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Li X, Guo T, Zhang Y, Liu K, Xu X, Fu Y, Liu X, Ren X, Yang H. Risk Factors for Fellow Eye Involvement in Patients with Nonarteritic Anterior Ischemic Optic Neuropathy. Ophthalmic Res 2022; 66:398-405. [PMID: 36502803 DOI: 10.1159/000528627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The aim of the study was to investigate the possible risk factors for fellow eye involvement in patients with nonarteritic anterior ischemic optic neuropathy (NAION). METHODS A total of 113 patients with unilateral NAION attack were included and divided into two groups according to whether fellow eye involvement was present over a mean follow-up period of 2.70 years (P25-P75: 0.77-3.54 years). General characteristics (including age, sex, diabetes, hypertension, hyperlipidemia, and obstructive sleep apnea syndrome [OSAS]) and ocular characteristics (including initial best-corrected visual acuity, initial visual field damage of the first eye, and the presence/absence of a crowded disc) were analyzed and compared between the two groups. Cox regression was used to assess the risk factors for fellow eye involvement. RESULTS During the follow-up period, 40 patients developed fellow eye involvement. The initial best-corrected visual acuity (p = 0.048) and mean deviation of the visual field (VF) (p = 0.039) of the first eye in patients with fellow eye involvement were worse than those in patients without it. Diabetes (HR = 3.06, 95% CI: 1.50, 6.26, p = 0.002) and increased VF damage (moderate vs. mild, HR = 2.92, 95% CI: 1.03, 8.25, p = 0.043; severe vs. mild, HR = 5.01, 95% CI: 1.65, 15.20, p = 0.004) were associated with a significantly increased risk of fellow eye involvement. In 57 patients with apnea-hypopnea index (AHI) data for further study, an AHI score ≥23.2 was also found to be a risk factor (HR = 3.36, 95% CI: 1.17, 9.69, p = 0.025). CONCLUSION Diabetes, severer initial VF damage, and more severe OSAS were risk factors for fellow eye involvement in NAION. For patients with these risk factors, more intensive follow-ups might be warranted.
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Affiliation(s)
- Xinnan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China,
| | - Taimin Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yurong Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Kaiqun Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yue Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaoning Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xin Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hui Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Mesentier-Louro LA, Stell L, Yan Y, Montague AA, de Jesus Perez V, Liao YJ. Immunoprofiling of Nonarteritic Anterior Ischemic Optic Neuropathy. Transl Vis Sci Technol 2021; 10:17. [PMID: 34264294 PMCID: PMC8288058 DOI: 10.1167/tvst.10.8.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Nonarteritic anterior ischemic optic neuropathy (NAION) is a common acute optic neuropathy in those older than 50 years. There is no blood diagnostic test or efficient treatment for NAION. We investigated the suitability of blood inflammatory proteins as biomarkers and therapeutic targets of NAION. Methods We conducted an exploratory, cross-sectional case-control study including 18 patients with NAION (n = 5 acute, and n = 13 chronic) and 9 controls. NAION was confirmed by clinical examination and optical coherence tomography. Subjects underwent peripheral blood collection; plasma was isolated within 2 hours and analyzed using a 76-plex array of cytokines, chemokines, and growth factors. Results In acute NAION, there was increased peripapillary retinal thickness on optical coherence tomography consistent with optic disc edema. Plasma profiling revealed dramatic changes in inflammatory proteins in NAION. Statistical analysis generated a list of 20 top-ranked molecules in NAION, with 15% overlap in acute and chronic NAION. Principal component analysis, hierarchical clustering, and Spearman correlation generally segregated controls, acute and chronic NAION, with some overlap. Longitudinal data from one patient demonstrated an evolving inflammatory pattern from acute to chronic NAION. In acute NAION, Eotaxin-3, MCP-2, TPO, and TRAIL were the top biomarker candidates. In chronic NAION, IL-1α and CXCL10 emerged as the strongest therapeutic targets. Conclusions Post-NAION inflammation occurs in both acute and chronic NAION. Statistical analysis of plasma profile changes generated a list of 20 potential biomarker and therapeutic targets of NAION. Translational Relevance We identified blood molecular targets to improve NAION diagnosis and treatment.
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Affiliation(s)
| | - Laurel Stell
- Department of Biomedical Data Science, Stanford University, School of Medicine, Stanford, CA, USA
| | - Yan Yan
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, CA, USA.,Department of Ophthalmology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Artis A Montague
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, CA, USA
| | - Vinicio de Jesus Perez
- Department of Pulmonary Medicine, Stanford University, School of Medicine, Stanford, CA, USA
| | - Yaping Joyce Liao
- Department of Ophthalmology, Stanford University, School of Medicine, Stanford, CA, USA.,Department of Neurology, Stanford University, School of Medicine, Stanford, CA, USA
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Ocular Manifestations in Patients with Philadelphia-Negative Myeloproliferative Neoplasms. Cancers (Basel) 2020; 12:cancers12030573. [PMID: 32121664 PMCID: PMC7139696 DOI: 10.3390/cancers12030573] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 02/07/2023] Open
Abstract
The major complications of Philadelphia-negative (Ph-Negative) myeloproliferative neoplasms (MPNs) are thrombosis, haemorrhage and leukemic transformation. As systemic and haematological diseases, MPNs have the potential to affect many tissues and organs. Some complications lead to the diagnosis of MPNs, but other signs and symptoms are often misdiagnosed or neglected as a sign of MPN disease. Therefore, we reviewed the current literature to investigate and delineate the clinical manifestations seen in the eyes of Ph-negative MPN patients. We found that ocular manifestations are common among patients with MPNs. The most frequently described manifestations are due to the consequences of haematological abnormalities causing microvascular disturbances and hyperviscosity. More serious and vision-threatening complications as thrombotic events in the eyes have been repeatedly reported as well. These ocular symptoms may precede more serious extraocular complications. Accordingly, combined ophthalmological and haematological management have the potential to discover these diseases earlier and prevent morbidity and mortality in these patients. Furthermore, routine ophthalmological screening of all newly diagnosed MPN patients may be a preventive approach for early diagnosis and timely treatment of the ocular manifestations.
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Lewczuk N, Zdebik A, Bogusławska J. Interferon Alpha 2a and 2b in Ophthalmology: A Review. J Interferon Cytokine Res 2019; 39:259-272. [PMID: 30950678 DOI: 10.1089/jir.2018.0125] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Interferon alpha (IFN-α) is a glycoprotein with antitumor, antiviral, and immunomodulatory activity, used widely in the treatment of viral infections (hepatitis B and C, condylomata acuminata, herpes zoster, etc.), hematological disorders (leukemia, multiple myeloma, T cell lymphoma, and essential thrombocythemia), and solid tumors (clear cell carcinoma in the metastatic stage, melanoma, hepatocellular carcinoma, and cervical neoplasia). Studies have proven the effectiveness of IFN-α in the treatment of ophthalmic disorders involving the anterior segment of the eye (conjunctival papilloma, squamous neoplasia, conjunctival mucosa-associated lymphoid tissue, Mooren's ulcer, and vernal keratoconjunctivitis) and the posterior segment of the eye (serpiginous choroidopathy, posterior uveitis, pseudophakic and diabetic cystoid macular edema, and proliferative diabetic retinopathy). The therapy with IFN-α remains a promising alternative in cases of a failing response to conventional therapy, helping to maintain or improve visual acuity, prevent vision loss, and ameliorate the prognosis of the patient. However, clinicians who decide to use IFN-α in their patients must be aware of general and ophthalmological side effects and inform their patients to undergo a systemic evaluation such as a physical examination, blood and serological tests, and a chest X-ray before the beginning of treatment. This review presents the current knowledge of the use of IFN-α, its efficacy, and properties in ophthalmological diseases, and thus may encourage clinicians to administer this drug as a treatment modality in ophthalmological diseases in the future.
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Affiliation(s)
- Natalia Lewczuk
- 1 Department and Clinic of Ophthalmology, University of Wrocław Medical College, Wrocław, Poland
| | - Alexander Zdebik
- 2 Department and Clinic of Dermatology and Allergology, Asklepios Nordseeklinik GmbH, Sylt, Germany
| | - Joanna Bogusławska
- 1 Department and Clinic of Ophthalmology, University of Wrocław Medical College, Wrocław, Poland
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Miller NR, Arnold AC. Current concepts in the diagnosis, pathogenesis and management of nonarteritic anterior ischaemic optic neuropathy. Eye (Lond) 2015; 29:65-79. [PMID: 24993324 PMCID: PMC4289822 DOI: 10.1038/eye.2014.144] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/13/2014] [Indexed: 01/12/2023] Open
Abstract
Nonarteritic anterior ischaemic optic neuropathy (NAION) is the most common acute optic neuropathy in patients over the age of 50 and is the second most common cause of permanent optic nerve-related visual loss in adults after glaucoma. Patients typically present with acute, painless, unilateral loss of vision associated with a variable visual field defect, a relative afferent pupillary defect, a swollen, hyperaemic optic disc, and one or more flame-shaped peripapillary retinal haemorrhages. The pathogenesis of this condition is unknown, but it occurs primarily in patients with structurally small optic discs that have little or no cup and a variety of underlying vascular disorders that may or may not be known at the time of visual loss. There is no consistently beneficial medical or surgical treatment for the condition, but there are now animal models that allow testing of various potential therapies. About 40% of patients experience spontaneous improvement in visual acuity. Patients in whom NAION occurs in one eye have a 15-19% risk of developing a similar event in the opposite eye over the subsequent 5 years.
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Affiliation(s)
- N R Miller
- Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - A C Arnold
- UCLA Department of Ophthalmology, The Jules Stein Eye Institute, Los Angeles, CA, USA
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Iferkhass S, Elasri F, Chatioui S, Khoyaali A, Bargach T, Reda K, Oubaaz A. [Bilateral non-arteritic ischemic optic neuropathy during treatment of viral hepatitis C with pegylated interferon and Ribavirin]. J Fr Ophtalmol 2014; 38:34-40. [PMID: 25533994 DOI: 10.1016/j.jfo.2014.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 05/22/2014] [Accepted: 06/16/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hepatitis C is a serious viral infection, for which the current treatment is based on the combination of pegylated interferon (IFN) and Ribavirin(®). Ophthalmic complications observed with PEG-IFN are infrequent and of variable prognosis. They often include an ischemic retinopathy with typical cotton-wool spots, hemorrhage and retinal edema, and rarely acute non-arteritic anterior ischemic optic neuropathy as illustrated by our report. OBSERVATION We report the case of a 51-year-old man followed for chronic active hepatitis C, who presented in the fourth month of treatment with pegylated interferon and vidarabine with a sharp decline in visual acuity secondary to acute bilateral non-arteritic anterior ischemic optic neuropathy. The hepatitis C treatment was discontinued. His course was notable by the third week for a significant regression of papilledema with improvement in visual acuity in the right eye and no change in the left eye, remaining at counting fingers. After regressing for four years, the disease progressed to bilateral temporal optic atrophy without change in visual acuity. CONCLUSION Pegylated interferon and Ribavirin(®) are commonly used in the treatment of chronic hepatitis C. They are the source of various ophthalmologic complications of varied severity. The pathophysiology of this ocular toxicity currently remains hypothetical. Non-arteritic ischemic optic neuropathy is still a relatively rare complication with a poor functional prognosis, often requiring discontinuation of treatment. Thus, careful ophthalmologic monitoring before and during antiviral treatment of patients with hepatitis C appears necessary.
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Affiliation(s)
- S Iferkhass
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc.
| | - F Elasri
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - S Chatioui
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - A Khoyaali
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - T Bargach
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - K Reda
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
| | - A Oubaaz
- Service d'ophtalmologie, hôpital militaire d'instruction Mohamed V, Madinat Al Irfane, Rabat, Maroc
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Pérez-Carro G, Fernández-Alonso R, González-Diéguez ML, Rodríguez-García M, Junceda-Moreno J. [Interferon-alpha toxicity and reversible bilateral optical neuropathy: a timely withdrawal of the drug]. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2014; 89:146-151. [PMID: 24269470 DOI: 10.1016/j.oftal.2012.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/06/2012] [Accepted: 09/02/2012] [Indexed: 06/02/2023]
Abstract
Clinical case A patient with chronic, painless, bilateral loss of vision, after significant intake of interferon (IFNα) and ribavirina due to liver transplant. Ocular fundus is normal. A suspected retrobulbar optic neuropathy is confirmed by a prolongation of the latency of the patient's visual evoked potential. There being no prior record of risk factors and with the patient's systemic analysis giving normal results, the clinical improvement and the electro-physiological tests conducted after the drug was withdrawn point to interferon as negatively affecting the bilateral optic nerve. Discussion Interferon-α is used in the treatment of viral and neoplastic illnesses. Currently the drug is formulated as Interferon alfa pegilado (IFNα-p) in order to reduce toxicity and increase tolerance. The most common secondary effects are flu symptoms, asthenia and weigh loss. Affected ocular tissue is rare and optic neuropathy is also an infrequent complication: retinopathy at the beginning of treatment is, however, more frequent. The most widely accepted hypothesis as to the cause of toxicity is the presence of circulating immune complexes. It is, therefore, essential for ophthalmologists to be aware of the toxicity of this drug in order to be able to withdraw it in good time, thus preventing potentially irreversible sight loss.
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Affiliation(s)
- G Pérez-Carro
- Servicio de Oftalmología, Hospital Valle del Nalón, Langreo, Asturias, España.
| | - R Fernández-Alonso
- Servicio de Neurofisiología, Facultativo Especialista de Área, Hospital Valle del Nalón, Langreo, España
| | - M L González-Diéguez
- Servicio de Digestivo, Área de Hepatología, Hospital Universitario de Asturias, Asturias, España
| | - M Rodríguez-García
- Servicio de Digestivo, Área de Hepatología, Hospital Universitario de Asturias, Asturias, España
| | - J Junceda-Moreno
- Servicio de Oftalmología, Hospital Valle del Nalón, Langreo, Asturias, España
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Jancoriene L, Norvydaite D, Galgauskas S, Balciunaite E. Transient visual loss in a hepatitis C patient treated with pegylated interferon alfa-2a and ribavirin. HEPATITIS MONTHLY 2014; 14:e15124. [PMID: 24693308 PMCID: PMC3950629 DOI: 10.5812/hepatmon.15124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/07/2014] [Accepted: 01/13/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Patients with Hepatitis C are commonly treated with combination of Pegylated Interferon alfa-2a and Ribavirin. Less than 1% of patients receiving this treatment experience very uncommon ophthalmological side effects such as optic neuropathy and vision disorder, which are usually subclinical, mild and reversible, not requiring the withdrawal of the treatment. Retinopathy is the most commonly reported ocular side effect of interferon use, usually presenting with cotton wool spots and retinal hemorrhages. CASE PRESENTATION We represent a case of severe retinopathy and optic neuropathy in a patient with chronic hepatitis C genotype 3a infection, treated with the combination of PEG-IFN alfa-2a (180 mkg once weekly) and Ribavirin (1200 mg daily). Bilateral visual loss of both eyes developed at 11th week of therapy and changes in retina and optic nerve were observed. Fluorescein angiography and optical coherence tomography showed bilateral anterior ischemic optic neuropathy and macular edema. Visual acuity improved 1 month and fundoscopic changes were no longer present 6 months after the urgent permanent discontinuation of PEG-IFN treatment and the pulse steroid therapy followed by a 2 week course of oral prednisone. DISCUSSION In case of interferon-associated retinopathy discontinuation of the therapy and treatment with high dose steroids can be beneficial. The prognosis of interferon-associated opthalmological side effects remains uncertain: in some patients visual acuity improves, other continues with poor visual outcome. Considering that, all patients should undergo ophthalmologic examination before treatment with interferon and their ophthalmological status should be monitored regularly while receiving this therapy.
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Affiliation(s)
- Ligita Jancoriene
- Department of Infectious, Chest Diseases, Dermatovenerology and Alergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Corresponding Author: Ligita Jancoriene, Department of Infectious, Chest Diseases, Dermatovenerology and Alergology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. Tel: +37-68785870, Fax: +37-52752790, E-mail:
| | - Dovile Norvydaite
- Department of Otolaryngology and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Saulius Galgauskas
- Department of Otolaryngology and Eye Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Evelina Balciunaite
- Department of xx, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Sellner J, Steiner I. Neurologic complications of hepatic viruses. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:647-61. [PMID: 25015509 DOI: 10.1016/b978-0-444-53488-0.00031-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Johann Sellner
- Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universität Munich, Germany
| | - Israel Steiner
- Department of Neurology, Rabin Medical Center, Petach Tikva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Bilateral Ischemic Optic Neuropathy Developed under Interferon Therapy. Case Rep Ophthalmol Med 2012; 2012:102739. [PMID: 23119208 PMCID: PMC3483686 DOI: 10.1155/2012/102739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 09/25/2012] [Indexed: 12/03/2022] Open
Abstract
Introduction. Interferon is a glycoprotein produced by assigned cells of immune system. It has been used in many different diseases. Although flu-like syndrome, myalgia, rash, hypotension, thrombocytopenia and peripheral neuropathy due to interferon use are encountered frequently, ocular side effects are rare, generally mild and transient. Case Report. 47-year-old female patient, presented with a mass lesion in right renal pelvis. Right radical nephrectomy was applied and the histopathological examination was consistent with papillary renal cell carcinoma. Interferon alpha treatment was started subcutaneously at the dose of 5 MIU/3 times in a week. Four weeks after the interferon therapy, suddenly bilateral visual loss developed. We discussed the diagnosis, followup, and treatment of the patient who developed irreversible ischemic optic neuropathy and had no previous known primary systemic disease to cause this condition. Conclusion. We suggest that patients should be screened for risk factors causing optic ischemic neuropathy, before interferon therapy. Although there was no adequate information in the literature for the followup, patients should be monitorized before, 1 month after, and 2 months after the treatment. And if there is no complication, we suggest that they should be followed up at 3-month intervals.
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Al Mannai F, Qaddoura R, Derbala M. Ischemic Optic Neuropathy in Chronic Viral Hepatitis C Treated with Interferon and Ribavirin. Qatar Med J 2012. [DOI: 10.5339/qmj.2012.1.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Ischemic Optic Neuropathy (ION) is a rare complication of interferon (IFN) during treatment of Hepatitis C virus (HCV) with all reported cases occurring within three months of the start of therapy. We report a case of a late bilateral sequential ischemic optic neuropathy after 36 weeks of pegylated-interferon therapy. In contrast to previous reports, we recommend a regular ophthalmological follow-up throughout the whole course of interferon therapy.
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Affiliation(s)
- F.A. Al Mannai
- Ophthalmology Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - R.H. Qaddoura
- Ophthalmology Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
| | - M.F. Derbala
- Ophthalmology Section, Department of Surgery, Hamad Medical Corporation, Doha, Qatar
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Current concepts in the diagnosis, pathogenesis, and management of nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol 2011; 31:e1-3. [PMID: 21593625 DOI: 10.1097/wno.0b013e31821f955c] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Unilateral ocular sarcoidosis associated with interferon therapy. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Retinopathy associated with pegylated interferon and ribavirin treatment for chronic hepatitis C. ACTA ACUST UNITED AC 2010; 81:580-6. [DOI: 10.1016/j.optm.2010.04.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 02/08/2023]
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Ophthalmologic complications in children with chronic hepatitis C treated with pegylated interferon. J Pediatr Gastroenterol Nutr 2010; 51:183-6. [PMID: 20512062 PMCID: PMC2910798 DOI: 10.1097/mpg.0b013e3181b99cf0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Interferon treatment for chronic viral hepatitis C (HCV) has been associated with the development of retinopathy in 19% to 29% of adults. Our purpose is to describe the ophthalmologic complications of pegylated interferon-alpha2a with either placebo or ribavirin in children with chronic HCV (the PEDS-C trial). MATERIALS AND METHODS Prospective, comprehensive ophthalmologic examinations including slit lamp at enrollment and after 24 and 48 weeks of treatment of 114 children participating in a randomized clinical trial. RESULTS One hundred and twenty-eight children were screened for entry, of whom 123 had an eye examination and no child had existing retinal disease. One hundred fourteen children were eligible and were treated. One hundred ten children had an eye examination at 24 weeks and 103 children at 48 weeks. Three of 114 subjects (2.6%) developed documented (n = 2) or possible (1) serious eye complications. One subject developed evidence of ischemic retinopathy (cotton-wool spots) by week 24, 1 developed uveitis by week 48, and 1 reported at week 48 transient (<4 hours) monocular blindness that had occurred at week 36 with a subsequent normal examination at week 48. CONCLUSIONS Ophthalmologic complications are infrequent in children who are treated with pegylated interferon-alpha2a for HCV (2%-3%). Because of the potential severity of ischemic retinopathy and uveitis, prospective ocular assessment should remain part of the monitoring strategy for children who are treated with interferon for HCV.
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Abstract
A 52-year-old man with chronic hepatitis C presented with painless, bilateral, simultaneous nonarteritic anterior ischemic optic neuropathy (NAION) and peripheral neuropathy. Symptoms began 19 weeks after starting peginterferon alpha-2a. The peripheral neuropathy and vision of the right eye improved, but the vision of the left eye worsened after stopping interferon. We identified 23 additional cases of NAION during interferon alpha therapy. At least 12 of these patients suffered bilateral NAION. Patients lost vision 1-40 weeks after initiating therapy. Of 21 eyes that had documented initial and follow-up acuities, 8 improved, 1 worsened, and the rest remained stable. One patient had a painful peripheral neuropathy. Treatment with interferon alpha may result in NAION. Discontinuation of therapy deserves consideration after weighing individual risks and benefits.
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Fraunfelder FW, Fraunfelder FT. Interferon alfa-associated anterior ischemic optic neuropathy. Ophthalmology 2010; 118:408-11.e1-2. [PMID: 20630599 DOI: 10.1016/j.ophtha.2010.03.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 02/20/2010] [Accepted: 03/29/2010] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To report a possible association between interferon alfa therapy and anterior ischemic optic neuropathy (AION). DESIGN Database study and review of the literature. PARTICIPANTS Thirty-six case reports from spontaneous reporting systems and the literature. METHODS Case reports from a review of the literature were combined with spontaneous reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, and the Food and Drug Administration looking for reports on interferon therapy associated with optic neuropathy. MAIN OUTCOME MEASURES Data from the spontaneous reports include the type of interferon, age, gender, adverse drug reaction (ADR), dosage, duration of therapy until onset of ADR, concomitant drugs, systemic disease, and dechallenge and rechallenge data. RESULTS Thirty-six case reports of AION are described in association with interferon alfa therapy. The average age of subjects was 54.5 years; 26 were male and 10 were female. The median duration of therapy to onset of AION was 4.5 months, with 50% of subjects having some form of permanent vision loss. Anterior ischemic optic neuropathy was bilateral in 67% of subjects. There are 3 positive rechallenge case reports. CONCLUSIONS Interferon alfa's association with AION can be classified as "possible" using the World Health Organization classification system. If optic neuropathy is suspected, rapid cessation of interferon therapy may portend a better prognosis because multiple case reports indicate visual defects may be permanent if this possible ADR remains unrecognized.
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Affiliation(s)
- F W Fraunfelder
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon 97239-4197, USA.
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Wei YH, Wang IH, Woung LC, Jou JR. Anterior ischemic optic neuropathy associated with pegylated interferon therapy for chronic hepatitis C. Ocul Immunol Inflamm 2009; 17:191-4. [PMID: 19585362 DOI: 10.1080/09273940802687820] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To report a case of anterior ischemic optic neuropathy (AION) associated with the combined therapy of pegylated interferon alpha (PEG-IFNalpha) and ribavirin. METHODS Case report. RESULTS A 57-year-old male with chronic hepatitis C, treated with PEG-IFNalpha -2b and ribavirin for 6 months, noted sudden onset of painless blurred vision in his right eye. The initial visual acuity decreased to 20/60 in the right eye. Fundoscopy of right eye revealed optic disc edema with disc hemorrhage. Visual field examination disclosed inferior altitudinal defect. Relative afferent pupillary defect with poor color vision function was also noted in the right eye. Visual evoked potential demonstrated decreased amplitude in the right eye. A marked resolution of disc edema and improvement of visual acuity to 20/20 were noted at 6 weeks follow-up. CONCLUSIONS AION may occur in combined treatment of PEG-IFNalpha -2b and ribavirin for chronic hepatitis C. Patients who are candidates for this treatment should be informed about its possible occurrence.
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Affiliation(s)
- Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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Viennet A, Glatre F, Bacin F. [Interferon-related retinopathy in a man with chronic hepatitis C]. J Fr Ophtalmol 2009; 32:505-10. [PMID: 19592135 DOI: 10.1016/j.jfo.2009.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 04/12/2009] [Indexed: 11/28/2022]
Abstract
A 50-year-old diabetic man receiving insulin, and suffering from chronic hepatitis C treated with interferon alfa and ribavirin presented with an acute peripheral scotoma and retinopathy associated with interferon therapy. When the treatment was interrupted, all the clinical symptoms and the test abnormalities returned to normal. If the association of interferon alpha and ribavirin increase the incidence of retinopathy, diabetes, and hypertension are also risk factors. Therapeutic abstention and monitoring are usual in the absence of visual acuity changes. However, in certain cases, such as in this patient, ceasing treatment as a matter of urgency avoids serious visual aftereffects. However, because of the incidence on the liver disease, this treatment interruption requires having clearly ruled out all other differential diagnoses.
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Affiliation(s)
- A Viennet
- Service d'Ophtalmologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand Cedex 1, France.
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Kabbaj N, Sentissi S, Mohammadi M, Benaïssa A, Amrani N. Anterior ischemic optic neuropathy complicating interferon alpha and ribavirin therapy in patients with chronic hepatitisC. ACTA ACUST UNITED AC 2009; 33:115-7. [DOI: 10.1016/j.gcb.2008.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/15/2008] [Accepted: 12/14/2008] [Indexed: 11/24/2022]
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21
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Long-term management of thrombocytosis in essential thrombocythaemia. Ann Hematol 2008; 88:1-10. [DOI: 10.1007/s00277-008-0531-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/04/2008] [Indexed: 01/13/2023]
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22
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Fodor M, Nagy V, Berta A, Tornai I, Pfliegler G. Hepatitis C virus presumably associated bilateral consecutive anterior ischemic optic neuropathy. Eur J Ophthalmol 2008; 18:313-5. [PMID: 18320531 DOI: 10.1177/112067210801800226] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in a hepatitis C (HCV) infected patient and demonstrate the relationship between HCV and the development of NAION. METHODS Case report. RESULTS A 43-year-old woman with chronic HCV infection and long-term euthyroid autoimmune thyroiditis suddenly lost vision in her right eye, and 6 months later in her left eye, due to NAION. Slightly elevated levels of aminotransferases suggested liver infection activity. Anti-HCV antibody was detected; the genotype of the virus was 1b and the viral RNA level was 1.8 x 106 IU/mL. Liver biopsy proved chronic active hepatitis (Ishak score grading: 7, staging: 2). Except for the elevated levels of antithyroid antibodies and a weak antinuclear factor, the detailed laboratory examinations (thrombophilia, cryoglobulin, anticardiolipin antibodies, co-infections) revealed no other abnormalities; a causative relationship between the underlying chronic hepatitis C and bilateral NAION therefore seems probable. The patient was treated with pegylated interferon and ribavirin for 1 year and a sustained viral remission could be achieved. Her vision has neither improved nor deteriorated further. CONCLUSIONS This appears to be the first reported case of bilateral NAION presumably caused by HCV infection.
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Affiliation(s)
- M Fodor
- Department of Ophthalmology, Medical and Health Sciences Center, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
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Milet A, Blaise P, Andris C, Rakic JM. Atrophie papillaire bilatérale chez un patient héroïnomane. J Fr Ophtalmol 2007; 30:e29. [DOI: 10.1016/s0181-5512(07)74037-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sauer A, Lenoble P, Bader P, Speeg-Schatz C, Bourcier T, Nasica X. [Ocular complications of hepatitis C treatment]. J Fr Ophtalmol 2007; 30:e20. [PMID: 17878818 DOI: 10.1016/s0181-5512(07)91366-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Hepatitis C is a viral infection that can lead to hepatocellular carcinoma. According to current recommendations, the treatment is based on the association of pegylated interferon and ribavirin. Strict treatment criteria are available and apply for the 8,000 patients diagnosed every year in France. Ophthalmological side effects are numerous, unpredictable, and sometimes severe. CASE REPORT We report the case of a patient treated with an association of interferon and ribavirin for hepatitis C, who presented two periods of decreased visual acuity 4 years apart. Interferon-related toxic retinopathy was suggested for the first event, while optical neuropathy was diagnosed for the second. CONCLUSION Ocular complications of hepatitis C treatment with interferon and ribavirin are frequent but often benign. Our recommendations are periodic ophthalmological examinations, including visual acuity and fundus examination, before starting the treatment, at 3 months, and if necessary at 9 months.
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Affiliation(s)
- A Sauer
- Service d'Ophtalmologie, Hôpitaux universitaires de Strasbourg, Hôpital Civil, Strasbourg.
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Touitou V, Sene D, Fardeau C, Boutin THD, Duhaut P, Piette JC, LeHoang P, Cacoub P, Bodaghi B. Interferon-alpha2a and Vogt-Koyanagi-Harada disease: a double-edged sword? Int Ophthalmol 2007; 27:211-5. [PMID: 17318324 DOI: 10.1007/s10792-007-9040-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 01/09/2007] [Indexed: 11/24/2022]
Abstract
Successful therapy based on the use of interferon-alpha has been reported in different types of severe chronic uveitis. The immunomodulatory effects of this drug, combined with its antiviral properties seem to contribute to its efficacy in the treatment of different forms of severe and refractory uveitis such as Vogt-Koyanagi-Harada disease, Behçet-associated uveitis, or even human herpes virus 8 (HHV-8) associated uveitis. At the same time, severe ocular complications have been reported in patients treated with interferon-alpha for chronic viral hepatitis C. Among these complications, six cases of Vogt-Koyanagi-Harada-like disease have been described.We report a small case series of two patients with refractory Vogt-Koyanagi-Harada disease, treated with interferon-alpha and discuss the potential benefits or detrimental role of interferon therapy in these patients.
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Affiliation(s)
- Valerie Touitou
- Department of Ophthalmology, Pitié-Salpêtrière Hospital, University of Paris VI, 47-83 boulevard de l'Hôpital, 75013 Paris, France.
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Mehmet A, Yilmaz N, Zorludemir S, Güleryüz A, Acoskun B, Haciyakupoglu GM. Interferon-alpha2b may impair myelinization of rat optic nerve. Adv Ther 2006; 23:23-32. [PMID: 16644604 DOI: 10.1007/bf02850343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This story investigated the effects of interferon-alpha-2b (IFN-alpha2b) on the optic nerves of 17 adult male Wistar albino rats. Animals were divided into 3 groups: 6 rats (group 1) received 7.5 units (5 mIU/m2) IFN-alpha2b-a normal treatment dose, and 6 (groups 2) received 30.0 units (20 mIU/m2)-a high dose; 5 rats (control group) received 0.5 mL saline. Test substances were delivered by intraperitoneal injection 3 times a week for 3 weeks with animals under inhalation anesthesia. After the rats were sacrificed, their optic nerves were dissected, sectioned, and examined under an electron microscope. The mean thicknesses of the basal membranes of blood vessels were 86.354 nm in the control group, 104.297 nm in group 1, and 140.181 nm in group 2. Basal membrane changes in IFN groups were dose dependent. Mitochondrial swelling, degeneration, increased diameter of vacuoles, and vacuolization in the cytoplasm of oligodendrocytes and astrocytes were also observed. IFN-alpha2b has histopathologic effects on blood vessels and cells of the optic nerve.
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Affiliation(s)
- Atila Mehmet
- Department of Ophthalmology, Mersin University School of Medicine, Turkey
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d'Alteroche L, Majzoub S, Lecuyer AI, Delplace MP, Bacq Y. Ophthalmologic side effects during alpha-interferon therapy for viral hepatitis. J Hepatol 2006; 44:56-61. [PMID: 16223542 DOI: 10.1016/j.jhep.2005.07.026] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 07/13/2005] [Accepted: 07/15/2005] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS Ophthalmologic side effects have been reported during interferon therapy, particularly retinal lesions and neurovisual impairment. The aim of this prospective study was to assess the nature and the frequency of such lesions during alpha-interferon therapy for viral hepatitis. METHODS Between 1995 and 2003, 156 patients treated with standard or pegylated alpha-interferon, with or without ribavirin, had a regular ophthalmologic examination before and during treatment. No patient had signs of retinopathy before treatment. Cotton-wool spots were found in 31 patients and retinal hemorrhage in nine patients during treatment (24% of patients). These lesions remained asymptomatic and disappeared in all patients. A previous history of arterial hypertension (RR 4.60, 95% CI 1.95-10.85), age above 45 years (RR 2.80, 95% CI 1.36-5.85), and use of pegylated alpha-interferon (RR 2.75, 95% CI 1.41-5.38) were significantly associated with retinopathy. Neurovisual impairment was present in 31 patients (20%) before treatment and in 74 patients (47%) during treatment. CONCLUSIONS In conclusion, this study showed that signs of retinopathy and neurovisual impairment were common in patients receiving alpha-interferon therapy but were rarely symptomatic. It suggests that alpha-interferon may usually be continued in asymptomatic patients as long as there is careful fundoscopic examination.
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Affiliation(s)
- Louis d'Alteroche
- Service d'Hépato-Gastroentérologie, Hôpital Trousseau, 37044 Tours cedex, France.
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Hoare M, Woodall T, Alexander GJM. Bell's palsy associated with IFN-alpha and ribavirin therapy for hepatitis C virus infection. J Interferon Cytokine Res 2005; 25:174-6. [PMID: 15767792 DOI: 10.1089/jir.2005.25.174] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
First-line therapy for hepatitis C virus (HCV) infection comprises interferon-alpha (IFN-alpha) and ribavirin for 6 or 12 months. Mild complications of therapy are common, but more serious complications are rare. Three patients with chronic HCV infection, acquired through injecting drug use, developed idiopathic facial paralysis (Bell's palsy) during therapy, with spontaneous resolution after withdrawal of treatment. Large-scale cohort studies reveal that IFNs are associated rarely with neurologic complications, and only one previous report has linked IFN-alpha therapy and Bell's palsy. We postulate that IFN-alpha therapy led to a breakdown of peripheral tolerance to myelin sheath antigens, leading to neuropathy, just as IFN-alpha therapy can cause autoimmune thyroiditis through breakdown of tolerance to native thyroid antigens.
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Affiliation(s)
- Matthew Hoare
- Department of Hepatology, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
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Yaghi C, Baz P, Koussa S, Daniel F, Haddad F, Sayegh R. Neuropathie optique ischémique antérieure aiguë compliquant un traitement par interféron alpha-2a et ribavirine pour hépatite aiguë virale C. ACTA ACUST UNITED AC 2005; 29:616-7. [PMID: 15980766 DOI: 10.1016/s0399-8320(05)82144-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Affiliation(s)
- Ayalew Tefferi
- Department of Internal Medicine and Division of Hematology, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
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Su DH, Chang YC, Liao SL, Chang TC. Lanreotide treatment in a patient with interferon-associated Graves? ophthalmopathy. Graefes Arch Clin Exp Ophthalmol 2004; 243:269-72. [PMID: 15452720 DOI: 10.1007/s00417-004-1012-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2004] [Revised: 07/08/2004] [Accepted: 08/02/2004] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND We report a case of Graves' ophthalmopathy (GO) developed after the administration of interferon-alpha for chronic hepatitis C. METHODS The GO was treated with lanreotide. RESULTS A 47-year-old female patient presented with euthyroid GO with spontaneous retrobulbar pain, eyelid edema, conjunctival injection and eyelid retraction of the right eye and conjunctival injection of the left eye 6 months after administration of interferon-alpha for chronic hepatitis C. Orbital computed tomography revealed no involvement of extraorbital muscles and no increase in retrobulbar adipose tissue. Only soft tissue was involved. These symptoms subsided after 12 weeks of lanreotide treatment, except right eyelid retraction, which, however, disappeared later during follow-up. CONCLUSION The use of interferon-alpha may be complicated by GO and lanreotide might be considered for GO if patients cannot accept steroid therapy.
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Foroozan R. Unilateral Pallid Optic Disc Swelling and Anemia Associated with Interferon Alpha Treatment. J Neuroophthalmol 2004; 24:98-9. [PMID: 15206453 DOI: 10.1097/00041327-200403000-00035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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