Outcome of Retinopathy in Chronic Hepatitis C Patients Treated with Peginterferon and Ribavirin

Abstract

The purpose of this study is to evaluate the incidence and outcome of retinopathy in chronic hepatitis C patients treated with peginterferon and ribavirin. A total of 74 hepatitis C patients with baseline eye exams and eye exams during therapy were included. Retinopathy was defined as development of cotton wool spots and/or intra-retinal hemorrhage. Demographics, hepatitis C viral characteristics, treatment and laboratory data, and eye exam findings were compared in groups with and without retinopathy. Retinopathy developed in 28 (38%), early in therapy. Pre-treatment eye exams did not predict risk of retinopathy. Therapy was continued in all but one; cotton wool spots resolved in 24 of 26. All nine patients with intra-retinal hemorrhage had resolution. No patient had retinopathy-related visual deterioration. Retinopathy is common with peginterferon therapy, but the outcome is favorable. Cessation of therapy for retinopathy is not warranted. Severe visual disturbances and scotomas deserve further evaluation.

Ophthalmologic complications of antiviral therapy in hepatitis C treatment

“…Their study, which included a number of patients with hypertension and diabetes, 12 and 16 respectively, found that both predicted the development of interferon-associated retinopathy using logistic regression analysis. By contrast, Mehta et al [31] found higher rates of interferon-associated retinopathy in patients with hypertension and diabetes, but the differences were not statistically significant. Their study had sufficient numbers of patients with these conditions -13 patients with diabetes mellitus and 31 with hypertension -however, ophthalmological follow up was poor with less than 70% of patients receiving an eye exam within 12 weeks of starting standard of care therapy.…”

“…Atypical adverse events: unilateral CRVO in 1 patient with a background of DM resulting in irreversible vision loss. Mehta et al [31] 18 of 64 (28%) 3 United States Baseline, 3 and 6 mo IAR: no reduced VA in eyes that developed IAR. 1 of 88 ceased treatment for asymptomatic IAR.…”

“…It is logical, however, that these patients would be at higher risk of having retinopathy during treatment than eyes without retinopathy at baseline. In the 22 observational studies considered in this review, 22 patients were identified as having retinopathy at baseline and 17 (77%) of these had progression of retinopathy [26,29,31] . In one trial, half of the patients with retinopathy at baseline had resolution of retinopathy during treatment [31] .…”

“…In the 22 observational studies considered in this review, 22 patients were identified as having retinopathy at baseline and 17 (77%) of these had progression of retinopathy [26,29,31] . In one trial, half of the patients with retinopathy at baseline had resolution of retinopathy during treatment [31] . In the other trials that identified patients with retinopathy, all eyes with baseline retinopathy had progression during the course of treatment.…”

“…Observational studies of standard of care therapy for chronic hepatitis C infection during which at least 10 patients developed interferon-associated retinopathy identified diabetes and hypertension as its main risk factors [28,29,31,32] (Table 2). Fouad et al [28] performed a comprehensive study of 84 patients treated with standard of care therapy in Egypt with extensive ophthalmologic follow up.…”