Long-Term Study of Levodopa/Carbidopa for Refractory Childhood Amblyopia

Young-Ho Kim; Seong-Beom Ko; Yoonae A. Cho; Seung-Hyun Kim

doi:10.3341/jkos.2009.50.11.1692

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Kim, Ko, Cho, and Kim: Long-Term Study of Levodopa/Carbidopa for Refractory Childhood Amblyopia

Original Article

J Korean Ophthalmol Soc 2009;50(11):1692-1697.

Published online: 31 August 2009

DOI: https://doi.org/10.3341/jkos.2009.50.11.1692

Long-Term Study of Levodopa/Carbidopa for Refractory Childhood Amblyopia

Young-Ho Kim, MD¹, Seong-Beom Ko, MD², Yoonae A. Cho, MD¹, Seung-Hyun Kim, MD¹

¹Department of Ophthalmology, Korea University College of Medicine, Ansan, Korea

²Department of Neurology, Korea University College of Medicine, Ansan, Korea

Address reprint requests to Seung-Hyun Kim, MD, Department of Ophthalmology, Korea University College of Medicine #516 Gojan 1-dong, Danwon-gu, Ansan 425-707, Korea Tel: 82-31-412-5160, Fax: 82-31-414-8930, E-mail: ansaneye@hanmail.net

Received 10 February 2009 Accepted 21 July 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the long-term (12 to 30 months) effect of L-dopa with part-time occlusion in patients in which occlusion therapy failed.

Methods

Seventeen eyes of 12 amblyopic children who failed with part-time occlusion (4 to 8 hours/day) treatment for a minimum period of 6 months were studied. The follow-up period was 12 to 30 months. The average best corrected visual acuity (BCVA) before treatment was 0.28±0.20 (0.05-0.5). After full informed consent was obtained from their parents, the children received levodopa (2 to 4 mg/kg) for 8 weeks combined with part-time occlusion and spectacles.

Results

The average age of the subjects was 7.0±2.7 years and the mean follow-up period was 23.7±7.7 (12 to 30) months. After the administration of levodopa for 8 weeks, 9 eyes (53%) showed improvement in BCVA, and only 4 eyes showing a mean regression of 0.20±0.11 logMAR visual acuities. The BCVA reached the maximum value after a mean of 8.47 months. After 8 weeks from baseline, 13 eyes (76%) reached the maximum BCVA. After 12 to 30 months of follow-up, 12 out of 17 eyes (70.6%) showed a BCVA improvement of 0.14±0.19 logMAR.

Conclusions

After the long-term (12 to 30 months) follow-up, L-dopa with part-time occlusion in patients in which occlusion therapy failed showed improved visual acuities in 76% of the cases.

Keywords: Amblyopia, L-dopa

References

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Figure 1.

Average best corrected visual acuity (BCVA) of patients with improved visual acuity after administration of levodopa for 8 weeks (9 eyes).(^* the log of minimum angle of resolution visual acuity)

Figure 2.

Changes in best corrected visual acuity (BCVA) in all patients after dopamine administration. (^* BCVA=best corrected visual acuity; ^† wks=weeks; ^‡ mons=months)

Table 1.

Patient profiles and characteristics

Patient	Age (years)	Sex	Diagnosis	Follow-up periods (months)	Initial VA^*	VA at 8 wks	Maximum VA	Last VA	Side effect
1	5.2	M^†	AA^§	30	0.2	0.4	0.5	0.5	None
2	10.8	F^‡	AA	18	0.5	1.0	1.0	1.0	None
3	5.3	M	Mixed(AA+SA^∏)	14	0.1	0.2	0.3	0.3	None
4	5.8	F	DA^#	15	0.5	0.6	0.8	0.6	Nervousness
					0.5	0.6	0.6	0.5
5	4.5	F	DA	30	0.05	0.05	0.1	0.08	Loss of
					0.6	0.6	1.0	1.0	appetite
6	5.1	M	DA	30	0.15	0.15	0.4	0.3	Nervousness
					0.1	0.1	0.3	0.2
7	3.8	M	Mixed(DA+SA)	30	0.05	0.05	0.1	0.1	None
8	6.3	F	Mixed(AA+OA^**)	12	0.15	0.15	0.2	0.1	None
9	6.5	M	Mixed(AA+OA)	30	0.1	0.1	0.2	0.1	None
10	11.1	M	AA	14	0.3	0.5	0.7	0.3	None
					0.1	0.1	0.3	0.15
11	12	F	SA	27	0.5	0.6	0.6	0.3	None
12	8.5	M	DA	30	0.4	0.8	0.8	0.6	None
					0.5	0.6	0.7	0.6
Mean	7.0±2.70			23.7±7.7

^*VA=decimal visual acuity

^†M=male

^‡F=female

^§AA=anisometropic amblyopia

^∏SA=strabismic amblyopia

^#DA=stimulus deprivation amblyopia

^**OA=organic amblyopia.

Table 2.

Patients with improved visual acuity at 8 week

Patient	Initial VA^*	VA at 8 wks	Maximum VA	Periods^† (months)	Last VA
1	0.2	0.4	0.5	2	0.5
2	0.5	1.0	1.0	2.5	1.0
3	0.1	0.2	0.3	11	0.3
4	0.5	0.6	0.8	13	0.6
	0.5	0.6	0.6	6	0.5
10	0.3	0.5	0.7	7	0.3
11	0.5	0.6	0.6	2.5	0.3
12	0.4	0.8	0.8	2	0.6
	0.5	0.6	0.7	3	0.6
^‡Mean(decimal)	0.39±0.15	0.59±0.23	0.67±0.20		0.52±0.22
^§ Mean(logMAR)	0.46±0.25	0.26±0.20	0.20±0.15		0.33±0.15

^*VA=deciaml visual acuity

^†Periods=time to reach maximum visual acuity

^‡Mean (decimal)=average of decimal visual acuities

^§Mean (logMAR)=average of logMAR equivalent of decimal visual acuities.

Table 3.

Comparison of initial, maximum and last visual acuity

	Decimal VA^*	logMAR VA
Mean initial BCVA^†	0.28±0.20	0.68±0.38
Mean maximum BCVA	0.51±0.38	0.39±0.32	p^‡=0.00
Mean last BCVA	0.38±0.26	0.54±0.35	p^§=0.01

^*VA=visual acuity

^†BCVA=best corrected visual acuities

^‡p=p-value of Wilcoxonsigned rank test between mean maximum BCVA and mean initial BCVA

^§p=p-value of Wilcoxon signed rank test between mean maximum BCVA and mean last BCVA.

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