Document Type : Original Article
Authors
1
Forensic Medicine and Clinical Toxicology Department, Al-Azhr University
2
Forensic Medicine and Clinical Toxicology Department, Ain Shams University
3
Ophthalmology Department, Ain Shams University
Abstract
Methanol poisoning and toxic optic neuropathy is still seen in many parts of the developing world. In Egypt, it is one of the recorded cases in poison control centers especially among members of lower socioeconomic class. Particular vulnerability of the optic nerve and the retina; to toxic effect of methanol is known. The principle of steroid use is based on the postulation that blurring of vision in methanol poisoning could be following acute optic neuritis due to retrolaminar demyelination. The benefit has been proposed to be due to anti-inflammatory and immunosuppressant effect of steroids. Some authors objected to the effectiveness of this therapy. Aim of this study was to clarify the role of pulse steroid therapy in management of the victims of acute methanol poisoning who complained from visual defecit. Also, estimation of some prognostic factors for survival and final visual outcome was targeted. Methods: Prospective study carried out in poison control center (P.C.C.)of Ain Shams University Hospitals, 25 cases of acute methanol poisoned patients studied for history, complete ocular and systemic examination details, time to presentation, amount of alcohol ingested, and results of laboratory investigations, such as, arterial pH, methanol levels, bicarbonate levels, and, therapy administered. Twelve patients of them, have been given pulse steroids. Visual acuity (VA), pupillary reaction, and fundus findings were assessed at presentation and 3 months after discharge. Statistical Analysis: Was done by chi square test, Fisher exact test& independent t-test using SPSS 20 version software for studying the significance. Receiver operating characteristic curve (ROC) was used to assess the best cut off point with its area under curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results & Conclusion: Blood pH at admission is an excellent predictor for final visual outcome in methanol induced optic neuritis, with best cut off point: ≤ 7.06 for poor outcome. Reactivity of pupils at admission was a significant prognostic factor, whereas reactive pupil means good visual outcome, and dilated non-reactive pupil predicts final deterioration and blindness .Two thirds of cases who received pulse steroid therapy had improved by the final follow up at 3 months, with a dramatic effect on fundus finding and visual acuity in some cases. Hemodialysis is a good treatment for methanol toxicity associated with decreased mortalities in a highly significant manner.
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