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Purpose <p>This study aimed to investigate the temporal evolution and influencing factors of visual function and optic nerve structure in ethambutol-associated optic neuropathy (EON).</p> Methods <p>In this single-center retrospective observational study, we analyzed data from 48 EON patients (26 males and 22 females) with a 12-month follow-up. Comprehensive ophthalmologic assessments, including best corrected visual acuity (BCVA), visual field (VF), optical coherence tomography (OCT), and magnetic resonance imaging (MRI), were conducted to evaluate visual function and optic nerve structure. Statistical analyses including multiple linear regression and comparative analyses (independent <i>t</i>-tests/Mann–Whitney <i>U</i> tests) were performed to identify factors influencing recovery, with effect sizes calculated using Cohen’s <i>d</i>.</p> Results <p>Significant improvements in best corrected visual acuity and visual field were observed between 3 and 6&#xa0;months. The mean improvement in BCVA was 0.25 logMAR (from 1.28 ± 0.64 at 3&#xa0;months to 0.82 ± 0.60 at 6&#xa0;months, <i>p</i> &lt; 0.0001, Cohen’s <i>d</i> = 0.74, 95% CI [0.33, 1.15]), and the mean improvement in VF mean deviation was 2.5&#xa0;dB (from − 13.85 ± 9.23&#xa0;dB at 3&#xa0;months to − 10.33 ± 7.58&#xa0;dB at 6&#xa0;months, <i>p</i> = 0.037, Cohen’s <i>d</i> = 0.42, 95% CI [0.11, 6.93]), indicating a critical recovery window. Peripapillary retinal nerve fiber layer (pRNFL) thinning was most pronounced between 3 and 9&#xa0;months, with the temporal quadrant showing the earliest thinning (40.21% reduction by 3&#xa0;months). Macular ganglion cell-inner plexiform layer (mGCIPL) thickness showed a decreasing trend (73.20 ± 4.76&#xa0;μm to 55.33 ± 4.16&#xa0;μm) from 1&#xa0;month post-onset. Multivariate analysis revealed that disease course was the primary factor influencing VF recovery (<i>β</i> = − 0.31, <i>p</i> = 0.001), while peripapillary retinal nerve fiber layer thinning was associated with gender, ethambutol dosage, and disease duration. Female patients exhibited slower peripapillary retinal nerve fiber layer thinning compared to males.</p> Conclusions <p>This study identifies a critical recovery window for visual function in EON between 3 and 6&#xa0;months, with peripapillary retinal nerve fiber layer thinning progressing significantly between 3 and 9&#xa0;months. The temporal quadrant of the peripapillary retinal nerve fiber layer may serve as an early marker for disease progression. These findings provide valuable insights for optimizing monitoring and intervention strategies in EON patients, highlighting that early therapeutic interventions—particularly for patients showing temporal RNFL thinning or high-risk features—may maximize visual recovery potential.</p>

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Temporal evolution and factors influencing visual function and RNFL thickness in ethambutol-associated optic neuropathy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月23日

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  • Taimin Guo,
  • Yue Fu,
  • Xiaoyu Xu,
  • Xiaoning Liu,
  • Yurong Zhang,
  • Hui Yang

摘要

Purpose

This study aimed to investigate the temporal evolution and influencing factors of visual function and optic nerve structure in ethambutol-associated optic neuropathy (EON).

Methods

In this single-center retrospective observational study, we analyzed data from 48 EON patients (26 males and 22 females) with a 12-month follow-up. Comprehensive ophthalmologic assessments, including best corrected visual acuity (BCVA), visual field (VF), optical coherence tomography (OCT), and magnetic resonance imaging (MRI), were conducted to evaluate visual function and optic nerve structure. Statistical analyses including multiple linear regression and comparative analyses (independent t-tests/Mann–Whitney U tests) were performed to identify factors influencing recovery, with effect sizes calculated using Cohen’s d.

Results

Significant improvements in best corrected visual acuity and visual field were observed between 3 and 6 months. The mean improvement in BCVA was 0.25 logMAR (from 1.28 ± 0.64 at 3 months to 0.82 ± 0.60 at 6 months, p < 0.0001, Cohen’s d = 0.74, 95% CI [0.33, 1.15]), and the mean improvement in VF mean deviation was 2.5 dB (from − 13.85 ± 9.23 dB at 3 months to − 10.33 ± 7.58 dB at 6 months, p = 0.037, Cohen’s d = 0.42, 95% CI [0.11, 6.93]), indicating a critical recovery window. Peripapillary retinal nerve fiber layer (pRNFL) thinning was most pronounced between 3 and 9 months, with the temporal quadrant showing the earliest thinning (40.21% reduction by 3 months). Macular ganglion cell-inner plexiform layer (mGCIPL) thickness showed a decreasing trend (73.20 ± 4.76 μm to 55.33 ± 4.16 μm) from 1 month post-onset. Multivariate analysis revealed that disease course was the primary factor influencing VF recovery (β = − 0.31, p = 0.001), while peripapillary retinal nerve fiber layer thinning was associated with gender, ethambutol dosage, and disease duration. Female patients exhibited slower peripapillary retinal nerve fiber layer thinning compared to males.

Conclusions

This study identifies a critical recovery window for visual function in EON between 3 and 6 months, with peripapillary retinal nerve fiber layer thinning progressing significantly between 3 and 9 months. The temporal quadrant of the peripapillary retinal nerve fiber layer may serve as an early marker for disease progression. These findings provide valuable insights for optimizing monitoring and intervention strategies in EON patients, highlighting that early therapeutic interventions—particularly for patients showing temporal RNFL thinning or high-risk features—may maximize visual recovery potential.