Bilateral anterior toxic optic neuropathy and the use of infliximab
تعليق: ربما ذو صلة وربما ليست ذو صلة.--احمد شوقي محمدين 20:43، 20 أكتوبر 2016 (ت ع م)
Patient 3, a man aged 54, noticed a loss in the visual field of his right eye two weeks after he was given the last of three doses of intravenous infliximab for rheumatoid arthritis. He was also taking prednisone, diclofenac, and omeprazole. Fundoscopy showed disc swelling in both eyes and fundus fluorescein angiography showed capillary dilation and vascular leakage in the optic nerve heads. Perimetry of the right eye showed a large cecocentral scotoma; the left eye was normal. Within a few days the patient's vision in the right eye deteriorated to 20/400 and two months later the optic nerve head turned pale. At that time the vision in the left eye decreased to 20/100 and the visual field showed a central defect.
All patients were diagnosed as having anterior optic neuropathy. The defects in the central and cecocentral visual fields indicate that they had the toxic form of anterior optic neuropathy. (Altitudinal visual field defects, absent in our cases, indicate the ischaemic form.) All patients were treated with steroids to exclude temporal arteritis, but their condition did not improve.
Various drugs have been linked with optic neuropathy, but these drugs were not used by our patients, with the exception of omeprazole, which was taken by the third patient. It is questionable whether omeprazole causes optic neuropathy, however, and our patient has used omeprazole for a long time without ocular problems.4
