Visual Disturbances In Patients Research Articles

Visual disorders in children with shunted hydrocephalus.

The introduction of shunt operations in neurosurgical practice gave a chance for life to these patients and significantly improved its quality. Along with its positive effect, surgical treatment is associated with a number of complications that, together with hydrocephalus itself, affect the subsequent development of shunted patients in the short and long term. In the long term, problems observed in shunted patients are mental retardation, cerebral palsy (CP), epilepsy, hearing and vision disorders. Visual disturbances are common in children with shunted hydrocephalus. These include reduced visual acuity, eye movement disorders, refractive anomalies, visual field defects, reduced color vision and strabismus, optic atrophy. The mechanism of visual disturbances is associated with damage to the oculomotor pathways, optic nerves and optic radiation, dilatation of the lateral ventricles, and damage to the periventricular white matter. Age at onset of hydrocephalus and ventricular dimension are important in the development of visual disturbances and placement of a shunting system can improve visual function. At the same time ophthalmic disturbances may be the first and only sign of shunt dysfunction and rapid normalization of elevated ICP preserves vision. Visual disturbances in patients with shunted hydrocephalus correlate with higher incidence of CP and epilepsy. They determine the children’s social integration and quality of life.

Visual disturbances in patients with Parkinson's Disease treated with oral medications or deep brain stimulation.

Ophthalmological symptoms are common in patients with Parkinson's Disease (PD) and can be evaluated by the Visual Impairment in Parkinson's Disease Questionnaire (VIPD-Q). This study aimed to assess the prevalence of ophthalmological symptoms in PD depending on the type of treatment used i.e. pharmacological or subthalamic nucleus deep brain stimulation (STN-DBS). We performed a cross-sectional study. The data was gathered from a VIPD-Q and from medical records. Patients with PD were divided into two groups based on the type of treatment - pharmacological (control group, CG) (39 patients) or STN-DBS (40 patients). The great majority of patients - 72 (91.1%) - experienced an ophthalmological symptom. The prevalence of three symptoms differed significantly between the groups. A burning sensation or a gritty feeling in the eyes occurred more often in patients in the STN-DBS group (40.0% vs. 15.4%; p = 0.015). On the other hand, the inability to read plain text on a coloured or grey background and problems with rapid changes of light intensity were more common in the CG group (38.5% vs. 15.0%, p = 0.018 and 28.2% vs. 10.0%, p = 0.039, respectively). The prevalence of ophthalmological symptoms in PD is high. Despite significant differences in the three symptoms, the overall prevalence of ophthalmological clinical features was similar in the evaluated groups.

Non-aura visual disturbance with high visual aura rating scale scores has stronger association with migraine chronification than typical aura.

To investigate the clinical correlates of visual symptoms in patients with migraine. Patients with migraine that attended our headache clinics were enrolled. Headache profiles, disability, and comorbidities were acquired with structured questionnaires. A semi-structured visual phenomenon questionnaire was also used to assess the characteristics of visual symptoms, including visual aura in patients with migraine with aura and transient visual disturbance in patients with migraine without aura. Headache specialists interviewed with the participants for the ascertainment of diagnosis and verification of the questionnaires. Migraine with aura patients with visual aura (n = 743, female/male = 2.3, mean age: 34.7 ± 12.2 years) and migraine without aura patients with non-aura transient visual disturbance (n = 1,808, female/male = 4.4, mean age: 39.4 ± 12.6 years) were enrolled. Patients with transient visual disturbance had higher headache-related disability and more psychiatric comorbidities. Chronic migraine was more common in migraine without aura than migraine with aura patients (41.9% vs. 11.8%, OR = 5.48 [95% CI: 4.33-7.02], p < 0.001). The associations remained after adjusting confounding factors. Presence of non-aura transient visual disturbance may suggest a higher migraine-related disability and is linked to higher risk of chronic migraine than typical migraine aura in migraine patients. Further studies are needed to elucidate the potential mechanism.

Visual disturbances in patients with pituitary tumors and early improvement of visual acuity and visual field defects after resection of pituitary tumors.

Objective: The aim behind this study was to determine the frequency of visual field and visual acuity disturbances before resection and improvement after resection of pituitary tumors in patients. Study Design: Observational study. Setting: Neurosurgery Department of Jinnah Post Graduate Medical Center, Karachi. Period: August 2015 to August 2016. Material &amp; Methods: A total of 30 patients presented with headache and visual deterioration and diagnosed as pituitary adenoma at neurosurgery OPD, ward and ER were included through a consecutive purposive sampling technique. The detailed visual and ocular analysis (visual acuity, visual field, and extra ocular movements) carried out at time of admission and postoperatively. Tumor was removed by consultant neurosurgeon through trans-sphenoidal approach. SPSS version 17.0 was used to analyze the collected data. Results: A total of 30 cases of pituitary adenoma were included. The average age of the patients was 34.5 ± 10.8 years and among them 17 (56.7%) were males and 13 (43.3%) were females. Pre-operative assessment of the mean deviation of visual function was -8.21 ± 6.10 dB which is significantly improved to -4.6 ± 3.9 dB post-operatively (P &lt; 0.0001). While pre-operative Visual Acuity (logMAR) was 0.3 ± 0.26 and post-operative 0.21 ± 0.2 (P &lt;0.0001). Conclusion: Scientific observation from our study has shown that more than 90% of the patients suffering from pituitary adenomas experience visual impairment which can be improved to significant extent if treated with trans-sphenoidal surgical resection of the tumor.

Visual Disturbances in Patients With Acute Methanol Poisoning: A Cross-sectional Study

Background: Methanol poisoning is a serious problem in public health, especially in developing countries. The present study aimed to evaluate the incidence of visual disturbances in patients with acute methanol poisoning in the south of Iran. Methods: This cross-sectional study (from 21/March/2014 to 21/March/2019) was conducted on all adult patients’ medical records who were referred to Ali-Asghar Hospital in Shiraz City, Iran, with acute methanol poisoning. The required data were collected using a data-gathering form and were then analyzed. Results: Twenty male patients were enrolled in this research, with Mean±SD age of 33.15±10.40 years. Visual disturbances were observed in 15(75%) of the study subjects, as the most common clinical manifestations. Blurred vision (40%) and blindness (35%) were the most frequent visual disturbances in the study participants. None of the study subjects reported photophobia. The explored variables did not differ between patients with visual disturbances and those without visual disturbances. Only one patient who encountered blindness was expired. Conclusion: The incidence of visual disturbances in the study patients with acute methanol poisoning was higher than that of similar studies

Saccadic suppression in schizophrenia

About 40% of schizophrenia patients report discrete visual disturbances which could occur if saccadic suppression, the decrease of visual sensitivity around saccade onset, is impaired. Two mechanisms contribute to saccadic suppression: efference copy processing and backwards masking. Both are reportedly altered in schizophrenia. However, saccadic suppression has not been investigated in schizophrenia. 17 schizophrenia patients and 18 healthy controls performed a saccadic suppression task using a Gabor stimulus with individually adjusted contrast, which was presented within an interval 300 ms around saccade onset. Visual disturbance scores were higher in patients than controls, but saccadic suppression strength and time course were similar in both groups with lower saccadic suppression rates being similarly related to smaller saccade amplitudes. Saccade amplitudes in the saccadic suppression task were reduced in patients, in contrast to unaltered amplitudes during a saccade control task. Notably, smaller saccade amplitudes were related to higher visual disturbances scores in patients. Saccadic suppression performance was unrelated to symptom expression and antipsychotic medication. Unaltered saccadic suppression in patients suggests sufficiently intact efference copy processing and backward masking as required for this task. Instead, visual disturbances in patients may be related to restricted saccadic amplitudes arising from cognitive load while completing a task.

Should “Retro-ocular Pain, Photophobia and Visual Acuity Loss” Be Recognised as a Distinct Entity? The ROPPVAL Syndrome

ABSTRACT Unilateral retro-ocular pain, photophobia and visual disturbance in patients suspected as having acute optic neuritis was described as a distinct clinical entity by Jefferis et al. in 2018. We hereby report a further four patients with the same clinical phenotype and propose the term ROPPVAL syndrome (Retro-Ocular Pain, Photophobia and Visual Acuity Loss). All of them had a previous (mis)diagnosis of optic neuritis. All of the patients had normal ocular and neurological examinations, no relative afferent pupillary defect and no objective structural abnormality was identified. We also discuss possible mechanisms, the role of cycloplegics that we found to be useful in reducing symptoms, and the importance of distinguishing this syndrome from optic neuritis

Visual disturbances in patients with brain metastases and primary brain tumors; palliative care perspective

Summary Background and objectives Visual disturbances in primary brain tumors or metastatic disease in brain are seldom complained by patients due to diagnosis of malignancy and so rarely evaluated, especially if they are subtle with respect to pain and other symptoms due to cancer. Objective of this study is to determine magnitude of visual problem in such patients and to plan strategy to provide adequate care. Methods Seventy-eight patients evaluated cross-sectionally with demographic data and disease related information from case sheets and data analyzed to represent the magnitude of problem. Results Metastases from lung (35.9%), and breast (26.9%) were most common followed by GBM (Glioblastoma Multiforme) in 12.9% cases. Poor or defective vision was the most common presenting symptoms (71.8%), followed by diplopia (11.5%). The mean duration between the onset of visual disturbances and the diagnosis of intracranial tumor was 8 months (range 20 days to 3 years). Optic atrophy or edema of optic disc was found in 37 patients (47.5%). Sixth nerve palsy was detected in five patients (6.4%) and defective color vision was seen in three patients (3.8%). Conclusion Visual disturbances are common in brain metastases as well as in primary brain tumors and in time evaluation may provide better ophthalmic quality of life in cancer patients.

Measures of visual disturbance in patients receiving extended depth-of-focus or trifocal intraocular lenses.

The degree of visual disturbance associated with a particular model of intraocular lens (IOL) depends on several factors, including IOL optic, material, and mechanics. Characterization of visual disturbance profiles is paramount for informing clinical IOL selection. Although many studies evaluating presbyopia-correcting IOLs include subjective assessment of visual symptoms, the types of patient-reported outcome measures (PROMs) used to capture these outcomes are inconsistent across studies, complicating data contextualization. Furthermore, some tools produce more meaningful results than others. This review presents a discussion on the scientific literature published on the subjective and semiobjective (halo and glare simulator, light-distortion analyzer, vision monitor, and halometers) methods used to assess visual disturbances in patients implanted with trifocal or extended depth-of-focus IOLs, highlighting their advantages and limitations. It underscores the importance of between-study comparisons and the need for standardized PROMs in clinical IOL research to provide more accurate information for IOL selection.

The Chiasmal Compression Index: An Integrative Assessment Tool for Visual Disturbances in Patients with Pituitary Macroadenomas

Visual status is routinely evaluated by neuro-ophthalmologic examination and computerized visual field (VF) tests in patients with chiasmal compression secondary to pituitary macroadenoma. Currently, no relevant data exists to accurately quantify the extent of optic apparatus compromise to further guide clinical decision-making. We aimed to assess for a possible quantitative correlation between optic chiasm geometric properties on magnetic resonance imaging (MRI) and VF deficits. Visual assessments and concurrent MRI scans were retrospectively reviewed from patients treated for pituitary macroadenoma in a single medical institution. Chiasm width, chiasm minimal and maximal height, and chiasm angle were measured on MRI coronal plane images by 3 independent reviewers (for the sake of variability analysis). VF numerical summary parameters were also retrieved. A total of 30 patients were included in the final analysis. Average VF index was 70% (±30), and averaged mean deviation was 10.0 db (±9). Chiasm angle and width (which together represents the bending and stretching of the chiasm by the upward directed compression; both of which demonstrated high inter- and intraobserver agreement) showed strong correlation with VF loss. Chiasmal compression index derived from those parameters showed even stronger correlation. The strong correlation demonstrated by our results of this relatively simple radiologic measurement with VF status, despite the relatively small cohort, calls for further investigation in this promising direction, and may facilitate with basic assessment and clinical decision-making for patients with equivocal neuro-ophthalmologic evaluation, as well as with poor compliance.

Изучение влияния состояния эпителия роговицы на формирование транзиторных зрительных расстройств у пациентов после факоэмульсификации возрастной катаракты

Изучение влияния состояния эпителия роговицы на формирование транзиторных зрительных расстройств у пациентов после факоэмульсификации возрастной катаракты

Neuro-retinal changes and its correlations with visual disturbances in patients with bipolar disorder

Si les réanimations ont largement ouverts leur porte aux proches, la présence des enfants et adolescents visiteurs en réanimation reste une question sensible et dans une volonté de protéger l’enfant face à un environnement potentiellement traumatique, certains services refusent ou restreignent la visite aux enfants.Dans ce contexte, la question de savoir si la visite en réanimation constitue un risque psychologique pour l’enfant se pose. À partir d’une revue de la littérature, cet article discute du vécu de la visite chez l’enfant et l’adolescent, les méthodologies de recherche mises en place auprès des enfants visiteurs, et enfin des dispositifs d’accompagnement existants.Les études menées à ce sujet ne relèvent pas de troubles psychologiques liés à la visite en réanimation, mais il s’avère que les travaux sont encore peu nombreux dans ce domaine et les méthodologies restent à développer. Des dispositifs d’accompagnement existent mais sont à l’initiative des équipes de réanimation.Il est aujourd’hui urgent de développer des études afin d’aboutir à une véritable politique d’accueil et d’accompagnement de l’enfant en visite en réanimation afin que proches accompagnants et professionnels puissent s’y appuyer.While ICUs encourage visits from patients’ loved ones, visits from children and adolescents have remained a rather sensitive issue. In an attempt to protect children from a potentially traumatic environment, certain services refuse or restrict their visits.In this context, the question arises as to whether the visit in intensive care constitutes a psychological risk for the child and adolescents. Based on the literature, this article discusses the experience of the visit on the child, the research methodology implemented with child visitors, and finally the existing support systems.The analyzed studies do not consider the psychological disorders associated with ICU visits. Moreover, there are many studies on this field and the methodologies have yet to be developed. Support measures exist but are at the initiative of the intensive care teams.There is now an urgent need to build on the studies focused on this field in order to propose a genuine policy with regard to the reception and support of children visiting ICU patients.

Visual Disturbance in Patients with Cryptococcal Meningitis: The Road Ahead.

Visual Disturbance in Patients with Cryptococcal Meningitis: The Road Ahead.

Neurological manifestations of giant cell arteritis

The article describes clinical, including neurological manifestations, of giant cell arteritis (GCA) - granulomatous vasculitis of large and medium-sized vessels, predominantly craniofacial, including precerebral and cerebral, arteries. Histopathological features of GCA are illustrated by the schemes of panarteritis and «postarteritis» (proliferative and fibrotic changes in the intima, underlying the development of cerebrovascular disorders). The main clinical manifestations of GCA are described as 3 groups of symptoms: general constitutional symptoms; manifestations of vasculitis of craniofacial, precerebral and cerebral arteries; polymyalgia rheumaticа. The authors present their own version of the taxonomy of visual disturbances in patients with GCA. Diagnostic steps in patients with suggestive signs of GCA are described. Therapeutic regimens of use of glucocorticoids for suggestion/diagnosis of GCA are presented.

Voriconazole, an antifungal triazol that causes visual side effects, is an inhibitor of TRPM1 and TRPM3 channels.

Administration of voriconazole, an antifungal triazole, causes transient visual disturbances in patients and attenuates the b-wave of the ERG. We sought to identify the retinal target of voriconazole underlying the effect on the ERG b-wave. Electroretinograms were recorded from mice before and after intraperitoneal injection of voriconazole. The effect of voriconazole on ON-bipolar cells was tested by patch-clamp recordings of ON-bipolar cells in mouse retinal slices. Effects of voriconazole on mGluR6 and TRPM3 were assessed by patch-clamp recordings of Chinese hamster ovary (CHO) and HEK293 cells transfected with either TRPM3 or mGluR6 plus Kir3.1/Kir3.4. Voriconazole attenuated the ERG b-wave in mice, and inhibited ON-bipolar cell responses evoked by application of CPPG, an mGluR6 antagonist, onto the ON-bipolar cell dendrites, indicating that voriconazole blocks a step in the mGluR6-TRPM1 signal transduction pathway. Voriconazole almost completely blocked capsaicin-activated currents in ON-bipolar cells, which have been attributed to direct activation of the TRPM1 cation channel. Furthermore, application of voriconazole to CHO cells expressing TRPM3, a closely related channel to TRPM1, showed that voriconazole reversibly blocked pregnenolone sulfate-stimulated TRPM3 currents in transfected cells. In contrast, voriconazole only slightly inhibited mGluR6-mediated activation of G-protein activated inward rectifier potassium (GIRK) currents in cotransfected cells, suggesting that mGluR6 is not the primary target of voriconazole in ON-bipolar cells. The visual disturbances associated with voriconazole are likely due to block of TRPM1 channels in retinal ON-bipolar cells. Other neurological effects of voriconazole may be due to block of TRPM3 channels expressed in the brain.

Dynamics of Visual Functions in Patient with Pituitary Tumors before and after Surgery

Object: To analyze frequency and dynamics of visual disturbances in patients with pituitary tumors before and postoperative.

Cortical visual loss in posterior reversible encephalopathy syndrome in late postpartum eclampsia: case series.

The purpose of this study was to determine the prevalence of visual disturbances in patients with posterior reversible encephalopathy syndrome (PRES) associated with late postpartum eclampsia. We retrospectively reviewed the clinical records of late postpartum eclampsia patients with features of PRES for the presence of visual disturbances and location of radiological abnormalities. We found a higher prevalence of cortical visual loss in patients with PRES associated with late postpartum eclampsia. Bilateral symmetrical vasogenic edema of the parieto-occipital lobe was the most common magnetic resonance imaging (MRI) abnormality noted. No significant differences were observed in the extent of edema in patients with and without visual loss.

This issue of ACTA, printed and electronic

The illustration on the cover shows virtual reality cataract surgery, which is discussed by Selvander and Åsman in this issue of ACTA. Prokofyeva et al. in Germany and Belgium review the potential prevention of cataracts in Europe. Risk factors for cataract include smoking, diabetes, asthma and cardiovascular disease. Heijl et al. in Sweden, Germany and the UK find visual field progression in patients with glaucoma to be variable and frequently rapid enough to influence quality of life. Andersson et al. in Sweden tested an artificial neural network and found this to equal physicians in the assessment of visual fields in glaucoma. Kok et al. in the Netherlands show that cataracts influence the estimation of retinal nerve fibre layer thickness with OCT. Martinez-de-la-Casa et al. in Spain recommend tissue glue to close conjunctiva after trabeculectomy. Rii et al. in Japan discuss childhood-onset optic disc pit maculopathy following blunt ocular trauma. Hamoudi et al. in Denmark report a small change in refraction following pars plana vitrectomy. Burstedt et al. in Sweden describe genotype–phenotype in Bothnia-type retinitis pigmentosa. Gustavsson et al. in Sweden found signs of intraocular inflammation in proliferative diabetic retinopathy, but less so in patients with no or nonproliferative retinopathy. Immonen et al. in Finland conclude that telomere length is not associated with exudative AMD or high-risk drusen. Matsuba et al. in Japan used 3D-CT to localize intraocular foreign body. Molvær et al. in Denmark use computer models to localize stem cells in the corneal limbal region. Koranyi et al. in Sweden recommend cut and paste method for surgery of pterygium. Selvander and Åsman in Sweden recommend a virtual reality training system for cataract surgery. Cornut et al. in France found that initial visual acuity predicts outcome in post-traumatic endophthalmitis. Nangia et al. in India and Germany found undercorrected refractive errors to be a major cause of visual impairment in India. Sveinn Hakon Hardarsson in Iceland presents his PhD thesis on retinal oximetry, which is published as an electronic supplement to the journal. The following publications are published in the electronic portion of ACTA and are available on www.actaophtalmologica.com, as are all publications in ACTA Ophthalmologica. Scanlon et al. in the UK demonstrate that the risk of progression of diabetic retinopathy is significantly higher for patients with diabetic retinopathy in both eyes compared with those who have retinopathy in one or neither eye. Bezatis et al. in Germany found that Ozurdex improves vision and reduces macular oedema in retinal vein occlusion. Pemp et al. in Romania and Austria found increased vessel diameters in the retina of patients with type 1 diabetes and no or mild retinopathy. Nishi et al. in Japan suggest that contrast and functional visual acuity may detect early visual disturbance in patients with epiretinal membranes. Yang et al. in China and Germany report choroidal vascular engorgement in patients with central serous chorioretinopathy. Linke et al. in Germany report similar results in both eyes in 12500 patients undergoing refractive surgery. Ling et al. in China found that doxycycline reduced angiogenesis and inflammation in alkali-burned mouse corneas. Mansouri et al. in USA found only modest intragrader reproducibility in evaluating parapapillary atrophy. Häntzschel et al. in Germany examined the correlation between structural damage to optic nerve and visual field and found this to be less prominent in normal tension than high tension glaucoma. Mastropasqua et al. in Italy found increased density of conjunctival goblet cells in patients treated with preservative-free tafluprost. Kim et al. from Korea found the I-care tonometer to be reliable and give slightly higher IOP readings than Goldman tonometry. Dimitrova et al. in Macedonia and Japan comment on the paper by Stalmans et al. on blood flow and body posture. Rencová et al. in Czech Republic report that rheohemapheresis reduces drusenoid retinal pigment epithelium detachment. Comez et al. in Turkey recommend evisceration with cornea preservation. Yoshikawa et al. in Japan suggest that blocking vascular adhesion protein suppresses neovascularization. Mattila et al. in Finland used corneal cross-linking to treat pseudomonas keratitis. de Geus et al. in the Netherlands found little help in changing from bevacizumab to ranibizumab in unresponsive patients. Bailie et al. in the UK report significant visual and psychological morbidity in patients with optic atrophy. I wish you all a warm and happy summer.

1268P - Visual Disturbances in Patients (PTS) with Anaplastic Lymphoma Kinase (ALK)-Positive Advanced Non-Small Cell Lung Cancer (NSCLC) Treated with Crizotinib

ABSTRACT Background Crizotinib is a potent, small-molecule ALK inhibitor with a high response rate in advanced ALK-positive NSCLC. In early phase studies, patients (pts) commonly reported mild visual disturbances. Here we characterize such visual effects with objective and subjective measures in an ongoing phase II study (PROFILE 1005). Methods Previously treated pts with advanced ALK-positive NSCLC received crizotinib 250 mg BID. Ophthalmological examinations, comprising best corrected visual acuity (BCVA), biomicroscopy, and fundoscopy, were performed at screening and after a visual effect event was reported, except for a subset of pts in France, where examinations were done every 4 cycles. In addition, on day 1 of each cycle, pts completed the Visual Symptom Assessment Questionnaire (VSAQ) that assessed the presence, frequency, timing, duration, and severity of visual effects and their impact on activities of daily living (ADL). Results As of Jan 2012, 901 pts had enrolled in PROFILE 1005; 21 - 27% were evaluable for ophthalmological examinations (visual acuity: 193/901; biomicroscopy: 239/901; fundoscopy: 239/901). There were no changes in BCVA, conjunctiva, cornea, anterior chamber, iris, lens, or fundus attributable to crizotinib. The most frequently reported ophthalmological finding was worsening of cataracts (right eye: 9%; left eye: 10%), which was not attributed to crizotinib. Visual effects as identified by the VSAQ were reported by 65% of pts (405/622) at cycle 2 (C2), 58% at C3 (323/558), 55% at C4 (287/519), and 50% at C5 (247/495). The most common were appearance of flashing lights, streamers/strings/floaters, and overlapping shadows. Most pts reported each event as lasting ≤1 min (C2: 63%; C3: 68%; C4: 72%; C5: 75%), occurring mostly in the morning (46–59%) and/or evening (70–74%). The majority of pts reported that visual effects were not at all or a little bothersome, with no or minimal impact on ADL. Similar results were observed in the French pt subset. Conclusions There were no objective ophthalmological changes associated with the visual effects on crizotinib. Pt-reported visual effects were frequent, but transient, with no or minimal impact on ADL. Disclosure B. Besse: Research funding: Pfizer. B. Solomon: Compensated advisory relationship: Pfizer. Research funding: Pfizer. A. Shaw: Compensated advisory relationship: Pfizer, Ariad, Chugai, Novartis, and Daiichi-Sankyo. Research funding: AstraZeneca and Novartis. D. Kim: Compensated advisory relationship: Pfizer. Honoraria: Pfizer. R. Schachar: Compensated employment: Pfizer. Stock ownership: Pfizer. K. Wilner: Compensated employment: Pfizer. Stock ownership: Pfizer. A. Reisman: Compensated employment: Pfizer. Stock ownership: Pfizer. C.H. Bartlett: Compensated employment: Pfizer. Stock ownership: Pfizer. S. Iyer: Compensated employment: Pfizer. All other authors have declared no conflicts of interest.

Outcomes of visual disturbances after methanol poisoning

Introduction. Methanol poisoning and toxic optic neuropathy is still seen worldwide. Little attention has been paid to the persistent visual disturbances following methanol poisoning. We aimed to evaluate the outcomes of visual disturbances in methanol-poisoned patients referred to us with visual disturbances. Methods. This retrospective observational case series evaluated the outcomes of visual disturbances in patients with methanol poisoning hospitalized in Loghman Hakim and Hazrat Rasoul Akram hospitals between March 2003 and October 2009. Medical charts were evaluated for age, gender, time between consumption and hospital presentation, gastrointestinal symptoms, abnormal neurological findings at presentation and during hospital admission, arterial blood gas results, treatment modalities, history of chronic diseases, and status of vision at presentation and discharge from the hospital. The patients or their relatives were contacted 1 year after the admission date of the last patient and questioned about the status of the patients' vision at the time of hospital discharge, after discharge, and at the time of phone contacts. Results. A total of 50 patients with methanol poisoning and visual disturbances at presentation survived. Thirty-seven cases were followed; 16 showed visual disturbance improvement before hospital discharge, and 21 had visual disturbance after discharge. Visual disturbances were classified into two groups: severe to total blindness and blurred/snowfield vision. Patients were also grouped into one of four categories: group I: patients whose blurred or snowfield vision completely recovered within up to a maximum of 2 weeks after discharge (n = 7); group II, the patients who were blind at the time of discharge (n = 5) and partially recovered within a maximum of 3–4 weeks; group III, the patients who were blind at the time of discharge and gained no improvement in their vision (n = 5); group IV, who were blind at the time of discharge, partially recovered within few days to approximately 1 month and experienced reduced vision and blindness after about a maximum of 9 months (n = 4). Patients whose visual disturbances improved with treatment and the patients in group I were considered as transient (n = 23) and groups II, III, and IV as permanent visual disturbance cases (n = 14). Significant difference was not seen in age, sex, elapsed time to presentation, gastrointestinal symptoms, abnormal neurological and CT findings, and arterial blood gas results at presentation between the transient and permanent visual disturbance groups. No association existed between the visual disturbance and abnormal neurological and CT findings.Conclusion. Blurred or snowfield vision in methanol poisoning resolved. However, outcomes of the blindness cannot be predicted. Insome patients, blindness improves but these patients eventually experience reduced vision afterwards.