Is screening for interferon retinopathy in hepatitis C justified?

Cuthbertson, F M

doi:10.1136/bjo.2004.043968

Cited by 58 publications

(65 citation statements)

References 10 publications

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“…These findings were similar to previous results like Cuthbertson et al (13), d'Alteroche et al (24) and Sene et al (33) who showed that hypertension, diabetes and older age were possible risk factors for IFN-induced retinopathy. On the contrary, Kawano et al (34), Saito et al (32) and Okuse et al (20), reported no association between diabetes and IFN-RBV induced retinopathy, this may be explained by the very low number of patients with DM in those studies.…”

Section: Discussionsupporting

confidence: 93%

Ophthalmological side effects of interferon therapy of chronic hepatitis C

Medhat¹,

Esmat²,

Hamza³

et al. 2016

Hepatobiliary Surg. Nutr.

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Background: Egypt has one of the highest prevalence of hepatitis C virus (HCV) worldwide.Ophthalmological side effects are recognized complications of interferon (IFN) therapy. This study aimed to evaluate IFN-induced ophthalmological manifestations in patients receiving PEGylated interferon (PEG IFN) and ribavirin (RBV) and to assess the effect of IFN duration, response and systemic risk factors on the severity. Methods:We retrospectively analyzed 100 patients with chronic HCV who were candidates for PEG-IFN and RBV therapy. All patients were subjected to clinical and ophthalmological examination, laboratory investigations, abdominal ultrasound, colored fundus photography and fundus fluorescein angiography, follow up was made at weeks 12, 24, and 48 of treatment.Results: IFN-induced retinopathy had been found in (9/100; 9%), 5 (5/9; 55.5%) of them had bilateral lesions, (3/9; 33.3%) were treatment responders and (6/9; 66.6%) non responders. The time of retinopathy appearance was mainly at W12. Retinopathy was asymptomatic in most of the affected patients (7/9; 77.77%) and reversible, cotton wool spots was the major associated sign. Patients with older age, DM and or HTN, and non-responders to antiviral therapy were associated with more severe retinopathy. Conclusions:Retinopathy is not a rare complication of IFN therapy for chronic HCV infection, but fortunately it's asymptomatic and reversible. Ophthalmological assessment at base-line and at follow up during IFN treatment is very important.

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Section: Discussionsupporting

confidence: 93%

Ophthalmological side effects of interferon therapy of chronic hepatitis C

Medhat¹,

Esmat²,

Hamza³

et al. 2016

Hepatobiliary Surg. Nutr.

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“…One of these papers (43) reports that, of all the interferon-related adverse events, 8.4% affected the eye. In contrast, Cuthbertson et al (104) ana l y zing their series of cases did not see any reason to recommend routine ophthalmological evaluation of patients using interferons.…”

Section: Discussionmentioning

confidence: 85%

Literature systematic review on the ophthalmological side effects of interferons

Fragoso¹,

Paggiaro²,

Mastromauro³

et al. 2011

Arq. Bras. Oftalmol.

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Interferons alpha and beta have been used worldwide for a few decades, altering the natural history of several severe diseases including hepatitis C, cancer and immu nemediated conditions such as multiple sclerosis. The adverse events profile of interferons is well established, but only isolated reports of ophthalmological compli ca tions of interferon therapy have been published. The objective of this study was to carry out a literature systematic review on the subject, bringing to light the need for ca reful ophthalmological monitoring of patients undergoing interferon treatment. Nearly 500 cases of ophthalmological complications related to interferon have been repor ted. The most frequent findings were soft exudates, hemorrhages and retina ischemia. Keywords BACKGROUNDInterferons are natural glycoproteins that have antiviral, antipro liferative and immune regulatory functions. There are several classes including interferon alpha, beta and gamma. Interferons alpha and beta are used worldwide in the treatment of several di seases including hepatitis C, cancer and immune-mediated condi tions such as multiple sclerosis. Due to the long-term use of interferons for most patients, the safety profile of these compounds is well known. Cutaneous(1) , hematological (2) , psychiatric (3,4) , endo crine (5) and hepatic (6) side effects of interferons have been reported. However, some side effects are specifically related to the eye, and a variety of ophthalmological diseases may arise from the use of inter ferons. Although recognised as relatively rare, ophthalmo lo gical complications due to interferons should be considered even if the patient is visually asymptomatic.The literature on the subject is restricted to case reports or a small series of cases. In order to better understand the most fre quent ophthalmological side effects of interferons and the outcome of these conditions, a literature systematic review was carried out.

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“…Tanto o vírus da hepatite C como o INFα induzem à formação de grande variedade de anticorpos trombogênicos, incluindo crioglobulinas, fator reumatóide, fator antimúsculo liso, antimicrossoma de fígado-rim, anticardiolipina e antifosfolípide (positivo em 22% dos pacientes com hepatite C), o que predispõe os pacientes portadores do vírus e/ou em tratamento com INFα ao desenvolvimento de trombose de veia retiniana (17) . A incidência de retinopatia associada ao uso de INFα varia de 18 a 86% em pacientes orientais; e em pacientes não-orientais, com hepatite C crônica tratada com INFα e ribavirina, chega a 42% (14,23) .…”

Section: Relato Do Casounclassified

“…Alguns pacientes, entretanto, podem desenvolver isquemia por não-perfusão dos capilares retinianos, edema retiniano, extravasamento vascular, anormalidades microvasculares e oclusões, com dano retiniano severo e conseqüente baixa de acuidade visual (13) . Quadros oculares atípicos incluem hemorragia subconjuntival, hemorragia vítrea, glaucoma neovascular, edema do nervo óptico e paralisias oculomotoras (13)(14)16) ; entretanto oclusões de ramo arterial, de ramo venoso ou da veia central da retina, embora bastante infreqüentes, já foram associadas ao uso da terapia com INFα (14,17) . A despeito dos efeitos colaterais com o uso sistêmico de ribavirina incluírem somente lacrimejamento e conjuntivite, essa medicação pode contribuir para a retinopatia em razão de sua ação sinergística, quando utilizada em combinação com o interferon (5,14) .…”

Section: Introductionunclassified

Trombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso

Helal¹,

Zacharias²,

Alencar³

2006

Arq. Bras. Oftalmol.

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Descritores: Hepatite C; Ribavirina/efeitos adversos; Interferon/efeitos adversos; Retinopatia; Oclusão da veia retiniana; Relato de casos [tipo de publicação] INTRODUÇÃOA infecção crônica pelo vírus da hepatite C afeta cerca de 4 milhões de pessoas nos Estados Unidos e aproximadamente 170 milhões em todo o mundo (1)(2) . Somente 15 a 20% destes pacientes apresentam resposta sustentada à terapia com interferon alfa -INFα (3)(4) , mas a combinação da terapia com ribavirina aumenta significativamente esse índice (5)(6) . O INFα, um agrupamento complexo de proteínas, com atividades antivirais, antiproliferativas e imunorregulatórias, é uma droga atualmente utilizada não só no tratamento da hepatite C crônica, mas também de condições sistêmicas, como o sarcoma de Kaposi, os hemangiomas, os melanomas cutâneos e o carcinoma renal metastático (7) . A ribavirina, por sua vez, é um nucleosídio sintético, análogo à guanidina, com propriedades anti-retrovirais contra uma série de DNA e RNA vírus (8) , e também com atividade imunorregulatória (9) . A terapia com INFα é associada a vários efeitos colaterais sistêmicos, como fadiga, mal-estar, perda de peso, depressão, náusea, anorexia, diarréia, neutropenia e trombocitopenia (10)(11)(12) . Em 1993, Guyer e colaboradores descreveram uma forma de retinopatia associada à terapia com interferon, marcada pela presença de exsudatos algodonosos e hemorragias intraretinianas (13) . Desde então, vários relatos demonstraram alterações oculares associadas ao uso desta droga.A retinopatia típica inclui exsudatos algodonosos e hemorragias retiniaTrombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso O interferon alfa (INF α) é droga atualmente utilizada no tratamento de várias doenças sistêmicas, como a hepatite C crônica. A ribavirina quando associada ao interferon alfa aumenta muito a resposta ao tratamento. Estima-se que a infecção crônica pelo vírus da hepatite C afete 170 milhões de pessoas no mundo, muitas delas em uso dessas medicações. A forma típica da retinopatia associada ao interferon alfa apresenta exsudatos algodonosos e hemorragias intra-retinianas. Há vários relatos de alterações oculares associadas ao uso do interferon alfa. Este trabalho descreve um caso de oclusão de veia central da retina em olho direito, com hemorragias no olho contralateral, em paciente usuária dessas medicações por dois anos. O caso descrito expõe em um dos olhos o quadro mais freqüente da retinopatia associada ao uso de interferon alfa (hemorragias de fundo) e no olho contralateral, uma apresentação muito mais atípica (trombose de veia central da retina). O quadro fundoscópico apresentou melhora com a interrupção da medicação. RESUMO RELATOS DE CASOS

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Is screening for interferon retinopathy in hepatitis C justified?

Cited by 58 publications

References 10 publications

Ophthalmological side effects of interferon therapy of chronic hepatitis C

Ophthalmological side effects of interferon therapy of chronic hepatitis C

Literature systematic review on the ophthalmological side effects of interferons

Trombose de veia central da retina em paciente usuária de interferon e ribavirina: relato de caso

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