가림치료에 반응하지 않는 난치성 약시에서 도파민 약물치료의 효과 = The Effect of L-dopa in Amblyopic Children for Whom Occlusion Therapy Failed

다국어 초록 (Multilingual Abstract)

Purpose: This study was undertaken to evaluate the effect of L-dopa in amblyopic children for whom occlusion treatment failed. Methods: We studied nine amblyopic children (11 eyes) for whom part-time occlusion (4～8 hours/day) treatment for a minimum period of 6 months had failed. The types of amblyopia included: anisometropic (1 patient, 1 eye), stimulus deprivation (4 patients, 6 eyes) and mixed (anisometropic and strabismic: 2 patients, 2 eyes; anisometropic and organic: 2 patients, 2 eyes). Best corrected visual acuity before treatment was between 0.05 and 0.5. They received, with full informed consent of the parent, levodopa (2～4 mg/kg) for 8 weeks combined with part-time occlusion. Results: The children were between 4 and 11 years old (mean 5.8±2.05). Of the subjects, 45.5% (4 patients, 5 eyes) had improved visual acuity after 8 weeks of treatment. In one patient with anisometropic, two patients with mixed (anisometropic and strabismic), and one patient with stimulus deprivation (ametropic) amblyopia, visual acuity improved by one to five lines. Conclusions: In anisometropic, strabismic amblyopes and mild deprivational amblyopes for whom occlusion treatment failed, L-dopa improved visual acuity. L-dopa may be an additional option for treatment of amblyopic patients with a guarded visual prognosis.

참고문헌 (Reference)

1 "development,aging,and effects of monocular visual deprivation" 2 : 465-71, 1989

2 "Visual acuities and scotomas after one week of levodopa administration in human amblyopia" 33 : 2722-8, 1992

3 "Stability of visual acuity in amblyopic patients after visual maturity" 226 : 154-7, 1988

4 "Single responses in cat visual cortex to visual stimulation during iontophoresis of noradrenaline" 45 : 317-27, 1982

5 "Pharmacokinetics and bioavailability of Sinemet CR:a summary of human studies" 39 : 25-38, 1989

6 "Penalization treatment of amblyopia:a follow-up study of two years in older children" 19 : 137-9, 1982

7 "Outcome of occlusion treatment for amblyopia" 36 : 19-24, 1999

8 "Ocular dominance plasticity in kitten visual cortex integration of noradrenergic and cholinergic regulation Activation to Acquisition functional aspects of the basal forebrain cholinergic system" 289-324, 1991

9 "Occlusion and levodopa-carbidopa for childhood amblyopia" 2 : 257-264, 1998

10 "Longitudinal study of levodopa/carbidopa for childhood amblyopia" 30 : 354-60, 1993

11 "Long-term follow-up of L-dopa treatment in children with amblyopia" 39 : 326-330, 2002

12 "Levodopa/carbidopa treatment for amblyopia in older children" 32 : 143-151, 1995

13 "Levodopa/carbidopa for childhood amblyopia" 34 : 3090-5, 1993

14 "Levodopa and childhood amblyopia:discussion" 29 : 299-, 1992

15 "Enhancement of neuronal plasticity by activating the norepinephrine system in the brain:a remedy for amblyopia" 1 : 49-54, 1982

16 "Effect of levodopa therapy on visually evoked potential and visual acuity in amblyopia" 213 : 110-113, 1999

17 "Effect of levodopa on contrast sensitivity and scotomas in human amblyopia" 31 : 776-80, 1990

18 "Effect of levodopa and carbidopa in human amblyopia" 39 : 81-89, 2002

19 "Dopaminergic neurons in human retina" 210 : 65-79, 1982

20 "Development of receptive field properties of retinal ganglion cells in kittens raised with convergent spuint" 39 : 313-20, 1980

21 "Current concepts in strabismus" Naewehaksul 117-128, 2004

22 "Cerebral accumulation and metabolism of C14-dopa after selective inhibition of peripheral decarboxylase" 161 : 14-20, 1968

23 "Altered spatiotemporal contrast vision in Parkinson's disease and MTTP treated monkeys the role of dopamine Mechanism in Vision" Alan R Liss Inc piccoli (piccoli): 205-20, 1988