October - LRS Institute of Tuberculosis & Respiratory Diseases
October - LRS Institute of Tuberculosis & Respiratory Diseases October - LRS Institute of Tuberculosis & Respiratory Diseases
B.B. LAL AND R.K. GUPTA Visual acuity on Snellen’s TABLE 5 Effect of ethambutol on visual acuity Before treatment chart Both One eyes eye only 6/6 552 96 6/9 42 36 6/12 38 After treatment Both One eyes eye only 81 206 47 139 5 152 6/18 2 24 246 6/24 — 102 6/36 52 51 6/60 _ _ Below 6/60 — 46 noted. In symptomatic group of patients, the symptoms disappeared within 2-5 months of stopping the therapy. Discussion Various ocular toxicities including the change in vision following ethambutol therapy TABLF 6 Relationship between time of appearance of symptoms & visual function distrbance Time after starting therapy No. or patient showing visual function disturbance Symptomatic group of patients Asymptomatic group of patients 4 Months 2 — 5 ” 1 — 6 ” 2 — 7 ” - 11 8 ” 7 7 9 ” — 9 10 ” — 8 11 ” 12 14 12 ” — 8 Total 24 57 TABLE 7 Effect of Ethambutol on field of vision Field of vision Before treatment After treatment Central Within normal limits in all 680 cases for white, Blue, Red & Green colours No Change Peripheral -do- White, Blue & Red colour fields no change Green Colour field No Change Constriction Binocular 641 32 Cases Cases (1289 Eyes) (64 Eyes) Uniocular 7 Cases (7 Eyes) Ind. J. Tub., Vol. XXIX, No. 4
VISUAL PATTERN IN ETHEMBUTOL TREATED TUBERCULAR PATIENTS 225 have been reported by many workers—Bhola & Purhoit (1976), Citron (1969), Mathur & Mathur (1981). The diminution in visual acuity and peripheral field defects have been reported as visual changes. The present study reveals a change in visual pattern in the form of diminution of visual acuity and change in normal relative extent of green colour fields in 1.2% patients treated with ethambutol, a finding similar to that of Mathur & Mathur (1981). Strikingly enough, in our study, no patient complained of colour vision defect nor was it evident on testing with Ishihara’s colour vision charts. In the series reported by Mathur & Mathur (1981) 6% patients were unable to identify red and green colour on Ishihara’s colour charts. This diminution of sensitivity to green colour preceding that for blue colour indicates the involvement of transmitting neural apparatus, a change which may be evident before the field for white shows demonstrable alteration. The decrease in visual acuity and loss of ability to perceive the colour green, has been attributed to optic neuritis (Mathur & Mathur, 1981). Okcu (1975) and Schimidt (1966). It was observed that the symptoms of visual function disturbance following ethambutol therapy disappeared within 2 to 5 months of stopping the therapy on appearance of symptoms. Of course, in both the symptomatic and asymptomatic groups there was recordable functional improvement, as well, following the cessation of therapy. Hence it is recommended that a regular visual checkup be carried out in all the patients put on ethambutol therapy, because the optic nerve changes once produced are not reversible except in mild and early cases, since once optic nerve fibres degenerate they never regenerate The patient must be primarily made aware of the toxic symptoms which he may develop, in which case he should report immediately at the hospital. This will prevent any permanent damage to vision due to ethambutol. REFERENCES 1. Bhola S.S. & Purhat S.D.; Ocular toxicity with Ethambutol in tuberculosis patients. Ind. Jr. of chest diseases & allied science; 1976, 18, 190. 2. Citron K.M.; Ethambutol: a review with special reference to ocular toxicity. Tubercle: 1969, 50, (supple, March). 3. Corpe, R.F. & Blalock F.A.: Retreatment of drag resistant tuberculosis at Battey State Hospital; Diseases of chest; 1956, 48, 4. Duke Elder, S.: System of Ophthalmology, Vol VII (1965V Henry Kemptom, London. 5. Dipalma J.R.: Drill’s Pharmacology in Medicine, IV Ed. Mcgraw Hill Book Co. New York. 6. Goodmen L.S. & Oilman A.: The pharmacological basis of therapeutics, V. Ed. (1975), Ma Hill Publishing Co. Inc; New York. 7. Mathur S.S. & Mathur G.B., Ocular toxicity of Ethambutol 1981, 29, 19. 8. Okcu, Fachkliu H., Wilhelmstein Lunglu. Praxpneumol Toxic eye lesions caused by Ethambulol; 1975, 29, 266. 9. The ocular toxicity of Ethambutol & its relation to dose. N.Y. Acad. Sci; 1966, 135. 904. 10. Schimidt I.G., Central N.S.: Effects of Ethambutol in Monkeys. Ann. N.Y. Acad. Sci 1966; 135-159. 11. Toxic eye lesions caused by Ethambutol Ex. Medica Sec 15; 1976. 296. 266. Ind. J. Tub., Vol. XXIX, No. 4
- Page 1 and 2: The Indian Journal of Tuberculosis
- Page 3 and 4: REVIEW ARTICLE Skeletal tuberculosi
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- Page 7 and 8: TUBERCULOSIS OF SPINE 217 it has es
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- Page 11 and 12: TUBERCULOSIS OF SPINE 221 treatment
- Page 13: VISUAL PATTERN IN ETHAMBUTOL TREATE
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- Page 23 and 24: GENITO-URINARY TUBERCULOSIS IN PULM
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- Page 39 and 40: GASTRIC TUBERCULOSIS ERODING SPLENI
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B.B. LAL AND R.K. GUPTA<br />
Visual acuity<br />
on Snellen’s<br />
TABLE 5<br />
Effect <strong>of</strong> ethambutol on visual acuity<br />
Before treatment<br />
chart Both One<br />
eyes eye<br />
only<br />
6/6 552 96<br />
6/9 42 36<br />
6/12 38<br />
After treatment<br />
Both One<br />
eyes eye<br />
only<br />
81 206<br />
47 139<br />
5 152<br />
6/18 2 24 246<br />
6/24 — 102<br />
6/36 52 51<br />
6/60 _ _<br />
Below 6/60 — 46<br />
noted. In symptomatic group <strong>of</strong> patients, the<br />
symptoms disappeared within 2-5 months <strong>of</strong><br />
stopping the therapy.<br />
Discussion<br />
Various ocular toxicities including the<br />
change in vision following ethambutol therapy<br />
TABLF 6<br />
Relationship between time <strong>of</strong> appearance <strong>of</strong> symptoms<br />
& visual function distrbance<br />
Time after starting<br />
therapy<br />
No. or patient showing visual<br />
function disturbance<br />
Symptomatic<br />
group <strong>of</strong> patients<br />
Asymptomatic<br />
group <strong>of</strong> patients<br />
4 Months 2 —<br />
5 ” 1 —<br />
6 ” 2 —<br />
7 ” - 11<br />
8 ” 7 7<br />
9 ” — 9<br />
10 ” — 8<br />
11 ” 12 14<br />
12 ” — 8<br />
Total 24 57<br />
TABLE 7<br />
Effect <strong>of</strong> Ethambutol on field <strong>of</strong> vision<br />
Field <strong>of</strong> vision Before treatment After treatment<br />
Central<br />
Within normal limits in<br />
all 680 cases for white,<br />
Blue, Red & Green<br />
colours<br />
No Change<br />
Peripheral<br />
-do-<br />
White, Blue & Red<br />
colour fields no change<br />
Green Colour field<br />
No Change Constriction<br />
Binocular<br />
641 32 Cases<br />
Cases<br />
(1289 Eyes) (64 Eyes)<br />
Uniocular<br />
7 Cases<br />
(7 Eyes)<br />
Ind. J. Tub., Vol. XXIX, No. 4
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