Assessment of Optic Nerve Changes in Patients Receiving Anti-Tuberculosis Drugs at Different Time Interval
DOI:
https://doi.org/10.51985/JBUMDC2021125Keywords:
Ethambutol, Isoniazid, Optic Neuropathy, Optic Nerve, TuberculosisAbstract
Objectives: To assess optic nerve changes in patients receiving anti-tuberculosis drugs and to assess optic nerve changes
at different time interval of therapy.
Study design and settings: Descriptive cross-sectional study was conducted from August 2021 to November 2021 in
Madinah Teaching Hospital, Faisalabad.
Methodology: 200 eyes of 100 patients receiving anti-tuberculosis therapy since 2-month, 4-month, 6 month and 8 months
were taken. Patients had not any systemic disease other than Tuberculosis. Indirect Ophthalmoscopy was performed to
assess changes in fundus and optic nerve head. Optical Coherence Tomography was performed for assessment of retinal
nerve fiber layer thickness and cup to disc ratio. Data was analysed by using descriptive statistics and chi-square test with
SPSS version 20.
Results: In 2 months there was 16(66.66%) normal fundus, 8(33.33%) glaucomatous optic disc cupping. In 4 months, there
was 12(15.38%) normal fundus, 16(20%) optic atrophy, 16(20%) optic neuropathy, 4.00(5%) optic neuritis and 30(38%)
glaucomatous optic disc cupping. In 6 months, there was 7(21%) normal fundus, 4(12.5%) optic atrophy and 21(50%) optic
neuropathy. In 8 months, there was 24(36%) optic atrophy, 34(51.5%) optic neuropathy, 4(6%) optic neuritis and 4(6%)
Glaucomatous optic dis cupping (P 0.00). Result of this study also shows that retinal nerve fiber layer thickness is normal
in 83(41.5%), increase in 4(2.0%) and decrease in 113(56.5%).
Conclusions: This study concluded that anti-tuberculosis drugs responsible for optic nerve changes and severity of optic
nerve changes increase when duration of therapy increases.
References
Nitu FM, Olteanu M, Streba CT, Jimborean G, Postolache P,
Man MA, et al. Tuberculosis and its particularities in Romania
and worldwide. Rom J Morphol Embryol. 2017; 58(2): 385-
Fukunaga R, Glaziou P, Harris JB, Date A, Floyd K, Kasaeva
T. Epidemiology of tuberculosis and progress toward meeting
global targets—worldwide, 2019. Morbidity and Mortality
Weekly Report. 2021; 70(12):427-430. doi: 10.15585/mmwr.
mm7012a4
Qadeer E, Fatima R, Yaqoob A, Tahseen S, Ul Haq M, Ghafoor
A, et al. Population based national tuberculosis prevalence
survey among adults (> 15 years) in Pakistan, 2010–2011.
PloS one. 2016;11(2): e0148293. doi.org/10.1371/ journal.
pone.0148293
Wang L, Zhang H, Ruan Y, Chin DP, Xia Y, Cheng S, et al.
Tuberculosis prevalence in China, 1990–2010; a longitudinal
analysis of national survey data. The Lancet. 2014;
(9934):2057-2064. https://doi.org/10.1016/S0140-
(13)62639-2.
Tiberi S, Scardigli A, Centis R, D’Ambrosio L, Munoz-Torrico
M, et al. Classifying new anti-tuberculosis drugs: rationale
and future perspectives. International Journal of Infectious
Diseases. 2017; 56:181-184. https://doi.org/ 10.1016/ j.ijid.
10.026
Rendon A, Tiberi S, Scardigli A, D’Ambrosio L, Centis R,
Caminero JA, et al. Classification of drugs to treat multidrugresistant tuberculosis (MDR-TB): evidence and perspectives.
Journal of thoracic disease. 2016;8(10):2666-2671. doi: 10.
/jtd.2016.10.14
Abbas A. Monitoring of Side Effects of Anti-Tuberculosis
Drugs (ATD) On The Intensive Phase Treatment Of Pulmonary
TB Patients In Makassar. Journal of Agromedicine and Medical
Sciences. 2017;3(1): 19-24. DOI: https://doi.org/ 10.19184/
ams.v3i1.4093
Fredj NB, Gam R, Kerkni E, Chaabane A, Chadly Z,
Boughattas N, Aouam K. Risk factors of isoniazid-induced
hepatotoxicity in Tunisian tuberculosis patients. The
pharmacogenomics journal. 2017;17(4):372-377. https://
doi.org/10.1038/tpj.2016.26
Panchal K et al. Ocular side effects of anti-tubercular drugs
in patients receiving Anti-Tb treatment at tertiary care center.
IP International Journal of Ocular Oncology and Oculoplasty.
;6(3):187-191. DOI:10.18231/j.ijooo.2020.042
Solu TM, Panchal KM. Ocular Side Effects of Anti-Tubercular
Drugs in Patients Receiving Anti-Tb Treatment at Tertiary
Care Center. Journal of dental and medical sciences. 2020;
(8):9-13. DOI: 10.9790/0853-1908100913
Spaide RF, Fujimoto JG, Waheed NK, Sadda SR, Staurenghi
G. Optical coherence tomography angiography. Progress in
retinal and eye research. 2018; 64:1-55. https://doi.org/ 10.1016
/j.preteyeres.2017.11.003
Saxena R, Singh D, Phuljhele S, Kalaiselvan V, Karna S,
Gandhi R, et al. Ethambutol toxicity: Expert panel consensus
for the primary prevention, diagnosis and management of
ethambutol-induced optic neuropathy. Indian journal of
ophthalmology. 2021; 69(12):3734-9. doi: 10.4103/
ijo.IJO_3746_20
Mandal S, Saxena R, Dhiman R, Mohan A, Padhy SK,
Phuljhele S, Sharma P, Guleria R. Prospective study to evaluate
incidence and indicators for early detection of ethambutol
toxicity. British Journal of Ophthalmology. 2021; 105(7):1024-
http://dx.doi.org/10.1136/bjophthalmol-2020-316897
Chamberlain PD, Sadaka A, Berry S, Lee AG. Ethambutol
optic neuropathy. Current opinion in ophthalmology. 2017
Nov 1;28(6):545-51. DOI: https://doi.org/10.1097 /ICU.
Jin KW, Lee JY, Rhiu S, Choi DG. Longitudinal evaluation
of visual function and structure for detection of subclinical
Ethambutol-induced optic neuropathy. Plos one. 2019;
(4):e0215297. doi: 10.1371/journal.pone.0215297
Ezer N, Benedetti A, Darvish-Zargar M, Menzies D. Incidence
of ethambutol-related visual impairment during treatment of
active tuberculosis. The International journal of tuberculosis
and lung disease. 2013; 17(4):447-455. doi: 10.5588/
ijtld.11.0766.
Konnakkodan SM, Solomon CB, Prabhu PB, Kumar AA.
Optic nerve head-retinal nerve fiber layer analysis with
spectral-domain optical coherence tomography of ethambutolinduced ocular toxicity in patients on a daily regime of antitubercular therapy. Kerala Journal of Ophthalmology. 2021;
(3):291-298. DOI:10.4103/kjo.kjo_162_20.
Raghu V, Rajender M, Beesam K, Reddy N. A Prospective
evaluation of visual function for early detection of ethambutol
toxicity. MRIMS Journal of Health Sciences. 2016; 4(2):89-
DOI:10.4103/2321-7006.302256
Singh PK. The Effect of Anti-Tubercular Drugs on Retinal
Nerve Fiber Layer Thickness Using Optical Coherence
Tomography. Ophthalmology Research: An International
Journal. 2020; 13(1):12-15. DOI: 10.9734/OR /2020/ v13i1
Bandyopadhyay S, Banerjee S, Bandyopadhyay SK,
Shamantha MC, Biswas S. A prospective evaluation of ocular
toxicity in patients receiving ethambutol as anti-tubercular
therapy. Sudanese Journal of Ophthalmology. 2020; 12(1):12-
DOI:10.4103/sjopthal.sjopthal_4_20.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 Shakila Abbas, Sonia Abdul Sammad, Mariyam Akhtar, Syeda Tasneem Zahra, Syeda Najam Gulzar, Ayesha Kiran
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
