PURPOSE: To study the dynamics and clinical determinants of chronic retinal nerve fiber layer thickness (RNFL) loss after methanol-induced optic neuropathy. DESIGN: Prospective cohort study. METHODS: All patients underwent complete ophthalmic evaluation including spectral-domain optical coherence tomography 3 times during 4 years of observation: 4.9 (±0.6), 25.0 (±0.6), and 49.9 (±0.5) months after discharge. PARTICIPANTS: Eighty-four eyes of 42 survivors of methanol poisoning, mean age (standard deviation) of 45.7 (±4.4) years; and 82 eyes of 41 controls, mean age 44.0 (±4.2) years. MAIN OUTCOME MEASURES: Global and temporal RNFL loss. RESULTS: Abnormal RNFL thickness was registered in 13 of 42 (31%) survivors of methanol poisoning and chronic axonal loss in 10 of 42 (24%) patients. Significant decrease of global/temporal RNFL thickness during the observation period was found in the study population compared to the controls (P < .001). The risk estimate of chronic global RNFL loss for arterial blood pH < 7.3 at admission was 11.65 (95% confidence interval 1.91-71.12) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated progressive visual loss in 7 of 10 cases. The patients with abnormal RNFL thickness had magnetic resonance signs of brain damage in 10 of 13 vs 8 of 29 cases with normal RNFL thickness (P = .003). Signs of brain hemorrhages were present in 7 of 13 patients with abnormal RNFL thickness vs 5 of 29 cases with normal RNFL thickness (P = .015). CONCLUSIONS: Methanol-induced optic neuropathy may lead to chronic retinal axonal loss during the following years. Arterial blood pH on admission is the strongest predictor of chronic RNFL thickness decrease. Chronic retinal neurodegeneration is associated with the progressive loss of visual functions and necrotic brain lesions.

Clinic of Ophthalmology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Biomimetic Electrochemistry J Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences Prague Czech Republic

Department of Methodology Faculty of Physical Education and Sport Charles University Prague Czech Republic

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Institute of Medical Biochemistry and Laboratory Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Toxicological Information Centre Department of Occupational Medicine 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

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$a Nurieva, Olga $u Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Progressive Chronic Retinal Axonal Loss Following Acute Methanol-induced Optic Neuropathy: Four-Year Prospective Cohort Study / $c O. Nurieva, P. Diblik, P. Kuthan, P. Sklenka, M. Meliska, J. Bydzovsky, J. Heissigerova, P. Urban, K. Kotikova, T. Navratil, M. Komarc, Z. Seidl, M. Vaneckova, D. Pelclova, S. Zakharov,

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$a PURPOSE: To study the dynamics and clinical determinants of chronic retinal nerve fiber layer thickness (RNFL) loss after methanol-induced optic neuropathy. DESIGN: Prospective cohort study. METHODS: All patients underwent complete ophthalmic evaluation including spectral-domain optical coherence tomography 3 times during 4 years of observation: 4.9 (±0.6), 25.0 (±0.6), and 49.9 (±0.5) months after discharge. PARTICIPANTS: Eighty-four eyes of 42 survivors of methanol poisoning, mean age (standard deviation) of 45.7 (±4.4) years; and 82 eyes of 41 controls, mean age 44.0 (±4.2) years. MAIN OUTCOME MEASURES: Global and temporal RNFL loss. RESULTS: Abnormal RNFL thickness was registered in 13 of 42 (31%) survivors of methanol poisoning and chronic axonal loss in 10 of 42 (24%) patients. Significant decrease of global/temporal RNFL thickness during the observation period was found in the study population compared to the controls (P < .001). The risk estimate of chronic global RNFL loss for arterial blood pH < 7.3 at admission was 11.65 (95% confidence interval 1.91-71.12) after adjusting for age and sex. The patients with chronic axonal degeneration demonstrated progressive visual loss in 7 of 10 cases. The patients with abnormal RNFL thickness had magnetic resonance signs of brain damage in 10 of 13 vs 8 of 29 cases with normal RNFL thickness (P = .003). Signs of brain hemorrhages were present in 7 of 13 patients with abnormal RNFL thickness vs 5 of 29 cases with normal RNFL thickness (P = .015). CONCLUSIONS: Methanol-induced optic neuropathy may lead to chronic retinal axonal loss during the following years. Arterial blood pH on admission is the strongest predictor of chronic RNFL thickness decrease. Chronic retinal neurodegeneration is associated with the progressive loss of visual functions and necrotic brain lesions.

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$a Diblik, Pavel $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Kuthan, Pavel $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Sklenka, Petr $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Meliska, Martin $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Bydzovsky, Jan $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Heissigerova, Jarmila $u Clinic of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Urban, Pavel $u Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Navratil, Tomas $u Department of Biomimetic Electrochemistry, J. Heyrovský Institute of Physical Chemistry of the Czech Academy of Sciences, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Komarc, Martin $u Department of Methodology, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic.

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$a Seidl, Zdenek $u Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Vaneckova, Manuela $u Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Pelclova, Daniela $u Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.

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$a Zakharov, Sergey $u Toxicological Information Centre, Department of Occupational Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. Electronic address: Sergey.Zakharov@vfn.cz.

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