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(15): 3502-3510 [PMID: 37383889 DOI: 10.12998/wjcc.v11.i15.3502]
Corresponding Author of This Article
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
Research Domain of This Article
Ophthalmology
Article-Type of This Article
Observational Study
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. 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 Processing time: 138 Days and 0.3 Hours
ARTICLE HIGHLIGHTS
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.
