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Temporal evolution and factors influencing visual function and RNFL thickness in ethambutol-associated optic

Taimin Guo¹, Yue Fu¹, Xiaoyu Xu¹

¹State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, 510060, China.

European Journal of Medical Research

|April 24, 2025

Summary

Ethambutol-associated optic neuropathy (EON) shows significant visual function recovery between 3 and 6 months. Early intervention, especially for patients with temporal peripapillary retinal nerve fiber layer thinning, is crucial for maximizing visual recovery potential.

Keywords:

Ethambutol-induced neuropathy Optic neuropathy recovery Prognosis Risk factors Visual function

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Area of Science:

Ophthalmology
Neuroscience

Background:

Ethambutol is a first-line treatment for tuberculosis.
Ethambutol-associated optic neuropathy (EON) is a potential vision-threatening side effect.
Understanding EON's temporal dynamics is crucial for patient management.

Purpose of the Study:

To investigate the temporal evolution of visual function and optic nerve structure in EON.
To identify factors influencing visual recovery and optic nerve changes in EON patients.

Main Methods:

Retrospective observational study of 48 EON patients with 12-month follow-up.
Comprehensive ophthalmologic assessments including BCVA, VF, OCT, and MRI.
Statistical analyses including multiple linear regression and comparative tests to identify influencing factors.

Main Results:

Significant improvements in BCVA and VF were observed between 3 and 6 months, indicating a critical recovery window.
Peripapillary retinal nerve fiber layer (pRNFL) thinning was most pronounced between 3 and 9 months, with the temporal quadrant showing earliest changes.
Disease course influenced VF recovery, while pRNFL thinning was associated with gender, ethambutol dosage, and disease duration; females showed slower pRNFL thinning.

Conclusions:

A critical recovery window for visual function in EON exists between 3 and 6 months.
Temporal pRNFL thinning may serve as an early marker for EON progression.
Early therapeutic interventions are recommended for EON patients, particularly those with temporal RNFL thinning, to maximize visual recovery.