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Cet abstract a été assigné à session AOB Poster session 2 - Inflammatory pathology – Anterior segment – Ophthalmogenetics - Miscellaneous
TitreClinical practice guidelines for ethambutol optic neuropathy baseline screening in patients with pulmonary tuberculosis.
Abstract Nr.2028
ButTuberculosis (TB) remains an important public health issue. Ethambutol (EMB) is currently part of standardized treatment to reduce the risk of inducing multidrug resistance (MDR), but can induce toxic optic neuropathy. Screening with BCVA, colour vision, VF exam, PVEP and OCT NFL allows detection in subclinical stages. However, the organization of the baseline screening is a challenge in pulmonary TB. We wanted to develop a practical guideline, whilst minimizing risks to personnel and other patients.
MéthodesBoth general contagiousness of TB and time to develop neurotoxicity were taken into account when developing a safe and practical screening strategy, with maximal reduction of transmission to medical staff and other patients and minimal interference of clinic organization.
RésultatsTreatment of pulmonary TB preferably consists of an intensive phase of 2 mths of isoniazid (INH), rifampin (RIF), pyrazinamide, and EMB followed by a continuation phase of 4 mths of INH and RIF. In drug-susceptible organisms it usually takes 2-3 wks to obtain sputum conversion, after which the patient is no longer contagious (longer in case of MDR TB). Before this conversion, precaution measures to reduce transmission risk consist of protective masks or closure of exam rooms for 6 hrs. Ocular toxicity of EMB is dose- and duration-related and generally does not develop until after 6 wks (sooner with concurrent renal disease).
ConclusionScreening for EMB induced ocular toxicity starting with baseline exam to establish pre-existing ocular damage can safely be postponed to 2-3 wks after start of treatment to reduce contamination risk of other patients and health care workers. In patients with MDR TB or concurrent disease, other protocols should be applied.
Conflit d'intérêtNon
Auteur 1
NomLEYSEN
InitialesL
InstitutUZ
VilleGent
Auteur 2
NomVAN BRAECKEL
InitialesE
InstitutUZ
VilleGent
Auteur 3
NomLEROY
InitialesBP
InstitutUZ
VilleGent
Auteur 4
NomDE ZAEYTIJD
InitialesJ
InstitutUZ
VilleGent
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