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Optical coherence tomography can monitor reversible nerve-fibre layer changes in a patient with ethambutol-induced optic neuropathy
  1. Christopher I Zoumalan,
  2. Alfredo A Sadun
  1. Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  1. Correspondence to: Dr C I Zoumalan Department of Ophthalmology, Stanford University Medical Center, 900 Blake Wilbur Drive, Room W3002, Stanford, CA 94305, USA; zoumalan{at}stanford.edu

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Ethambutol (EMB) has been used as an antimycobacterial agent against tuberculosis since 1961, and its principal side effect is toxic optic neuropathy, which can be seen in up to 6% of patients.1,2

Through the use of optical coherence tomography (OCT), we can document evidence of reversible changes in nerve-fibre layer (NFL) secondary to EMB-induced optic neuropathy.

Case report

A 70-year-old man weighing 70 kg, who was being treated for Mycobacterium aviumintracellulare complex pneumonia, initially presented with a 3-month history of gradual, painless loss of vision in both eyes. He had received EMB treatment for 7 months at 2 g/day (29 mg/kg/day). His visual complaints began 7 months after initiation of EMB treatment, and continued to worsen up to his presentation to our clinic. Before EMB treatment, his best-corrected vision was 20/30 OU (with mild nuclear sclerotic cataracts), but with normal subjective colour and contrast sensitivity.

Our patient underwent a full neuro-ophthalmological examination, which included an assessment of colour vision using the eight-plate Ishihara Color Vision Test, Humphrey Field Analyzer (HFA) 30-2 (SITA Fast test, Humphrey-Zeiss Medical Systems, …

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