This young gentleman (29yo) had methanol intoxication 3 days ago along with his 4 friends. His 4 friends died, and he survived. But had his vision lost completely (NLP, both eyes).
One will say “where there are no RCTs, I will not experiment on the patients”. However, what are my options? I googled. And there are some promising case reports and case series on the effect of erythropoietin IV injections together with IV pulse steroids and supplements of various Vitamins B. There is hope, even in bilateral no light perception, according to few papers, some of such patients recover up to 6/6!
Each of these medications was prescribed. And depending on what the patient will afford, I will see the results in two weeks to one month.
On the pictures: bilateral optic and peripapillary swelling + white infarcts areas; left optic pallor and cherry-red spot.
Plan (for those, who will google this page, the sources of doses are indicated below):
THIS BY IS NOT RECOMMENDED BY ANY MEANS FOR SELF-TREATMENT!
– 10,000 IU of intravenous erythropoietin twice a day for 3 days
– 500 mg of methylprednisolone (or equivalent dexamethasone 100 mg twice a day for 5 days (inject slowly during 2-3 hours in 200 ml of 5% dextrose)
– After 5 days – shift from IV steroids to oral – 2 weeks of tab. prednisolone 1 mg/kg per day
– daily doses of vitamins:
Vitamin B6 (Pyridoxine): Tab. 20mg twice daily 1/12
Vitamin B12 (Riboflavin): Tab. 5 mg twice daily 1/12
Vitamin B9 (Folic acid): Tab. 1 mg once daily for 1/12
Or equivalent substitution with vitamin B-complex
Erythropoietin treatment for methanol optic neuropathy. (pubmed/22810212) (promising results)
Intravenous methylprednisolone could salvage vision in methyl alcohol poisoning (DOI: 10.4103/0301-4738.21628) (recovery even in bilateral NLP)
Pulse Steroid Therapy – Indian J Pediatr 2008; 75 (10): 1057-1066 (how to administer IV pulse steroids)
http://clincalc.com/corticosteroids/ (how to substitute methylprednisolone with dexamethasone IV)