Ethambutol-induced optic neuropathy in renal disorder: a clinico-electrophysiological study

Kanaujia, Vikas; Jain, Vaibhav; Sharma, Kumudini; Agarwal, Rachna; Mishra, Prabhakar; Sharma, Raj Kumar

doi:10.1016/j.jcjo.2018.06.013

Cited by 16 publications

(8 citation statements)

References 13 publications

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“…Furthermore, the damages to this sheath result in progressive axonal degeneration [27]. In this condition, ethambutol affects either the axonal or preaxial parts of the optic nerves by the demyelination process, primarily observed in the optic nerves and chiasma [4]. Consequently, it is probable that EMB binds to the optic chiasm with high affinity and causes bitemporal visual field abnormalities, which express themselves as toxic symptoms in the eyes [28].…”

Section: Discussionmentioning

confidence: 99%

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Ethambutol Effect on Retinal and Optic Nerve Structural Changes in Toxic Optic Neuropathy Case: A Literature Review

Islam

Umar

Minhajat

et al. 2022

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Introduction: Ethambutol (EMB) is one of the first-line antituberculosis drugs that reported to cause toxic effects on the eye structure. This study aims to elucidate the histological mechanism of retinal and optic nerve damage in toxic optic neuropathy cases. Reference Sources: The literature search was conducted in the PUBMED and MEDLINE databases using the latest publication of the 2012-2022 series. Studies Selection: The observational and randomized controlled trial studies analyzing the effect of ethambutol on retinal nerve fiber layer, retinal ganglion layer, inner cell plexiform layer thickness, optic nerve tissue, best-corrected visual acuity (BCVA), color perception, visual evoked response, and patients' visual field were included. Data Extraction Method: Articles that met the inclusion criteria underwent a specific evaluation, whereby the main focus was the ethambutol on retinal and optic nerve tissue. Results: The results showed that ethambutol affects the thinning of the Retinal Nerve Fiber Layer (RNFL), decreasing the amount of Ganglion Cells and changing the optic nerve's histological function by damaging the mitochondria and axonal fiber. Conclusion: It was concluded that ethambutol has adverse effects on retinal and optic nerve tissue due to several mechanisms and significantly affects the patient's visual outcome.

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Section: Discussionmentioning

confidence: 99%

“…In a 10-year survey of 4.803 patients newly diagnosed with tuberculosis, it was reported that approximately 1.29% of them developed a case of ethambutol optic neuropathy [4]. Ethambutol has been shown to cause bulbar and retrobulbar neuritis, generally due to visual impairment with painless, subacute, symmetrical, and progressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

Ethambutol Effect on Retinal and Optic Nerve Structural Changes in Toxic Optic Neuropathy Case: A Literature Review

Islam

Umar

Minhajat

et al. 2022

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“…Ocular side effects are believed to be dose-dependent, with most patients developing neuropathy at 60–100 mg/kg/day, although this is possible even at ≤15 mg/kg/day [ 146 ]. In addition, patients with kidney disease should not be treated with ethambutol, as this drug is mainly excreted via the kidneys and accumulates in the body when the kidney disease is present [ 147 ]. Discontinuation of the drug usually results in visual improvement [ 126 , 148 ], although some reports indicate that visual disability persists [ 149 , 150 ], as well as progressive structural damage in the absence of clinical symptoms [ 151 ].…”

Section: Treatment Optionsmentioning

confidence: 99%

Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review

Baj

Forma

Kobak

et al. 2022

IJERPH

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Optic neuropathies constitute a group of conditions with various etiologies and might be caused by different factors; we can distinguish the genetic and acquired causes of optic neuropathies. Even though the symptoms are not highly specific, this condition is primarily characterized by unilateral or bilateral vision loss with worsening color detection. The loss may be acute or gradual depending on the causation. In this article, we included a specification of toxic optic neuropathy (TON) mainly triggered by alcohol abuse and also the usage of other substances, including drugs or methanol, as well as intoxication by metals, organic solvents, or carbon dioxide. Nutritional deficiencies, vitamin absorption disorder, and anemia, which usually appear during excessive alcohol intake, and their effect on the etiology of the optic neuropathy have been likewise discussed.

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“…In all these cases, it was identified that after ethambutol was discontinued, renal function recovered and no long-term renal dysfunction occurred 17 . In the process within the body, about 65% to 80% of ethambutol consumed will be excreted unchanged through the urine after passing through the kidneys, this condition proceed an increase in serum ethambutol levels causing its half-life also increases (about 7 to 15 hours in patients with stage renal failure) compared to 4 hours in normal people, therefore the toxicity due to the drug either increases 19 . Administration of isoniazid, pyrazinamide, rifampicin and of course ethambutol as antituberculosis drugs causes renal impairment and dysfunction due to involvement of these organs in the excretion of metabolites and active metabolites of these drugs.…”

Section: Toxicity Of Ethambutol On Renal Tissuementioning

confidence: 99%

Ethambutol Effect on Renal and Hepatic Tissue Changes: A Literature Review

2022

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Background: Ethambutol is an oral chemotherapeutic drug specifically effective against the active growth of microorganisms of the genus Mycobacterium. Ethambutol is generally well-tolerated and rarely causes side effects. One of the commonly known side effects of ethambutol is optic neuritis, some others include peripheral neuropathy, numbness and tingling, hepatotoxicity, mental disorders, disorientation, hallucinations, to psychosis. Purpose: This review aims to explain current and previous opinions about ethambutol use and its effects on kidney and liver tissue. The results of this review are expected to provide an overview of the impact of using ethambutol caused tissue damage in humans. Methods: In this literature review, we performed a search for several keywords such as "ethambutol", "renal tissue", and "hepatic tissue” on PubMed, Science Direct, and Google Scholar databases from January 2010 to January 2022. Results: Combination antituberculosis therapy intervention of isoniazid, rifampin, pyrazinamide, and ethambutol causes elevated liver enzymes and drug-induced liver injury. Studies reported 14 of 634 (2%) patients on ethambutol are at risk for DILI. Antituberculosis medications have also been reported to affect the kidneys because of their association with the liver as part of the excretory system. Therefore, the kidneys are exposed to the harmful effects of intermediate or waste metabolism leading to injury in these cases. Conclusion: Ethambutol has not been shown to significantly cause damage to liver and kidney tissue, but it has been reported to have an impact on elevated liver enzymes and renal impairment supported by histological findings. Keywords: Ethambutol, renal tissue, hepatic tissue.

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Ethambutol-induced optic neuropathy in renal disorder: a clinico-electrophysiological study

Cited by 16 publications

References 13 publications

Ethambutol Effect on Retinal and Optic Nerve Structural Changes in Toxic Optic Neuropathy Case: A Literature Review

Ethambutol Effect on Retinal and Optic Nerve Structural Changes in Toxic Optic Neuropathy Case: A Literature Review

Toxic and Nutritional Optic Neuropathies—An Updated Mini-Review

Ethambutol Effect on Renal and Hepatic Tissue Changes: A Literature Review

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