Crochet M, Ingster-Moati I, Even G, Dupuy P
Cabinet Ophtalmologique, Creil.
J Fr Ophtalmol. 2004 Mar;27(3):257-62. doi: 10.1016/s0181-5512(04)96127-x.
Ophthalmological complications with interferon alpha (INF-alpha) have been described since 1992: toxic retinopathy with cotton-wool spots, retinal hemorrhages, visual evoked potential (VEP) modifications and visual field abnormalities.
In 2002, a 44-year-old woman was referred complaining of visual problems. In 1986, she had been diagnosed with chronic hepatitis C and underwent INF-alpha therapy for 6 months with no ophthalmological symptoms. In 2001, she began a second course of INF-alpha therapy along with ribavirin. After 5 months, in February 2002, she developed hypothyroidism induced by INF, received levothyroxine and her treatment for the hepatitis C was stopped. One month later, in March, she complained of visual difficulties in dim light. Clinical ophthalmological examination and Goldmann visual field testing, electroretinogram (ERG) and visual evoked potentials (VEP) were normal but the electro-oculogram (EOG) showed that the light-peak-to-dark-trough ratios were very low: 148% in the right eye, 156% in the left eye. The fluorescein angiography was normal. The patient was followed up 4 months later, in June 2002 (after 5 months without INF-alpha therapy), showing a slight improvement of the EOG and no visual symptoms. Two other follow-up examinations were done in September 2002 and January 2003: the slight improvement persisted but the EOGs remain below the normal range values.
A review of the literature brought out that an EOG is not usually done in the monitoring of patients taking INF-alpha, but we decided to do this examination because of her symptoms, the first case to our knowledge in a patient taking INF-alpha. This case report underlines the necessity of an EOG on patients with INF-alpha therapy. Until now, the pathogenesis of this retinal toxicity has been poorly understood. These results show that the retinal pigmented epithelium is probably implicated at an early stage in this retinal toxicity.
自1992年以来，已有关于干扰素α（INF-α）眼部并发症的描述：伴有棉絮斑的中毒性视网膜病变、视网膜出血、视觉诱发电位（VEP）改变和视野异常。
2002年，一名44岁女性因视力问题前来就诊。1986年，她被诊断为慢性丙型肝炎，并接受了6个月的INF-α治疗，当时无眼部症状。2001年，她开始了第二轮INF-α联合利巴韦林治疗。5个月后，即2002年2月，她出现了由INF引起的甲状腺功能减退，接受了左甲状腺素治疗，丙型肝炎治疗停止。1个月后，即3月，她主诉在暗光下视力困难。临床眼科检查、Goldmann视野检测、视网膜电图（ERG）和视觉诱发电位（VEP）均正常，但眼电图（EOG）显示光峰与暗谷比值非常低：右眼为148%，左眼为156%。荧光素血管造影正常。2002年6月（在停止INF-α治疗5个月后）对该患者进行了4个月的随访，结果显示EOG略有改善且无视觉症状。2002年9月和2003年1月进行了另外两次随访检查：轻微改善持续存在，但EOG仍低于正常范围值。
文献回顾表明，在监测接受INF-α治疗的患者时通常不进行EOG检查，但由于该患者的症状，我们决定进行此项检查，据我们所知这是接受INF-α治疗患者中的首例。本病例报告强调了对接受INF-α治疗患者进行EOG检查的必要性。到目前为止，这种视网膜毒性的发病机制尚不清楚。这些结果表明，视网膜色素上皮可能在这种视网膜毒性的早期就受到牵连。
