Manesis E K, Petrou C, Brouzas D, Hadziyannis S
Academic Department of Medicine, Hippocration General Hospital, Athens, Greece.
J Hepatol. 1994 Sep;21(3):474-7. doi: 10.1016/s0168-8278(05)80331-9.
Optic neuritis occurred in three of our patients receiving treatment with alpha interferon-2b (Intron-A; 3MU thrice weekly) for chronic hepatitis. The complication appeared within, 1, 9 1/2 and 10 months of treatment, respectively. In all cases, blurred vision was the initial complaint and subsequent electrophysiologic investigation confirmed the presence of optic tract neuropathy. The patients had no other neurologic signs. Computerized tomography and magnetic resonance image of the brain were not remarkable. Psychiatric symptoms, in the form of an interferon-associated depressive reaction, were present in two of them; in one case, it was severe enough to require immediate discontinuation of treatment. In two patients the visual symptoms resolved and the parameters of neurophysiologic testing returned to normal within 1 month after stopping interferon. In one case, however, residual optic tract impairment associated with a unilateral central scotoma and a substantial decrease of visual acuity was present 2 years later, despite a course of methylprednizolone. In this patient the interferon treatment was continued for 3 months despite the visual symptoms, and he later received two additional interferon courses because of relapses of hepatitis. We conclude that clinically evident optic tract neuropathy may complicate interferon administration. Candidates for interferon treatment may need routine examination of optic fields and visual evoked potentials, before and during administration of the drug to avoid possibly permanent visual sequelae.
我们有3例接受α-干扰素-2b（Intron - A；300万单位，每周3次）治疗慢性肝炎的患者发生了视神经炎。并发症分别出现在治疗后的1个月、9个半月和10个月。所有病例中，视力模糊均为首发症状，随后的电生理检查证实存在视束神经病变。这些患者无其他神经体征。脑部计算机断层扫描和磁共振成像均无异常。其中2例出现了以干扰素相关抑郁反应形式存在的精神症状；1例严重到需要立即停药。2例患者在停用干扰素后1个月内视觉症状消失，神经生理测试参数恢复正常。然而，1例患者在2年后尽管接受了甲泼尼龙治疗，仍存在与单侧中央暗点和视力大幅下降相关的残留视束损害。该患者尽管出现视觉症状仍继续干扰素治疗3个月，后来因肝炎复发又接受了2个疗程的干扰素治疗。我们得出结论，临床上明显的视束神经病变可能使干扰素治疗复杂化。干扰素治疗的候选者在用药前和用药期间可能需要对视野和视觉诱发电位进行常规检查，以避免可能出现的永久性视觉后遗症。
