■我们旨在研究乙胺丁醇诱导的中毒性视神经病变(EON)患者的视觉恢复时间,并确定与视觉恢复时间相关的因素。
■在这项回顾性队列研究中,我们回顾了35例EON患者的35只眼的医疗记录.视觉恢复定义为从最低点获得≥3行。
■停用乙胺丁醇(EMB)后观察到患者,平均随访21.0±16.0个月。最低点时的视敏度(VA)为logMAR1.3±0.5,最终VA为logMAR0.6±0.5。27眼(77.1%)视力恢复显著。在Kaplan-Meier生存中,视力恢复的平均估计时间为15.2±3.0个月,和50%的患者在EMB停药后8.3±2.2个月时视力恢复。多因素Cox回归分析确定了视力恢复延迟的几个显著危险因素,包括EMB药物治疗的持续时间≤6个月,从症状发作到EMB停药期>14天,基线乳头周围视网膜神经纤维层(pRNFL)厚度>98μm。
■我们的研究表明EON病例的平均视力恢复时间为15个月。因此,诊断为EON的患者应随访1-2年以上,以评估其视力恢复情况.延迟停止EMB,EMB使用时间短,初始pRNFL增厚与视力恢复延迟相关。因此,服用EMB的患者应定期随访,以便早期发现EON,并立即停用EMB,以防止视神经严重损伤.
OBJECTIVE: We aimed to investigate the visual recovery time in patients with ethambutol-induced toxic optic neuropathy (EON) and identify the factors associated with the visual recovery time.
METHODS: In this retrospective cohort study, we reviewed the medical records of 35 eyes from 35 patients with EON. Visual recovery was defined as a gain of three or more lines from the nadir.
RESULTS: Patients were observed following discontinuation of ethambutol (EMB), with the mean follow-up period of 21.0 ± 16.0 months. The visual acuity at nadir was logarithm of the minimum angle of resolution 1.4 ± 0.4, and the final visual acuity was logarithm of the minimum angle of resolution 0.6 ± 0.5. Twenty-seven eyes (77.1%) showed significant visual recovery. In Kaplan-Meier survival, the mean estimated time for visual recovery was 15.2 ± 3.0 months, and 50% of the patients experienced visual recovery at 8.3 ± 2.2 months following EMB discontinuation. Multivariate Cox regression analysis identified several significant risk factors for delayed visual recovery, including duration of EMB medication ≤6 months, period from symptom onset to EMB discontinuation >14 days, and baseline peripapillary retinal nerve fiber layer thickness >98 μm.
CONCLUSIONS: Our study indicated a mean time of visual recovery of 15 months for EON cases. Therefore, patients diagnosed with EON should be followed up for more than 1 to 2 years to evaluate their visual recovery. Delayed EMB discontinuation, short duration of EMB use, and initial peripapillary retinal nerve fiber layer thickening were associated with delayed visual recovery. Therefore, patients taking EMB should be followed up regularly for early detection of EON and immediate discontinuation of EMB to prevent severe damage to the optic nerve.