Therapeutic Effects of High Dose Intravenous Prednisolone on Methanol Induced Toxic Optic Neuropathy

Background: The effects of high dose steroids for the treatment of methanol optic neuropathy was evaluated in this study. Methods: In an interventional case series, 9 patients with a history of sudden visual loss after an ingestion of homemade alcoholic beverages were included in the study. The patients received 250 mg intravenous methyl prednisolone every 6 hours for 4 days continued with oral prednisolone at 1 mg/Kg for 10 days. Best corrected visual acuity (BCVA), optical coherent tomography (OCT), fundus photo, and a complete ophthalmologic exam of the patients were taken before the treatment and 3 months after treatment. Six of them referred before 48 hours and 3 after 72 hours. Results: All patients were men. The mean age was 24.68 ± 4.2 years.  In those who referred before 48 hours, the mean BCVA before the treatment was 0.86 ± 0.08 in the right eye (RE) and 0.93 ± 0.1 in the left eye (LE) using the logMAR scale. Four patients showed nerve fiber layer edema as a white density in peripapillary area. After treatment, the mean BCVA in the RE was 0.33 ± 0.18 and 0.29 ± 0.2 in the LE using the logMAR scale. The differences between before and after treatment were significant (P = 0.008 and P = 0.003, respectively). The mean macular thickness and CDR were unchanged. In those who referred after 72 hours, BCVA was not changed significantly (0.96 ± 0.3 and 0.94 ± 0.2 vs. 0.97 ± 0.3 and 0.94 ± 0.2 in RE and LE respectively). Conclusion: Intravenous high dose methyl prednisolone may have benefits in the treatment of methanol optic neuropathy, if initiated before 48 hours.