ETHAMBUTOL KULLANIMININ OPTİK SİNİRE ETKİSİNİN SPECTRAL DOMAİN OPTİK KOHERENS TOMOGRAFİ İLE DEĞERLENDİRİLMESİ

Amaç: Çalışmanın amacı spectral domain optik koherens tomografi (SD-OCT) kullanarak sağlıklı kişiler ile ethambutol kullanan kişiler arasındaki retina sinir lifi tabakası (RNFL) kalınlığını analiz etmek ve ethambutole bağlı gelişecek optik nöropatinin erken aşamada teşhisi için SD-OCT kullanımını değerlendirmek. Materyal ve Metot: En az 2 aydır tüberküloz nedeniyle ethambutol kullanan 20 kişinin 40 gözü aynı yaş ve cinsiyetteki 20 sağlıklı kişinin 40 gözü ile RNFL kalınlık parametreleri yönünden karşılaştırıldı. Bütün hastalara tam bir oftalmolojik muayene yapıldı. RNFL’yi etkiyecek hastalığı veya ilaç kullanım öyküsü bulunanlar çalışmaya dahil edilmedi. SD-OCT ile yapılan RNFL analizinde superior, inferior, temporal ve nazal kadran ile maküla kalınlığı değerlendirmeye alındı. Bulgular: Ethambutol kullanan hastaların RNFL değerleri: superior 123,12±16,07µm, inferior 131,20±13,26 µm, nazal 79,47±11,54 µm, temporal 78,80±12,82 µm, maküla kalınlığı 266,16±11,94 µm olarak saptandı. Sonuç: Ethambutol kullanan kişiler kontrol grubu ile karşılaştırıldığında istatistiksel olarak anlamlı derecede temporal kadranda kalınlaşma, nazal kadranda incelme saptandı(p0,05). Superior ve inferior kadranda ve maküla kalınlığında istatiksel olarak anlamlı değişiklik saptanmadı(p>0,05).

The Effect of Ethambutol on Optic Nerve by Spectral Domain Optical Coherence Tomography

Aim: To evaluate; the retinal nerve fiber layer difference between healthy control groups and patients who were taking ethambutol medication by using spectral domain optical coherence tomography (SD-OCT) and to evaluate the usage of SD-OCT for early diagnosis of optic neuropathy due to ethambutol. Materials and Methods: 40 eyes of 20 patients using ethambutol for at least 2 months have been compared to 40 eyes of 20 healthy subjects of the same age and sex in terms of RNFL thickness parameters. All participants underwent a complete ophthalmologic examination. Patients with a history of disease or drug use affecting RNFL were not included in the study. Superior, inferior, nasal and temporal quadrants and macular thickness were evaluated in SD-OCT. Results: RNFL thickness values of ethambutol patients were as follows: superior 123,12±16,07µm, inferior 131,20±13,26 µm, nazal 79,47±11,54 µm, temporal 78,80±12,82 µm, macular thickness 266,16±11,94 µm. Conclusion: There was statistically significant increase in temporal quadrant and decrease in nasal quadrant in patients taking ethambutol medication compared to control group (p0,05). There was no statistically significant change in superior and inferior quadrant and macular thickness (p>0,05).

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1. Barron GJ, Tepper L, Iovine G. Ocular toxicity from ethambutol. Am J Ophthalmol. 1974;77(2):256-60.
2. Chan RY, Kwok AK. Ocular toxicity of ethambutol. Hong Kong Med J. 2006;12(1):56-60.
3. Etiz P, Altınsu AT. Retrospective analysis of 232 newly diagnosed cases with pulmonary tuberculosis. Türk Mikrobiyol Cem Dergisi. 2018;48(2):117-24.
4. Chuenkongkaew W, Samsen P, Thanasombatsakul N. Ethambutol and optic neuropathy. J Med Assoc Thai. 2003:86(7):622-5.
5. Schild HS, Fox BC. Rapid-onset reversible ocular toxicity from ethambutol therapy. Am J Med. 1991;90(1):404-6.
6. Bıçakçı Ş, Özeren A, Yerdelen D, Sarıca Y. Etambutol kullanımına bağlı optik nöropati. Türkiye Klinikleri J Med Sci. 2005;25(3):460-2.
7. Kumar A, Sandramouli S, Verma L, Tewari H K, Khosla P K. Ocular ethambutol toxocity is it reversible? J Clin Neuroophthamol. 1993;13(1):15-7.
8. Zoumalan CI, Sadun AA, Agarwal M. Optical coherence tomography can measure axonal loss in patients with ethambutol-induced optic neuropathy. Graefes Arch Clin Exp Ophthalmol. 2005;243(5): 410-6.
9. Sivakumaran P, Harrison AC, Marschner J, Martin P. Ocular toxicity from ethambutol: a review of four cases and recommended precautions. N Z Med J. 1998;111(1077):428-30.
10. Petri WA : Drugs used in the chemotherapy of tuberculosis, Mycobacterium avium complex disease and leprosy. In: Hardman JS, Limbird LE, eds. Goodman & gilman’s The Pharmacological Basis of Therapeutics. 10th ed New York, NY: McGraw-Hill. 2001;1279-80.
11. Buyske DA, Peets E, Sterling W. Pharmacological and biochemical studies on ethambutol in laboratory animals. Ann NY Acad Sci. 1966;135(2):711-25.
12. Cole A, May PM, Williams DR Metal binding by Pharmaceuticals. Part 3. Copper and zinc interactions with isoniazid. Agents Actions. 1983;13(11):91-7.
13. Sadun AA. Acquired mitochondrial impairment as a cause of optic nerve disease. Trans Am Opthalmol Soc. 1998;96:881-923.
14. Mudun A. Nöro-oftalmolojik Hastalıklarda Optik Koherens Tomografi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi. 2011;2(1):5-9.
15. Kim U, Hwang JM. Early stage ethambutol optic neuropathy: retinal nerve fiber layer and optical coherence tomograph. Europan Journal of Ophthalmol. 2009;19(3):466-9.
16. Chai SJ, Foroozan RD. Decreased retinal nerve fiber layer thickness detected by optical coherence tomography in patients with ethambutol-induced optic neuropathy. Br J Ophthalmol. 2007;91(7):895-7.
17. Taffner BMP, Mattos FB, Cunha MC, Saraiva FP. The use of optical coherence tomography for the detection of occular toxity by ethambutol. Plos One. 2018;13(11):e0204655.