A case of ocular toxicity to ethambutol—an idiosyncratic reaction?

Karnik, AC; Al-Shamali, M. A.; Fenech, Frederick F.

doi:10.1136/pgmj.61.719.811

Cited by 23 publications

(4 citation statements)

References 6 publications

(7 reference statements)

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“…Although it is not a typical bitemporal haemianopia, which should respect the central vertical meridian, many authors have described it for EON (ref. [19][20][21][22][23] ). Heng et al demonstrated retinal ganglion cell damage in a rat model 24 .…”

Section: Discussionmentioning

confidence: 99%

Ethambutol-induced optic neuropathy

Kyncl¹,

Fus²,

Lešták³

2023

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Purpose. A case report of a 40-year-old patient with tuberculosis treated with ethambutol is described. Within six months of starting treatment, there was a painless sudden decline in visual function. Despite the known complications of ethambutol treatment, it was discontinued after another three months. Methods. In the case report, we highlight the damage to the dominantly peripheral visual pathways. Using electrophysiological examinations, we showed a significant alteration in the optic nerves. Optical Coherence Tomography (OCT) showed progressive loss of vessel density and nerve fibre layer of retinal ganglion cells. Perimetric examination showed both a central decrease in sensitivity and mainly scotomas in the temporal parts of the visual fields. Although there was improvement in visual fields over time, OCT findings indicated progression of ethambutol-induced optic neuropathy (EON). Magnetic Resonance Imaging confirmed the alteration in the peripheral part of the visual pathway (intraorbital, intracranial parts of optic nerves, chiasma, and optic tracts). Conclusion. Even though EON is not an unknown complication, new cases still occur and, unfortunately, with an irreversible course. Therefore, it is important to draw attention constantly to this complication and to consider it not only in ophthalmologists' surgeries.

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Section: Discussionmentioning

confidence: 99%

Ethambutol-induced optic neuropathy

Kyncl¹,

Fus²,

Lešták³

2023

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…This inhibition may extend to mammalian cells and especially the mitochondrial DNA. Apart from anecdotal idiosyncratic reactions, this toxicity is largely dose and duration dependent [2].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Ethambutol Ocular Toxicity in Extended Use Therapy

Mehta¹

2019

Cureus

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We report the clinical and perimetric findings of three patients with ethambutol toxicity with an extended use regimen. In this observational case series, we extracted data from case records that included age, sex, complaints, details of the current disease, anti-tubercular therapy, ocular findings, and perimetric findings. We identified three patients, two female and one male with ages ranging from 16 to 65 years (mean: 37 years). The perimetric patterns we observed were incomplete homonymous hemianopia in two patients and bitemporal hemianopia in one. Incomplete hemianopia was the predominant perimetric finding, suggesting that the likely lesions were chiasmal or post-chiasmal rather than pre-chiasmal.

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“…Meanwhile, Poussos and Tsolkas found a 2% incidence of ocular toxicity among 250 patients receiving 15 mg/kg EMB daily for 4 -8 months. [7,13,14] Although often reversible when the drug is discontinued early, many reports exist of permanent blindness following EMB treatment at the standard dosage. Because the risk of ocular toxicity is increased in patients with renal failure, the maximum recommended dose is 15 mg/kg/day, and the dosage of EMB should be adjusted according to residual renal function.…”

Section: Discussionmentioning

confidence: 99%

“…[7] The maximum recommended dose (conventional dosage) for healthy people is 25 mg/kg/day, and this dose is generally only given for first two months of the therapy, after which it is reduced to 15 mg/kg/day. [1,7,13] Owing to the similarities between the toxic optic neuropathy of EMB and nutritional (tobacco/alcohol) amblyopia, parenteral hydroxocobalamin therapy (vitamin B12) has been studied as a possible treatment for restoring vision loss. Meanwhile, the recommended dose for ESRD patients is 15 mg/kg QOD.…”

Section: Discussionmentioning

confidence: 99%

Ethambutol‐Induced Optic Neuritis in Patients with End Stage Renal Disease on Hemodialysis: Two Case Reports and Literature Review

Fang¹,

Chen²,

Chang³

2004

Renal Failure

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Ethambutol, a synthetic bacteriostatic agent, is a first line agent against Mycobacterium tuberculosis. Although optic neuritis is the most serious adverse effect of ethambutol, most cases in the literature are reversible. Renal failure prolongs the half-life of ethambutol and increases the risk of ethambutol-induced optic neuritis. We present two patients with end stage renal disease (ESRD), who were on maintenance dialysis and suffering ethambutol-induced optic neuritis. The first woman had been suffering ESRD on hemodialysis for 2 years. After tuberculosis was diagnosed, she was prescribed three-combined anti-tuberculosis medications, including ethambutol 800 mg/day. Bilateral blurred vision suddenly occurred 4 months after the start of treatment, and she became totally blind despite discontinuing ethambutol. The second woman had been on hemodialysis for 5 months. Tuberculosis was diagnosed by lung biopsy. After 3 weeks of three-combined anti-tuberculosis medications including ethambutol (1,200 mg/day), reduced visual acuity and color vision defects occurred. One year after the discontinuation of ethambutol, visual acuity remained little improved. Physicians should be aware of ethambutol-induced optic neuritis and ethambutol should be used cautiously in patients with renal failure.

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A case of ocular toxicity to ethambutol—an idiosyncratic reaction?

Cited by 23 publications

References 6 publications

Ethambutol-induced optic neuropathy

Ethambutol-induced optic neuropathy

Patterns of Ethambutol Ocular Toxicity in Extended Use Therapy

Ethambutol‐Induced Optic Neuritis in Patients with End Stage Renal Disease on Hemodialysis: Two Case Reports and Literature Review

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