Abstract | AIMS: METHODS: We included 50 patients on anti-tubercular therapy (ATT) including EMB (HRE regimen) based on total body weight for 6 months. Best-corrected visual acuity (ETDRS), colour vision (Ishihara pseudo-isochromatic plates), contrast sensitivity (Pelli-Robson chart), Humphrey visual field analysis (HVF 30-2 SITA FAST), pattern visual evoked response (VER) and spectral-domain optical coherence tomography (SDOCT) for ganglion cell inner plexiform layer (GCIPL) and retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 2, 4 and 6 months after starting ATT. RESULTS: Mean age of the patients was 36.5±14.7 years with male:female ratio of 2.5:1. Mean daily dosage of EMB was 17.5±1.3 mg/kg/day. No significant change was observed in visual acuity, contrast sensitivity, color vision and mean or pattern SD on HVF at 6 months. Significant increase in VER latency of >2 SD (>125 ms) was observed in 46% eyes on follow-up indicating subclinical toxicity. Significant loss of mean RNFL (from 100.79±16.05 μm to 89.96±13.79 μm) and GCIPL thickness (from 83.1±5.60 μm to 79.85±6.45 μm) was observed at 6 months (p=0.001 for both). Patients with subclinical toxicity had significantly greater damage in temporal RNFL quadrant, supero-nasal and infero-nasal GCIPL sectors compared with others. CONCLUSION: The incidence of clinical EMB optic neuropathy was <2%, though subclinical damage in the form of increase in VER latency, and decrease in RNFL and GCIPL on OCT was seen in 46% eyes.
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Authors | Sohini Mandal, Rohit Saxena, Rebika Dhiman, Anant Mohan, Srikanta Kumar Padhy, Swati Phuljhele, Pradeep Sharma, Randeep Guleria |
Journal | The British journal of ophthalmology
(Br J Ophthalmol)
Vol. 105
Issue 7
Pg. 1024-1028
(07 2021)
ISSN: 1468-2079 [Electronic] England |
PMID | 32713840
(Publication Type: Journal Article)
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Copyright | © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ. |
Chemical References |
- Antitubercular Agents
- Ethambutol
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Topics |
- Adult
- Aged
- Antitubercular Agents
(toxicity)
- Color Vision
(physiology)
- Contrast Sensitivity
(physiology)
- Ethambutol
(toxicity)
- Evoked Potentials, Visual
(drug effects, physiology)
- Female
- Humans
- Incidence
- Male
- Middle Aged
- Nerve Fibers
(pathology)
- Optic Nerve
(drug effects)
- Optic Nerve Diseases
(chemically induced, diagnosis, epidemiology)
- Prospective Studies
- Retinal Ganglion Cells
(pathology)
- Tomography, Optical Coherence
- Visual Acuity
(physiology)
- Visual Fields
(physiology)
- Young Adult
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