The Effects of Pyridoxine on Retinal Nerve Fiber Layer in Tuberculous Treatment

Abstract

Aim: Ethambutol and isoniazid, two of the main drugs used in the treatment of tuberculosis, can lead to optic neuropathy. Optical coherence tomography (OCT) is a non-invasive, repeatable, high resolution imaging technique used in the diagnosis and follow-up of optic nerve diseases. The purpose of this study was to investigate the effect of pyridoxine added to antituberculous therapy on retinal nerve fiber layer (RNFL) thickness and the effectiveness of OCT in the early diagnosis and monitoring of optic neuropathy.

Material and Methods: Twenty four patients diagnosed with pulmonary or non-pulmonary tuberculosis were included in the study. Patients divided into two groups. One group received antituberculous therapy alone, and the other group received 50 mg pyridoxine in addition to antituberculous therapy. RNFL thickness in both eyes was measured using OCT before treatment and 2-month after treatment.

Results: The change in the second month of treatment according to baseline in terms of average RNFL thicknesses in the right eyes, showed a statistically significant difference between the groups using and not using pyridoxine (p=0,038). However, there was no significant difference in the left eyes in terms of RNFL thickness in any of the quadrants between the groups.

Conclusion: Despite a decrease in RNFL thickness in patients receiving antituberculous therapy alone, no change in RNFL thickness occurred in patients receiving pyridoxine in addition to antituberculous therapy. We think that early ototoxicity can be detected with RNFL thickness measurement using OCT in asymptomatic patients and that the addition of pyridoxine to antituberculous therapy prevents ototoxicity.

Keywords

• isoniazid,optical coherence tomography,retinal nerve fiber layer thickness

Piridoksinin Tüberküloz Tedavisinde Retina Sinir Lifi Tabakası Üzerindeki Etkileri

Abstract

Amaç: Tüberküloz tedavisinde kullanılan başlıca ilaçlardan ikisi olan etambutol ve izoniazid, optik nöropatiye yol açabilir. Optikal kohorens tomografi (OCT), optik sinir hastalıklarının tanı ve takibinde kullanılan noninvaziv, tekrarlanabilir, yüksek çözünürlüklü bir görüntüleme yöntemidir. Bu çalışmanın amacı, antitüberküloz tedavi ile birlikte verilen piridoksinin, retinal sinir lifi tabakası (RNFL) kalınlığı üzerindeki etkisini ve OCT’nin, optik nöropatinin erken tanı ve takibindeki etkinliğini araştırmaktır.

Gereç ve Yöntemler: Çalışmaya pulmoner veya pulmoner olmayan tüberküloz tanısı alan yirmi dört hasta dahil edildi. Hastalar iki gruba ayrıldı. Bir gruba sadece antitüberküloz tedavi uygulandı, diğer gruba ise antitüberküloz tedaviye ek olarak 50 mg piridoksin verildi. Her iki gözde de RNFL kalınlığı tedaviye başlamadan önce ve tedaviye başladıktan 2 ay sonra OCT cihazı kullanılarak ölçüldü.

Bulgular: Sağ gözlerde ortalama RNFL kalınlıkları bakımından başlangıca göre tedavinin 2. ayındaki değişim, piridoksin kullanan ve kullanmayan gruplar arasında istatistiksel olarak anlamlı bir farklılık göstermekteydi (p=0.038). Bununla birlikte, olguların sol gözlerinde ise gruplar arasında hiçbir kadranda RNFL kalınlıkları açısından anlamlı bir farklılık bulunmadı.

Sonuç: Sadece antitüberküloz tedavi alan hastalarda RNFL kalınlığında bir azalma olmasına rağmen, antitüberküloz tedaviye ek olarak piridoksin de alan hastalarda RNFL kalınlığında herhangi bir değişiklik olmadı. Asemptomatik hastalarda OCT cihazı kullanılarak yapılan RNFL kalınlık ölçümü ile erken ototoksisitenin saptanabileceğini ve antitüberküloz tedaviye piridoksin eklenmesinin ototoksisiteyi önlediğini düşünüyoruz.

Keywords

• izoniazid,optikal koherens tomografi,retina sinir lifi tabakası kalınlığı

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