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[急性甲醇中毒所致中毒性视神经病变患者视网膜和视神经的结构及功能变化]

[Structural and functional changes in the retina and optic nerve in patients with toxic optic neuropathy caused by acute methanol poisoning].

作者信息

Sheremet N L, Andreeva N A, Zhorzholadze N V, Shmelkova M S, Fomin A V

机构信息

Research Institute of Eye Diseases, Moscow, Russia.

Tradomed Invest JSC, Moscow, Russia.

出版信息

Vestn Oftalmol. 2020;136(4. Vyp. 2):243-250. doi: 10.17116/oftalma2020136042243.

Abstract

PURPOSE

To identify the specifics of structural and functional changes in patients with toxic optical neuropathy caused by acute methanol poisoning.

MATERIAL AND METHODS

One female patient with toxic optic neuropathy (TON), 2 male patients with partial optic atrophy caused by methanol poisoning, and 1 male patient with methanol intoxication after ethanol containing alcohol use were examined with kinetic perimetry and optical coherence tomography.

RESULTS

Patients with TON caused by acute methanol poisoning were observed to have decreasing visual acuity to the extent of complete blindness. OCT follow-up studies revealed thinning of the retinal nerve fiber layer (RNFL) as well as formation of microcysts in the inner retinal layers, destruction of ellipsoid zone and outer segments of photoreceptors. The patient with methanol intoxication after use of ethanol containing alcohol had retained his visual functions; he was found to have microcysts and RNFL thinning during the first few months after the intoxication, but they were within normal range of OCT parameters.

CONCLUSION

Patients with TON caused by acute methanol poisoning are common to have optic atrophy with either residual visual functions or complete blindness as well as microcysts formation, structural changes and destruction of the ellipsoid zone and outer segments of photoreceptors. In patient with methanol intoxication after use of ethanol, which is known to be an antidote, complete visual recovery was observed, although some microcystic changes and ganglion cells layer thinning were noted.

摘要

目的

确定急性甲醇中毒所致中毒性视神经病变患者结构和功能变化的具体情况。

材料与方法

对1例中毒性视神经病变(TON)女性患者、2例因甲醇中毒导致部分视神经萎缩的男性患者以及1例饮用含乙醇酒精后甲醇中毒的男性患者进行了动态视野检查和光学相干断层扫描。

结果

观察到急性甲醇中毒所致TON患者视力下降至完全失明程度。光学相干断层扫描(OCT)随访研究显示视网膜神经纤维层(RNFL)变薄以及视网膜内层形成微囊肿,椭圆体带和光感受器外段遭到破坏。饮用含乙醇酒精后甲醇中毒的患者保留了其视觉功能;在中毒后的最初几个月发现其有微囊肿和RNFL变薄,但这些均在OCT参数的正常范围内。

结论

急性甲醇中毒所致TON患者常见视神经萎缩,伴有残余视觉功能或完全失明,以及微囊肿形成、结构改变和椭圆体带及光感受器外段破坏。对于饮用已知为解毒剂的乙醇后甲醇中毒的患者,尽管观察到一些微囊肿性改变和神经节细胞层变薄,但视力完全恢复。

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