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A. Ghirlando, S. Vujosevic, D. Lazzarini, M. Cortese, E. Midena; Corneal Side Effects of Systemic Interferon and Ribavirin in Hepatitis-C Patients: A Clinical Confocal Microscopy Study. Invest. Ophthalmol. Vis. Sci. 2010;51(13):6229.
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To quantify corneal changes, recorded by means of corneal confocal microscopy (CCM), during the course of associated systemic interferon alpha and ribavirin therapy in patients with chronic hepatitis C .
Forty two patients (84 eyes) affected by chronic hepatitis C were enrolled in this study. Systemic therapy was formulated as an association of subcutaneous pegylated interferon alfa-2a or alfa-2b once a week and ribavirin per os at 10.8mg/kg/day and given for at least one year. All patients underwent full ophtahlmic evaluation (best corrected visual acuity (BCVA), slit lamp anterior segment and fundus evaluation), color fundus photography and CCM at baseline, 3 and 6 months and at the end of treatment (12 months). CCM was performed using the z-ring device of Confoscan 4 (NIDEK, Japan) to improve the detection of corneal details and allow the evaluation of both corneal cells morphology and morphometry. Thirty patients (sixty eyes) were used as age-matched controls.
Fifteen patients (35.7 %) reported symptoms associated with ocular surface discomfort such as burning, photophobia and iperemia . From the three months examination up to end of the studyall eyes showed: decreased extracellular matrix and keratocytes activation in the anterior stroma, (p<0.05) compared to age-matched controls. Medium and posterior stroma maintained normal along the study. Epithelial cells and basal membrane showed high (pathologic) reflectivity in 58 eyes (69%). Basal membrane of epithelial cells cells showed tatistically significant decrease in cellular density vs controls, (p<0.05). Sub-basal nerve plexus fiber length was significantly decreased, mainly at 6 months follow-up vs controls, (p<0.05).
The association of systemic interferon alfa and ribavirin treatment in patientswith chronic hepatitis C quantitatively and qualitatively alters corneal cells and innervation. Corneal confocal microscopy may be uesful to detect peripheral neural damage and corneal wound healing changes secondary to systemic therapy.
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