Sharma Ranjana, Marasini Sanjay, Sharma Ananda Kumar, Shrestha Jeevan Kumar, Nepal Bhagvat Prasad
Department of Ophthalmology, Kathmandu University Hospital, Dhulikhel Hospital, Dhulikhel, Nepal.
Optom Vis Sci. 2012 Feb;89(2):178-82. doi: 10.1097/OPX.0b013e31823ee128.
The purpose of this study was to examine the effectiveness of ethanol and high-dose intravenous steroid for preserving vision in acute methanol poisoning.
Eight cases of acute methanol poisoning presented to the emergency department. Detailed physical examination including neurological assessment was performed. Detailed ocular examinations were performed including visually evoked potential and electroretinography in indicated cases. All patients had visual symptoms. Pupillary abnormality was observed in all. Edema of the optic disc and nerve fiber layer were common fundus findings. The majority of cases were treated with methylprednisolone intravenously. Ethanol was given intravenously in four cases who presented within 48 h. Hemodialysis was performed in two cases having neurological manifestations and metabolic acidosis. Sodium bicarbonate was given to four patients. Folinic acid and multivitamins were also given to all the patients based on neurological advice.
Most of the patients showed a good response to the treatment. In 87.5% of the cases, improvements in visual acuity of at least two lines were noted in follow-up visits.
Early presentation with prompt treatment has a significant role in preserving and improving visual acuity. Ethanol and high-dose intravenous methylprednisolone can be an alternative treatment with better visual outcome where fomepizole is unavailable.
本研究旨在探讨乙醇和大剂量静脉注射类固醇对急性甲醇中毒患者视力保护的有效性。
8例急性甲醇中毒患者就诊于急诊科。进行了包括神经学评估在内的详细体格检查。对有指征的病例进行了详细的眼科检查，包括视觉诱发电位和视网膜电图检查。所有患者均有视觉症状。所有患者均观察到瞳孔异常。视盘和神经纤维层水肿是常见的眼底表现。大多数病例接受了静脉注射甲泼尼龙治疗。4例在48小时内就诊的患者接受了静脉注射乙醇治疗。2例有神经学表现和代谢性酸中毒的患者进行了血液透析。4例患者给予了碳酸氢钠。根据神经科建议，所有患者还给予了亚叶酸和多种维生素。
大多数患者对治疗反应良好。在87.5%的病例中，随访时视力至少提高了两行。
早期就诊并及时治疗对视力的保护和改善具有重要作用。在无法获得甲吡唑的情况下，乙醇和大剂量静脉注射甲泼尼龙可作为一种具有更好视力预后的替代治疗方法。
