18例乙胺丁醇中毒性视神经病变的临床特点

Clinical features of 18 cases of ethambutol-induced optic neuropathy

目的归纳乙胺丁醇中毒性视神经病变（EON）患者的临床特点,并探讨其预后。设计回顾性病例系列。研究对象2011年6月至2015年6月解放军总医院EON患者18例36眼。方法分析所有入组患者的病例资料,记录其人口学特征、临床表现。跟踪随访6~50个月,进一步分析其预后。主要指标人口学特征、矫正视力、色觉、视野、视网膜神经纤维层（RNFL）厚度、视觉诱发电位（VEP）、结核病侵袭部位及预后。结果平均发病年龄（40.56±12.57）岁,全部为双眼发病,其中男性11例（61.1%）。30眼（83.3%）色觉障碍。17例双眼视野缺损类型一致,23眼（63.9%）呈中心视野缺损。初诊时矫正视力0.09±0.59（手动~0.25）。乙胺丁醇每日剂量（17.06±5.62）mg/kg,服用时间（5.97±5.12）个月。随访时间（30.27±16.18）个月。停乙胺丁醇后,6例（33.3%）患者视力较前提高（初始视力0.17±0.67 vs.治疗后视力0.33±0.49）,视力改善（6例）和视力未改善（12例）的两组患者之间的每日服药剂量分别为（13.31±3.98）mg/kg和（18.50±3.15）mg/kg（P=0.037）。随访中8例（16眼）复查相干光断层扫描,视盘颞侧、上方、鼻侧所对应的RNFL不同程度较前变薄。结论乙胺丁醇中毒性视神经病变多见于中老年男性,易累及双眼,约1/3的患者停药同时给予治疗后视力可好转。

Objective To investigate the clinical features and prognosis of ethambutol-induced optic neuropathy（EON）. Design Retrospective case series. Participants During June 2011 to June 2015, 18 patients were diagnosed as EON in People’s Liberation Army（PLA） General Hospital. Methods A retrospective chart review of 18 patients diagnosed as EON was performed, collecting and analyzing their demographic characteristics, clinical features. The patients were followed for 6~50 months. Main Outcome Measures Demographic characteristics, best corrected visual acuity（BCVA）, visual field, color vision, visual field and retinal nerve fiber layer（RNFL） thickness. Results The mean age of affected patients was 40.56±12.57 years. 11 of them were men, and all of them were presented with blurry vision in both eyes. 30 eyes（83.3%, 30/36） had dyschromatopsia. 23 eyes（63.9%） showed central scotoma. The mean BCVA was 0.09±0.59 at first sight. The mean dose and duration of ethambutol were（17.06±5.62） mg/kg over（5.97±5.12） months. The period of follow-up was（30.27±16.18） months. The visual function recovery after discontinuation of ethambutol was seen in 6 of the 18 patients.Between the vision improved group and non-improved group, there was a statistically significant difference of the ethambutol daily dose（P=0.037）. During the follow-up, 16 eyes of 8 patients were examined by optical coherence tomography（OCT）, which displayed RNFL thinning in temporal, superior and nasal side. Conclusions Ethambutol-induced optic neuropathy was more common in elderly men, and tended to involve both eyes. About 1/3 of the patients showed visual improvement after discontinuation of ethambutol.