A Case of Optic Nerve Atrophy with Severe Disc Cupping after Methanol Poisoning

다국어 초록 (Multilingual Abstract)

We report a rare case of optic nerve atrophy with severe disc cupping resulting from methanol poisoning. A 30-year-old man presented to the hospital complaining of decreased visual acuity in both eyes a day after drinking alcohol containing methanol. His initial visual acuity allowed for only visualizing hand motion and not corrected in either eye. Initial intraocular pressure was within normal limits in both eyes. Initial fundus examination showed optic disc swelling in both eyes. Four years later, he visited our hospital for an eye evaluation. Visual acuity in both eyes still only allowed for visualizing hand motion. No nystagmus was observed in either eye during the optokinetic nystagmus test, and no waves were found in a visual evoked potential test. No specific change was noted on brain magnetic resonance imaging. On fundus examination, there was disc pallor in both eyes and disc cupping with a high cup/disc (C/D) ratio above 0.9 in the left eye. C/D ratio of the right eye was 0.5. Methanol poisoning may induce glaucomatous disc cupping in the late stage as well as optic atrophy. One possible mechanism of disc cupping is ganglion cell loss due to acute demyelination of the retrobulbar optic nerve. This report is the first photographic evidence of methanol induced optic disc cupping in Korea.

참고문헌 (Reference)

1 방재순, "메탄올에 의한 중독성 약시의 치험 1예" 대한안과학회 48 (48): 1731-1735, 2007

2 Fink WH, "The ocular pathology of methyl alcohol poisoning" 40 : 439-498, 1942

3 Benton CD Jr, "The ocular effects of methyl alcohol poisoning:report of a catastrophe involving 320 persons" 36 : 1677-1685, 1953

4 Roe O, "The ganglion cells of the retina in cases of methanol poisoning in human beings and experimental animals" 26 : 169-182, 1948

5 Medeiros FA, "Retinal nerve fiber layer loss after traumatic optic neuropathy detected by scanning laser polarimetry" 119 : 920-921, 2001

6 Rang HP, "Pharmacology. 4th ed" Churchill Livingstone 628-629, 1999

7 Stelmach MZ, "Partly reversible visual failure with methanol toxicity" 20 : 57-64, 1992

8 Lindenberg R, "Neuropathology of vision: an atlas" Lea and Febiger 118-, 1973

9 Baumbach GL, "Methyl alcohol poisoning.IV.Alterations of the morphological findings of the retina and optic nerve" 95 : 1859-1865, 1977

10 Hayreh MS, "Methyl alcohol poisoning III.Ocular toxicity" 95 : 1851-1858, 1977

11 Sharma M, "Methanol-induced optic nerve cupping" 117 : 286-, 1999

12 Becker CE, "Methanol poisoning" 1 : 51-58, 1983

13 Sharpe JA, "Methanol optic neuropathy:a histopathological study" 32 : 1093-1100, 1982

14 Liesivuori J, "Methanol and formic acid toxicity:biochemical mechanisms" 69 : 157-163, 1991

15 Jacobsen D, "Methanol and ethylene glycol poisonings.Mechanism of toxicity,clinical course,diagnosis and treatment" 1 : 309-334, 1986

16 Kong SM, "2 Cases of toxic amblyopia caused by acute methanol poisoning" 23 : 259-263, 1982