Anterior Segment Inflammation Research Articles

Auxiliary Laboratory and Imaging in Non-Infectious Uveitis

Intraocular inflammations are still a diagnostic challenge for ophthalmologists. It is often difficult to make a precise etiological diagnosis in certain situations. Ancillary investigations are very useful in diagnosing the pathologies and monitoring inflammation in the anterior as well as the posterior segment. The most commonly used ancillary investigations in noninfectious uveitis include laser flare meter for anterior segment inflammation, fundus fluorescein angiography (FA) for retinal diseases, indocyanine green angiography (ICGA) for choroidal pathologies, fundus autofluorescence (FAF) for retinal pigment epithelium (RPE) and optical coherence tomography (OCT) as well as ultrasonography for the posterior segment. Laboratory investigations in the diagnosis of noninfectious uveitis are also very important, This review aims to be an overview describing the role of commonly used investigations.

Correlation between Subfoveal Choroidal Thickness and Anterior Segment Inflammation in Patients with Chronic Stage of Vogt-Koyanagi-Harada Disease

ABSTRACT Purpose To correlate changes in subfoveal choroidal thickness (SCT) with the degree of anterior inflammatory activity in chronic Vogt-Koyanagi-Harada (VKH) disease. Methods Anterior segment inflammation was assessed using SUN anterior chamber cell grading criteria, and SCT was measured using EDI-OCT in patients with VKH at multiple visits. ANOVA was used to compare the mean SCT for each anterior chamber cell grade. Regression analysis was used to correlate the anterior segment cell grade and the SCT. Results 14 patients were included in the study. A total of 432 data points consisting of SCT and anterior segment cell values were analyzed. ANOVA demonstrated significant difference between the mean SCT for different anterior chamber cell grades (p < .0001). Regression analysis demonstrated significant correlation between SCT and grade of anterior chamber cells (R2 = 0.37, p < .001). Conclusions Chronic VKH is characterized by a dynamic change in SCT that correlates with anterior segment inflammatory activity.

Anterior Segment Inflammation in Pediatric Uveitis Is Associated with Reduced Retinal Vascular Density as Quantified by Optical Coherence Tomography Angiography

ABSTRACT Purpose To analyze the retinal capillary vascular density (VD) as quantified by optical coherence tomography angiography (OCTA) in patients with pediatric uveitis. Methods OCTA images of 32 pediatric uveitis patients and 30 normal controls (NC) were obtained retrospectively. The foveal avascular zone (FAZ) area, VDs in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), the central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were analyzed and compared between active and quiescent uveitic eyes, contralateral eyes and NC eyes. Results Compared with NCs, the VDs in the SCP and DCP were significantly reduced in eyes with both active and quiescent pediatric uveitis (P < .05).The SFCT was increased significantly in the active group relative to the quiescent group and NC groups (P < .05). In contrast, no significant differences were observed in the FAZ and CMT (all P > .05). Conclusions Our quantitative OCTA findings suggest that the posterior segment is affected during anterior segment recurrence in patients with pediatric uveitis.

Current clinical application of sclera and amniotic membrane for ocular tissue bio-replacement.

To report the current clinical applications and trends of scleral and amniotic membrane use in ophthalmology. Review of annual reports from the Catalan Transplant Organization (OCATT), on scleral patch and amniotic membrane eye indications in Catalonia region (Spain) over a 6-year period from 2013 to 2018. A total of 874 scleral and 1665 amniotic membranes patches were implanted, from January 2013 to December 2018. The most frequent indication over the 6-year period for scleral patch was glaucoma surgery (77.5%), eyelid reconstruction (5.2%) and corneal or scleral ulcer (5%). Regarding amniotic membrane, corneal ulcer (26.9%), conjunctival reconstruction (23.8%) and corneal epithelial defect (22.7%) were the most common indications. During the study period, an increasing trend was found on sclera patches for eyelid reconstruction (p = 0.0032) and amniotic membrane for inflammation management (p = 0.0198). Glaucoma surgery and corneal ulcers have represented the top indications for scleral patch and amniotic membrane use, over the period, respectively. A significant trend has also been found towards eyelid reconstruction using scleral patches and amniotic membrane for anterior segment inflammation management. This evolving scenario in tissue use for ocular surgery has to be taken into consideration, especially regarding eye banks facing current and futures changes in tissue preservation, storage and indications.

Devastating sight- and life-threatening laser blepharoplasty complications

A 53-year-old woman was referred to our centre by a private aesthetic clinic. She presented with bilateral severe periorbital swelling and reduced visual acuity in her left eye for three days prior to presentation. She had undergone CO2 laser blepharoplasty one week prior to assessment. Ophthalmic examination revealed periorbital swelling in both eyes with pouring pus discharge from the lower lid as well as underlying erythematous and ulcerative skin. There was limitation of extraocular muscle movement and conjunctival chemosis. Right-eye vision was 6/9, left-eye vision was counting fingers secondary to anterior segment inflammation. No sign of optic nerve involvement was noted. Computed tomography findings showed rim-enhancing preseptal collections with air pockets bilaterally involving the lower eyelids and measuring 2.6 x 4.3 x 2.7 cm on the left and 2.3 x 4.2 x 2.8 cm on the right with an extension of the collection into the lateral extra-conal region. She was treated as bilateral orbital cellulitis secondary to postsurgical infection. The patient underwent incision and drainage and started with systemic antibiotics promptly. She showed significant improvement after treatment. This is an unusual complication from cosmetic surgery in which delayed treatment can lead to sight- and life-threatening complications.

Chemical eye injury: pathophysiology, assessment and management.

Chemical eye injury (CEI) is an acute emergency which can threaten sight and life. These commonly occur at home or the workplace with the former being generally mild and the latter more severe and bilateral. Major workplace accidents involve other parts of the body and can be associated with inhalation or ingestion of the chemical. Alkali injuries cause damage by saponification of tissue and deeper penetration as a consequence. Acid injuries cause rapid coagulation of tissue, which impedes penetration and limits damage. Irritants such as alcohols, cause superficial epithelial denudation. Severe chemical insult can affect all anterior segment structures causing iris, pupil and lens abnormalities. Eye pressure is variably affected and can be low or high or start as one and rapidly change to the other. Chorioretinal changes in the form of vasculopathy are seen and ascribed to be secondary to anterior segment inflammation rather than due to the direct effect of CEI. Final outcome related to structure and function is determined by the injurious agent, duration of exposure, nature of treatment and the rapidity with which it is instituted. Prevention of further damage by profuse and prolonged eye wash, after ascertaining pH of both eyes, together with exploration and removal of all particulate matter, is the key. Other management principles include a complete and thorough assessment, control of inflammation, facilitation of healing and prevention and management of sequelae and complications. Intraocular pressure is often forgotten and must be assessed and managed. Management often requires a multidisciplinary approach.

Triamcinolone acetonide induces sterile endophthalmitis in patients with intermediate uveitis: A case report series.

Due to their anti-inflammatory, antiangiogenic and antiedematous properties, corticosteroids have been commonly used in the treatment of retinal diseases. Intravitreal administration of steroids offers the maximal drug efficacy and the lowest risk of systemic side effects. The authors report three cases of presumed sterile endophthalmitis induced by triamcinolone acetonide (TA) in three eyes with intermediate non-infectious uveitis. Each patient received a single intravitreal injection of TA of 4 mg. Because of the intense vitreous inflammatory reaction, retina examination and the optical coherence tomography could not be performed, although vitreous opacities were observed on the ocular ultrasound. The dense vitreous opacity is a defining factor, the anterior segment inflammation is mild to moderate and a hypopyon is present, which may be a sterile inflammatory reaction or the triamcinolone material itself. In cases of sterile endophthalmitis, the visual acuity increases progressively as the intraocular inflammation diminishes. Local treatment with topical antibiotics, prednisolone acetate and cycloplegic eyedrops is recommended to control the inflammatory reaction.

Rhegmatogenous retinal detachment masquerading as exudative panuveitis with intense anterior chamber inflammatory reaction

PurposeThis is a retrospective case report illustrating the diagnostic and therapeutic challenges associated with a chronic rhegmatogenous retinal detachment masquerading as a severe panuveitis with intense anterior chamber inflammation. We have included clinical features, anterior segment and fundus photography, B-scan ultrasonography, fluorescein angiography, and intraoperative findings. ObservationsA 26-year-old male presented with features of unilateral panuveitis: hypotony, anterior segment inflammation (posterior synechiae and anterior chamber cell with fibrin clumping), diffuse choroidal thickening, and retinal detachment. Laboratory investigations for infectious or rheumatologic processes were negative, and empiric systemic corticosteroid therapy was unsuccessful. This prompted suspicion for an alternate primary etiology, and pars plana vitrectomy revealed small retinal breaks as the underlying cause of the retinal detachment and inflammation. ConclusionsRhegmatogenous retinal detachments are a known cause of intraocular inflammation. Nevertheless, it remains a challenge to recognize retinal breaks in this setting, particularly with robust anterior segment inflammation and posterior findings resembling severe exudative uveitis. Being aware of this unique presentation may prevent delays in diagnosis and have important prognostic implications.

Anterior segment optical coherence tomographic characterisation of keratic precipitates

Background/objectivesAnterior segment optical coherence tomography (AS-OCT) can be used to visualise keratic precipitates (KPs) on the corneal endothelium. However, there has been no correlation between characteristic clinical appearances of KPs and AS-OCT morphology. We wished to assess the potential diagnostic role of AS-OCT in patients presenting with inflammatory eye disease and KPs. Subjects/methodsSix patients with inflammatory KPs were compared to one patient with infective interface keratitis following Descemet Membrane Endothelial Keratoplasty (DMEK) and one patient with endothelial pigment. AS-OCT was performed in each case and morphological features of the KPs were compared. Reflectivity of KPs was also compared numerically by measuring their relative lightness. ResultsAS-OCT images in acute and active inflammation generally demonstrated hyperreflective KP variants in comparison to conditions with moderate or longstanding inflammation. In the patient with infective interface keratitis, KPs were evident on the endothelial surface but no changes could be identified at the graft-host interface. There were no significant differences between infective and inflammatory KPs to help distinguish between the two. Endothelial pigment deposits were clearly differentiated from keratic precipitates with smaller, poorly defined deposits on the endothelium surface which were isoreflective to the cornea. ConclusionHyperreflective KPs could be suggestive of newly deposited KPs and active inflammation; they may also be increased in KPs of herpetic origin. AS-OCT should not be used to differentiate infective infiltrate from inflammatory KPs if a patient were to present with post-operative inflammation and interface infection should still be suspected even if only endothelial deposits are identified on AS-OCT. AS-OCT may be used as a diagnostic and monitoring tool to assess response to treatment in cases where anterior segment inflammation of uncertain aetiology is present.

Uveitis\u2013glaucoma\u2013hyphema syndrome with sclera-fixed posterior-chamber two-haptic intraocular lens in a highly myopic eye: a case report

BackgroundWe report a case of uveitis–glaucoma–hyphema (UGH) syndrome in a highly myopic pseudophakic eye with seemingly normal positioning of a two-haptic intraocular lens (IOL).Case presentationThe patient was a 61-year-old woman suffering recurrent episodes of blurred vision, floaters, redness, elevated intraocular pressure (IOP), and pain in the right eye following implantation of a sclera-fixed IOL. The symptoms were alleviated by the systemic and topical administration of IOP-lowering and anti-inflammatory medications. A slit-lamp examination revealed depigmentation and atrophy of the iris, and a quiet anterior chamber in the right eye. Endophthalmitis caused by hypovirulent bacteria and UGH syndrome were both considered. Ultrasound biomicroscopy (UBM) and gonioscopy provided direct evidence of malpositioned IOL haptics, which pushed the root of the iris forward, resulting in persistent mechanical chaffing, the probable cause of UGH syndrome. IOL explantation resolved her symptoms. Negative bacterial culture results for the IOL excluded the possibility of endophthalmitis.ConclusionsHeightened awareness of underlying UGH syndrome and prompt UBM are important when doctors encounter a patient with a sclera-fixed IOL suffering from recurrent anterior segment inflammation and elevated IOP.

Role of choroidal thickness assessment in unilateral acute anterior uveitis.

Purpose:The aim of our study was to investigate the change in the subfoveal choroidal thickness in unilateral acute anterior uveitis with treatment. Choroidal inflammation is uncommon but can occur in the acute stage of anterior uveitis.Methods:All diagnosed patients with the first episode of unilateral acute anterior uveitis were included in the study conducted for a period of July 2017–July 2018. Choroidal thickness at subfoveal region was measured with spectralis spectral domain optical coherence tomography using enhanced depth-imaging scans. Standardized, masked manual measurement of the choroidal thickness was performed in the center of the ETDRS fields. The unaffected fellow eye of the same patient was taken as a control group and their subfoveal choroidal thickness was measured. Follow up of the patients was done at 2 weeks posttreatment to reevaluate the choroidal thickness.Results:A total of 61 eyes of 61 patients with unilateral acute anterior uveitis were included in the study. The mean central subfoveal choroidal thickness was significantly higher (304.82 ± 73.17 μm) as compared to that of controls (251.28 ± 66.38 μm) at presentation (P < 0.001). Following treatment and at two weeks follow up, the subfoveal choroidal thickness significantly reduced from 304.82 ± 73.17 to 274.46 ± 63.82 μm (P < 0.001). Also the subfoveal choroidal thickness was positively correlated with visual acuity (r = 0.22, P < 0.251) before treatment.Conclusion:Acute anterior uveitis is associated with an increase in the subfoveal choroidal thickness followed by the significant decrease in choroidal thickness with treatment, suggesting that choroid is also inflamed along with anterior segment inflammation.

Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study.

We analysed histologically two Acanthamoeba keratitis (AK) eyes with anterior and posterior segment inflammation and blindness. Two enucleated eyes of 2 patients (age 45 and 51y) with AK (PCR of epithelial abrasion positive) were analysed. Histological analysis was performed using hematoxylin-eosin, periodic acid-Schiff and Gömöri-methenamine silver staining. We could not observe Acanthamoeba trophozoites or cysts neither in the cornea nor in other ocular tissues. Meanwhile, we found uveitis, retinal vasculitis and scleritis in these eyes, due to the long-standing, recalcitrant AK. So in this stage of AK, systemic immune suppression may be necessary for a longer time period.

Synthetic Glucocorticoid-Induced Leucine Zipper Peptide Inhibits Lipopolysaccharide-Induced Ocular Inflammation in Rats

Purpose: To demonstrate the anti-inflammatory action of a synthetic glucocorticoid-induced leucine zipper (GILZ^98–134) peptide (GILZ-p) in a model of endotoxin-induced uveitis (EIU) in rats. Methods: The EIU model was induced in Sprague Dawley rats with an intravitreal injection of lipopolysaccharide (LPS). Synthetic GILZ-p was injected intravitreally 6 h after the LPS injection. To evaluate the anti-inflammatory effects of GILZ-p, the inflammatory response in the anterior chamber and iris of the rat eyes was evaluated with a slitlamp microscope on days 0, 1, 2, 3, and 4 after GILZ-p injection. The retinal expression of inflammatory cytokines was measured on days 0, 1, 2, 3, and 4 after GILZ-p injection. Müller cell gliosis was also detected at planned time points after GILZ-p injection. Results: Anterior segment inflammation peaked at 24 h after LPS injection in the EIU model. Compared with the controls, intravitreal GILZ-p significantly suppressed LPS-induced anterior segment inflammation in the EIU rats. The levels of retinal inflammatory factors IL-1β, TNF-α, MCP-1, and ICAM-1 were simultaneously reduced by the intravitreal GILZ-p injection. The expression of vimentin in the EIU retina was significantly reduced by GILZ-p, and the downregulated aquaporin 4 in the EIU retina was significantly restored by GILZ-p. Conclusion: The synthetic GILZ-p inhibited the inflammatory reaction in the EIU model and may have utility in the treatment of inflammatory ocular disease.

Clinical Features and Diagnosis of Anterior Segment Inflammation Related to Cytomegalovirus in Immunocompetent African, Asian, and Caucasian Patients

ABSTRACT Objective: To report the clinical features and treatment outcomes in immunocompetent patients with anterior segment inflammation (ASI) related to human cytomegalovirus (HCMV) depending on their ethnic origin. Material and Methods: Multicenter retrospective study of 38 patients with at least one test, either HCMV-positive PCR or GWc. Results: Features of Posner-Schlossman syndrome were observed in 50% of the eyes, Fuchs heterochromic iridocyclitis in 13% of the eyes, chronic nonspecific anterior uveitis in 21% of the eyes, and corneal endotheliitis in 18% of the eyes. PCR and GWc were positive for HCMV in 50% and 96.2% of the eyes, respectively. Glaucoma was diagnosed in 50% of eyes. Treatment was oral valganciclovir in about half of the patients. Other treatments were intravenous ganciclovir and/or ganciclovir topical ointment and/or intravitreal ganciclovir. Conclusions: No obvious association of specific clinical features with individual ethnicity could be identified. We found a high rate of glaucoma in all ethnic groups. There was a delay in diagnosis and specific treatment of HCMV in most patients.

Incidence, Risk Factors and Surgical Outcomes of Cataract among Patients with Vogt-Koyanagi-Harada Disease

ABSTRACT Purpose: To investigate risk factors and surgical outcomes of cataract in Vogt-Koyanagi-Harada (VKH) disease. Methods: Review of 187 patients (374 eyes). Results: At presentation, cataract was diagnosed in 56 (14.9%) eyes all had chronic recurrent VKH. During follow-up, cataract developed in additional 51 (13.6%) eyes. Fifteen (13.6%) of these had initial-onset acute VKH with anterior segment (AS) inflammation and 36 (19.4%) had chronic recurrent VKH. No patient with initial-onset acute VKH without AS inflammation developed cataract. Risk factors for cataract development during follow-up included female gender, keratic precipitates, anterior chamber reaction ≥2+, chronic recurrent VKH, posterior synechiae, iris nodules, glaucoma, glaucoma surgery, choroidal neovascular membrane, “sunset glow fundus” and chorioretinal atrophy. Thirty-two eyes underwent cataract extraction. Fourteen (43.8%) eyes achieved ≥20/40. Posterior segment complications of chronic recurrent VKH accounted for <20/40 outcome. Conclusions: Poor outcome after surgery is secondary to posterior segment complications of chronic recurrent VKH.

Ultra-widefield Fluorescein Angiography and OCT Findings in Tubulointerstitial Nephritis and Uveitis Syndrome

To report the spectrum of posterior segment findings in tubulointerstitial nephritis and uveitis syndrome (TINU) and discuss the abnormalities that can be seen on imaging. Retrospective, consecutive case series. Patients with TINU and posterior segment manifestations on examination or imaging. Patients with elevated urine beta-2 microglobulin (Uβ2M) and a diagnosis of TINU were included if they were evaluated at the Cole Eye Institute and did not have alternative etiologies for uveitis. Electronic medical records were reviewed for abnormal findings on ultra-widefield fluorescein angiography (UWFFA) and OCT. Presence of peripheral vascular leakage, optic disc leakage, chorioretinal lesions, or leakage within the macula on UWFFA. For OCT findings, patients were categorized as having intraretinal fluid, epiretinal membrane, or optic nerve edema. Twenty eyes from 10 patients (6 female, 4 male) with a bimodal age distribution (10-46 years and 77-83 years) were included. Eighteen of 20 eyes (90%) underwent UWFFA; 13 eyes demonstrated the presence of peripheral vascular leakage, 5 eyes showed optic disc leakage, and 6 eyes had leakage within the macula. All eyes underwent OCT imaging; 7 eyes demonstrated intraretinal fluid, 4 eyes were found to have an epiretinal membrane, and 1 eye had optic nerve edema. Six eyes lacked anterior uveitis on initial or follow-up examination but had abnormal findings on UWFFA or OCT. Tubulointerstitial nephritis and uveitis syndrome is under-recognized in the clinical setting. It can manifest in patients of all ages, and posterior segment involvement is not uncommon. Abnormalities may be seen on posterior segment examination or imaging in the absence of anterior segment inflammation. Tubulointerstitial nephritis and uveitis syndrome should be considered in the differential diagnosis for patients presenting with bilateral uveitis without evidence of infection or other clear etiology for intraocular inflammation.

Cistoidni makularni edem nakon operacije katarakte

Pseudophakic cystoid macular edema (PCME) is the most common complication of cataract surgery and is one of the possible causes of low visual acuity after cataract surgery. Various factors are implicated in its development but the core mechanism is likely surgically induced anterior segment inflammation that results in the release of endogenous inflammatory mediators. Anti-inflammatory medicines, including steroid and nonsteroid anti-inflammatory drugs, are postulated as having a role in both the prophylaxis and treatment of PCME. This article presents an updated review on the pathogenesis, risk factors, prophylaxis and treatment in PCME that reflect current research and practice.

Instrument-based tests for measuring anterior chamber cells in uveitis: a systematic review protocol

BackgroundUveitis describes a group of inflammatory conditions affecting the eye. The ability to monitor inflammatory changes in anterior uveitis is crucial in clinical practice for making treatment decisions and in clinical trials for testing therapeutic agents. The current standard for quantifying anterior segment inflammation is clinical slit-lamp examination findings classified using the Standardisation of Uveitis Nomenclature (SUN) grading system. Such clinical grading systems rely on a subjective estimation using the slit lamp and are often non-linear and non-continuous scales, with large increases in cell count between each grade. Novel instrument-based technologies have emerged over the last few decades, which can provide objective and quantifiable measurements. This review will evaluate the reliability of such technologies and their level of agreement with anterior chamber (AC) cell count using clinical slit-lamp examination.MethodsStandard systematic review methodology will be used to identify, select and extract data from studies that report the use of any instrument-based technology in the assessment of AC cells. Searches will be conducted through bibliographic databases (MEDLINE, EMBASE and Cochrane Library), clinical trial registries and the grey literature. No restrictions will be placed on language or year of publication. The outcomes of interest are the correlation of index test measurements of AC cells with clinical grading systems using slit-lamp examination and the reliability of each index test identified. Quality assessment will be undertaken using QUADAS2. Degree of correlation between the index and reference test measures will be pooled and meta-analysed if appropriate.DiscussionA number of instrument-based tools are available for measuring AC cells. This review will evaluate the technologies available and measure the level of correlation of these alternative methods with clinical grading systems as well as their performance in reliability and repeatability. The findings of this review will identify those objective, instrument-based technologies which show good utility for measuring AC cells in a quantifiable way and which warrant further exploration for their sensitivity and reliability over the current standard.Systematic review registrationPROSPERO CRD42017084156 (Liu X, Moore DJ, Denniston AK). Instrument-based tests for measuring anterior chamber (AC) cells in uveitis: a systematic review. 2017). Study screening stage is complete. Data extraction stage has not yet commenced.

Comparison of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection versus topical steroids for treatment of postcataract surgery inflammation in children.

BACKGROUND:The aim of this study is to compare the clinical efficacy of a single intraoperative posterior sub-Tenon's capsule triamcinolone acetonide injection with postoperative topical steroids in controlling intraocular inflammation in uncomplicated pediatric cataract surgery.MATERIALS AND METHODS:A prospective comparative study of children (<13 years of age) undergoing cataract surgery in a tertiary care eye center in South India. Preoperative evaluation was similar in both groups. The surgical procedure was the same for both groups except at the end of surgery only Group 1 (right eye of bilateral cataracts and all unilateral cataracts) received intraoperative 0.5 ml (40 mg/ml) posterior sub-Tenon's injection of triamcinolone acetonide. Postoperatively, Group 1 was administered only topical antibiotic and Group 2 was put on topical antibiotic, mydriatic, and steroids. Intraocular inflammation and intraocular pressure (IOP) were assessed clinically on day 1, 1st week, 1st month, and 3 months, postoperatively.RESULTS:A total of 30 eyes were included in the study. Age ranged between 1 month and 132 months, with 18 eyes included in Group 1 and 12 eyes in Group 2. The mean postoperative IOP at the 3 months follow-up was not significantly different between groups (P = 0.4). The presence of intraocular lens had no role in postoperative inflammation (P = 1). Group 2 showed more anterior segment inflammation with six eyes (50%) developing posterior synechiae and distortion of the pupil 3 months postoperatively.CONCLUSION:In pediatric cataracts, a single intraoperative sub-Tenon's capsule injection of triamcinolone acetonide appears to be safe and effective in controlling postcataract surgery inflammation.

Incidence of retinopathy in patients with chronic hepatitis C treated with dual and triple antiviral protocols

Purpose The aim of this study was to compare the incidence of ophthalmological complications in chronic hepatitis C virus patients treated with dual versus triple antiviral protocols. Study design A Prospective, observational, comparative study. Setting Ahmed Maher Teaching Hospital and revised in the Outpatient Clinic of Ophthalmology Department of Beni Suef University. Patients and methods One hundred and fifty chronic hepatitis C virus patients were treated by dual therapy of sofosbuvir and ribavirin for 6 months (group A), and 150 patients were treated by triple therapy of sofosbuvir, ribavirin, and interferon pegylated interferon (pegINF-α) for 3 months (group B). Full general and ophthalmological examinations were done at the baseline visit before receiving treatment and at 3 and 6 months after treatment. Any ophthalmological complications including deterioration in best corrected visual acuity, anterior segment inflammation, or retinal complications in the form of hemorrhages, soft exudates, or changes in cup/disk ratio were recorded. Results In 11% of the patients under triple therapy, retinal hemorrhages and soft exudates were detected by the second visit; however, they resolved by the third visit. Patients under dual therapy showed no ophthalmological complications throughout the 6-month follow-up period. No uveitis or changes in best corrected visual acuity and cup/disk ratio were detected. Conclusion Interferon-free protocols showed no retinal complications. However, the retinal complications related to the interferon-containing protocols resolved shortly within weeks. Thus, interferon-free protocols showed higher safety on the eye.