Jancoriene Ligita, Norvydaite Dovile, Galgauskas Saulius, Balciunaite Evelina
Department of Infectious, Chest Diseases, Dermatovenerology and Alergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Department of Otolaryngology and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Hepat Mon. 2014 Feb 20;14(2):e15124. doi: 10.5812/hepatmon.15124. eCollection 2014 Feb.
Patients with Hepatitis C are commonly treated with combination of Pegylated Interferon alfa-2a and Ribavirin. Less than 1% of patients receiving this treatment experience very uncommon ophthalmological side effects such as optic neuropathy and vision disorder, which are usually subclinical, mild and reversible, not requiring the withdrawal of the treatment. Retinopathy is the most commonly reported ocular side effect of interferon use, usually presenting with cotton wool spots and retinal hemorrhages.
We represent a case of severe retinopathy and optic neuropathy in a patient with chronic hepatitis C genotype 3a infection, treated with the combination of PEG-IFN alfa-2a (180 mkg once weekly) and Ribavirin (1200 mg daily). Bilateral visual loss of both eyes developed at 11th week of therapy and changes in retina and optic nerve were observed. Fluorescein angiography and optical coherence tomography showed bilateral anterior ischemic optic neuropathy and macular edema. Visual acuity improved 1 month and fundoscopic changes were no longer present 6 months after the urgent permanent discontinuation of PEG-IFN treatment and the pulse steroid therapy followed by a 2 week course of oral prednisone.
In case of interferon-associated retinopathy discontinuation of the therapy and treatment with high dose steroids can be beneficial. The prognosis of interferon-associated opthalmological side effects remains uncertain: in some patients visual acuity improves, other continues with poor visual outcome. Considering that, all patients should undergo ophthalmologic examination before treatment with interferon and their ophthalmological status should be monitored regularly while receiving this therapy.
丙型肝炎患者通常采用聚乙二醇化干扰素α-2a和利巴韦林联合治疗。接受这种治疗的患者中，不到1%会出现非常罕见的眼科副作用，如视神经病变和视力障碍，这些副作用通常是亚临床的、轻微且可逆的，无需停止治疗。视网膜病变是使用干扰素最常报告的眼部副作用，通常表现为棉絮斑和视网膜出血。
我们报告一例慢性丙型肝炎3a基因型感染患者出现严重视网膜病变和视神经病变的病例，该患者接受聚乙二醇干扰素α-2a（每周一次，180微克）和利巴韦林（每日1200毫克）联合治疗。治疗第11周时双眼出现双侧视力丧失，并观察到视网膜和视神经的变化。荧光素血管造影和光学相干断层扫描显示双侧前部缺血性视神经病变和黄斑水肿。在紧急永久停用聚乙二醇干扰素治疗并进行脉冲类固醇治疗，随后口服泼尼松2周后，视力在1个月时有所改善，眼底镜检查变化在6个月后不再存在。
对于干扰素相关的视网膜病变，停止治疗并用高剂量类固醇治疗可能有益。干扰素相关眼科副作用的预后仍不确定：一些患者视力改善，另一些患者视力仍较差。考虑到这一点，所有患者在接受干扰素治疗前应进行眼科检查，并且在接受该治疗期间应定期监测其眼科状况。
