The Prevalence, Risk Factors and Outcome of Retinopathy Associated with Interferon Alfa-2a and Ribavirin Therapy in Patients with Chronic Hepatitis C
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- Category: Vol. 81, June 2013
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The Prevalence, Risk Factors and Outcome of Retinopathy Associated with Interferon Alfa-2a and Ribavirin Therapy in Patients with Chronic Hepatitis C,MAHMOUD M. SHEDED, KHALED A. ZAKY and SEHAM A. OMAR
Abstract
Background/Aim: In the treatment of chronic hepatitis C (HCV), by the use of a combination of interferon alfa-2a (IFN-a 2a) and ribavirin many side effects of this combination therapy have been described. Ocular complications are fairly common, retinopathy is a well recognized side effect of interferon therapy and is characterized by retinal hemorrhages, cotton wool spots, and macular edema. The aim of this study was to document the prevalence, risk factors and outcome of intraocular complications of IFN-a 2a and ribavirin therapy in patients with chronic HCV.
Patient and Methods: All patients started on treatment from May 2010 to August 2011 were invited to participate in the study according to the Egyptian national protocol for treatment of chronic HCV. The past medical and ocular history, visual symptoms, a full ophthalmological assessment were performed pre-treatment, any patient with retinal or optic diseases were excluded. Follow-up visits for full ophthalmo-logical assessment were done at 1, 3,6 ,9 and 12 months.
Results: Out of the eligible 168 patients, received IFN-a 2a, 41 (24.4%) patients had diabetes, 24 (14.9%) patients had hypertension and 30 (17.9%) patients had both diabetes; and hypertension. Only 13 (7.73%) of 168 patients had evi-dence of retinopathy including deep retinal hemorrhage and cotton wool spots (4 had DM; 2 had hypertension; 4 had both hypertension and diabetes; and 3 patient without DM or hypertension). None had any visual symptoms and in all thirteen patients the retinopathy resolved completely while the patients completed their course of treatment. Multiple logistic regression analysis revealed that diabetic and hyper-tensive patients are at significant higher risk for development of IFN-associated retinopathy.
Conclusions: The incidence of retinopathy with IFN-a 2a and ribavirin is low. The retinal complications resolve, while treatment is continued and are asymptomatic. Routine frequent screening and followed-up for retinopathy in diabetic, hypertensive patients treated with pegylated interferon and ribavirin for chronic HCV is recommended because they are at significant higher risk for IFN-associated retinopathy (IAR).