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Erythropoietin in Treatment of Methanol Optic Neuropathy

Pakdel, Farzad, MD; Sanjari, Mostafa, S., MD; Naderi, Asieh, PhD; Pirmarzdashti, Niloofar, MD; Haghighi, Anousheh, MD; Kashkouli, Mohsen, B., MD

Journal of Neuro-Ophthalmology: June 2018 - Volume 38 - Issue 2 - p 167–171
doi: 10.1097/WNO.0000000000000614
Original Contribution

Background: Methanol poisoning can cause an optic neuropathy that is usually severe and irreversible and often occurs after ingestion of illicit or homemade alcoholic beverages. In this study, we evaluated the potential neuroprotective effect of erythropoietin (EPO) on visual acuity (VA) in patients with methanol optic neuropathy.

Methods: In a prospective, noncomparative interventional case series, consecutive patients with methanol optic neuropathy after alcoholic beverage ingestion were included. All patients initially received systemic therapy including metabolic stabilization and detoxification. Treatment with intravenous recombinant human EPO consisted of 20,000 units/day for 3 successive days. Depending on clinical response, some patients received a second course of EPO. VA, funduscopy, and spectral domain optical coherence tomography were assessed during the study. Main outcome measure was VA.

Results: Thirty-two eyes of 16 patients with methanol optic neuropathy were included. Mean age was 34.2 years (±13.3 years). The mean time interval between methanol ingestion and treatment with intravenous EPO was 9.1 days (±5.56 days). Mean follow-up after treatment was 7.5 months (±5.88 months). Median VA in the better eye of each patient before treatment was light perception (range: 3.90–0.60 logMAR). Median last acuity after treatment in the best eye was 1.00 logMAR (range: 3.90–0.00 logMAR). VA significantly increased in the last follow-up examination (P < 0.0001). Age and time to EPO treatment after methanol ingestion were not significantly related to final VA. No ocular or systemic complications occurred in our patient cohort.

Conclusions: Intravenous EPO appears to improve VA in patients with methanol optic neuropathy and may represent a promising treatment for this disorder.

Department of Ophthalmology (FP, MSS, MBK), Eye Research Center, Tehran University of Medical Sciences, Rassoul Akram Hospital, Tehran, Iran; Department of Ophthalmology (FP), Eye Research Center, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran; Eye Research Center (AN, NP), Farabi Hospital, Tehran University of Medical Sciences; and Department of Internal Medicine (AH), Rassoul Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Address correspondence to Mostafa S. Sanjari, MD, Department of Ophthalmology, Eye Research Center, Tehran University of Medical Sciences, Rasool Akram Hospital, Sattarkhan Street, Niayesh Street, Tehran, Iran, postal code 1336616351; E-mail:

Presented at the 2013 Annual Meeting of the American Academy of Ophthalmology, New Orleans.

The authors report no conflicts of interest.

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© 2018 by North American Neuro-Ophthalmology Society