Abstract
Purpose: To evaluate the efficacy of a novel oral combination therapy—pentoxifylline, cilostazol, and methylcobalamin—in improving visual and electrophysiological outcomes in patients with ethambutol-induced optic neuropathy (EON).
Methods: A prospective interventional study was conducted on 34 patients (68 eyes) diagnosed with EON. Patients were randomly divided into two groups. The intervention group (n = 17) received oral pentoxifylline (16–18 mg/kg/day in two divided doses), cilostazol (50 mg/day), and methylcobalamin (1500 mcg/day) for 6 months. The control group (n = 17) received methylcobalamin alone for the same duration. Patients were evaluated at baseline and followed up at 1.5 months intervals for 6 months. Assessments included best-corrected visual acuity (BCVA) using early treatment diabetes retinopathy study (ETDRS) chart, contrast sensitivity via Pelli-Robson chart, color vision using Ishihara plates and fundus examination. Visual evoked potentials (VEP) with reverse pattern stimulation were performed at baseline and 6 months.
Results: The intervention group demonstrated significantly greater improvement in BCVA (mean gain: 0.71 ± 0.21; p = 0.001) and contrast sensitivity (0.697 ± 0.02; p = 0.002) compared to controls. VEP revealed a significant reduction in P100 latency in the intervention group (4.18 ± 1.23 ms; p = 0.003), indicating better optic nerve recovery, whereas latency worsened in the control group. Color vision improvement was not statistically significant (p > 0.05) in both groups.
Conclusion: The combination of pentoxifylline, cilostazol, and methylcobalamin significantly improved visual and electrophysiological parameters in EON patients. This multi-targeted neuro-regenerative therapy may represent a promising adjunct in the management of drug-induced optic neuropathies.