The aim of this study was to examine infantile spasms patients at school age for visual fields to see whether VGB treatment in infancy had caused defects.

This study included 35 children: ten children with tuberous sclerosis (TS), three with other symptomatic and 22 with cryptogenic aetiology for their spasms. Visual fields were examined by the Goldmann kinetic, by the static Humphrey or Octopus perimetry. Visual fields were re-evaluated by the ophthalmologist.

Typical VGB-attributed visual field defects were found altogether in 11/32 (34%) patients. Three of 35 patients were excluded because of VFD of other origin (2) or only with ERG study (1). The defects were mild in 5 and severe in 6 cases. One child out of 12 children (8%) who used VGB for less than one year (Group 1) had mild VFD. Three of the 9 patients (33%) using VGB for up to 22-24 months (Group 2), and 7/11 patients (63%) using VGB for more than 2 years (Group 3) had VFDs. Defects were mild (1) and severe (2) in Group 2, and mild (3) and severe (4) in Group 3. The mean cumulative doses were 155 g (Group 1), 808 g (Group 2) and 2547 g (Group 3), respectively. The patients with TS had more VFDs (6/10 patients).

VFDs were found to occur at the same frequency as that reported in adults. The plasticity of an infant retina seems not to protect from damage. The risk/benefit ratio should always be carefully considered when using VGB.