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CLINICAL REVIEW: Keyur Patel, Andrew J Muir, and John G McHutchison Diagnosis and treatment of chronic hepatitis C infection BMJ 2006; 332: 1013-1017 [Full text]

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Hepatitis C and Interferon-associated Retinopathy

Hiten G Sheth, Nabeel N Malik, Nigel Davies, Suzanne M Mitchell   (10 May 2006)

Hepatitis C and Interferon-associated Retinopathy 10 May 2006
Hiten G Sheth, specialist registrar Department of Ophthalmology, Chelsea and Westminster Hospital, 369 Fulham Rd, London SW10 9NH, Nabeel N Malik, Nigel Davies, Suzanne M Mitchell Send response to journal: Re: Hepatitis C and Interferon-associated Retinopathy	Editor – we write in relation to your recent review article on hepatitis C infection (HCV). Patel et al1 present an excellent overview but overlook the eye in their discussion of the non-hepatic manifestations of infection and do not mention the recent debate over interferon therapy possibly causing retinopathy. HCV infection has been associated with a dry eye syndrome and ischaemic retinopathy, both thought to be secondary to a HCV-induced vasculitis2. Interferon treatment has traditionally been associated with a significant incidence of retinopathy, as characterised by cotton wool spots and retinal haemorrhages, in several prospective case series3,4,5. Despite these retinal changes, patients rarely reported subjective problems and visual function is generally maintained. Anterior ischaemic optic neuropathy and macular oedema have also been described as rarer complications of interferon treatment. In view of this, ophthalmic assessment at baseline and during the interferon treatment period has generally been advocated for such patients. We have recently completed a prospective study of 52 patients (104 eyes) on a standardised 48-week regimen of pegylated interferon-alpha-2a (Pegasys) and Ribavirin6. We found no significant difference between baseline and follow-up LogMAR visual acuity, contrast sensitivity, colour vision or automated visual field analysis up to 30months. 3 patients (4 eyes) developed a transient retinopathy with no associated deterioration in visual function. It is postulated that recent introduction of pegylated forms of interferon (covalent attachment of a protein to increase molecular weight and plasma half-life of a drug) somehow protects against previously seen interferon-associated retinopathy. We conclude that despite being previously advocated, routine ophthalmic screening is no longer required and that this will reduce inconvenience to patients and reduce demand on NHS ophthalmic services. Hiten G Sheth specialist registrar Nabeel N Malik specialist registrar / fellow Nigel Davies consultant Suzanne M Mitchell consultant Department of Ophthalmology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH 1. Patel K, Muir A, Hutchinson J. Diagnosis and treatment of chronic hepatitis C infection. BMJ 2006;332:1013-17 2. Zegans ME, Anninger W, Chapman C, Gordon SR. Ocular manifestations of hepatitis C virus infection. Curr Opin Ophthalmol. 2002;13(6):423-7 3. Kawano T, Shigehira, Uto H, Nakama T, Kato J et al. Retinal complications during interferon therapy for chronic hepatitis C. Am J Gastroenterol. 1996;91(2):309-13 4. Hayasaka S, Fujii M, Yamamoto Y, Noda S, Kurome H et al. Retinopathy and subconjunctival hamorrage in patients with chronic viral hepatitis receiving interferon alpha. Br J Ophthalmol 1995;79(2):150-2 5. Schulman JA, Liang C, Kooragayala LM, King J. Posterior segment complications in patients with hepatitis C treated with interferon and ribavirin. Ophthalmology 2003;110(2):437-42 6. Mitchell SM, Malik NN, Sheth HG, Davies N, Akerman N. Prospective case series of changes in visual function in patients treated for hepatitis C with peginterferon alpha. www.arvo.org 2006 poster 5174 Competing interests: None declared