Intravenous erythropoietin shows promise for methanol optic neuropathy

The authors present two cases of methanol optic neuropathy seen in Tehran, Iran, that were treated with intravenous erythropoietin, in addition to standard treatments of methylprednisolone, vitamins and folic acid. Both patients responded dramatically, raising the possibility that intravenous erythropoietin may be an effective adjuvant when combined with current treatments for methanol optic neuropathy.

At presentation, both patients had no light perception bilaterally and mildly swollen optic discs. They were treated with 10,000 IU of intravenous erythropoietin twice a day for three days; 500 mg of methylprednisolone twice a day for five days (followed by two weeks of oral prednisolone [1 mg/kg per day]); and daily doses of vitamin B12, vitamin B6 and folic acid for one month.

Visual acuity improved to 20/20 in both eyes in one patient within three days. In the other patient, visual acuity returned to counting fingers at six feet in the right eye and 20/30 in the left eye within three weeks.

The authors conclude that the significant visual improvement of these patients is attributable to the additive effect of erythropoietin when combined standard treatments. Since erythropoietin is readily available and inexpensive, it may be a viable treatment option for methanol optic neuropathy in developing countries. However, they say additional studies are needed to determine whether erythropoietin alone or in combination with other therapeutic agents provides optimal visual recovery in patients with methanol optic neuropathy.