The authors present a pilot randomised placebo controlled double blind trial assessing 20mg fluoxetine once daily for 90 days versus placebo in stroke survivors with isolated homonymous hemianopia. Exclusion criteria were extensive in terms of pre-existing ophthalmic or neurologic disease, stroke severity, haemorrhagic transformation, contraindications to fluoxetine or placebo, pregnancy and enrollment in other clinical trials. Randomisation was a one-to-one ratio. Recruitment occurred within 10 days of the stroke onset. Assessments were carried out at baseline, one, three and six months, including 24-2 perimetry, modified Rankin Scale (mRS) and National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The sample size was calculated to detect 35% improvement with 80% power. Primary and secondary outcome measures related to perimetry assessment plus NEI VFQ-25 and mRS at three months. A total of 17 individuals were recruited with eight receiving fluoxetine. Five participants (three on fluoxetine and two controls) did not complete follow-up. The reasons for drop-out and stage of drop-out are outlined. The results showed outcomes in favor of fluoxetine in terms of improvement of perimetric mean deviation, area recovered, and percentage of full recovery. These results are strongly suggestive that a larger scale trial is needed. The authors do acknowledge the exclusion criteria may need to be reviewed in order to achieve required sample sizes. The retention rate is a positive finding for a future trial.
Pilot trial of Fluoxetine for post-stroke homonymous hemianopia
Reviewed by Lauren Hepworth
FLUORESCE: A pilot randomized clinical trial of Fluoxetine for vision recovery after acute ischemic stroke.
CONTRIBUTOR
Lauren R Hepworth
University of Liverpool; Honorary Stroke Specialist Clinical Orthoptist, Northern Care Alliance NHS Foundation Trust; St Helen’s and Knowsley NHS Foundation Trust, UK.
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