Literature systematic review on the ophthalmological side effects of interferons

Abstract

Interferons alpha and beta have been used worldwide for a few decades, altering the natural history of several severe diseases including hepatitis C, cancer and immu nemediated conditions such as multiple sclerosis. The adverse events profile of interferons is well established, but only isolated reports of ophthalmological compli ca tions of interferon therapy have been published. The objective of this study was to carry out a literature systematic review on the subject, bringing to light the need for ca reful ophthalmological monitoring of patients undergoing interferon treatment. Nearly 500 cases of ophthalmological complications related to interferon have been repor ted. The most frequent findings were soft exudates, hemorrhages and retina ischemia. Keywords BACKGROUNDInterferons are natural glycoproteins that have antiviral, antipro liferative and immune regulatory functions. There are several classes including interferon alpha, beta and gamma. Interferons alpha and beta are used worldwide in the treatment of several di seases including hepatitis C, cancer and immune-mediated condi tions such as multiple sclerosis. Due to the long-term use of interferons for most patients, the safety profile of these compounds is well known. Cutaneous(1) , hematological (2) , psychiatric (3,4) , endo crine (5) and hepatic (6) side effects of interferons have been reported. However, some side effects are specifically related to the eye, and a variety of ophthalmological diseases may arise from the use of inter ferons. Although recognised as relatively rare, ophthalmo lo gical complications due to interferons should be considered even if the patient is visually asymptomatic.The literature on the subject is restricted to case reports or a small series of cases. In order to better understand the most fre quent ophthalmological side effects of interferons and the outcome of these conditions, a literature systematic review was carried out.

Interferon-associated retinopathy in a patient with metastatic melanoma

“…This is thought to increase leukocyte adhesion, which may trigger microcirculation obstruction (1)(2)(3) . Furthermore, it has been reported that IFN induces thrombogenic antibody proliferation (9) .…”

“…Typical ocular complications associated with its use include ischemic retinopathy associated with cotton wool spots, retinal hemorrhages, and peripheral vascular obstructions (7,9) . Microaneurysms, neovascular glaucomas, and ischemic optic neuropathies have also been observed (2,7,8) . Currently, IFN is the only accepted adjuvant treatment for patients with high-risk relapse melanoma (1) .…”

“…The most common side effects are fever, myalgia, arthralgia, and headache. Retinal damage may also be associated with its use (2,3) . Furthermore, more serious disorders such as neurologic alterations, hepatotoxicity, and hematopoietic or cardiovascular irregularities, have been associated with IFN treatment (2,3) .…”

“…Retinal damage may also be associated with its use (2,3) . Furthermore, more serious disorders such as neurologic alterations, hepatotoxicity, and hematopoietic or cardiovascular irregularities, have been associated with IFN treatment (2,3) . While IFN-associated retinopathy appears in 18-86% of patients treated with the drug, (especially in patients suffering from hepatitis C, for whom IFN is widely administered), many of these cases are asym ptomatic (4) .…”

“…However, in some cases complications that result in significant visual impairment can occur. Thus, monitoring and periodic ophthalmologic evaluation of patients undergoing IFN treatment is highly recommended (1,2) . Here we report a case of atypical IFN-associated retinopathy involving macular changes, appearing in a young woman with cutaneous melanoma.…”