsy resistant to other drugs. VGB treatment improves quality of life, but it can induce characteristic bilateral nasal visual field defects and changes in retinal electrophysiology. Currently, the recommended procedure is to screen these patients before treatment, if possible, with a complete ophthalmological exam including perimetry and retinal electrophysiology every 6 months. It may be necessary to rely on retinal electrophysiology since some patients may not be able to undergo perimetry. The risk/benefit ratio sill clearly favors VGB treatment. Patients whose seizure incidence is reduced and have only minimal visual changes could continue VGB with strict monitoring. The others must discontinue VGB.