眼科学报2025，Vol.40Issue(12)：1032-1044,13.DOI:10.12419/25052701
甲醇中毒性视神经病变:病例系列报告与文献回顾
Methanol-induced toxic optic neuropathy:a case series report and literature review
摘要
Abstract
Objective:To analyze the clinical characteristics,dynamic imaging changes,and treatment responses of methanol-induced toxic neuropathy.Additionally,it sought to explore the correlation between poisoning severity,intervention timing,and visual functional outcomes,so as to evidence-based insights for optimizing clinical diagnosis and treatment strategies.Methods:A case-series study combined with a literature review was conducted.Nine patients(18 eyes)diagnosed with methanol-induced toxic neuropathy at Zhongshan Ophthalmic Center,Sun Yat-sen University from 2017 to 2024,were retrospectively included.Clinical data,including pupillary changes,fundus photography,optical coherence tomography(OCT),visual field tests,and visual evoked potentials(VEP),were collected and integrated with findings from the literature.The inclusion criteria were a confirmed history of methanol exposure,acute vision loss accompanied by optic disc edema or retinal nerve fiber layer(RNFL)thickening,and elevated blood/urine methanol or formic acid levels.Patients with pre-existing poor vision or retinal diseases were excluded.Multimodal imaging was employed to evaluate the characteristics of optic nerve injury,and treatment responses and prognostic factors were analyzed.Results:The nine patients(18 eyes)ranged in age from 23-51 years(7 males,2 females),with the time from poisoning to consultation spanning from 3 days to 3 months.The best-corrected visual acuity(BCVA)ranged from no light perception(NLP,11 eyes)to 1.0.Pupillary abnormalities were observed in 66.7%(12/18 eyes)of the cases.Fundus examination showed optic disc edema,while VEP revealed reduced amplitude and visual field defects.OCT demonstrated RNFL thickening in the acute phase and progressive atrophy with an increased cup-to-disc ratio(C/D)in the chronic phase.After treatment,12 eyes showed visual improvement(followed at 2 months;4 eyes with post-poisoning BCVA of 1.0 were excluded from this analysis).Among patients with extended follow-up(4 months to 3 years),most reached a visual acuity plateau after acute-phase intervention,although a minority remained at risk of delayed neurodegenerative decline.Early intervention with systemic high-dose steroid therapy,hemodialysis,and neuroprotective treatment might improve visual function in some patients,whereas delayed treatment often led to irreversible vision loss.Patients with preserved pupillary light reflexes had more favorable prognoses.Conclusions:The prognosis of methanol-induced optic neuropathy is closely related to poisoning severity,intervention timing,and pupillary reflex status.Early high-dose steroid therapy combined with neuroprotective treatment may enhance outcomes in some patients;however,prolonged poisoning typically results in irreversible neurovisual damage.Personalized staged treatment and long-term visual function monitoring are essential for preserving residual vision.关键词
甲醇/中毒/视神经病变/多模态影像学Key words
methanol/poisoning/optic neuropathy/multimodal imaging分类
医药卫生引用本文复制引用
唐明君,刘翀,梁自强,唐昱为,郑永欣,钟刘学颖..甲醇中毒性视神经病变:病例系列报告与文献回顾[J].眼科学报,2025,40(12):1032-1044,13.基金项目
广州市基础研究计划(SL2024A03J00533) （SL2024A03J00533）
广东省自然科学基金(2022A1515010356).This work was supported by Guangzhou Basic Research Program(SL2024A03J00533) （2022A1515010356）
Natural Science Foundation of Guangdong Province(2022A1515010356). （2022A1515010356）
