J Korean Ophthalmol Soc.  2009 Mar;50(3):383-389. 10.3341/jkos.2009.50.3.383.

Pegylated Interferon Associated Retinopathy in Chronic Hepatitis Patients

• Kang HY
• Lim JW
• Shin MC

• KMID: 2111248
• DOI: http://doi.org/10.3341/jkos.2009.50.3.383

Abstract

PURPOSE: To investigate clinical features of pegylated interferon-associated retinopathy in chronic hepatitis patients.
METHODS
The present study was a consecutive case series of 46 patients who were treated with pegylated interferon for chronic hepatitis C or B from October 2007 to September 2008 in our hospital. The patients had a regular ophthalmologic examination every 3 weeks for 6 months after treatment.
RESULTS
Out of 46 patients, 10 patients (21.73%) developed retinal abnormality. Pegylated interferon-associated retinopathy occurred at 7.25+/-10.28 weeks after the treatment with cotton-wool spots and retinal hemorrhage. All cases except one mild nonproliferative diabetic retinopathy case presenting broad perimacular non-perfusion recovered without cessation of the treatment.
CONCLUSIONS
Pegylated interferon-associated retinopathy in chronic hepatitis patients was reversible and had a recovery without visual complication. However, a single case did present with irreversible visual impairment. Pegylated interferon-associated retinopathy is usually asymptomatic and clinicians should observe patients closely for 3 months after treatment.

Keyword

Chronic hepatitis; Pegyalated interferon; Retinopathy

MeSH Terms

Diabetic Retinopathy
Hepatitis C, Chronic
Hepatitis, Chronic
Humans
Interferons
Retinal Hemorrhage
Retinaldehyde
Vision Disorders
Interferons
Retinaldehyde

Figure

• 

  Figure 1. Representative case of pegylated interferon-associated retinopathy in 66-year-old female patient treated for chronic hepatitis B. (A) before treatment, normal fundus in both eyes. her visual acuity (logMAR) was 0. (B) eight weeks after treatment, cotton wool spots and retinal hemorrhages developed. She has no symptom. (C) late phase in fluorescein angiography revealed only blocked fluorescein due to cotton wool spot and retinal hemorrhage. there was no delayed filling and no abnormal leakage. (D) twelve weeks after treatment, cotton wool spots and retinal hemorrhage decreased without cessation of the treatment. Her visual acuity did not change.

• 

  Figure 2. A case presenting pegylated interferon-associated retinopathy in 34-years-old female patients treated for chronic hepatitis C. (A) two months after pegylated interferon treatment, multiple cotton wool spots and intraretinal hemorrhages developed in both eyes. Her visual acuity (logMAR) decreased to 0.8 from 0.2 at baseline. (B) fluorescein angiography showed extensive hypoperfusion and vascular leakage. She ungerwent intravitreal bevacizumab injection and panretinalphotocoagulation in both eyes. (C) one month after cessation of the interferon treatment, cotton wool spots and intraretinal hemorrhages decreased. But her visual acuity was 1.5, not improved. (D) fluorescein angiography showed extensive non-perfusion area and severe macular ischemia developed.

Reference

References

1. d'Alteroche L, Majzoub S, Lecuyer AI, et al. Ophthalmologic side effects during alpha-interferon therapy for viral hepatitis. J Hepatol. 2006; 44:56–61.

2. Hayasaka S, Fujii M, Yamamoto Y, et al. Retinopathy and subconjunctival hemorrhage in patients with chronic viral hepatitis receiving interferon alfa. Br J Ophthalmol. 1995; 79:150–2.

3. Sene D, Touitou V, Bodaghi B, et al. Intraocular complications on INF-alpha and ribavirin therapy in patients with chronic viral hepatitis C. World J Gastroenterol. 2007; 13:3137–40.

4. Suzuki T, Yonemura K, Miyaji T, et al. Progressive renal failure and blindness due to retinal hemorrhage after interferon therapy for hepatitis C virus-ssociated membranoproliferative glomerulonephritis. Inter Med. 2001; 40:708–12.

5. Kargi SH, Oz O, Ustundag Y, Firat E. Epiretinal membrane development during interferon treatment. Can J Ophthalmol. 2003; 38:610–2.

6. Okanouse T, Sakamoto S, Itoh Y, et al. Side effects of high-dose interferon therapy for chronic hepatitis C. J Hepatol. 1996; 25:283–91.

7. Nicolo M, Artioli S, La Mattina GC, Ghigoione D. Branch retinal artery occlusion combined with branch retinal vein occlusion in a patient with chronic hepatitis C treated with interferon and rebavirin. Eur J Ophthalmol. 2005; 15:811–4.

8. Kiratli H, Irkec M. Presumed interferon-associated bilateral macular arterial branch obstruction. Eye. 2000; 14:920–2.

9. Kim JH, Koo HM, Chung SM. Clinical survey of interferon retinopathy. J Korean Ophthalmol Soc. 1996; 37:293–9.

10. Xirouchakis E, Triantos C, Manousou P, et al. Pegylatedinterferon and ribavirin in liver transplant candidates and recipients with HCV cirrhosis: systematic review and metaanalysis of prospective controlled studies. J Viral Hepat. 2008; 15:699–709.

11. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooerative Study Group. Hepatology. 1996; 24:289–93.

12. Saito H, Ebinuma H, Nagata H, et al. Interferon-associated retinopathy in a uniform regimen of natural interferon-alpha therapy for chronic hepatitis C. Liver. 2001; 21:192–7.

13. Abe T, Hakajima A, Satoh N, et al. Clinical characteristics of hepatitis C virus-associated retinopathy. Jpn J Ophthalmol. 1995; 39:411–9.

14. Nadir A, Amin A, Chalisa N, van Thiel DH. Retinal vein thrombosis associated with chronic hepatitis C: a case series and review of the literature. J Viral Hapat. 2000; 7:466–70.

15. Rubio JE Jr, Charles S. Interferon-associated combined branch retinal artery and central retinal vein obstruction. Retina. 2003; 23:546–8.

16. Jain K, Lam WC, Waheeb S, et al. Retinopathy in chronic hepatitis C patients during interferon treatment with ribavirin. Br J Ophthalmol. 2001; 85:1171–3.

17. Tu KL, Bowyer J, Schofield K, Harding S. Severe interferon associated retinopathy. Br J Ophthalmol. 2003; 87:247–8.

18. Malik NN, Sheth HG, Ackerman N, et al. A prospective study of change in visual function in patients treated with pegylated interferon alpha for hepatitis C in the UK. Br J Ophthalmol. 2008; 92:256–6.

19. Cuthbertson FM, Davies M, Mckibbin M. Is screening for interferon retinopathy in hepatitis C justified? Br J Ophthalmol. 2004; 88:1518–20.

20. Ogata H, Suzuki H, Shimizu K, et al. Pegylated interferon-associated retinopathy in chronic hepatitis C patients. Jpn J Ophthalmol. 2006; 50:293–5.

21. Buster EH, Ter Borg MJ, Vingerling JR, Janssen HL. Low incidence of retinopathy during peginterferon alpha-2b and lamivudine therapy for chronic hepatitis B. J Hepatol. 2006; 44:56–61.

22. Kadayifcilar S, Boyacioglu S, Kart H, et al. Ocular complications with high-dose interferon alpha in chronic active hepatitis. Eye. 1999; 13:241–6.

23. White DL, Ratziu V, El-Serag HB. Hepatitis C infection and risk of diabetes: A systematic review and meta-analysis. J Hepatol. 2008; 49:831–44.

24. Amarapurkar DN, Patel ND, Kamani PM. Impact of diabetes mellitus on outcome of HCC. Ann Hepatol. 2008; 7:148–51.

25. Alyan O, Kacmaz F, Ozdemir O, et al. Hepatitis C Infection is Associated With Increased Coronary Artery Atherosclerosis Defined by Modified Reardon Severity Score System. Circ J. 2008; 29:231–3.

26. Kau A, Vermehren J, Sarrazin C. Treatment predictors of a sustained virologic response in hepatitis B and C. J Hepatol. 2008; 49:634–51.

27. Chisholm JA, Williams G, Spence E, et al. Retinal toxicity during pegylated alpha-interferon therapy for chronic hepatitis C: a multifocal electroretinogram investigation. Aliment Pharmacol Ter. 2005; 21:723–32.

28. Nagaoka T, Sato E, Takahashi A, et al. Retinal circulatory changes associated with interferon-induced retinopathy in patients with hepatitis C. Invest Ophthalmol Vis Sci. 2007; 48:368–75.

29. Okuse C, Yotsuyanagi H, Nagase Y, et al. Risk factors for retinopathy associated with interferon alpha-2b and ribavirin combination therapy in patients with chronic hepatitis C. World J Gastroenterol. 2006; 12:3756–9.