Ethambutol-induced optic neuropathy with rare bilateral asymmetry onset:A case report

作     者：Wen-Yan Sheng Shuang-Qing Wu Ling-Ya Su Li-Wei Zhu 

作者机构：Department of OphthalmologyAffiliated Hangzhou Chest HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2022年第10卷第2期

页      面：663-670页

核心收录：

学科分类：1002[医学-临床医学] 100212[医学-眼科学] 10[医学] 

基　　金：Supported by the Hangzhou Science and Technology Development Project No.20170533B70. 

主　　题：Ethambutol-induced optic neuropathy Retinal nerve fiber layer Ganglion cell-inner plexiform layer Optical coherence tomography Asymmetry Case report 

摘      要：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.