Sheng WY, Wu SQ, Su LY, Zhu LW. Ethambutol-induced optic neuropathy with rare bilateral asymmetry onset: A case report. World J Clin Cases 2022; 10(2): 663-670 [PMID: 35097092 DOI: 10.12998/wjcc.v10.i2.663]
Corresponding Author of This Article
Li-Wei Zhu, MD, Chief Doctor, Department of Ophthalmology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, 208 Huancheng Road East, Gongshu District, Hangzhou 310003, Zhejiang Province, China. zlwgsy1995@126.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Jan 14, 2022; 10(2): 663-670 Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.663
Ethambutol-induced optic neuropathy with rare bilateral asymmetry onset: A case report
Wen-Yan Sheng, Shuang-Qing Wu, Ling-Ya Su, Li-Wei Zhu
Wen-Yan Sheng, Shuang-Qing Wu, Ling-Ya Su, Li-Wei Zhu, Department of Ophthalmology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Author contributions: Sheng WY was the patient’s ophthalmologist, reviewed the literature and contributed to manuscript drafting; Wu SQ reviewed the literature and contributed to manuscript drafting; Su LY performed the examinations and collected all the data; Zhu LW was responsible for revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported bythe Hangzhou Science and Technology Development Project, No. 20170533B70.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Wei Zhu, MD, Chief Doctor, Department of Ophthalmology, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, 208 Huancheng Road East, Gongshu District, Hangzhou 310003, Zhejiang Province, China. zlwgsy1995@126.com
Received: June 7, 2021 Peer-review started: June 7, 2021 First decision: June 25, 2021 Revised: July 12, 2021 Accepted: December 8, 2021 Article in press: December 8, 2021 Published online: January 14, 2022 Processing time: 219 Days and 2 Hours
Abstract
BACKGROUND
Ethambutol-induced optic neuropathy (EON) most commonly manifests as bilateral symmetrical loss of vision and often cause serious and irreversible visual impairment because of the lack of early detection and effective treatment. We followed a case of EON with rare binocular asymmetric clinical manifestations and observed the changes of visual function and retinal structure after drug withdrawal, so as to further understand the clinical characteristics of this disease.
CASE SUMMARY
A 54-year-old man complained of gradual visual decline in the left eye. The patient presented with best-corrected visual acuity of 20/20 in the right eye and 20/50 in the left eye. Color vision examination revealed difficulty in reading green color plates in the left eye. The visual field manifested as concentric contraction in the left eye. After nearly a month of drug withdrawal, the right eye had a similar decline in visual function. At the last visit, 19 mo after drug withdrawal, the visual function significantly recovered in both eyes. During follow-up optical coherence tomography (OCT) examination, both eyes manifested the thickness of the retinal nerve fiber layer from mild thickening to thinning and finally temporal atrophy, and the ganglion cell-inner plexiform layer showed significant thinning. The difference was that a reversible structural disorder in the outer retina of the nasal macula was detected in the left eye by macular high-definition OCT.
CONCLUSION
Nephropathy and high blood pressure, which damage the retinal microcirculation, may cause damage to the outer layer of the retina. Ethambutol may influence photoreceptor as well as retinal ganglion cells.
Core Tip: Ethambutol-induced optic neuropathy is most commonly characterized by bilateral symmetrical loss of vision, but it may also occur successively in both eyes. Ethambutol may influence retinal photoreceptor cells and retinal ganglion cells.
