Ocular side effects of anti-tubercular drugs in patients receiving Anti-Tb treatment at tertiary care center

Abstract

India is among the countries that carry the highest burden for tuberculosis. Antitubercular drugs are frequently associated with ocular toxicity. Among ATT, ethambutol is the most commonly implicated drug causing optic neuropathy. For assessing spectrum of ATT induced ocular toxicity, clinical presentation, monitoring, and preventive measures a prospective observational follow up study was conducted. Materials and Methods: A newly diagnosed drug susceptible pulmonary tuberculosis patients referred to ophthalmology OPD during a study period from May 2018 -October 2019 at a tertiary care hospital. The detailed history, best corrected visual acuity, fundus examination, color vision test and visual fields were carried out in all patients at the start of treatment and thereafter every month up to 6 months after initiation of ATT. Results: During six month follow up study, out of 94 study participants, 14 eyes of seven patients (7.44%) had drop in visual acuity from baseline (p value = 0.03). Total 10 eyes of five patients (5.32%) had developed colour vision abnormality (p=0.001) and 8 eyes of four patients had developed optic disc changes from baseline. Visual field defects were noted in ten (5.32%) eyes (p = 0.001). In our study ATT related ocular toxicity was found in 5.32% on standard HRZE drug regimen. Conclusion:The course of ethambutol-induced ocular toxicity is unpredictable. The early recognition of ocular toxicity is paramount to prevent irreversible visual loss.

Assessment of Optic Nerve Changes in Patients Receiving Anti-Tuberculosis Drugs at Different Time Interval

“…There are approximately 1.2 million ganglion cells per retina and approximately 4-6 cones and 100 rods per ganglion cell. 9 Pupillary abnormalities are observed in patient receiving antituberculosis drugs. Binocular Indirect Ophthalmoscope is an instrument and it is clinically applicable for the diagnosis and early intervention.…”