Treatment of refractory amblyopia with levodopa associated with full-time occlusion in the dominant eye

Abstract Purpose: To evaluate visual outcomes of levodopa treatment associated with full occlusion of the dominant eye in patients with refractory amblyopia. Methods: A prospective study of 19 attended patients who were subject to treatment with Levodopa and Carbidopa on doses of 0.7mg/kg/day, a ratio of 4:1 divided into three daily doses for 5 weeks, combined with full occlusion (24 hours/day) of the dominant eye. The ophthalmologic exam from previous consultations up to treatment and after 8 weeks of therapy were collected from medical record data. Patients who had completed treatment for more than 12 months were included for complete eye examination. Results: The mean age before treatment with levodopa was 11.0 ± 4.2 years old (varying from 7 to 23 years). The best-corrected visual acuity (Snellen chart) of the amblyopic eye before treatment was 0.24 (0.6 in logMAR) ± 0.16, after 8 weeks of treatment it was 0.47(0.3 in logMAR) ± 0.33, while during the final evaluation it was 0.46 (0.3 in logMAR) ± 0.34. There was a statistically significant improvement in vision after 8 weeks of therapy which was maintained until the final evaluation (p = 0.007). Conclusion: Levodopa/Carbidopa therapyat doses of 0.7 mg/kg/day at a ratio of 4:1 divided in three daily doses, associated with full occlusion of the dominant eye during 5 weeks had a significant improvement on the visual acuity of the amblyopic eye, and persisted up to 1 year after the treatment.

摘要
研究目的：评估难治性弱视患者接受左旋多巴（Levodopa）联合卡比多巴（Carbidopa）与健眼全遮盖治疗后的视觉预后效果。
研究方法：本研究为前瞻性研究，纳入19例完成随访的患者，给予左旋多巴与卡比多巴联合治疗，剂量为0.7mg/kg/天，按4:1比例分每日三次给药，持续5周，同时联合健眼24小时全遮盖。从病历数据中提取治疗前历次门诊的眼科检查结果，以及治疗8周后的检查数据；对于完成治疗满12个月的患者，追加完整的眼科检查。
研究结果：左旋多巴治疗前患者的平均年龄为11.0±4.2岁，年龄范围为7~23岁。治疗前弱视眼的最佳矫正视力采用斯内伦（Snellen）视力表检测，结果为0.24（等效对数最小分辨角（logMAR）0.6）±0.16；治疗8周后提升至0.47（logMAR 0.3）±0.33；末次随访时视力为0.46（logMAR 0.3）±0.34。治疗8周后视力出现具有统计学意义的显著提升，且该效果持续至末次随访（p=0.007）。
研究结论：按4:1比例配制、剂量为0.7mg/kg/天且分每日三次给药的左旋多巴/卡比多巴联合治疗，联合5周健眼全遮盖方案，可显著改善弱视眼的视力，且该疗效可持续至治疗后1年。