AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON...AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON patients at an Indonesian eye center(2017-2022).Demographics,ethambutol treatment,ophthalmologic findings were collected.Visual outcomes after ethambutol cessation assessed at 3-12mo.Patients categorized as having visual improvement(≥2 Snellen lines and/or>5°visual field gain)or no improvement.RESULTS:Mean age was 55.5±12.9y,with 56.9%females.Median duration of ethambutol use was 9mo(range:2-20)at a mean daily dose of 19.7±5.3 mg/kg.At presentation,mean visual acuity was 1.3 logMAR(range:0-2.5),with normal fundus appearance in 72.4%of eyes.The most common visual field defect was generalized depression(52.4%).After ethambutol cessation,56.9%of patients had visual improvement.Younger age(50.24±13.8y vs 62.14±8.9y,P<0.01),lower ethambutol dose(17.3±5 vs 23.3±2.9 mg/kg‧d,P<0.01),shorter treatment duration(6.79±2.6mo vs 10.27±1.2mo,P<0.01),and absence of hypertension(16%vs 83%,P=0.012)or kidney disease(0 vs 83%,P<0.01)were associated with higher likelihood of visual improvement.Diabetes did not differ between groups(P=0.889).CONCLUSION:Over half experience visual recovery after ethambutol cessation.Younger age,lower cumulative dose,absence of hypertension or kidney disease predict better visual outcomes.展开更多
Ethambutol is a common cause of drug-related optic neuropathy.Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss.Previous studi...Ethambutol is a common cause of drug-related optic neuropathy.Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss.Previous studies have shown that structural injury to the optic nerve occurred earlier than the damage to visual function.Therefore,we decided to detect structural biomarkers marking visual field loss in early stage ethambutol-induced optic neuropathy.The thickness of peripapillary retinal nerve fiber layer,macular thickness and visual sensitivity loss would be observed in 11 ethambutol-induced optic neuropathy patients（22 eyes） using optical coherence tomography.Twenty-four healthy age-and sex-matched participants（48 eyes） were used as controls.Results demonstrated that the temporal peripapillary retinal nerve fiber layer thickness and average macular thickness were thinner in patients with ethambutol-induced optic neuropathy compared with healthy controls.The average macular thickness was strongly positively correlated with central visual sensitivity loss（r2=0.878,P=0.000）.These findings suggest that optical coherence tomography can be used to efficiently screen patients.Macular thickness loss could be a potential factor for predicting the onset of ethambutol-induced optic neuropathy.展开更多
AIMTo determine whether HIV and the use of antiretroviral therapy is a risk factor for the development of ethambutol toxic optic neuropathy. To describe the clinical course of ethambutol toxic optic neuropathy in pati...AIMTo determine whether HIV and the use of antiretroviral therapy is a risk factor for the development of ethambutol toxic optic neuropathy. To describe the clinical course of ethambutol toxic optic neuropathy in patients with HIV and to identify prognostic factors.展开更多
AIM:To compare the effects of thiamine pyrophosphate(TPP)and thiamine(TM)in oxidative optic neuropathy in rats induced by ethambutol.METHODS:The animals were divided into four groups:a control group(CG),an ethambutol ...AIM:To compare the effects of thiamine pyrophosphate(TPP)and thiamine(TM)in oxidative optic neuropathy in rats induced by ethambutol.METHODS:The animals were divided into four groups:a control group(CG),an ethambutol control(ETC)group,TM plus ethambutol group(TMG),and TPP plus ethambutol group(TPPG).One hour after intraperitoneal administration of TM 20 mg/kg to the TMG group and TPP 20 mg/kg to TPPG group,30 mg/kg ethambutol was given via gavage to all the groups but the CG.This procedure was repeated once daily for 90 d.After that period,all rats were exposed to high levels of anaesthesia in order to investigate the gene expression of malondialdehyde and glutathione in removed optic nerve tissue and histopathologically to examine these tissues.RESULTS:Malondialdehyde gene expression significantly increased,whereas glutathione gene expression significantly decreased in the ETC group compared to the CG.TM could not prevent the increase of malondialdehyde gene expression and the decrease of glutathione,while TPP significantly could suppress.Histopathologically,significant vacuolization in the opticnerve,single-cell necrosis in the glial cells,and a decrease in oligodendrocytes were observed in the ETC group.Vacuolization in the optic nerve,a decrease in oligodendrocytes and single-cell necrosis were found in the TMG group,while no pathological finding was observed in the TPPG group except for mild vacuolization.CONCLUSION:TPP protects the optic nerve against the ethambutol-induced toxicity but TM does not.TPP can be beneficial in prophilaxis of optic neuropathy in ethambutol therapy.展开更多
Morbidity and mortality associated with human immunodeficiency virus (HIV) has decreased with highly active anti-retroviral therapy (HAART). Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) that is pre...Morbidity and mortality associated with human immunodeficiency virus (HIV) has decreased with highly active anti-retroviral therapy (HAART). Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) that is preferred by the Department of Health and Human Services (DHHS) HIV treatment guidelines and is widely used for the initial treatment of HIV. Although tenofovir is generally well-tolerated, it has been associated with rare cases of acute nephrotoxicity. HIV-infected patients frequently have co-morbidities that require treatment, thus adding another level of complexity due to drug interactions and medication adverse effects with antiretrovirals. We present a patient who suffered an acute deterioration in renal function from tenofovir, leading to an accumulation of co-administered ethambutol, thus resulting in optic neuritis.展开更多
文摘AIM:To characterize the demographic and clinical features of ethambutol optic neuropathy(EON)in an Indonesian patient population and explore prognostic factors for visual recovery.METHODS:Retrospective study of 58 EON patients at an Indonesian eye center(2017-2022).Demographics,ethambutol treatment,ophthalmologic findings were collected.Visual outcomes after ethambutol cessation assessed at 3-12mo.Patients categorized as having visual improvement(≥2 Snellen lines and/or>5°visual field gain)or no improvement.RESULTS:Mean age was 55.5±12.9y,with 56.9%females.Median duration of ethambutol use was 9mo(range:2-20)at a mean daily dose of 19.7±5.3 mg/kg.At presentation,mean visual acuity was 1.3 logMAR(range:0-2.5),with normal fundus appearance in 72.4%of eyes.The most common visual field defect was generalized depression(52.4%).After ethambutol cessation,56.9%of patients had visual improvement.Younger age(50.24±13.8y vs 62.14±8.9y,P<0.01),lower ethambutol dose(17.3±5 vs 23.3±2.9 mg/kg‧d,P<0.01),shorter treatment duration(6.79±2.6mo vs 10.27±1.2mo,P<0.01),and absence of hypertension(16%vs 83%,P=0.012)or kidney disease(0 vs 83%,P<0.01)were associated with higher likelihood of visual improvement.Diabetes did not differ between groups(P=0.889).CONCLUSION:Over half experience visual recovery after ethambutol cessation.Younger age,lower cumulative dose,absence of hypertension or kidney disease predict better visual outcomes.
基金supported by the National High Technology Research and Development Program of China(863 Program),No.2015AA020511
文摘Ethambutol is a common cause of drug-related optic neuropathy.Prediction of the onset of ethambutol-induced optic neuropathy and consequent drug withdrawal may be an effective method to stop visual loss.Previous studies have shown that structural injury to the optic nerve occurred earlier than the damage to visual function.Therefore,we decided to detect structural biomarkers marking visual field loss in early stage ethambutol-induced optic neuropathy.The thickness of peripapillary retinal nerve fiber layer,macular thickness and visual sensitivity loss would be observed in 11 ethambutol-induced optic neuropathy patients（22 eyes） using optical coherence tomography.Twenty-four healthy age-and sex-matched participants（48 eyes） were used as controls.Results demonstrated that the temporal peripapillary retinal nerve fiber layer thickness and average macular thickness were thinner in patients with ethambutol-induced optic neuropathy compared with healthy controls.The average macular thickness was strongly positively correlated with central visual sensitivity loss（r2=0.878,P=0.000）.These findings suggest that optical coherence tomography can be used to efficiently screen patients.Macular thickness loss could be a potential factor for predicting the onset of ethambutol-induced optic neuropathy.
文摘AIMTo determine whether HIV and the use of antiretroviral therapy is a risk factor for the development of ethambutol toxic optic neuropathy. To describe the clinical course of ethambutol toxic optic neuropathy in patients with HIV and to identify prognostic factors.
文摘AIM:To compare the effects of thiamine pyrophosphate(TPP)and thiamine(TM)in oxidative optic neuropathy in rats induced by ethambutol.METHODS:The animals were divided into four groups:a control group(CG),an ethambutol control(ETC)group,TM plus ethambutol group(TMG),and TPP plus ethambutol group(TPPG).One hour after intraperitoneal administration of TM 20 mg/kg to the TMG group and TPP 20 mg/kg to TPPG group,30 mg/kg ethambutol was given via gavage to all the groups but the CG.This procedure was repeated once daily for 90 d.After that period,all rats were exposed to high levels of anaesthesia in order to investigate the gene expression of malondialdehyde and glutathione in removed optic nerve tissue and histopathologically to examine these tissues.RESULTS:Malondialdehyde gene expression significantly increased,whereas glutathione gene expression significantly decreased in the ETC group compared to the CG.TM could not prevent the increase of malondialdehyde gene expression and the decrease of glutathione,while TPP significantly could suppress.Histopathologically,significant vacuolization in the opticnerve,single-cell necrosis in the glial cells,and a decrease in oligodendrocytes were observed in the ETC group.Vacuolization in the optic nerve,a decrease in oligodendrocytes and single-cell necrosis were found in the TMG group,while no pathological finding was observed in the TPPG group except for mild vacuolization.CONCLUSION:TPP protects the optic nerve against the ethambutol-induced toxicity but TM does not.TPP can be beneficial in prophilaxis of optic neuropathy in ethambutol therapy.
文摘Morbidity and mortality associated with human immunodeficiency virus (HIV) has decreased with highly active anti-retroviral therapy (HAART). Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) that is preferred by the Department of Health and Human Services (DHHS) HIV treatment guidelines and is widely used for the initial treatment of HIV. Although tenofovir is generally well-tolerated, it has been associated with rare cases of acute nephrotoxicity. HIV-infected patients frequently have co-morbidities that require treatment, thus adding another level of complexity due to drug interactions and medication adverse effects with antiretrovirals. We present a patient who suffered an acute deterioration in renal function from tenofovir, leading to an accumulation of co-administered ethambutol, thus resulting in optic neuritis.
