Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2023; 11(15): 3502-3510
Published online May 26, 2023. doi: 10.12998/wjcc.v11.i15.3502
Outbreak of methanol-induced optic neuropathy in early COVID-19 era; effectiveness of erythropoietin and methylprednisolone therapy
Seyed Ali Tabatabaei, Mohammad Amini, Ali A Haydar, Mohammad Soleimani, Kasra Cheraqpour, Mansoor Shahriari, Hossein Hassanian-Moghaddam, Nasim Zamani, Mohammad Reza Akbari
Seyed Ali Tabatabaei, Mohammad Amini, Ali A Haydar, Mohammad Soleimani, Kasra Cheraqpour, Mohammad Reza Akbari, 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
Author contributions: Amini M and Haydar AA contributed equally to this work; Tabatabaei SA, Amini M, Haydar AA, Soleimani M and Cheraqpour K designed the research study; Hassanian-Moghaddam H, Zamani N and Akbari MR performed the research; Shahriari M contributed new reagents and analytic tools; Haydar AA, Soleimani M, Cheraqpour K and Shahriari M analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study follows the tenets of the Declaration of Helsinki. Ethical approval was obtained from Institutional Review Board of Tehran University of Medical Sciences.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: There is no additional data available.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammad Soleimani, MD, Academic Editor, Academic Research, Postdoctoral Fellow, Senior Researcher, Department of Ophthalmology, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Qazvin square, Tehran 1336616351, Iran. soleimani_md@yahoo.com
Received: January 7, 2023
Peer-review started: January 7, 2023
First decision: January 30, 2023
Revised: February 1, 2023
Accepted: April 14, 2023
Article in press: April 14, 2023
Published online: May 26, 2023
Research background

Methanol, which is a type of non-drinking alcohol, has a highly toxic profile to humans. Methanol toxicity can damage to different sites of the human body such as the optic nerve. Epidemics of methanol toxicity occur when it is fraudulently added to alcoholic beverages as a cheaper substitute for ethanol, especially where alcoholic drinks are prohibited by law. Most recently, in parallel with the coronavirus disease 2019 pandemic, a methanol toxicity outbreak emerged in Iran.

Research motivation

The prognosis of methanol-induced optic neuropathy (MON) is generally poor. Currently, two antidotes are available for methanol toxicity: ethanol and fomepizole. Erythropoietin (EPO), a hormone produced mainly in the kidneys, has been shown neuroprotective and neuroregenerative properties.

Research objectives

We conducted a prospective study to investigate the effects of EPO on visual outcomes in MON patients.

Research methods

In this prospective study, patients with acute bilateral visual loss secondary to methanol intoxication from one month before presentation were enrolled. All patients underwent toxicology screening and received hemodialysis when deemed necessary. A comprehensive ophthalmic examination was performed. Patients were hospitalized for a three-day period. Intravenous recombinant human EPO (10000 IU/mL) was administered every 12 h for all three consecutive days. In addition, all patients received intravenous methylprednisolone (250 mg) every 6 h for three days.

Research results

The mean best corrected visual acuity (VA) improved significantly (P < 0.001). VA improvement was significant regardless of whether the patient presented before or after 72 h (P < 0.001).

Research conclusions

EPO and methylprednisolone therapy have been shown to be effective in improving visual outcomes in patients with methanol-induced optic neuropathy when administrated within the first month of exposure.

Research perspectives

Further research is needed to compare different treatment protocols, establish optimal dosages and timing of EOP through randomized clinical trials.