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J. Y. Huang, S. Nishizawa, S. Sakisaka, E. Uchio; Interferon Associated Retinopathy in Hepatitis C Patients During Pegylated Interferon Plus Ribavirin Treatment in Japan. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3722.
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Interferon associated retinopathy was first recognized in 1990 by Ikeb and associates reported signs of retinal hemorrhages and cotton wool spots following the antiviral treatment for chronic hepatitis C patients. Since then, the incidence of retinopathy induced by the conventional interferon (IFN) therapy and IFN plus ribavirin combined therapy has been reported to be 40 ~ 60%. Recently, a newly standard antiviral treatment regimen with a combined therapy of pegylated interferon (PEG-IFN-2a ) plus ribavirin is recommended. However, there is no report yet on the assessment of the incidence of retinopathy for the combined treatment. In this study, we compared the incidence, the time of onset of retinopathy following administration of PEG-IFN-2a plus ribavirin, and the patients’ medical background was assessed.
A prospective study of 51 patients with chronic hepatitis C who met the criteria for the antiviral treatment of PEG-IFN-2a plus ribavirin were assessed for ocular complications using slit lamp biomicroscopy and indirect ophthalmoscopy before, during, and after the treatment at regular intervals. The incidence was compared and assessed on patients’ medical background.
17/51 patients (33.3%), while on treatment, developed an asymptomatic retinopathy. Among these, 5 patients had retinal hemorrhage, 8 patients had soft exudates, and 4 had both retinal hemorrahage and soft exudates. Incidence of retinopathy was significantly higher in older age (56.5±7.8 v.s 62.3±7.8, P<0.05), higher BMI (22.27±2.58 v.s 24.15±2.46, P<0.05), diabetes and hypertension (58.8%), low platelet counts (16.5±4.8/µl v.s 13.6±3.6/µl, P<0.05), and low HDL-cholesterol level (56.0±17.5mg/dl v.s 46.2±12.3mg/dl,P<0.05). Retinopathy occurred in 11.5±6.5 weeks. Retinopathies were transient in all patients.
Incidence of retinopathy with newly recommended combined PEG-IFN-2a plus ribavirin therapy was determined to be 33.3% in our study. This is a lower incidence compared to prior reports on either the conventional INF or the IFN plus ribavirin therapy. Factors associated with this incidence were aging, obese, diabetes, hypertension, and a low HDL-cholesterol level.
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