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Feizi N, Mohamadzadeh-Nabiei M, Vahedi H, Farabi Maleki S, Jafarizadeh A. Therapeutic role of erythropoietin in methanol induced optic neuropathy: a systematic review. Daru 2024; 33:2. [PMID: 39613913 PMCID: PMC11607285 DOI: 10.1007/s40199-024-00551-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 11/06/2024] [Indexed: 12/01/2024] Open
Abstract
PURPOSE Despite various therapeutic attempts, an approved treatment for Methanol-induced optic neuropathy (MION), a sight-threatening disorder, is still lacking. Erythropoietin known as an erythropoietic cytokine, possesses various non-hematopoietic properties that make it a candidate for MION treatment. This systematic review aims to assess the potential therapeutic role of erythropoietin in MION. METHOD We systematically searched English and Persian databases including PubMed, Scopus, Embase, Web of Science, and Scientific Information Database (SID) as of July 2024. Two independent authors screened the articles based on their titles, abstracts, and full texts to finalize the included articles in this study. The selected articles underwent quality assessments via the Joanna Briggs Institute (JBI) checklists. RESULTS Out of 139 studies identified in the databases, 11 were finally included in the analysis. These studies encompassed 212 participants, with 192 receiving erythropoietin treatment. Visual acuity (VA) improved in 184 patients, with improvements ranging from no light perception to full vision recovery, or minor enhancements such as an improvement from 1.75 ± 0.72 to 1.32 ± 0.79 LogMAR. Only 8 patients showed no change or experienced deterioration. Additionally, 21 cases exhibited a reduction in retinal nerve fiber layer thickness, with one showing a reduction towards the normal range. CONCLUSION This review highlights erythropoietin's positive impact on VA in patients with MION. However, simultaneous use of erythropoietin and corticosteroids in studies without control groups complicates evaluating erythropoietin's independent efficacy. Future research should involve large, controlled trials to clarify erythropoietin's role and establish it as a standard treatment. PROSPERO REGISTRATION NUMBER CRD42023485772.
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Affiliation(s)
- Neda Feizi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Mohamadzadeh-Nabiei
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hadi Vahedi
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, 5166614766, Iran
| | - Shadi Farabi Maleki
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, 5166614766, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, 5166614766, Iran.
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Rajendra S, Shah VM, Manayath GJ, Kumar K. Multimodal Imaging Features of Subacute Methanol-Induced Bilateral Optic Neuropathy. J Neuroophthalmol 2024; 44:e390-e392. [PMID: 37166998 DOI: 10.1097/wno.0000000000001862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sharanya Rajendra
- Departments of Neuro-Ophthalmology (SR, VMS, KK) and Retina Vitreous (GJM), Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India
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Alrobaian M, Alkhuraiji A, Almohanna R, Alshehri M, Alyahya B. Visual outcome of methanol toxic optic neuropathy after erythropoietin treatment in Riyadh, Saudi Arabia. Saudi J Ophthalmol 2024; 38:41-46. [PMID: 38628402 PMCID: PMC11017006 DOI: 10.4103/sjopt.sjopt_174_22] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/29/2023] [Accepted: 03/07/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study is to evaluate the visual response of methanol-induced optic neuropathy to management with erythropoietin (EPO) along with conventional therapy. METHODS This retrospective case series examines the ophthalmological data of patients diagnosed with methanol-induced optic neuropathy between 2020 and 2021 at two centers, Riyadh, Saudi Arabia. Patients' characteristics and the results of initial and final ophthalmological examinations were documented and compared between patients who received EPO in addition to conventional management and those who received only conventional management. RESULTS A total of nine cases were reviewed, of which eight (88.9%) were males and one was female (11.1%). The mean age was 37.7 years. At presentation, funduscopic examination revealed optic disc edema in four eyes (two patients), and 14 eyes had normal appearance (seven patients). Among the nine patients who received conventional management, 5 (55.6%) additionally received intravenous EPO during the treatment course. There was no clinically or statistically significant difference in terms of visual outcome between the two groups. The mean visual acuity at the final presentation was 1.32 ± 0.79 logarithm of the minimum angle of resolution (LogMAR) in the EPO group and 1.36 ± 0.85 LogMAR in the non-EPO group. Optical coherence tomography indicated that the EPO group had an average retinal nerve fiber layer thickness of 48.13μm (±6.2), at the final assessment. CONCLUSION Managing the visual impairments in individuals with methanol-induced optic neuropathy using intravenous EPO resulted in similar final visual outcomes compared to conventional management.
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Affiliation(s)
- Malek Alrobaian
- Department of Ophthalmology, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Arwa Alkhuraiji
- Department of Ophthalmology, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rema Almohanna
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alshehri
- Department of Emergency Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Bader Alyahya
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Tabatabaei SA, Amini M, Haydar AA, Soleimani M, Cheraqpour K, Shahriari M, Hassanian-Moghaddam H, Zamani N, Akbari MR. Outbreak of methanol-induced optic neuropathy in early COVID-19 era; effectiveness of erythropoietin and methylprednisolone therapy. World J Clin Cases 2023; 11:3502-3510. [PMID: 37383889 PMCID: PMC10294205 DOI: 10.12998/wjcc.v11.i15.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/01/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Methanol is a highly toxic, non-potable alcohol. Outbreaks of methanol toxicity occur due to its fraudulent addition to alcoholic beverages as a cheaper substitute for ethanol. Recently, alongside the coronavirus disease 2019 (COVID-19) pandemic, rumors circulated on social media that consuming alcohol can prevent or cure the virus, leading to a COVID-19 and methanol-induced optic neuropathy (MON) syndemic. AIM To investigate the impact of erythropoietin (EPO) on the outcomes of patients diagnosed with MON. METHODS In this prospective study, 105 patients presenting with acute bilateral visual loss secondary to methanol intoxication were enrolled from March to May 2020 at Farabi Eye Hospital. A comprehensive ocular examination was conducted for all participants. Recombinant human EPO and methylprednisolone were administered intravenously to all patients for three consecutive days. RESULTS The mean age of the participants was 39.9 years (± 12.6). Ninety-four patients were male and eleven were female. The mean pre-treatment best corrected visual acuity (BCVA) improved from 2.0 ± 0.86 to 1.39 ± 0.69 logarithm of the minimum angle of resolution post-treatment (P < 0.001), with significant improvement observed in all age categories and genders (P < 0.001). Visual acuity improvement was also significant regardless of whether the patient presented before or after 72 h (P < 0.001), and the post-treatment BCVA remained significant at all monthly follow-up visits (P < 0.001). CONCLUSION EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with MON when administrated within the first month of exposure. Public awareness efforts are necessary to prevent further outbreaks of methanol toxicity in the current COVID-19 era.
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Affiliation(s)
- Seyed Ali Tabatabaei
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Amini
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Ali A Haydar
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Kasra Cheraqpour
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
| | - Mansoor Shahriari
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran
| | - Hossein Hassanian-Moghaddam
- Department of Clinical Toxicology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1964512642, Iran
| | - Nasim Zamani
- Department of Internal Medicine, Street, Agnes Medical Center, Fresno, CA 93720, United States
| | - Mohammad Reza Akbari
- Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran 1336616351, Iran
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Jafarizadeh A, Homaie M, Abdollahi M, Niyousha M. Time course study of optical coherence tomography angiography in patients with methanol induced optic neuropathy. BMC Ophthalmol 2023; 23:178. [PMID: 37098467 PMCID: PMC10126549 DOI: 10.1186/s12886-023-02937-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/21/2023] [Indexed: 04/27/2023] Open
Abstract
INTRODUCTION In countries where alcoholic beverages are legally prohibited, methanol toxicity usually occurs due to ingesting homemade alcoholic drinks. The initial ophthalmologic symptoms of methanol toxicity typically appear 6-48 h after ingestion, and the severity of symptoms varies widely from mild and painless decreased vision to no-light perception vision. METHODS This prospective study examines 20 patients with acute methanol poisoning within 10 days of use. Patients underwent ocular examinations, BCVA (Best Corrected Visual Acuity) recording, and OCTA (Optical Coherence Tomography Angiography) of the macula and optic disc. BCVA measurement and imaging were repeated one month and three months after intoxication. RESULTS There was a statistically significant reduction in superficial parafoveal vascular density (P-value = 0.026), inner retinal thickness (P-value = 0.022), RNFL (Retinal Nerve Fiber Layer) thickness (P-value = 0.031), and an increase in cup to disc ratio (P-value < 0.001), and central visual acuity (P-value = 0.002) in this time course. However, there was no statistically significant difference in FAZ (Foveal Avascular Zone) area (P-value = 0.309), FAZ perimeter (P-value = 0.504), FD-300 (Foveal density, vascular density within a 300 μm wide region of the FAZ) (P-value = 0.541), superficial vascular density (P-value = 0.187), deep foveal vascular density (P-value = 0.889), deep parafoveal vascular density (P-value = 0.830), choroidal flow area (P-value = 0.464), total retinal thickness (P-value = 0.597), outer retinal thickness (P-value = 0.067), optic disc whole image vascular density (P-value = 0.146), vascular density inside the disc (P-value = 0.864), or peripapillary vascular density (P-value = 0.680) at different times. CONCLUSION Over time, methanol poisoning can cause changes in retinal layers thickness, vasculature, and optic nerve head. The most important changes include cupping of the optic nerve head, reduction in RNFL thickness, and inner retinal thickness.
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Affiliation(s)
- Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mina Homaie
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mirsaeed Abdollahi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohamadreza Niyousha
- Department of Ophthalmology, Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Rashidi Alavijeh M, Mazaheri‐Tehrani S, Saffari AS, Fazel M, Fazel F. Intravenous plus intravitreal erythropoietin for management of methanol toxicity optic neuropathy: A case report and brief review. Clin Case Rep 2023; 11:e7011. [PMID: 36873065 PMCID: PMC9979964 DOI: 10.1002/ccr3.7011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/29/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Methanol can inhibit cellular aerobic respiration pathway and causes cell hypoxia specially in optic neurons. Despite using many drugs, methanol-induced optic neuropathy (MION) still has a poor prognosis. Here we present a case of MION which is managed by a combination of intravenous and intravitreal erythropoietin in addition to corticosteroids.
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Affiliation(s)
- Mehran Rashidi Alavijeh
- Student Research Committee, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Sadegh Mazaheri‐Tehrani
- Student Research Committee, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Amir Sepehr Saffari
- Student Research Committee, School of MedicineIsfahan University of Medical SciencesIsfahanIran
| | - Mohammadreza Fazel
- Isfahan Eye Research Center, Department of OphthalmologyIsfahan University of Medical SciencesIsfahanIran
| | - Farhad Fazel
- Isfahan Eye Research Center, Department of OphthalmologyIsfahan University of Medical SciencesIsfahanIran
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Margolin E, Donaldson L. A young woman with severe bilateral visual loss and putaminal infarcts. Pract Neurol 2023; 23:95-97. [PMID: 35450963 DOI: 10.1136/practneurol-2022-003407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Edward Margolin
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Ontario, Canada .,Department of Medicine, Division of Neurology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laura Donaldson
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
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Feizi S, Alemzadeh-Ansari M, Karimian F, Esfandiari H. Use of erythropoietin in ophthalmology: a review. Surv Ophthalmol 2021; 67:427-439. [PMID: 34157346 DOI: 10.1016/j.survophthal.2021.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
Erythropoietin (EPO) is a glycoprotein hormone that regulates hematopoiesis in the human body. The presence of EPO and its receptors in different tissues indicates that this hormone has extramedullary effects in other tissues, including the eye. We focus on the biological roles of this hormone in the development and normal physiologic functions of the eye. Furthermore, we explore the role of EPO in the management of different ocular diseases - including diabetic retinopathy, retinopathy of prematurity, inherited retinal degeneration, branch and central retinal vein occlusion, retinal detachment, traumatic optic neuropathy, optic neuritis, methanol optic neuropathy, nonarteritic anterior ischemic optic neuropathy, glaucoma, and scleral necrosis.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | - Farid Karimian
- Ophthalmic Research Center, Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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9
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Nikkhah H, Golalipour M, Doozandeh A, Pakravan M, Yaseri M, Esfandiari H. The effect of systemic erythropoietin and oral prednisolone on recent-onset non-arteritic anterior ischemic optic neuropathy: a randomized clinical trial. Graefes Arch Clin Exp Ophthalmol 2020; 258:2291-2297. [DOI: 10.1007/s00417-020-04781-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
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Abstract
There is a myriad of changes that can be produced in the eye by toxic drugs ranging from mild/no symptoms to severe loss of vision from endophthalmitis. The routes of administration include oral ingestion, smoking, nasal inhalation, intravenous injection, topical application or application to other mucosal surfaces. It is important to recognize certain clinical signs and symptoms in the eye produced by these toxins. This article describes in brief some of the ocular effects of commonly abused drugs. For identification of a particular poisoning, in addition to the clinical presentation, pulse, blood pressure, respiration and body temperature, pupillary size, pupillary reaction to light, ocular convergence and nystagmus can be useful indicators of the type of drug the patient is exposed to. Unmasking these features help the clinician in an early and accurate diagnosis of the offending drug as well as timely management.
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Affiliation(s)
- Deepika Dhingra
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Savleen Kaur
- Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Jagat Ram
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Effects of topical erythropoietin on healing experimentally-induced avascular scleral damage in a rabbit model. Exp Eye Res 2020; 190:107898. [DOI: 10.1016/j.exer.2019.107898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/15/2019] [Accepted: 12/18/2019] [Indexed: 01/20/2023]
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Pakdel F, Sanjari MS, Naderi A, Pirmarzdashti N, Haghighi A, Kashkouli MB. Erythropoietin in Treatment of Methanol Optic Neuropathy. J Neuroophthalmol 2019; 38:167-171. [PMID: 29300238 DOI: 10.1097/wno.0000000000000614] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Methanol poisoning can cause an optic neuropathy that is usually severe and irreversible and often occurs after ingestion of illicit or homemade alcoholic beverages. In this study, we evaluated the potential neuroprotective effect of erythropoietin (EPO) on visual acuity (VA) in patients with methanol optic neuropathy. METHODS In a prospective, noncomparative interventional case series, consecutive patients with methanol optic neuropathy after alcoholic beverage ingestion were included. All patients initially received systemic therapy including metabolic stabilization and detoxification. Treatment with intravenous recombinant human EPO consisted of 20,000 units/day for 3 successive days. Depending on clinical response, some patients received a second course of EPO. VA, funduscopy, and spectral domain optical coherence tomography were assessed during the study. Main outcome measure was VA. RESULTS Thirty-two eyes of 16 patients with methanol optic neuropathy were included. Mean age was 34.2 years (±13.3 years). The mean time interval between methanol ingestion and treatment with intravenous EPO was 9.1 days (±5.56 days). Mean follow-up after treatment was 7.5 months (±5.88 months). Median VA in the better eye of each patient before treatment was light perception (range: 3.90-0.60 logMAR). Median last acuity after treatment in the best eye was 1.00 logMAR (range: 3.90-0.00 logMAR). VA significantly increased in the last follow-up examination (P < 0.0001). Age and time to EPO treatment after methanol ingestion were not significantly related to final VA. No ocular or systemic complications occurred in our patient cohort. CONCLUSIONS Intravenous EPO appears to improve VA in patients with methanol optic neuropathy and may represent a promising treatment for this disorder.
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Affiliation(s)
- Farzad Pakdel
- Department of Ophthalmology (FP, MSS, MBK), Eye Research Center, Tehran University of Medical Sciences, Rassoul Akram Hospital, Tehran, Iran; Department of Ophthalmology (FP), Eye Research Center, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran; Eye Research Center (AN, NP), Farabi Hospital, Tehran University of Medical Sciences; and Department of Internal Medicine (AH), Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Kowalski T, Verma J, Greene SL, Curtin J. Methanol toxicity: a case of blindness treated with adjunctive steroids. Med J Aust 2019; 210:14-15.e1. [PMID: 30636315 DOI: 10.5694/mja2.12040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tanya Kowalski
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC.,Austin Health, Melbourne, VIC
| | | | - Shaun L Greene
- Victorian Poisons Information Centre, Austin Health, Melbourne, VIC
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Rashad MA, Abdel Latif AAM, Mostafa HA, Fawzy SM, Abdel Latif MAM. Visual-Evoked-Response-Supported Outcome of Intravitreal Erythropoietin in Management of Indirect Traumatic Optic Neuropathy. J Ophthalmol 2018; 2018:2750632. [PMID: 30647957 PMCID: PMC6311769 DOI: 10.1155/2018/2750632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/04/2018] [Accepted: 11/04/2018] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Investigating the efficacy of intravitreal injection of erythropoietin (EPO) in managing indirect traumatic optic neuropathy (ITON) of different durations. METHODS A case series that included two groups of ITON patients: recent ITON group (<3 months trauma duration; 7 eyes) and old duration ITON group (3-36 months; 7 eyes). Diagnostic computerized tomography (CT) and baseline flash visual evoked response (VER) were performed at the presentation time. At the initial visit and each follow-up, all patients had undergone assessment of best-corrected visual acuity (BCVA), pupil reaction, and anterior and posterior segments. VER was repeated 1 and 3 months after injection. All patients received an intravitreal injection of 2000 IU EPO in 0.2 ml of commercially available sterile EPREX 4000 solution, Jansen Cilag, Zug, Switzerland. Five patients had received a second injection 3 months later. RESULTS Significant improvement was found in BCVA, VER amplitude, and latency (P < 0.0001, 0.0154, and 0.0291, respectively). Initial values of BCVA, VER amplitude, and latency correlated significantly to the final values. Differences between recent and old trauma groups were insignificant in the three parameters. In patients who received second injection, further clinical but statistically insignificant improvement was noted in BCVA in 60% of patients, VER amplitude in 50% of patients, and in VER latency in 100% of patients. No complications were recorded. CONCLUSION Intravitreal injection of EPO may be effective and safe in treatment of recent and old indirect traumatic optic neuropathy.
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Affiliation(s)
| | | | - Hazem A. Mostafa
- Ain Shams University, Faculty of Medicine, Neurosurgery Department, Cairo, Egypt
| | - Samah Mahmoud Fawzy
- Ain Shams University, Faculty of Medicine, Ophthalmology Department, Cairo, Egypt
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Taşlı NG, Çimen FK, Karakurt Y, Uçak T, Mammadov R, Süleyman B, Kurt N, Süleyman H. Protective effects of Rutin against methanol induced acute toxic optic neuropathy: an experimental study. Int J Ophthalmol 2018; 11:780-785. [PMID: 29862175 DOI: 10.18240/ijo.2018.05.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 02/23/2018] [Indexed: 12/21/2022] Open
Abstract
AIM To determine the effects of Rutin on methanol induced optic neuropathy and compare the results with the effects of ethanol. METHODS Totally 30 rats were divided into 5 groups, with 6 rats in each group as follows: healthy controls (C), methotrexate (MTX), methotrexate+methanol (MTM), methotrexate+methanol+ethanol (MTME) and methotrexate+ methanol+Rutin (MTMR). In all rabbits except those of the control group, MTX, diluted in sterile serum physiologic, 0.3 mg/kg per oral was applied for 7d by the aid of a tube. After this procedure to the rats of MTM, MTME and MTMR groups, 20% methanol with a dose of 3 g/kg per oral was given by the aid of a tube. In MTME group, 4h after the application of methanol, 20% ethanol was applied by the same way with a dose of 0.5 g/kg. On the other hand, in MTMR group 4h after the application of methanol, Rutin, which was dissolved in distilled water, was applied by the same way with a dose of 50 mg/kg. RESULTS There were statistically significant differences in tissue 8-hydroxy-2 deoxyguanine (8-OHdG), interleukin-1β (IL-1β), tumor necrosis factor-alpha (TNF-α), malondialdehyde (MDA), myeloperoxidase (MPO). glutathione peroxidase (tGSH) and superoxide dismutase (SOD) levels between groups (P<0.001). In MTMR group tissue 8-OHdG, IL-1β, MDA, and MPO levels were similar with the healthy controls but significantly different than the other groups. In histopathological evaluations, in MTX group there was moderate focal destruction, hemorrhage and decrease in number of astrocytes and oligodendrocytes; in MTM group there was severe destruction and edema with decrease in number of astrocytes and oligodendrocytes; in MTME group there was mild hemorrhage, mild edema, mildly dilated blood vessels with congestion while in MTMR group, optic nerve tissue was resembling the healthy controls. CONCLUSION Rutin may prevent methanol-induced optic neuropathy via anti-inflammatory effects and decreasing the oxidative stress. New treatment options are warranted in this disease to avoid loss of vision in patients.
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Affiliation(s)
- Nurdan Gamze Taşlı
- Department of Ophthalmology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Ferda Keskin Çimen
- Department of Pathology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Yücel Karakurt
- Department of Ophthalmology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Turgay Uçak
- Department of Ophthalmology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Renad Mammadov
- Department of Pharmacology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Bahadır Süleyman
- Department of Pharmacology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
| | - Nezahat Kurt
- Department of Biochemistry, Atatürk University Hospital, College of Medicine, Erzurum 25100, Turkey
| | - Halis Süleyman
- Department of Pharmacology, Erzincan University Hospital, College of Medicine, Erzincan 24100, Turkey
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Zamani N, Hassanian-Moghaddam H, Shojaei M, Rahimian S. Evaluation of the effect of erythropoietin + corticosteroid versus corticosteroid alone in methanol-induced optic nerve neuropathy. Cutan Ocul Toxicol 2017; 37:186-190. [PMID: 28849680 DOI: 10.1080/15569527.2017.1373121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Following methanol intoxication, optic nerve neuropathy may occur, which is currently treated by different therapeutic regimens. Erythropoietin (EPO) has recently been introduced as a good therapeutic option in methanol-induced optic neuropathy. The aim of the current study was to evaluate the efficacy of EPO in improvement of the visual disturbances in methanol-intoxicated patients. MATERIALS AND METHODS In a case-control study, all patients who had referred to our toxicology centre with confirmed diagnosis of methanol toxicity were considered to be included. Of them, those who had referred with visual disturbances, survived, and their visual disturbances had not improved after haemodialysis were entered. Cases received EPO and corticosteroids while controls only received corticosteroids. They were then compared regarding their visual outcome. RESULTS All five patients in the control group mentioned that after discharge, their visual acuity had improved while in the cases, three mentioned visual improvement, two mentioned their visual acuity had deteriorated after discharge, two mentioned no change in their visual acuity and three mentioned that their visual acuity had first improved but then deteriorated with a mean two-month interval period. In fundoscopic evaluations, two controls had normal fundospcopy while eight cases had abnormal fundoscopy (p = 0.055). CONCLUSIONS Protective effect of EPO on methanol-induced optic nerve may be strong at the beginning of the intervention but is probably transient.
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Affiliation(s)
- Nasim Zamani
- a Toxicological Research Center, Department of Clinical Toxicology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ministry of Health , Excellence Centre of Clinical Toxicology , Tehran , Iran
| | - Hossein Hassanian-Moghaddam
- a Toxicological Research Center, Department of Clinical Toxicology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ministry of Health , Excellence Centre of Clinical Toxicology , Tehran , Iran
| | - Maziar Shojaei
- c Department of Neurology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sara Rahimian
- d Ophtalmology Clinic , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Intravitreal erythropoietin injection in late-stage optic neuropathy: a safety study on human. Int Ophthalmol 2017; 38:1021-1025. [DOI: 10.1007/s10792-017-0553-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/10/2017] [Indexed: 10/24/2022]
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Pakravan M, Esfandiari H, Hassanpour K, Razavi S, Pakravan P. The Effect of Combined Systemic Erythropoietin and Steroid on Non-arteritic Anterior Ischemic Optic Neuropathy: A Prospective Study. Curr Eye Res 2017. [PMID: 28632028 DOI: 10.1080/02713683.2016.1270328] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND To investigate the effect of combined intravenous (IV) erythropoietin (EPO) and corticosteroid as well as systemic steroid alone for the treatment of non-arteritic anterior ischemic optic neuropathy (NAION). METHODS In this prospective interventional comparative case series, 113 consecutive patients diagnosed with recent onset (less than 14 days) NAION were included. Patients were categorized into three groups. 40 patients received systemic IV corticosteroid combined with recombinant human erythropoietin (rhEPO) (group 1), 43 patients received systemic corticosteroid alone (group 2), and 30 patients were enrolled as the control group (group 3). Functional and structural outcomes were analyzed 3 and 6 months after treatment. Best corrected visual acuity (BCVA) was the main outcome, and mean deviation (MD) and peripaillary retinal nerve fiber layer thickness (PRNFLT) were secondary outcome measures. RESULTS The mean BCVA at the time of presentation was 0.98 (±0.65), 0.96 (±0.67), and 1.02 (±0.63) log MAR in groups 1, 2, and 3, respectively (P = 0.95). At month 3, the corresponding values were 0.73 (±0.45), 0.76 (±0.49), and 0.8 (±0.45) log MAR (P = 0.80), and at the 6-month follow-up, they were 0.76 (±0.45), 0.71 (±0.4), and 0.71 (±0.46) log MAR, respectively (P = 0.87). There was no statistically significant difference in BCVA between months 3 and 6, which implies stabilization of the visual acuity by month 3. Considering the visual field, within 6 months of follow-up after disease onset, the MD index improved in all groups with no statistically significant differences between them (P = 0.82). PRNFLT at presentation was 178 (±60), 186 (±59), and 166 (±57) micrometers in groups 1, 2, and 3, respectively (P= 0.99), which decreased to 77 (±16), 83 (±22), and 73 (±11), respectively, at final visit (P = 0.14) Conclusion: We found no beneficial effect of either systemic steroid alone or combined with EPO in the visual outcome of NAION patients.
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Affiliation(s)
- Mohammad Pakravan
- a Ophthalmic Epidemiology Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Hamed Esfandiari
- b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Kiana Hassanpour
- b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sarvnaz Razavi
- b Ophthalmic Research Center , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Pakravan M, Esfandiari H, Sanjari N, Ghahari E. Erythropoietin as an adjunctive treatment for methanol-induced toxic optic neuropathy. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:633-639. [PMID: 27463192 DOI: 10.1080/00952990.2016.1198800] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methanol-induced optic neuropathy (MTON) is frequently seen in countries where alcohol consumption is banned or poorly regulated. MTON frequently results in blindness and there is no empirically validated treatment. OBJECTIVE To evaluate the effect of erythropoietin (EPO) as an adjunctive treatment for MTON. METHODS In this nonrandomized interventional comparative study, all participants were diagnosed with MTON and received the steroid methylprednisolone. Eleven participants received intravenous EPO (10000 IU twice a day) for three days as an adjuvant to methylprednisolone (EPO group); 11 participants in a historical control group received methylprednisolone only (control group). Main outcomes were best-corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer thickness (PRNFLT), and visual field mean deviation (MD). RESULTS Mean BCVA improved significantly in both groups: from 2.93 ± 0.55 to 1.75 ± 1.16 LogMAR at month 3 (p < 0.001) in the EPO group, and from 2.65 ± 0.68 to 2.19 ± 0.75 at final visit in the control group (p = 0.001). The final BCVA was significantly better in the EPO group (p = 0.012). The mean PRNFLT decreased in both groups. However, at the final follow-up, PRNFLT was significantly thinner in the control group (53 ± 6 vs. 77 ± 26 microns, respectively; p < 0.001). CONCLUSION Intravenous EPO plus high-dose intravenous steroid may be an effective combination therapy for the patients with MTON.
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Affiliation(s)
- Mohammad Pakravan
- a Ophthalmic Research Center and Department of Ophthalmology , Shaheed Beheshti Medical University , Tehran , Iran
| | - Hamed Esfandiari
- a Ophthalmic Research Center and Department of Ophthalmology , Shaheed Beheshti Medical University , Tehran , Iran
| | - Nasrin Sanjari
- a Ophthalmic Research Center and Department of Ophthalmology , Shaheed Beheshti Medical University , Tehran , Iran
| | - Elham Ghahari
- a Ophthalmic Research Center and Department of Ophthalmology , Shaheed Beheshti Medical University , Tehran , Iran
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Shirley Ding SL, Leow SN, Munisvaradass R, Koh EH, Bastion MLC, Then KY, Kumar S, Mok PL. Revisiting the role of erythropoietin for treatment of ocular disorders. Eye (Lond) 2016; 30:1293-1309. [PMID: 27285322 DOI: 10.1038/eye.2016.94] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 03/23/2016] [Indexed: 12/15/2022] Open
Abstract
Erythropoietin (EPO) is a glycoprotein hormone conventionally thought to be responsible only in producing red blood cells in our body. However, with the discovery of the presence of EPO and EPO receptors in the retinal layers, the EPO seems to have physiological roles in the eye. In this review, we revisit the role of EPO in the eye. We look into the biological role of EPO in the development of the eye and the physiologic roles that it has. Apart from that, we seek to understand the mechanisms and pathways of EPO that contributes to the therapeutic and pathological conditions of the various ocular disorders such as diabetic retinopathy, retinopathy of prematurity, glaucoma, age-related macular degeneration, optic neuritis, and retinal detachment. With these understandings, we discuss the clinical applications of EPO for treatment of ocular disorders, modes of administration, EPO formulations, current clinical trials, and its future directions.
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Affiliation(s)
- S L Shirley Ding
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - S N Leow
- Department of Ophthalmology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - R Munisvaradass
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - E H Koh
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - M L C Bastion
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - K Y Then
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - S Kumar
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia.,Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
| | - P L Mok
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia.,Genetics and Regenerative Medicine Research Centre, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia
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Erythropoietin in ophthalmology: A literature review. J Curr Ophthalmol 2016; 28:5-11. [PMID: 27239595 PMCID: PMC4881220 DOI: 10.1016/j.joco.2016.01.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 01/27/2016] [Accepted: 01/27/2016] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To review the current literature on ocular application of erythropoietin (EPO). METHODS A comprehensive search was performed on Pubmed and Scopus databases. All selected articles were reviewed thoroughly by the authors to review current applications of the EPO in ocular diseases. RESULTS Various aspects of administration of EPO for different ischemic, traumatic, vascular, and degenerative disorders have been explained. The articles are generally preclinical with few small studies reporting clinical outcomes. CONCLUSION EPO has been used for the treatment of different ophthalmic conditions with promising results. Further studies are needed to elaborate the role of EPO in management of ocular diseases.
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Palau AEB, Morgan ML, Yalamanchili S, Lee AG. Neuro-Ophthalmology Annual Review. Asia Pac J Ophthalmol (Phila) 2014; 3:104-25. [PMID: 26107493 DOI: 10.1097/apo.0000000000000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to update the practicing ophthalmologist on the English-language neuro-ophthalmology literature from the prior year. This study is a review of English-language literature from August 1, 2012, to August 1, 2013. The authors searched PubMed articles published from August 1, 2012, to August 1, 2013, limited to English-language publications including original articles, review articles, and case reports and excluding letters to the editor, unpublished work, and abstracts. We researched the following topics: pupillary abnormalities, eye movement dysfunction, neuromuscular diseases, optic neuropathies, optic neuritis and demyelinating disease including multiple sclerosis, lesions of the chiasm and posterior primary visual pathways, elevated intracranial pressure, tumors and aneurysms affecting the visual pathways, vascular diseases, higher visual functions, and neuroimaging advances. We intend to share clinically relevant literature of the past year with the practicing ophthalmologist. We aimed to highlight remarkable and interesting literature rather than exhaustively including all new neuro-ophthalmological publications of the year. We reviewed literature in the past year with a focus on relevance and novelty. This review updates the comprehensive ophthalmologist on neuro-ophthalmic topics.
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Affiliation(s)
- Angelina Espino Barros Palau
- From the *Department of Ophthalmology, Houston Methodist Hospital, Houston, TX; †Baylor College of Medicine, Houston, TX; ‡Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, TX; §University of Texas Medical Branch, Galveston, TX; ¶University of Texas M.D. Anderson Cancer Center, Houston, TX; and ∥The University of Iowa Hospitals and Clinics, Iowa City, IA
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Permpalung N, Cheungpasitporn W, Chongnarungsin D, Hodgdon TM. Bilateral putaminal hemorrhages: serious complication of methanol intoxication. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:623-4. [PMID: 24350079 PMCID: PMC3842708 DOI: 10.4103/1947-2714.120804] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Context: Methanol intoxication is a life-threatening condition. Hallmark of clinical presentations include severe wide anion gap metabolic acidosis with very high serum osmolar gap and visual complication. Case Report: We report a case of severe methanol intoxication with bilateral putaminal hemorrhage, an uncommon serious complication. A 56-year-old man presented with altered mental status. Fundus examination showed optic disc edema. Arterial Blood Gas (ABG) revealed severe anion gap metabolic acidosis with osmolal gap. Head computed tomography (CT) showed hypodense lesions in basal ganglia bilaterally. Hemodialysis and intravenous fomepizole were initiated. Serum methanol level was significantly elevated. Unfortunately, patient was lethargic 2 weeks after discharge. Repeated CT of head demonstrated new putaminal hemorrhages. Conclusion: Bilateral putaminal hemorrhage is an uncommon but serious complication in methanol intoxication. Clinicians should have high index of suspicion for putaminal hemorrhage when patients with recent methanol intoxication present with altered mental status.
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Affiliation(s)
| | | | | | - Travis M Hodgdon
- Department of Medicine, Bassett Medical Center, Cooperstown, New York, USA
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Abstract
PURPOSE OF REVIEW Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. RECENT FINDINGS Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. SUMMARY Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. VIDEO ABSTRACT See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11).
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