Liu Shin-Shin, Feng Shih-Chao, Wu Ming-Feng, Chin Chun-Shih, Chen Hui-Chen, Huang Wei-Chang
Nursing Department, Taichung Veterans General Hospital, Taichung, 407219, Taiwan.
Department of Chest Medicine, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan.
Infect Dis Ther. 2025 Sep 3. doi: 10.1007/s40121-025-01219-x.
Comprehensive data on ethambutol (EMB)-related optic neuropathy (EON) are lacking, creating a knowledge gap. Accordingly, this prospective programmatic study established a collaborative multidisciplinary team to explore EON.
This study enrolled patients who received EMB as part of their treatment regimen for mycobacterial infections. Programmatic assessments of visual abnormalities were performed for each patient by the team. EON was diagnosed by ophthalmologists. Patients diagnosed as having EON completed short-term (6-month) and long-term (5-year) follow-up.
Of 476 patients, 31 (6.5%) were diagnosed as having EON. Older age (≥ 65 years, odds ratio [OR] = 2.5, P = 0.043) and diabetes mellitus (OR = 2.2, P = 0.045) were independent predictors of EON, and coexisting subjective and objective ocular abnormalities (OR = 4.8, P = 0.009) and concomitant visual acuity and color discrimination impairment (OR = 5.9, P = 0.009) were independently associated with EON in patients with ocular abnormalities at EMB discontinuation. Among patients with EON, 56.7% and 50.0% had favorable 6-month visual acuity and color discrimination outcomes, respectively. Among patients with unfavorable 6-month visual acuity outcomes, 45.5% had favorable outcomes at the 5-year follow-up. Moreover, 88.2% and 100% of patients with favorable and unfavorable 6-month visual acuity outcomes, respectively, already had these outcomes at the third month of follow-up. Additionally, 50.0% and 100% of patients with favorable and unfavorable 6-month color discrimination outcomes, respectively, already had these outcomes at the fourth month of follow-up.
The incidence of EON exceeded 6%. This study provides a feasible model for the comprehensive management of EON in clinical practice.
关于乙胺丁醇（EMB）相关视神经病变（EON）的全面数据尚缺，存在知识空白。因此，这项前瞻性项目研究组建了一个多学科协作团队来探究EON。
本研究纳入了接受EMB作为分枝杆菌感染治疗方案一部分的患者。团队对每位患者进行视觉异常的项目评估。由眼科医生诊断EON。诊断为EON的患者完成短期（6个月）和长期（5年）随访。
476例患者中，31例（6.5%）被诊断为患有EON。年龄较大（≥65岁，比值比[OR]=2.5，P=0.043）和糖尿病（OR=2.2，P=0.045）是EON的独立预测因素，在停用EMB时存在主观和客观眼部异常（OR=4.8，P=0.009）以及伴有视力和色觉障碍（OR=5.9，P=0.009）在有眼部异常的患者中与EON独立相关。在患有EON的患者中，分别有56.7%和50.0%在6个月时视力和色觉结果良好。在6个月视力结果不佳的患者中，45.5%在5年随访时有良好结果。此外，6个月视力结果良好和不佳的患者分别有88.2%和100%在随访第3个月时已有这些结果。另外，6个月色觉结果良好和不佳的患者分别有50.0%和100%在随访第4个月时已有这些结果。
EON的发生率超过6%。本研究为临床实践中EON的综合管理提供了一个可行的模式。
