Identifying predictors of visual improvement in ethambutol optic neuropathy: insights from a 5-year retrospective analysis in a tertiary clinic in Indonesia.

AIM

To characterize the demographic and clinical features of ethambutol optic neuropathy (EON) in an Indonesian patient population and explore prognostic factors for visual recovery.

METHODS

Retrospective study of 58 EON patients at an Indonesian eye center (2017-2022). Demographics, ethambutol treatment, ophthalmologic findings were collected. Visual outcomes after ethambutol cessation assessed at 3-12mo. Patients categorized as having visual improvement (≥2 Snellen lines and/or >5° visual field gain) or no improvement.

RESULTS

Mean age was 55.5±12.9y, with 56.9% females. Median duration of ethambutol use was 9mo (range: 2-20) at a mean daily dose of 19.7±5.3 mg/kg. At presentation, mean visual acuity was 1.3 logMAR (range: 0-2.5), with normal fundus appearance in 72.4% of eyes. The most common visual field defect was generalized depression (52.4%). After ethambutol cessation, 56.9% of patients had visual improvement. Younger age (50.24±13.8y 62.14±8.9y, <0.01), lower ethambutol dose (17.3±5 23.3±2.9 mg/kg·d, <0.01), shorter treatment duration (6.79±2.6mo 10.27±1.2mo, <0.01), and absence of hypertension (16% 83%, =0.012) or kidney disease (0 83%, <0.01) were associated with higher likelihood of visual improvement. Diabetes did not differ between groups (=0.889).

CONCLUSION

Over half experience visual recovery after ethambutol cessation. Younger age, lower cumulative dose, absence of hypertension or kidney disease predict better visual outcomes.