Ophthalmologic complications of antiviral therapy in hepatitis C treatment

Abstract

Antiviral therapy consisting of interferon-alpha and ribavirin for chronic hepatitis C infection is associated with multi-system side-effects. Ophthalmologic complications are common and can be classified into two groups: interferon-associated retinopathy and atypical adverse events. Interferon-associated retinopathy has been investigated by multiple observational studies that have found widely divergent results. The clinical importance of this complication is, consequently, controversial. This review examines the literature with the specific goal of identifying the most important ophthalmologic issues facing the hepatologist prescribing antiviral therapy. Accordingly, it assesses the incidence of interferon-associated retinopathy, as well as its risk factors, pathogenesis, clinical manifestations and options for management using data from the observational studies. The likely benefit of a screening program, especially one targeting patients with the highest risk of developing interferon-associated retinopathy, is analysed. Atypical ophthalmologic adverse events occur less frequently than interferon-associated retinopathy during antiviral therapy for chronic hepatitis C infection. They often, however, lead to irreversible vision loss. We examine the reports of these adverse events - in individual case reports or case series and in the observational studies investigating interferon-associated retinopathy - to describe the spectrum of these adverse events, the likely outcome for patients and to highlight the most important areas of future clinical research.

Relationship Between Uveitis, Different Types of Viral Hepatitis, and Liver Cirrhosis

“…8 In the literature, few published reports have estimated the relationship between viral hepatitis, liver cirrhosis, and the potential risk of uveitis. 1–7,15,16 Grob et al 1 demonstrated that 13% of patients with uveitis were sera positive for hepatitis B surface antigen in a study from Switzerland. A survey from England showed 2% of patients with various types of uveitis were sera hepatitis B surface antigen positive.…”

“…17,18 Ocular manifestations related to treatment and nontreatment such as dry eye syndrome, Sjögren syndrome, xerophthalmia, Mooren ulcer, cystoid macular edema, ischemic retinopathy, ischemic optic neuropathy, uveitis, scleritis, and Vogt–Koyanagi–Harada disease with hepatitis B or C have been reported. 1–7,15,19,20 Nevertheless, the association between uveitis and viral hepatitis has not been extensively studied to date.…”

“…15,16,21,22 There were also few case reports of Vogt–Koyanagi–Harada disease occurring during interferon-α and ribavirin therapy for HCV. 19,23–25 …”

Bilateral simultaneous anterior ischemic optic neuropathy, an extrahepatic manifestation of hepatitis C cured with direct acting antivirals

“…One of the most frequent complications is an interferon-associated retinopathy [12], [13]. This retinopathy occurs in 30–60% of cases.…”

O olho na hepatite C: uma revisão

“…Conjunctivitis is the primary ocular side effect of ri bavirin. In addition, ribavirin increases the risk and severity of retinopathy when combined with IFN (81) . This potentiating effect of IFN can be ascribed to changes in the immune system in the balance between type 1 and 2 T-helper cells (82,83) .…”