Branch retinal vein thrombosis and visual loss probably associated with pegylated interferon therapy of chronic hepatitis C

Abstract

Ophthalmological complications with interferon therapy are usually mild and reversible, not requiring the withdrawal of the treatment. We report a case of a patient who had visual loss probably associated with interferon therapy. Chronic hepatitis C virus infection (genotype 1a) was diagnosed in a 33-year old asymptomatic man. His past medical history was unremarkable and previous routine ophthalmologic check-up was normal. Pegylated interferon alpha and ribavirin were started. Three weeks later he reported painless reduction of vision. Ophthalmologic examination showed extensive intraretinal hemorrhages and cotton-wool spots, associated with inferior branch retinal vein thrombosis. Antiviral therapy was immediately discontinued, but one year later he persists with severely decreased visual acuity. This case illustrates the possibility of unpredictable and severe complications during pegylated interferon therapy.

Branch Retinal Vein Occlusion

“…Over the recent years, there have been a number of anecdotal case reports of BRVO with many systemic diseases, including Bartonella [ 17 ], Behcet's disease [ 18 , 19 ], Coats' disease [ 20 ], Crohn's disease [ 21 ], deep-sea diving [ 22 ], Eales' disease [ 23 ], focal retinal phlebitis [ 24 ], high altitude [ 25 ], human immunodefi ciency virus [ 26 , 27 ], infl iximab treatment [ 28 ], interferon therapy [ 29 ], lipemia retinalis [ 30 ], during fi ngolimod treatment of multiple sclerosis [ 31 ], ocular candidiasis [ 32 ], ocular Lyme borreliosis [ 33 ], ocular tuberculosis [ 34 ], primary intraocular lymphoma [ 35 ], pseudoexfoliation [ 36 , 37 ], quetiapine fumarate [ 38 ], sarcoidosis [ 39 -42 ], superior ophthalmic vein thrombosis [ 43 ], systemic lupus erythematosus [ 44 ], Takayasu's arteritis [ 45 ], tamoxifen [ 46 ], toxoplasmic chorioretinitis [ 47 ], Tsutsugamushi disease [ 48 ], and Waardenburg syndrome [ 49 ]. As discussed above, the association of a condition with a systemic disease does not always mean cause and effect.…”

Trombofilia y factores de riesgo vascular en la obstrucción venosa retiniana

“…Por otro lado, se han descrito casos aislados de OVR en pacientes con hepatitis C tratados con interferón 23 . Nosotros tuvimos ocasión de observar un caso de OVR en un paciente con hepatitis C tratado con dicho fármaco, en el que se detectó además un déficit de proteína S.…”

Ophthalmologic complications of antiviral therapy in hepatitis C treatment

“…The most common of these are retinal vein occlusion (RVO) [21,29,30,32,[49][50][51][52][53][54][55] , and non-arteritic anterior ischemic optic neuropathy (NAION) [28,49,[56][57][58][59] . Other atypical adverse events that have been reported include ocular myasthenia [60,61] , optic neuritis [62] , Vogt-Koyanagi-Harada disease [49,[63][64][65][66][67] , ocular sarcoidosis [68,69] , ocular toxocariasis [70] , neurovascular glaucoma [71] , conjunctival hemorrhage [20,26,35] , macular edema [72][73][74] , oculomotor nerve palsy [75] , trichomegaly [23] and retinal detachment [76] .…”

“…It has been suggested that there may be common elements between the pathogenesis of these complications and interferon-associated retinopathy [49,56] . Certainly, there are many cases in the literature where AION and RVO are concomitant with interferon-associated retinopathy [51,55,79] . As the atypical complications are the key causes of vision loss during antiviral therapy and interferon-associated retinopathy is common and well-described, any relationship between them should be explored in depth.…”