PMC4540358_01
Optical Coherence Tomography (OCT). Images are labeled according to the date taken; each date corresponds to one set of left and right eye images. 2011.06 and 2012.11 depict normal retinal layers throughout. The left and right eye images taken 2014.03 are notable for left eye greater than right eye thinning of the retinal nerve fiber layer, ganglion cell layer, inner plexiform and inner nuclear layers with loss of the foveal pit in the left eye.
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F1
However, on her second follow up visit, 5 months after starting vigabatrin therapy, the ERG was notable for decreased b:a ratio, but OCT and visual fields were unremarkable (Figure 1, 2 and 3). OU (Figure 2). OCT was within normal limits (Figure 1).
Goldmann perimetry field. Images show constricted visual fields. Notably, the field dated 2014.03, is moderately improved from the visual field taken four months earlier - 2013.12.
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F2
However, on her second follow up visit, 5 months after starting vigabatrin therapy, the ERG was notable for decreased b:a ratio, but OCT and visual fields were unremarkable (Figure 1, 2 and 3). OU (Figure 2). OCT was within normal limits (Figure 1). VGB therapy the patient presented for routine follow up with complaints of significant decrease in vision. Visual acuity was 20/25 OD and 20/150 OS, there was an afferent pupillary defect in the left eye, OCT and RNFL mapping showed marked thinning of the nerve fiber layer (Figure 3, 2014.03; Figure 4), but the GVF showed moderate improvement from previous studies (Figure 2, 2014.03).
Electroretinogram (ERG) of both eyes. Scotopic 2-Rod Response showing bilateral decrease, though left greater than right, in wave amplitude. 3- maximum response showing decrease In b: a wave ratio. Photophopic 2-cone response and 3-30Hz flicker showing bilateral, but again, left greater than right decrease in wave amplitude.
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F3
However, on her second follow up visit, 5 months after starting vigabatrin therapy, the ERG was notable for decreased b:a ratio, but OCT and visual fields were unremarkable (Figure 1, 2 and 3). The decreased maximal b:a ratio first seen 6 months ago on ERG persisted (Figure 3). ERG consistently showed a decreased b:a ratio and decreased 30Hz flicker amplitude (Figure 3). VGB therapy the patient presented for routine follow up with complaints of significant decrease in vision. Visual acuity was 20/25 OD and 20/150 OS, there was an afferent pupillary defect in the left eye, OCT and RNFL mapping showed marked thinning of the nerve fiber layer (Figure 3, 2014.03; Figure 4), but the GVF showed moderate improvement from previous studies (Figure 2, 2014.03).
Retinal Nerve Fiber Layer (RNFL) Thickness Map. RNFL map showing bilateral decrease in RNFL thickness over time with left RNFL loss greater than right. Green corresponds to normal RNFL thickness, yellow borderline, and red below normal and borderline thickness. Anatomic orientation - T: temporal, S: superior, I: inferior, N: nasal.
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F4
VGB therapy the patient presented for routine follow up with complaints of significant decrease in vision. Visual acuity was 20/25 OD and 20/150 OS, there was an afferent pupillary defect in the left eye, OCT and RNFL mapping showed marked thinning of the nerve fiber layer (Figure 3, 2014.03; Figure 4), but the GVF showed moderate improvement from previous studies (Figure 2, 2014.03).