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Sobhi N, Abdollahi M, Arman A, Mahmoodpoor A, Jafarizadeh A. Methanol Induced Optic Neuropathy: Molecular Mysteries, Public Health Perspective, Clinical Insights and Treatment Strategies. Semin Ophthalmol 2024:1-12. [PMID: 38804878 DOI: 10.1080/08820538.2024.2358310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
Methanol-induced optic neuropathy (MION) represents a critical public health issue, particularly prevalent in lower socioeconomic populations and regions with restricted alcohol access. MION, characterized by irreversible visual impairment, arises from the toxic metabolization of methanol into formaldehyde and formic acid, leading to mitochondrial oxidative phosphorylation inhibition, oxidative stress, and subsequent neurotoxicity. The pathogenesis involves axonal and glial cell degeneration within the optic nerve and potential retinal damage. Despite advancements in therapeutic interventions, a significant proportion of affected individuals endure persistent visual sequelae. The study comprehensively investigates the pathophysiology of MION, encompassing the absorption and metabolism of methanol, subsequent systemic effects, and ocular impacts. Histopathological changes, including alterations in retinal layers and proteins, Müller cell dysfunction, and visual symptoms, are meticulously examined to provide insights into the disease mechanism. Furthermore, preventive measures and public health perspectives are discussed to highlight the importance of awareness and intervention strategies. Therapeutic approaches, such as decontamination procedures, ethanol and fomepizole administration, hemodialysis, intravenous fluids, electrolyte balance management, nutritional therapy, corticosteroid therapy, and erythropoietin (EPO) treatment, are evaluated for their efficacy in managing MION. This comprehensive review underscores the need for increased awareness, improved diagnostic strategies, and more effective treatments to mitigate the impact of MION on global health.
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Affiliation(s)
- Navid Sobhi
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mirsaeed Abdollahi
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Arman
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ata Mahmoodpoor
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Anesthesiology and Intensive care, Faculty of Medicine, Tabriz University of Medical Science, Tabriz, Iran
| | - Ali Jafarizadeh
- Nikookari Eye Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Alnefaie SA, Aldlgan AA, Albakiri KM, Kaabi MA, Alzwen GM, Al-Otaibi SS, Alasmari F. Methanol intoxication in the central region of Saudi Arabia: Five case studies. Saudi Pharm J 2024; 32:102018. [PMID: 38497087 PMCID: PMC10940806 DOI: 10.1016/j.jsps.2024.102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Outbreaks of methanol poisoning have been described in the medical literature worldwide. However, the few outbreaks that have occurred in Saudi Arabia remain undocumented. This is especially noteworthy in light of the fact that Saudi Arabia is among the countries that explicitly prohibit the usage of alcoholic beverages and recreational drugs. Herein, we describe five cases of methanol poisoning in Saudi Arabia. The first three comprise patients admitted to the emergency room (ER) with signs of methanol toxicity, such as heart palpitations, vomiting, and blurred vision; otherwise, those patients were considered medically free. The remaining two cases were examined postmortem. A headspace gas chromatography-flame ionization detector was used to test blood, vitreous humor, and urine samples for methanol. Specific lethal concentrations of methanol were defined based on published case studies as 23-740 mg/dL in blood and 12-396 mg/dL in vitreous humor. In postmortem cases of our present study, samples exhibited lethal concentrations: 118 and 257 mg/dL in blood, 116.3 and 283 mg/dL in vitreous humor. In ER cases, methanol concentrations in urine samples were lower, at 7.5, 9.1, and 20.9 mg/dL; however, toxic symptoms were still observed. These case studies indicate that it is necessary to raise community awareness about the risk of methanol poisoning in order to minimize future poisoning epidemics.
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Affiliation(s)
- Sattam A. Alnefaie
- Department of Forensic Sciences, College of Criminal Justice, Naif Arab University for Security Sciences, Riyadh, Saudi Arabia
| | | | - Khalid M. Albakiri
- Riyadh Poisons Control & Medical Forensic Chemistry Center, Ministry of Health, Riyadh, Saudi Arabia
| | - Mohammed A. Kaabi
- Department of Pathology and Laboratory Medicine, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Ghada M. Alzwen
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Hail, Saudi Arabia
| | - Sarah S. Al-Otaibi
- Drug & Poison Information Center, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Fawaz Alasmari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Durmaz Engin C, Kucuk HC, Yaman A, Men S, Bajin MS. The Role of Optic Nerve Diffusion Restriction on Visual Prognosis in Methanol Poisoning. Neuroophthalmology 2024; 48:159-168. [PMID: 38756343 PMCID: PMC11095577 DOI: 10.1080/01658107.2023.2293865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/22/2023] [Indexed: 05/18/2024] Open
Abstract
The aim of this study was to investigate the role of optic nerve diffusion status on cranio-orbital magnetic resonance imaging (MRI) in predicting visual prognosis in cases of methanol intoxication. Diffusion-weighted imaging (DWI) from 16 eyes of eight patients who were admitted to our clinic due to methanol intoxication was analysed retrospectively. The relationship between clinical and laboratory findings, treatment regimen, visual prognosis, and imaging findings was investigated. Diffusion restriction (DR) of the optic nerve on DWI was observed in seven (43%) eyes. Regardless of the clinical and laboratory characteristics and treatment regimen, visual acuity (VA) improved in eyes in which restricted diffusion regressed over the follow-up period. DWI of the optic nerve during the acute phase of methanol poisoning may provide prognostically important data. Improvement of DR during follow-up may be an indicator of an increase in VA.
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Affiliation(s)
- Ceren Durmaz Engin
- Department of Ophthalmology, Buca Seyfi Demirsoy Education and Research Hospital, Izmir, Turkey
| | - Hasan Can Kucuk
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Suleyman Men
- Department of Radiology, Dokuz Eylul University, Izmir, Turkey
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Alrobaian M, Alkhuraiji A, Almohanna R, Alshehri M, Alyahya B. Visual outcome of methanol toxic optic neuropathy after erythropoietin treatment in Riyadh, Saudi Arabia. Saudi J Ophthalmol 2024; 38:41-46. [PMID: 38628402 PMCID: PMC11017006 DOI: 10.4103/sjopt.sjopt_174_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/29/2023] [Accepted: 03/07/2023] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The purpose of this study is to evaluate the visual response of methanol-induced optic neuropathy to management with erythropoietin (EPO) along with conventional therapy. METHODS This retrospective case series examines the ophthalmological data of patients diagnosed with methanol-induced optic neuropathy between 2020 and 2021 at two centers, Riyadh, Saudi Arabia. Patients' characteristics and the results of initial and final ophthalmological examinations were documented and compared between patients who received EPO in addition to conventional management and those who received only conventional management. RESULTS A total of nine cases were reviewed, of which eight (88.9%) were males and one was female (11.1%). The mean age was 37.7 years. At presentation, funduscopic examination revealed optic disc edema in four eyes (two patients), and 14 eyes had normal appearance (seven patients). Among the nine patients who received conventional management, 5 (55.6%) additionally received intravenous EPO during the treatment course. There was no clinically or statistically significant difference in terms of visual outcome between the two groups. The mean visual acuity at the final presentation was 1.32 ± 0.79 logarithm of the minimum angle of resolution (LogMAR) in the EPO group and 1.36 ± 0.85 LogMAR in the non-EPO group. Optical coherence tomography indicated that the EPO group had an average retinal nerve fiber layer thickness of 48.13μm (±6.2), at the final assessment. CONCLUSION Managing the visual impairments in individuals with methanol-induced optic neuropathy using intravenous EPO resulted in similar final visual outcomes compared to conventional management.
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Affiliation(s)
- Malek Alrobaian
- Department of Ophthalmology, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Arwa Alkhuraiji
- Department of Ophthalmology, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Rema Almohanna
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Surgery, Ministry of the National Guard – Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed Alshehri
- Department of Emergency Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Bader Alyahya
- Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Sener K, Cakır A, Altug E, Korkut S, Güven R, Kapci M. Is optic nerve sheath diameter diagnostic in methanol intoxication? Alcohol 2023; 113:27-31. [PMID: 37481045 DOI: 10.1016/j.alcohol.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND AND AIM Methyl alcohol intoxication causes severe morbidity and mortality, especially in developing countries. Formic acid is formed as a result of methanol metabolism. Formic acid accumulation and inhibition of adenosine triphosphate synthesis result in ophthalmic issues. This study aimed to demonstrate that the optic nerve sheath diameter (ONSD) measurement is an accurate prognostic marker and can be helpful in the diagnosis of methanol intoxication. MATERIALS AND METHODS This prospective study was conducted with 52 patients who were admitted to the emergency department after alcohol consumption and agreed to participate in the study. Age, gender, comorbid diseases, vital signs, ONSD ultrasonography measurements, hospitalization and discharge status, in-hospital mortality status, dialysis need, presence of visual impairment, blood gas parameters, respiratory status, time since alcohol intake, ethanol levels, urea levels, and creatinine levels were analyzed. RESULTS ROC curve analysis was performed to evaluate the predictive power of ONSD to diagnose methanol intoxication. The area under the curve was 0.857 for the cut-off value of 5.05 mm (95 % CI: 0.728-0.985; p < 0.001), with a sensitivity of 80.8 % and a specificity of 100 %. In the regression analysis performed to determine the prognostic value of the parameters in estimating mortality in methanol intoxication cases, an increase in ONSD (OR: 3.619; 95 % CI: 0.057-0.199; p = 0.001), an increase in lactate levels (OR: 5.653; 95 % CI: 0.040-0.085; p < 0.001), and increased duration after alcohol intake (OR: 2558; 95 % CI: 0.004-0.034; p = 0.014) were identified as independent predictors of mortality, but pH, HCO3, and base deficit levels were not significant predictors. CONCLUSIONS We believe that ONSD can be helpful for the differential diagnosis and prognosis of patients with suspected methanol toxicity who presented with alcohol intake.
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Affiliation(s)
- Kemal Sener
- Department of Emergency Medicine, Ministry of Health, Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey.
| | - Adem Cakır
- Department of Emergency Medicine, Ministry of Health of Turkey, Canakkale Mehmet Akif Ersoy State Hospital, Canakkale, Turkey
| | - Ertugrul Altug
- Department of Emergency Medicine, Ministry of Health, Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Semih Korkut
- Department of Emergency Medicine, Ministry of Health, Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Ramazan Güven
- Department of Emergency Medicine, Ministry of Health, Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Mücahit Kapci
- Department of Emergency Medicine, Ministry of Health, Başaksehir Çam and Sakura State Hospital, Istanbul, Turkey
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Miller HV, Cao AA, McClelland CM, Lee MS. Linezolid optic neuropathy. Curr Opin Ophthalmol 2023; 34:481-486. [PMID: 37603423 DOI: 10.1097/icu.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW In this article, we reviewed 67 reported cases of linezolid optic neuropathy and describe the common characteristics and expectations for recovery with an emphasis on recent findings in the literature. RECENT FINDINGS Linezolid classically causes a reversible, duration-dependent optic neuropathy. However, in our review, we found only 66.7% of patients recovered complete visual function. Vision loss most commonly affected visual acuity followed by visual field and color vision. We also found patients taking higher doses of linezolid experienced full recovery less often, suggesting a dose-dependent component of linezolid optic neuropathy. Linezolid use has increased in frequency and duration, especially in the treatment of drug-resistant tuberculosis, and data indicate that these patients experience lower rates of complete vision recovery compared with patients taking linezolid for other indications. SUMMARY Linezolid is an effective medication for treating drug-resistant infections; however, it may result in optic neuropathy. It is reasonable for patients on linezolid to undergo screening examinations, especially those on higher doses or for prolonged duration of therapy.
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Affiliation(s)
| | | | - Collin M McClelland
- University of Minnesota Department of Ophthalmology
- University of Minnesota Division of Neuro-ophthalmology, Minneapolis, Minnesota, USA
| | - Michael S Lee
- University of Minnesota Department of Ophthalmology
- University of Minnesota Division of Neuro-ophthalmology, Minneapolis, Minnesota, USA
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Allata Y, Chouhani BA, El Bardai G, Kabbali N, Sqalli Houssaini T. The Role of Nephrologists in the Management of Methanol Poisoning. Cureus 2023; 15:e37471. [PMID: 37187623 PMCID: PMC10176525 DOI: 10.7759/cureus.37471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Acute methanol poisoning is a rare but serious condition that can lead to significant morbidity and mortality. Toxic metabolites produced by methanol, primarily formaldehyde, can cause high anion gap metabolic acidosis, with the severity of clinical presentation ranging from mild symptoms to multi-organ failure. Nine people died and four patients needed treatment at our university hospital following a collective intoxication caused by the consumption of homemade alcoholic beverages in the central region of Morocco. The four patients presented to the emergency department with varying clinical symptoms, such as decreased visual acuity, severe agitation, and dyspnea. The laboratory tests confirmed high anion gap metabolic acidosis and a subsequent toxicology screen revealed that they had consumed methanol-tainted alcohol. The treatment regimen involved inhibiting the formation of toxic metabolites using an antidote (ethanol or fomepizole), correcting metabolic acidosis, enhancing the elimination of toxic metabolites through prolonged hemodialysis, and administering adjunctive therapies. While two patients had favorable outcomes, the other two died from multi-organ failure. These findings highlight the importance of prompt diagnosis and treatment in cases of methanol poisoning.
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Affiliation(s)
- Yassine Allata
- Nephrology, Hemodialysis and Transplantation, Hassan II University Hospital, Fez, MAR
| | - Basmat Amal Chouhani
- Nephrology, Hemodialysis and Transplantation, Hassan II University Hospital, Fez, MAR
- Epidemiology and Health Sciences Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Ghita El Bardai
- Nephrology, Hemodialysis and Transplantation, Hassan II University Hospital, Fez, MAR
- Epidemiology and Health Sciences Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Nadia Kabbali
- Nephrology, Hemodialysis and Transplantation, Hassan II University Hospital, Fez, MAR
- Epidemiology and Health Sciences Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, MAR
| | - Tarik Sqalli Houssaini
- Nephrology, Hemodialysis and Transplantation, Hassan II University Hospital, Fez, MAR
- Epidemiology and Health Sciences Research Laboratory, Faculty of Medicine, Pharmacy and Dentistry, Sidi Mohamed Ben Abdellah University, Fez, MAR
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Topical Review: Optometry in Nepal-Clinical Practice, Research Advances, and Challenges. Optom Vis Sci 2023; 100:134-142. [PMID: 36728818 DOI: 10.1097/opx.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
SIGNIFICANCE This article reviews educational standard, clinical practice, research advances, and challenges associated with optometry in Nepal and provides critical considerations for contemporary and new optometry programs in countries with similar socioeconomic status and health care systems.Optometry education started in Nepal in 1998 with the primary objective of addressing the unmet needs of eye health and vision care in the country. Over the last two decades, this program has made significant contributions to facilitating and improving the delivery of quality eye care and establishing the nation's eye health system as an exemplary model in South Asia. Despite the positive impact in a short time, optometry education and the profession continue to face several challenges, including a shortage of training resources and facilities, poor quality control and regulation of practice standards, lack of professional recognition, limited pathways for entry to governmental jobs via the national public service commission, and limited clinical and academic opportunities in existing eye care programs. This article reviews current education and clinical practice standards, highlights research advances, and discusses present and future challenges in sustaining and improving the quality of education and advancing the scope of practice of optometry in Nepal. Given the limited access to primary eye care services in Nepal, appropriate professional recognition and integration into the national health system, and initiatives targeted at improving the delivery of optometry education in alignment with successful international models may provide a long-sought solution to making eye care services accessible to all and lowering the burden of visual impairment in the country.
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Eskandrani R, Almulhim K, Altamimi A, Alhaj A, Alnasser S, Alawi L, Aldweikh E, Alaufi K, Mzahim B. Methanol poisoning outbreak in Saudi Arabia: a case series. J Med Case Rep 2022; 16:357. [PMID: 36199119 PMCID: PMC9535885 DOI: 10.1186/s13256-022-03600-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Outbreaks of methanol poisoning have been described in the medical literature in different regions around the world. Even though in Saudi Arabia a few outbreaks of methanol poisoning have occurred, they remain undocumented. Herein, we describe several cases of methanol poisoning in Saudi Arabia with the goal of increasing awareness about the dangers of methanol poisoning among healthcare staff. Case presentation Nine middle-aged Saudi patients (five men aged 24, 26, 27, 36, and 49 years and four females aged 19, 20, 24, and 25 years) were admitted to our emergency department after alcohol consumption. All patients presented with severe metabolic acidosis and some visual impairment. Treatment was initiated based on the clinical suspicion of methanol intoxication because of laboratory test limitations and time constraints. Patients showed improvement and favorable hospital outcomes after aggressive empirical treatment. Conclusions Many social and cultural factors influence the lack of reporting of methanol poisoning cases in Saudi Arabia. We believe it is important to document these outbreaks to increase the knowledge among healthcare providers and promote public health awareness. A high index of suspicion and the development of local public health networks to monitor, survey, follow-up, and facilitate data exchange can help healthcare providers recognize and aggressively treat affected individuals. Early empiric and aggressive management can greatly decrease morbidity and mortality despite challenges and limited resources.
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Affiliation(s)
- Rawan Eskandrani
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia.
| | - Khalid Almulhim
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Abdulla Altamimi
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Abeer Alhaj
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Shahd Alnasser
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Laale Alawi
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Eman Aldweikh
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia
| | - Khalid Alaufi
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia.,Emergency Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Bandr Mzahim
- Poison Control Center, Emergency Medicine Administration, King Fahad Medical City, Prince Abdulaziz Ibn Jalwi St, As Sulimaniyah, Riyadh, 12231, Saudi Arabia.,Emergency Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
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Use of Visual Electrophysiology to Monitor Retinal and Optic Nerve Toxicity of Medications. Biomolecules 2022; 12:biom12101390. [PMID: 36291599 PMCID: PMC9599231 DOI: 10.3390/biom12101390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
It is important for clinicians to consider exposure to toxic substances and nutritional deficiencies when diagnosing and managing cases of vision loss. In these cases, physiologic damage can alter the function of key components of the visual pathway before morphologic changes can be detected by traditional imaging methods. Electrophysiologic tests can aid in the early detection of such functional changes to visual pathway components, including the retina or optic nerve. This review provides an overview of various electrophysiologic techniques, including multifocal electroretinogram (mfERG), full-field ERG (ffERG), electrooculogram (EOG), pattern electroretinogram (PERG), and visual evoked potential (VEP) in monitoring the retinal and optic nerve toxicities of alcohol, amiodarone, cefuroxime, cisplatin, deferoxamine, digoxin, ethambutol, hydroxychloroquine, isotretinoin, ocular siderosis, pentosane, PDE5 inhibitors, phenothiazines (chlorpromazine and thioridazine), quinine, tamoxifen, topiramate, vigabatrin, and vitamin A deficiency.
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Nalcacıoglu P, Kavuncu S, Taskın Turkmenoglu T, Sonmez CA. The effect of idebenone and corticosteroid treatment on methanol-induced toxic optic nerve and retinal damage in rats: biochemical and histopathological examination. Cutan Ocul Toxicol 2022; 41:250-256. [PMID: 35894634 DOI: 10.1080/15569527.2022.2106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the therapeutic effects of methylprednisolone, the CoenzymeQ10 (CoQ10) structural analogue idebenone, and both together on the optic nerve (ON) and retinal layers following methanol intoxication in rats with histopathological and biochemical methods. MATERIALS AND METHODS This experimental study was conducted with 30 male Wistar rats. The rats were divided into five equal groups depending on the treatment protocol:healthy controls (HC), methanol (M), methanol + methylprednisolone (MM), methanol + idebenone (MI), and methanol + methylprednisolone + idebenone (MMI).Distilled water was provided orally to the HC group, while 20% methanol was administered orally at a dose of 3 g/kg with a nasogastric tube to all rats in groups except the HC group. Four hours later, group MM received 1 mg/kg of intraperitoneal methylprednisolone for 10 days using an insulin syringe, and group MI received 20 mg/kg idebenone by nasogastric catheter for 28 days. MMI group was administered oral idebenone and intraperitoneal methylprednisolone at the same dose. Serum samples were obtained on the 28th day for biochemical analysis and afterwards the rats were euthanized for histopathological examination and eyes were enucleated. ON was evaluated for circumference thickness, vascularization and number of astrocytes, also retinal layers were examined for structural changes by histopathological examination. RESULTS Comparison of the antioxidant and oxidative stress biomarkers between the groups revealed no statistically significant difference (p > 0.05). By histopathological evaluation the most marked results were obtained by MMI group with an improvement of all parameters mentioned. There was no statistically significant difference between MM group and M group for RD score (p = 0.123). In addition, ON vacuolization in MI group (p < 0.001) and ON astrocyte increase in both MI and MMI groups were statistically significantly lower than in M group (p = 0.001, p = 0.001, respectively). CONCLUSIONS The early use (within hours) of idebenone and short-term methylprednisolone treatment together may protect against the retinal and ON damage developing after methanol ingestion in rats as guided by the histopathological data.
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Affiliation(s)
- Pinar Nalcacıoglu
- M.D, Associate Professor, XXXXXXXX, Department of Ophthalmology, Ankara, Turkey
| | | | | | - Cigdem Atay Sonmez
- MD, Associate Professor, XXXXXXXX, Department of Biochemistry, Ankara, Turkey
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Liberski S, Kaluzny BJ, Kocięcki J. Methanol-induced optic neuropathy: a still-present problem. Arch Toxicol 2022; 96:431-451. [PMID: 34988610 PMCID: PMC8731680 DOI: 10.1007/s00204-021-03202-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
Methanol-induced optic neuropathy (Me-ION) is a serious condition that may result in long-term or irreversible visual impairment or even blindness secondary to damage and loss of function of the optic nerve and retina. Me-ION shows a tendency to occur as mass poisonings around the world with a clear predilection for poor societies in developing countries. The main mechanism underlying the molecular basis of Me-ION is the inhibition of the mitochondrial oxidative phosphorylation process through the binding of the toxic metabolite of methanol—formic acid—with the key enzyme of this process—cytochrome c oxidase. However, other mechanisms, including damage to the eye tissues by oxidative stress causing the intensification of the oxidative peroxidation process with the formation of cytotoxic compounds, as well as an increase in the synthesis of pro-inflammatory cytokines and influence on the expression of key proteins responsible for maintaining cell homeostasis, also play an important role in the pathogenesis of Me-ION. Histopathological changes in the eye tissues are mainly manifested as the degeneration of axons and glial cells of the optic nerve, often with accompanying damage of the retina that may involve all its layers. Despite the development of therapeutic approaches, persistent visual sequelae are seen in 30–40% of survivors. Thus, Me-ION continues to be an important problem for healthcare systems worldwide.
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Affiliation(s)
- Sławomir Liberski
- Department of Ophthalmology, Poznan University of Medical Sciences, ul. Augustyna Szamarzewskiego 84, 61-848, Poznań, Poland.
| | - Bartlomiej J Kaluzny
- Division of Ophthalmology and Optometry, Department of Ophthalmology, Collegium Medicum, Nicolaus Copernicus University, ul. Kornela Ujejskiego 75, 85-168, Bydgoszcz, Poland
| | - Jarosław Kocięcki
- Department of Ophthalmology, Poznan University of Medical Sciences, ul. Augustyna Szamarzewskiego 84, 61-848, Poznań, Poland
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Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F, Banimostafavi ES, Sharifpour A, Ebrahim Ghuchi N, Fakhar M, Tabaripour R, Safanavaei S. Methanol poisoning as a new world challenge: A review. Ann Med Surg (Lond) 2021; 66:102445. [PMID: 34141419 PMCID: PMC8187162 DOI: 10.1016/j.amsu.2021.102445] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Methanol poisoning (MP) occurs often via ingestion, inhalation, or dermal exposure to formulations containing methanol in base. Clinical manifestations of MP include gastrointestinal symptoms, central nervous system (CNS) suppression, and decompensated metabolic acidosis occurred with blurred vision and early or late blindness. OBJECTIVE This study reviewed the clinical manifestations, laboratory and radiology findings, and treatment approaches in MP. DISCUSSION Methanol is usually rapidly absorbed after ingestion and metabolized by alcohol dehydrogenase (ADH), then distributed to the body water to reach a volume distribution approximately equal to 0.77 L/kg. It is also eliminated from the body as unchanged parent compounds. Clinical manifestations of MP alone initiate within 0.5-4 h after ingestion and include gastrointestinal symptoms and CNS suppression. After a latent period of 6-24 h, depending on the absorbed dose, decompensated metabolic acidosis occurs with blurred vision and early or late blindness. Blurred vision with normal consciousness is a strong suspicious sign of an MP. The mortality and severity of intoxication are well associated with the severity of CNS depression, hyperglycemia, and metabolic acidosis, but not with serum methanol concentration. After initial resuscitation, the most important therapeutic action for patients with known or suspected MP is correction of acidosis, inhibition of ADH, and hemodialysis. CONCLUSION Since MP is associated with high morbidity and mortality, it should be considered seriously and instantly managed. Delay in treatment may cause complications, permanent damage, and even death.
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Affiliation(s)
- Zahra Nekoukar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
- Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Taghizadeh
- Psychiatry and Behavioral Sciences Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Musavi
- Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasrin Ebrahim Ghuchi
- Knowledge and Information Science, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Rabeeh Tabaripour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sepideh Safanavaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
- Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
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14
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Karimi S, Arabi A, Shahraki T. Alcohol and the Eye. J Ophthalmic Vis Res 2021; 16:260-270. [PMID: 34055263 PMCID: PMC8126742 DOI: 10.18502/jovr.v16i2.9089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 09/14/2020] [Indexed: 11/24/2022] Open
Abstract
In this article, we present a review of ocular conditions related to alcohol consumption. A search of the literature published from 1952 to March 2020 was performed. The titles and abstracts were screened and the eligible studies were selected. PubMed, ISI Web of Knowledge database, Scopus, Embase, and the Cochrane Library were searched. We categorized the relationship between alcohol intake and ocular conditions by the type of ocular exposure to alcohol. Accordingly, ocular findings following acute alcohol intoxication, optic neuropathy following methanol toxicity, congenital conditions related to maternal alcohol consumption, and ocular disease related to chronic alcoholism are discussed. The main feature of alcohol intoxication in the eye is abnormal eye movement. Acute optic neuropathy secondary to methyl alcohol consumption is a serious ocular disease with permanent vision loss or scotoma. Prenatal exposure to ethanol may end in fetal alcohol spectrum disease, where ocular findings are a constant component. The association between chronic alcohol consumption and increased risks of cataract, age-related macular degeneration, diabetic retinopathy, different types of optic neuropathy, impairment of visual quality, retinal vascular disease, and ocular surface disease has also been reported. Along with detrimental medical and social effects, the role of alcohol consumption in different ocular conditions should be considered, as alcohol-induced visual disturbances may contribute to the heavy burden of alcohol abuse on the healthcare system and overall quality of life.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Arabi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toktam Shahraki
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Torfeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Simani L, Ramezani M, Roozbeh M, Shadnia S, Pakdaman H. The outbreak of methanol intoxication during COVID-19 pandemic: prevalence of brain lesions and its predisposing factors. Drug Chem Toxicol 2020; 45:1500-1503. [PMID: 33172326 DOI: 10.1080/01480545.2020.1845192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
During the COVID-19 pandemic, methanol-containing beverages' consumption has risen because people mistakenly believed that alcohol might protect them against the virus. This study aimed to evaluate the prevalence and predisposing factors of brain lesions in patients with methanol toxicity and its outcome. A total of 516 patients with confirmed methanol poisoning were enrolled in this retrospective study, of which 40 patients underwent spiral brain computed tomography (CT) scan. The presence of unilateral or bilateral brain necrosis was significantly higher in the non-survival group (p = 0.001). Also, intracerebral hemorrhage (ICH) and brain edema were prevalent among patients that subsequently died (p = 0.004 and p = 0.002, respectively). Lower Glasgow Coma Scale (GCS) was related to a higher mortality rate (p = 0.001). The mortality rate in chronic alcohol consumption was lower than the patients who drank alcohol for the first time (p = 0.014). In conclusion, increasing the number of methanol poisoning and its associated mortality and morbidity should be considered a threat during the COVID-19 pandemic.
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Affiliation(s)
- Leila Simani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahtab Ramezani
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Roozbeh
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Shadnia
- Department of Clinical Toxicology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pakdaman
- Brain Mapping Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Lešták J, Diblík P, Zacharov S, Fůs M, Kynčl M, Tintěra J, Heissigerová J. Late Functional and Morphological Findings after Methylalcohol Poisoning. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:278-285. [PMID: 33691428 DOI: 10.31348/2020/39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM The aim of the study was to determine the morphological and functional findings in a patient after methanol poisoning. Examination methods: The patient (male, 38 years old) was suffered methanol poisoning in eight years ago (2012). The following tests and examinations were performed: neurological visual field XR test (Medmont M700), retinal nerve fibre layer (RNFL), ganglion cell complex (GCC) and peripapillary vessel density (all using Avanti RTvue, Optovue), pattern electroretinography (PERG) and pattern visual evoked potential (PVEP) examination according to ISCEV methodology (Roland Consult Instrument) and brain MRI examination (Philips Achieva Dstream 3 T). RESULTS The biggest changes were found in RNFL and VD. PERG also showed damage to retinal ganglion cell axons. In left eye we determined decrease in oscillations (in comparison with contralateral eye) at N35-P50 and P50-N95. VEPs in both eyes were significantly reduced, almost inconspicuous in the left eye. Extension of latency time of P100 was not identified. Functional MRI showed a bilateral decrease in voxel activity with a greater decrease in the left eye. There were postmalatical changes in the dorsal parts of the putamen on MRI. The width of the optic nerve and chiasm was physiological. CONCLUSION Asymmetric damaging of RNFL and cortical centres of the brain were determined. We registered large pathological changes in VD, which are probably responsible for the deepening of optic nerve excavation and further loss of nerve fibers of retinal ganglion cells, which have not yet been described in the literature. Following these results is possible to define direct damage of nerve structures and blood vessels by toxins of methanol metabolism in the acute stage and upcoming reparation processes in following periods.
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17
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Pilz YL, Bass SJ, Sherman J. A Review of Mitochondrial Optic Neuropathies: From Inherited to Acquired Forms. JOURNAL OF OPTOMETRY 2017; 10:205-214. [PMID: 28040497 PMCID: PMC5595256 DOI: 10.1016/j.optom.2016.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/02/2016] [Accepted: 09/22/2016] [Indexed: 05/28/2023]
Abstract
In recent years, the term mitochondrial optic neuropathy (MON) has increasingly been used within the literature to describe a group of optic neuropathies that exhibit mitochondrial dysfunction in retinal ganglion cells (RGCs). Interestingly, MONs include genetic aetiologies, such as Leber hereditary optic neuropathy (LHON) and dominant optic atrophy (DOA), as well as acquired aetiologies resulting from drugs, nutritional deficiencies, and mixed aetiologies. Regardless of an inherited or acquired cause, patients exhibit the same clinical manifestations with selective loss of the RGCs due to mitochondrial dysfunction. Various novel therapies are being explored to reverse or limit damage to the RGCs. Here we review the pathophysiology, clinical manifestations, differential diagnosis, current treatment, and promising therapeutic targets of MON.
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MESH Headings
- DNA, Mitochondrial
- Diagnosis, Differential
- Humans
- Mitochondrial Diseases/diagnosis
- Mitochondrial Diseases/genetics
- Mitochondrial Diseases/physiopathology
- Mitochondrial Diseases/therapy
- Optic Atrophy, Autosomal Dominant/diagnosis
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Autosomal Dominant/therapy
- Optic Atrophy, Hereditary, Leber/diagnosis
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/physiopathology
- Optic Atrophy, Hereditary, Leber/therapy
- Optic Nerve Diseases/diagnosis
- Optic Nerve Diseases/genetics
- Optic Nerve Diseases/physiopathology
- Optic Nerve Diseases/therapy
- Retinal Ganglion Cells/pathology
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Affiliation(s)
- Yasmine L Pilz
- State University New York, College of Optometry, New York, USA.
| | - Sherry J Bass
- State University New York, College of Optometry, New York, USA
| | - Jerome Sherman
- State University New York, College of Optometry, New York, USA
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18
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Zamani N, Hassanian-Moghaddam H, Shojaei M, Rahimian S. Evaluation of the effect of erythropoietin + corticosteroid versus corticosteroid alone in methanol-induced optic nerve neuropathy. Cutan Ocul Toxicol 2017; 37:186-190. [PMID: 28849680 DOI: 10.1080/15569527.2017.1373121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Following methanol intoxication, optic nerve neuropathy may occur, which is currently treated by different therapeutic regimens. Erythropoietin (EPO) has recently been introduced as a good therapeutic option in methanol-induced optic neuropathy. The aim of the current study was to evaluate the efficacy of EPO in improvement of the visual disturbances in methanol-intoxicated patients. MATERIALS AND METHODS In a case-control study, all patients who had referred to our toxicology centre with confirmed diagnosis of methanol toxicity were considered to be included. Of them, those who had referred with visual disturbances, survived, and their visual disturbances had not improved after haemodialysis were entered. Cases received EPO and corticosteroids while controls only received corticosteroids. They were then compared regarding their visual outcome. RESULTS All five patients in the control group mentioned that after discharge, their visual acuity had improved while in the cases, three mentioned visual improvement, two mentioned their visual acuity had deteriorated after discharge, two mentioned no change in their visual acuity and three mentioned that their visual acuity had first improved but then deteriorated with a mean two-month interval period. In fundoscopic evaluations, two controls had normal fundospcopy while eight cases had abnormal fundoscopy (p = 0.055). CONCLUSIONS Protective effect of EPO on methanol-induced optic nerve may be strong at the beginning of the intervention but is probably transient.
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Affiliation(s)
- Nasim Zamani
- a Toxicological Research Center, Department of Clinical Toxicology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ministry of Health , Excellence Centre of Clinical Toxicology , Tehran , Iran
| | - Hossein Hassanian-Moghaddam
- a Toxicological Research Center, Department of Clinical Toxicology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,b Ministry of Health , Excellence Centre of Clinical Toxicology , Tehran , Iran
| | - Maziar Shojaei
- c Department of Neurology , Loghman-Hakim Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Sara Rahimian
- d Ophtalmology Clinic , Loghman-Hakim Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Ghanbari A, Ghareghani M, Zibara K, Delaviz H, Ebadi E, Jahantab MH. Light-Emitting Diode (LED) therapy improves occipital cortex damage by decreasing apoptosis and increasing BDNF-expressing cells in methanol-induced toxicity in rats. Biomed Pharmacother 2017; 89:1320-1330. [DOI: 10.1016/j.biopha.2017.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/24/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022] Open
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20
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The Intoxication Effects of Methanol and Formic Acid on Rat Retina Function. J Ophthalmol 2016; 2016:4087096. [PMID: 27688906 PMCID: PMC5027045 DOI: 10.1155/2016/4087096] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/15/2016] [Accepted: 06/29/2016] [Indexed: 11/23/2022] Open
Abstract
Objective. To explore the potential effects of methanol and its metabolite, formic acid, on rat retina function. Methods. Sprague-Dawley rats were divided into 3- and 7-day groups and a control. Experimental groups were given methanol and the control group were provided saline by gavage. Retinal function of each group was assessed by electroretinogram. Concentrations of methanol and formic acid were detected by GC/HS and HPLC, respectively. Results. The a and b amplitudes of methanol treated groups decreased and latent periods delayed in scotopic and photopic ERG recordings. The summed amplitudes of oscillatory potentials (OPs) of groups B and C decreased and the elapsed time delayed. The amplitudes of OS1, OS3, OS4, and OS5 of group B and OS3, OS4, and OS5 of group C decreased compared with the control group. The IPI1 of group B and IPI1-4 of group C were broader compared with the control group and the IPI1-4 and ET of group B were broader than group C. Conclusions. Both of scotopic and photopic retinal functions were impaired by methanol poisoning, and impairment was more serious in the 7-day than in the 3-day group. OPs, especially later OPs and IPI2, were more sensitive to methanol intoxication than other eletroretinogram subcomponents.
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Recommendations for the role of extracorporeal treatments in the management of acute methanol poisoning: a systematic review and consensus statement. Crit Care Med 2015; 43:461-72. [PMID: 25493973 DOI: 10.1097/ccm.0000000000000708] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Methanol poisoning can induce death and disability. Treatment includes the administration of antidotes (ethanol or fomepizole and folic/folinic acid) and consideration of extracorporeal treatment for correction of acidemia and/or enhanced elimination. The Extracorporeal Treatments in Poisoning workgroup aimed to develop evidence-based consensus recommendations for extracorporeal treatment in methanol poisoning. DESIGN AND METHODS Utilizing predetermined methods, we conducted a systematic review of the literature. Two hundred seventy-two relevant publications were identified but publication and selection biases were noted. Data on clinical outcomes and dialyzability were collated and a two-round modified Delphi process was used to reach a consensus. RESULTS Recommended indications for extracorporeal treatment: Severe methanol poisoning including any of the following being attributed to methanol: coma, seizures, new vision deficits, metabolic acidosis with blood pH ≤ 7.15, persistent metabolic acidosis despite adequate supportive measures and antidotes, serum anion gap higher than 24 mmol/L; or, serum methanol concentration 1) greater than 700 mg/L (21.8 mmol/L) in the context of fomepizole therapy, 2) greater than 600 mg/L or 18.7 mmol/L in the context of ethanol treatment, 3) greater than 500 mg/L or 15.6 mmol/L in the absence of an alcohol dehydrogenase blocker; in the absence of a methanol concentration, the osmolal/osmolar gap may be informative; or, in the context of impaired kidney function. Intermittent hemodialysis is the modality of choice and continuous modalities are acceptable alternatives. Extracorporeal treatment can be terminated when the methanol concentration is <200 mg/L or 6.2 mmol/L and a clinical improvement is observed. Extracorporeal Treatments in Poisoning inhibitors and folic/folinic acid should be continued during extracorporeal treatment. General considerations: Antidotes and extracorporeal treatment should be initiated urgently in the context of severe poisoning. The duration of extracorporeal treatment extracorporeal treatment depends on the type of extracorporeal treatment used and the methanol exposure. Indications for extracorporeal treatment are based on risk factors for poor outcomes. The relative importance of individual indications for the triaging of patients for extracorporeal treatment, in the context of an epidemic when need exceeds resources, is unknown. In the absence of severe poisoning but if the methanol concentration is elevated and there is adequate alcohol dehydrogenase blockade, extracorporeal treatment is not immediately required. Systemic anticoagulation should be avoided during extracorporeal treatment because it may increase the development or severity of intracerebral hemorrhage. CONCLUSION Extracorporeal treatment has a valuable role in the treatment of patients with methanol poisoning. A range of clinical indications for extracorporeal treatment is provided and duration of therapy can be guided through the careful monitoring of biomarkers of exposure and toxicity. In the absence of severe poisoning, the decision to use extracorporeal treatment is determined by balancing the cost and complications of extracorporeal treatment to that of fomepizole or ethanol. Given regional differences in cost and availability of fomepizole and extracorporeal treatment, these decisions must be made at a local level.
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Sanaei-Zadeh H. Optical coherence tomography of the macula and optic nerve in methanol-intoxicated patients and the effect of intravenous corticosteroids on their visual disturbances. Int Ophthalmol 2014; 34:447-8. [PMID: 24967461 DOI: 10.1007/s10792-012-9527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
PURPOSE OF REVIEW Many causes of toxic optic neuropathy have been described to date and novel causes of toxicity are continuously being added to the current literature. The pathophysiological basis for the toxicity or a direct causal relationship is yet to be determined for many of these agents. This review highlights the reports made over the last year about the commonly reported agents, with emphasis on the mechanisms of toxicity. RECENT FINDINGS Mitochondria of retinal ganglion cells and papillomacular bundle in particular could be the common target of many causes of toxic optic neuropathy, if not all. Agents or their metabolites responsible for the toxicity seem to interfere with the oxidative phosphorylation in mitochondria, causing a buildup of reactive oxidation species, energy depletion, oxidative stress, and activation of apoptosis. SUMMARY Further data are still necessary to understand how some of the usual suspects cause damage to the optic nerve or whether they indeed cause damage or not. A basic algorithm, as proposed, could be a useful addition to discriminate the novel causes of toxic optic neuropathy. VIDEO ABSTRACT See the Supplemental Digital Content 1 (http://links.lww.com/COOP/A11).
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