Efficacy and safety of pulsed intravenous Erythropoietin on Methanol-Induced Toxic Optic Neuropathy
Alireza Amirabadi, MD1 , Kiana Hassanpour, MD, MPH1 *, Negin Mohammadi, MD, MBA1 , Mohammad pakravan, MD1 , Sadid Hooshmandi, MD1
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: To report the efficacy and safety of pulsed intravenous erythropoietin (EPO) for a more extended period in patients with methanol-induced toxic optic neuropathy (MTON).
Methods: This study is obtained from another study conducted on patients with MTON. (Unpublished data) Patients with MTON and visual impairment who received EPO for three months and completed their 6-month follow-up were enrolled. Exclusion criteria consisted of patients older than 60 years, any contraindication to receive EPO including the history of thrombosis, hemoglobin (Hb) more than 16 g/dl or systolic blood pressure more than 160 mmHg, and unwillingness to participate. The patients received intravenous EPO 20000 units daily divided by two doses for five days. The intravenous EPO was continued at 20000 units weekly for three months. Conventional treatment was also administered. The primary outcome measure was visual acuity (VA). The secondary outcome measures were retinal nerve fiber layer thickness changes in peripapillary optical coherence tomography (PP-OCT).
Results: Fourteen eyes of 7 patients with MTON were included. The average age of the patients was 47.8 9.7 years. All patients were male. The average logMAR VA was 2.8 0.8 at baseline that significantly improved to 2.4 0.9 after five days (P< 0.001) and 2.3 0.9 at months 3 (P< 0.001). Fifty percent of eyes (7 out of 14) demonstrated an increase in logMAR BCVA after discontinuation of EPO at month 3. logMAR VA increased from 2.32 0.9 at month 3 to 2.41 0.9 at month 6. However, this increase did not reach statistically significant values. The mean RNFL was 135.4 25.8 microns at baseline that significantly reduced to 61.6 9.2 (P< 0.001) and 48.0 11.1 (P< 0.001) microns at month 3 (P< 0.001), and month 6 (P< 0.001). No patient showed evidence of deep vein thrombosis or rise of Hb over the study period.
Conclusion: Maintenance of pulsed EPO for a more extended period might have a role in improving VA after the early stages. After discontinuation of EPO, deterioration of VA in half of the patients might favor the neuroprotective effect of EPO. However, further studies with a control group are needed to confirm the present study's findings.
