ABSTRACT
@#AIM:To evaluate if early ethambutol toxicity can be detected by comparing pre-and post-treatment anatomical and visual function using retinal nerve fiber thickness,pattern visual evoked potentials and conventional optic nerve function tests.METHODS:This was a prospective study involving 72 eyes of 36 patients treated with ethambutol according to directly observed treatment short-course(DOTS) strategy in Hospital Universiti Sains Malaysia,Kelantan,Malaysia.The visual acuity and optic nerve function tests were performed by a single investigator.Likewise,Humphrey automated perimetry,optical coherence tomography (OCT) measurement of the retinal nerve fibre layer (RNFL) and pattern visual evoked potential (PVEP) were performed by a single technician.The examinations were performed before initiating ethambutol treatment and 3mo after that.RESULTS:There was no change in visual acuity,colour vision,light brightness,red saturation and fundus findings pre and post ethambutol.However,there was a statistically significant deterioration in the mean deviation of the visual field post treatment (P=0.010).There were also significant changes on OCT and PVEP,with increased RNFL thickness in all quadrants (P＜ 0.05) and PVEP delayed P100 peak latency and amplitude (P＜0.001).CONCLUSION:Ethambutol toxicity is a known complication of tuberculosis treatment.Early detection of this toxicity may prevent severe irreversible visual loss.The use of OCT to detect RNFL thickness and PVEP to assess P100 latency and amplitude can assist in the detection of subclinical anatomical and visual function changes prior to development of abnormalities on conventional optic nerve function tests.
ABSTRACT
Background: A thymectomy is considered effective for patients with myasthenia gravis (MG). Although a few studies have described the role of a thymectomy in the treatment of MG in Asians countries, there are no published data on the application of this surgical approach for MG in Malaysia. We aimed to describe the clinical outcomes of MG patients who underwent a thymectomy and the factors affecting these outcomes. Methods: This was a retrospective study involving 16 patients with MG who underwent a thymectomy at the Hospital Universiti Sains Malaysia (HUSM) from January 2002 until December 2012, with a follow-up period ranging from 3–120 months. Results: The study consisted of 16 patients aged 22–78 years, 10 of whom were males. The overall remission/improvement rate was 87.5%, and the rate of clinical outcomes classified as unchanged/ worsened was 12.5%. Thymomamatous or non-thymomamatous MG, histology features, Osserman stage and the duration of follow-up were not significant prognostic factors. Post-operative mortality was 6.2% (1 of 16 patients died of septic shock). Conclusion: A thymectomy seems to be an effective treatment for MG, with low surgical morbidity. Patients with a lower Osserman stage and those with/without thymomas had favourable outcomes.