Ophthalmic findings in fetal anticonvulsant syndrome(s).
OBJECTIVE
To report the prevalence of ocular abnormalities in a group of children diagnosed with fetal anticonvulsant (FAC) syndrome(s).


METHODS
Retrospective, observational, noncomparative case series.


METHODS
Forty-six children, age range 8 months to 16 years 5 months (mean, 7 years 1 month), with a confirmed diagnosis of an FAC syndrome. Thirty-seven subjects were exposed in utero to sodium valproate (29 as monotherapy), and the remainder (n = 9) to other anticonvulsants, mainly carbamazepine.


METHODS
A total of 46 subjects underwent ophthalmic assessment consisting of visual acuity, cover test, ocular movements, analysis of spectacle lens power, cycloplegic refraction, and anterior segment examination with portable slit lamp, plus direct and indirect ophthalmoscopy.


METHODS
Refraction and ocular motility status.


RESULTS
Thirty-one of 46 (67%) had ocular abnormalities, most commonly errors of refraction (19 of 46; 41%). Myopia was common (14 of 28; 50%) in those exposed to valproate monotherapy and there were high frequencies of strabismus (20%), astigmatism (24%), and anisometropia (11%) in the group as a whole. Thirty-one percent of myopes and 27% of astigmates did not wear glasses, of whom three subjects and two subjects, respectively, were less than 8 years old and therefore at risk of anisometropic or ametropic amblyopia. One subject had epicanthus, one color vision deficiency, and one bilateral congenital cataract.


CONCLUSIONS
We conclude that (1) abnormal ophthalmic findings are common in subjects with confirmed FAC syndrome, in particular myopia in those with fetal valproate syndrome; (2) children with FAC syndrome should receive preschool vision testing; (3) preschool vision testing should be considered in all children exposed to anticonvulsants in utero.
Glover
Simon J
SJ
West of England Eye Unit, Royal Devon & Exeter Hospital, Exeter, UK England.
Quinn
Anthony G
AG
Barter
Philippa
P
Hart
Jane
J
Moore
Susan J
SJ
Dean
John C S
JC
Turnpenny
Peter D
PD
D000014:Abnormalities, Drug-Induced / Q000209:etiology; D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004827:Epilepsy / Q000188:drug therapy; D005124:Eye Abnormalities / Q000139:chemically induced*; D005260:Female; D005315:Fetal Diseases / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D008297:Male; D010672:Phenytoin / Q000009:adverse effects / Q000627:therapeutic use; D015995:Prevalence; D012030:Refractive Errors / Q000139:chemically induced* / Q000175:diagnosis; D012189:Retrospective Studies; D013285:Strabismus / Q000139:chemically induced* / Q000175:diagnosis; D013577:Syndrome; D014635:Valproic Acid / Q000009:adverse effects / Q000627:therapeutic use; D014792:Visual Acuity
D000927:Anticonvulsants; D002220:Carbamazepine; D014635:Valproic Acid; D010672:Phenytoin