Ophthalmic Findings in Chronic Hepatitis C (CHC) Patients Treated with Pegylated-Interferon (PIFN) and Ribavirin (RBV)

Abstract

Purpose: Retinal changes have been described in 18–86% of CHC patients receiving interferon alfa2a/2b. There is paucity of data on ophthalmic changes in CHC patients on PIFN+RBV. Methods: Baseline eye exams were performed in 108 CHC patients treated with PIFN+RBV for 24–48 weeks. In a subcohort of 57 patients, visual acuity, tonometry, slit lamp and fundus examinations were done before, during and after therapy. Visual field testing, gonioscopy, color vision testing and fundus photography ± angiography were done, if indicated. Statistical comparisons between patients who developed retinopathy, Group A (GpA) versus those that did not, Group B (GpB) were performed (Student t test, p < 0.05). Results: Patient Characteristics: mean age 49.7y (26–68), male 53/57, Caucasian 86%, African American 12.5%, smoking status−50% active smokers, 25% ex-smokers; hypertension 37%, diabetes 14%, hypercholesterolemia 14%, thrombo-embolic events−0%, vasculitis−1.7%, epogen use−26%, advanced fibrosis/ cirrhosis 37%, genotype 1–82% and high viral load−65%. GpA and GpB were statistically similar. Laboratory data: Hgb, Platelets, WBC, ALT, Albumin, Bilirubin and INR were similar in the two groups. Retinopathy, cotton wool spots (CWS) and/or intraretinal hemorrhage (IRH) developed in 16 of 57 (28%) patients 1 to 9 months after start of therapy and in the majority (11) within 3 months. 12 patients had CWS, 3 had CWS+IRH and 1 had IRH. Treatment was continued in 15 of 16 patients with resolution in 9 (all had CWS only) during or shortly after completion of therapy. 3/4 patients with IRH continued to have stable eye changes (normal visual acuity) after completion of therapy; eye exam in the fourth patient is pending. Therapy was stopped in only 1 patient with complete resolution within 2 months. Visual and ocular symptoms: GpA: 9/16 (itching, blurring, floaters, diplopia). GpB: 15/41 (blurring, diplopia, eye pain, redness, grittiness). Dry eye syndrome was noted in 6 GpB patients, 2 at baseline and 4 during therapy. Conclusions: (1) Retinopathy developed in 28% of patients treated with PIFN+RBV. (2) 44% patients with retinopathy were asymptomatic. (3) Conversely, 62.5% of patients with visual and ocular symptoms had no retinopathy. (4) CWS remained stable or resolved despite continued therapy. (5) IRH persisted after completion of therapy, however did not affect vision. (6) Retinal changes developed early during PIFN+RBV therapy.