Retinal vein thrombosis associated with pegylated-interferon and ribavirin combination therapy for chronic hepatitis C

Abstract

An estimated 300 million people worldwide suffer from chronic hepatitis C with a prevalence of 0.8%-1.0% of the general population in Canada. An increasing pool of evidence exists supporting the use of pegylated- interferon (pegIFN) and ribavirin combination therapy for hepatitis C. We report a 49-year old male of North American aboriginal descent with chronic hepatitis C (genotype 2b). Biopsy confirmed that he had cirrhosis with a 2-wk history of left eye pain and decreased visual acuity. He developed retinal vein thrombosis after 16 of 24 wk of pegIFN-alpha 2a and ribavirin combination therapy. He was urgently referred to a retinal specialist and diagnosed with non-ischemic central retinal vein occlusion of the left eye. PegIFN and ribavirin combination therapy was discontinued and HCV RNA was undetectable after 16 wk of treatment. Hematologic investigations revealed that the patient was a factor V Leiden heterozygote with mildly decreased protein C activity. Our patient had a number of hypercoagulable risk factors, including factor V Leiden heterozygosity, cirrhosis, and hepatitis C that alone would have most likely remained clinically silent. We speculate that in the setting of pegIFN treatment, these risk factors may coalesce and cause the retinal vein thrombosis.

Anti-Interleukin-6 Receptor Antibody Therapy-Induced Retinopathy in a Patient with Rheumatoid Arthritis

“…This possibility is supported by a report of ocular findings that were similar to the ocular manifestations of infectious endocarditis [10]. Regarding the direct involvement of tocilizumab, the drug itself might directly affect the retinal vascular endothelial cells by impairing the retinal microcirculation as with interferon therapy [11, 12]. Modification of leukocyte adhesion to the vascular endothelial cells and retinal capillary occlusion might have caused the vascular changes in our patient.…”

A prospective study of change in visual function in patients treated with pegylated interferon alpha for hepatitis C in the UK

“…Furthermore, our detection rate for retinopathy may have been low, as cotton wool spots and other fundal signs are generally transient phenomena. It has also recently been postulated that additional risk factors for clotting, such as factor V Leiden heterozygosity and protein C or S disorders, can, in the setting of interferon treatment, tip the balance toward retinal vascular events such as vein occlusion 16. Again, examining risk factors such as lipid profile, factor V Leiden status and smoking habit would be useful in future, larger studies.…”

Ophthalmologic Complications in Children With Chronic Hepatitis C Treated With Pegylated Interferon

“…Following the initial reports of retinopathy in adults by Ikebe (9) there have been many reports in adults with HCV of the ophthalmologic complications of interferon (8, 9, 10, 11, 12, 13, 14, 15, 16, 17). Common interferon induced ophthalmologic side effects include retinopathy characterized by cotton-wool spots, often with retinal hemorrhage and microaneurysms (8).…”

“…Optic neuropathy has been described in up to 20% of patients (11). Rarer findings include optic neuritis, papilledema, retinal artery occlusion, retinal vein thrombosis, intraocular hemorrhage and Vogt-Koyanagi-Haradalike disease (idiopathic panuveitis) (8, 12, 15, 16, 17, 18, 19). HCV infection in and of itself may be associated with retinopathy, as the prevalence of retinopathy in adults with HCV who have not received interferon may be higher that adults without HCV (10).…”